Doctors as teachers
September 2006
Introduction
The word ‘doctor’ means physician, and is derived from the Latin docere, to teach. [Go to note 1] All doctors in the UK are required to teach future generations of doctors, yet, unlike the preparation provided for their roles as clinicians and despite their expertise in what they teach, there has traditionally been a deficiency in appropriate teacher education in the medical profession.[Go to notes 2,3,4,5,6,7 and 8]
The role of doctors as teachers is increasingly recognised as a core professional activity that should not be acquired through chance, aptitude or inclination alone. Teaching occurs at all stages of the medical career pathway, from formal classroom-based learning at undergraduate level through to informal training in the clinical environment. There is, however, no formal requirement or pre-defined route by which doctors can become competent teachers. For example, clinical teachers can often end up in a post through seniority and clinical experience, rather than by training and experience in teaching. The problem is compounded by a lack of flexibility in the time allocated to teaching and the development of teaching skills, suboptimal levels of funding and support, and a failure to reward and recognise the educational contributions of healthcare professionals in the form of career incentives and financial remuneration. In the current climate, doctors are under unprecedented pressure to meet targets for treating patients and administration, and the responsibility to teach puts another significant demand on their time.
Together with research and clinical practice, teaching is a core responsibility for medical academics. The requirement to combine teaching with research and clinical activity puts significant demands on them that often leads to an imbalance in these roles. For example, medical academics may have been propelled into their posts as a result of their research experience rather than teaching abilities, and have then been expected to take on a teaching role for which they have little training and experience. Inadequate funding and a lack of transparency in the allocation of funding between research and medical education adversely impacts on the status of teaching and the ability of academic institutions and medical academics to provide high quality teaching. It is worth noting, however, that the bias that exists in favour of research in both the allocation of funding and the recruitment of academic staff is not unique to medical education but occurs across the higher education sector. With a rise of 40 per cent since 2000, recent years have seen an unprecedented increase in the numbers of undergraduate medical students in the UK. There has, however, been a concurrent decline in the numbers of clinical lecturers because of some universally acknowledged disincentives to following this career path. The number of clinical lecturers in the UK declined 36 per cent between 2000 and 2003,[Go to note 9] and there was a further 17 per cent decline from 594 in 2003 to 494 in 2004.[Go to note 10] While medical academic staffing levels have remained virtually constant since 2003, the decline in the number of clinical lecturers mean they now make up only 16 per cent of the clinical academic workforce in UK medical schools.[Go to note 10] The substantial increase in medical student numbers in the UK has required many doctors to take on, or increase, existing teaching responsibilities which seriously compromises the capability to deliver high quality teaching in the 21st century.[Go to note 11]
Recent years, however, have seen a number of encouraging developments including the establishment of medical education units and departments within UK medical schools, the introduction of new medical education academic posts, a significant increase in the level of research in this area and the introduction of a variety of teaching courses relevant to the medical profession. While there are no national data on the number of doctors who attend teacher education courses or who have attained teaching qualifications, doctors are now taking advantage of the increasing range of opportunities to improve their teaching skills. The need for high quality teaching staff has been reinforced by commitments to teaching and training in The NHS Plan [Go to note 11] and The NHS Improvement Plan. [Go to note 12] This commitment emphasises Continuous Professional Development (CPD), lifelong learning, increasing training commissions for doctors, interprofessional learning and working, and preparing students and staff for new roles and new ways of working. Through the implementation of the European Working Time Directive, working patterns will change which could potentially impact on the time available for teaching and training. The introduction of Modernising Medical Careers (MMC) will create significant opportunities for change in the current postgraduate medical training programmes, including the chance to incorporate formal teacher education.
A professional obligation to teach
The General Medical Council (GMC) publications 'The Doctor as Teacher and Good Medical Practice' outline the educational obligations of doctors and set out what is expected of doctors with teaching responsibilities, including those who supervise medical students and/or junior colleagues.[Go to notes 13 and 14] All doctors have a professional obligation to contribute to the education and training of other doctors, medical students and non-medical healthcare professionals on the team, and those who accept special responsibilities for teaching should take steps to ensure that they develop and maintain teaching skills.[Go to notes 13 and 14] The joint publication from the GMC and the Postgraduate Medical Education and Training Board (PMETB), 'Principles of good medical education and training', outlines a common set of principles to underpin the design and delivery of all medical education and training including:
- doctors with responsibilities for teaching, training and providing CPD should gain and develop appropriate knowledge, skills, attitudes and behaviours
- there should be adequate training and support for anyone who provides education, training and CPD
- students and doctors should have appropriate teaching and learning resources, such as libraries, computing equipment and teaching rooms. These resources should be regularly reviewed and assessed
- professionals providing effective medical education, training and CPD need time to do so. Those responsible for programmes should make appropriate arrangements for time to be set aside for the students and trainees. There should be adequate resources, including time where teachers cannot be called away to see patients, to support assessment and appraisal.[Go to note 15]