Teacher development
Pedagogical and professional compromises by medical teachers in hospitals Jenny Barrett, Department of Paediatrics, The University of Melbourne, Australia Karen Scott, Discipline of Paediatrics and Child Health, The University of Sydney, Australia
How [do] medical teachers in hospitals respond to the institutional context for their teaching
SUMMARY Aim: Following research about workplace constraints reducing the effectiveness of teaching and the motivation to teach, this study sought to understand how medical teachers in hospitals respond to the institutional context for their teaching of medical students. Methods: Through purposive sampling, younger and older male and female teachers in a range of medical and surgical paediatrics subspecialties participated in this qualitative study. We drew on ethnographic methods in interviews so that answers to the questions came from the teachers’ own emphases. The systematic
coding and categorising procedures used in the inductive analysis of the interview transcripts reflect the constant comparison approach of grounded theory, locating features, patterns and conceptual categories. Results: We identified four main concepts: teachers’ goals and motivations; their approaches to teaching; teachers’ preferences; and, finally, as discussed in this article, the teachers’ perceptions of contextual and institutional pressures in hospital-based medical teaching and related compromises. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and the paucity
of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional. Conclusion: We conclude that professional development is not enough to address these issues: the conditions for medical teaching and teachers in hospitals require workplace responses to enable a more productive connection between the students, curriculum and pedagogy. In particular, teachers’ responsibilities in teaching and curriculum development need to be acknowledged, and practising teachers need to be supported and included in the education mission.
340 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
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INTRODUCTION
The impact of the workplace on these teachers requires more consideration
I
t is now a decade since the publication of Seabrook’s ethnographic study, that identified medical teachers’ concerns about hospital conditions for teaching, the low value placed on teaching and the neglect of teachers by universities.1 In the context of continued system and curricula reform, and the associated attractiveness of new learning technologies and new non-tertiary settings for course delivery, the teaching of medical students in hospitals remains a feature of medical school curricula. However, in Australia and in other countries, sustaining the engagement of teachers in this environment remains a challenge,2 despite efforts to understand teachers’ experiences of changes in the health and education systems, and successful professional development for individuals.2–5
Professional development (‘faculty’ development) is often not enough, given the challenging environment in which hospital-based doctors teach.6 The impact of the workplace on these teachers requires more consideration, particularly the constraints that may reduce the teachers’ effect on student learning and their motivation to teach.7 We conducted this study to look beyond medical teachers’ views of the context for their teaching in order to highlight how their experiences of context influence their approaches to teaching.
METHODOLOGY In this pilot study we interviewed a purposive sample of eight medical teachers at one specialist Australian teaching hospital. The teachers who agreed to participate were identified from the medical student teaching timetable in the hospital’s university department: four males and four
females, aged between their late 30s and their mid-50s; three surgeons and five doctors, none of whom had university teaching appointments. The semi-structured interviews were audio-recorded and transcribed. Approval for the study was obtained from the hospital’s Ethics and Research Department. The interview transcripts were separately analysed by the two researchers. The qualitative approach enabled the researchers to focus on the people involved, integrating their knowledge of the context with their insights and perceptions, with the aim of expanding upon existing theory. The research was undertaken through the grounded theory methodology, involving a process of coding, constant comparison and pattern-seeking, with the two researchers initially analysing the transcripts separately and then jointly.8
FINDINGS We identified 64 categories in the data and grouped them into four broad concepts: the teachers’ goals and motivation in teaching; approaches to teaching; likes and dislikes about teaching; and perceptions of the contextual and institutional pressures in hospital-based medical teaching, and the resulting compromises. The concepts and a condensed
version of the categories are provided in Table 1. Although our findings provide insight into the beliefs of this group of medical teachers, we are concerned about the implications of the constraints and compromises they perceive. This article offers a discussion of this concept and illustrates the findings with quotations from the interviews. We then consider insights from the education literature that inform a productive response to the teachers’ experiences. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and a paucity of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional. Constraints In the interviews, a number of mismatches were described, particularly in relation to what are perceived as continuous changes in the curricula and education structures of medical schools and specialist colleges. One teacher wondered whether ‘there is a mismatch between how I teach and what I teach, and what [students and medical trainees] want to or need to learn’ (Dr F), and another suggested a sense of losing control:
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344 341
tct_12190.indd 341
7/10/2014 5:53:55 PM
An underlying tension that constrains teachers lies in the very nature of clinical teaching and the effect on doctor–patient rapport
Table 1. Concepts and categories Concepts (frequency)
Condensed categories
Goals and motivations (7)
• Educating future colleagues • Makes clinical work interesting, pleasant • Convey concepts and messages
Teaching strategies (22)
• Elicit contributions, involve students • Fair expectations • Distil information, teach for understanding and retention • Patient based • Try new strategies • Traditional strategies: osmosis and observation; master and apprentice; quiz; grilling, guiding, correcting; humiliation Influences: • Observation of teachers during training • Not professional development Good teachers: • Passionate, inspiring, interact with students
Preferences (10)
Teachers like: • Small group, patient-based/rounds, engaged, informal, in context • Getting students to question and argue, seeing them learn, trying new teaching techniques • Teaching trainees – finishing school, future colleagues Teachers dislike: • Lectures: little perceived value • Students disrupt relationships in out-patient clinics
Challenges and compromises (17)
Constraints: • Time, space, availability of patients • Spaces in clinical settings • Large student numbers • Balancing workload: teaching, clinical, research • Teaching not resourced • Need to refresh repeat sessions • Students and trainees with higher expectations • Teaching not considered fundamental, effort not acknowledged, time not allocated Compromises: • More attention to trainees than students • Race through content • No time for new strategies Implications: • Not involved in curriculum: do not know content or level • No feedback about content or delivery • No time to attend courses • Changes: e–learning
There seems to be a minirevolution in the programme every couple of years so that at training level and students’ level, everyone’s
on quicksand and you keep losing your ground. Dr E Others noted a change in the attitudes of students and trainees from contemporary
medical programmes, particularly the older graduate students who have ‘different learning experiences, different knowledge base’ (Dr E). These students and trainees ‘feel much more empowered to question’ (Dr F), and perhaps even feel more entitled:
We’ve gone from a model which I grew up in where you learnt from your professors and your mentors and they taught you as good will, to now where people expect that I should teach them. Dr H Also experienced as a constraint was the lack of support for teaching by institutions (universities, hospitals and colleges) so that teaching is ‘under-resourced…[and] underallocated’ (Dr C). There is ‘a mismatch…with no acknowledgement or remuneration or understanding at all how [teaching] is supposed to happen’ (Dr F). All but one of the teachers reported the demand for teaching exceeded the time allocated:
Mine is a fundamentally clinical role and the teaching allowance might be something like 10%…but what I actually do is way way way way way more. Dr A Finally, an underlying tension that constrains teachers lies in the very nature of clinical teaching and the effect on doctor–patient rapport:
I actually feel…[when] I’m actively teaching the student that I am taking away time that I should give to the patient…It just seems to impact on the doctor– patient thing. Dr G
342 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
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7/10/2014 5:53:57 PM
COMPROMISES Teachers are aware of compromises in their interactions with students and the institutions. Some teachers reported being frustrated in their efforts ‘to fit teaching in’ around other responsibilities (Dr E). Several participants acknowledged that they concentrate on vocational trainees instead of students because they are more certain of the required knowledge. Advocating for better conditions was something of a mission for some, but for others it has been relegated ‘low down on the priorities’ (Dr H), as the workplace generates some complacency:
There are a few things I’d die in a ditch for and this isn’t one of them. So there’s a certain acceptance that this is how it is and you make the best of it. Dr C The environment forces particular compromises in pedagogy. The absence of allocated time for teaching means that they ‘don’t have a lot of time exploring or playing around’ (Dr B) with teaching methods that might be more effective than current practices. Also, students’ time in clinics was restricted to observing, or they were sent to ‘go and read this up’ (Dr F) instead of taking time in clinic. In classrooms, some teachers keep the ‘pedal to metal…really racing’ (Dr C) because little time has been allocated for teaching the specialty, and preferred or popular teaching methods are practical:
Some people will stop the lecture and get them to workshop with their partner…I tend not to do that because of time pressure. Dr G
IMPLICATIONS FOR TEACHER PREPARATION AND SUPPORT Some teachers expressed concern that they are not prepared for teaching the reformed curriculum. For some, this is felt as a desire for feedback about whether they are teaching content ‘at the right level’ (Dr D). Others feel that they have not been involved in the changes, have no control over curriculum content and do not even ‘understand why change is happening’ (Dr E). None of these teachers had participated in workshops or courses that are sometimes available to medical teachers, and feel they have ‘nothing formal to fall back on’ (Dr A). Not having time or motivation, and not being prepared to sacrifice salary, were reasons given for not participating.
DISCUSSION The study highlights particular mismatches between curricula, students, and teaching and workplace practices. We identified mismatches between what the teachers want to do, what they feel able to do and what is required. In summary, they perceive constraints in relation to: curriculum change; the characteristics of graduating students’ sense of ‘academic entitlement’9; poor institutional support for teaching (particularly the absence of allocated time); and an impact on the rapport between doctors and patients. The teachers appear to compromise in two broad ways: they reduce their advocacy for teaching and focus on what appears to be more immediately relevant – the teaching of trainees rather than students; in terms of their pedagogical commitments, they do not try new or preferred teaching methods, and reduce students’ active involvement in clinical settings. The teachers want to be consulted and better informed about reforms to the
curriculum, and although they are aware of professional development opportunities, experience professional barriers to participating in them.
The environment forces particular compromises in pedagogy
The teachers’ perspectives on contemporary teaching and learning suggest that there are more social and organisational challenges than can be dealt with either in professional development programmes or by attending to individuals’ resistance to change.10 This is consistent with contemporary emphases on social and cultural factors in the professional development of medical teachers.11,12 Also, in the education literature we found classical and contemporary emphases on the importance of factors beyond the individual teacher’s attitudes or expertise.7,13 Berliner highlights the need to look beyond individual talent, and even further, beyond opportunities for deliberate practice: he notes the significance of workplace policies and conditions in the development of expertise in teaching.13 The policies in the education workplace, as well as the expectations of the institution’s community, ‘subtly but powerfully affect teachers’ attitudes, beliefs, enthusiasm, sense of efficacy, conception of their responsibilities and teaching practices’.13 As Mallki and Lindblom-Ylänne noted recently, teachers’ perceptions of curricular or organisational constraints may reduce their effect on student learning, possibly leading to burnout.14 Typical of qualitative research, the sample of this pilot study was small, enabling deep insight into the participants and their beliefs; however, both the diversity in the sample and the setting for the study make it not atypical of the usual arrangements for hospitalbased teaching of medical students in a number of countries, including Australia and the UK. The findings draw attention to a dominant value in the
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344 343
tct_12190.indd 343
7/10/2014 5:53:57 PM
We need creative efforts to support and develop practising teachers as members of a community
institutional culture for medical teaching that influences these teachers: the expectation that teaching, curriculum development, education advocacy and individual professional development are – in Dr H’s words – just ‘supposed to happen’. However, in the high-stakes field of medical student teaching and learning, a more intentional approach is required. Firstly, hospitals need policies to explicate teachers’ workplace responsibilities in teaching and curriculum development. Secondly, we need creative efforts to support and develop practising teachers as members of a community, a community in which their opinions count and they feel linked to the education mission.15 In our experience the second effort could be led by the university, and may be achieved more readily than the first. REFERENCES 1. Seabrook MA. Medical teachers’ concerns about the clinical teaching context. Med Educ 2003;37:213–222. 2. Peadon E, Caldwell PH, Oldmeadow W. ‘I enjoy teaching but …’:
Paediatricians attitudes to teaching medical students and junior doctors. J Paediat Child Health 2010;46:647–652. 3. Ash JK. A case of meaning: change in clinical education. Adelaide: Flinders University; 2010. 4. Calkins S, Johnson N, Light G. Changing conceptions of teaching in medical faculty. Med Teach 2012;34:902–906. 5. Foster K, Laurent R. How we make good doctors into good teachers: A short course to support busy clinicians to improve their teaching skills. Med Teach 2013;35:4–7. 6. Steinert Y, Mann KV, Centeno A, Dolmans D, Spencer J, Gelula M, Prideaux D. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education. Med Teach 2006;28:497–526. 7. Berliner DC. The development of expertise in pedagogy. Charles W Hunt Memorial Lecture. New Orleans: American Association of Colleges for Teacher Education; 1988. 8. Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks: Sage; 2002. 9. Cain J, Romanelli F, Smith KM. Academic Entitlement in Pharmacy Education. Am J Pharm Educ 2012;76:1–8.
10. Knight LV, Bligh J. Physicians’ perceptions of clinical teaching: A qualitative analysis in the context of change. Adv Health Sci Educ 2006;11:221–234. 11. Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, power and location. Hamstra SJ, ed. London: Springer; 2011. 12. O’Sullivan PS, Irby D. Reframing research on faculty development. Acad Med 2011;86:421–428. 13. Berliner DC. Learning about and learning from expert teachers. Journal of Educational Research 2001;35:463–482. 14. Malkki K, Lindblom-Ylanne S. From reflection to action? Barriers and bridges between higher education teachers’ thoughts and actions. Studies in Higher Education 2011;37:33–50. 15. Irby D. Motivation theory: Can it offer clues for engaging faculty in the educational mission? Keynote address ANZAHPE 2013; Melbourne. Australian and New Zealand Association for Health Professional Educators; 2013. Available at http://www.anzahpe.org/#!2013conference/c11ij. Accessed on 10 September 2013.
Corresponding author’s contact details: Dr Jenny Barrett, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. E-mail: [email protected]
Funding: None Conflict of interest: None Ethical approval: The interview-based project was approved by the Ethics and Research Department at the hospital where the interviews were conducted. doi: 10.1111/tct.12190
344 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
tct_12190.indd 344
7/10/2014 5:53:57 PM
Pedagogical and professional compromises by medical teachers in hospitals Jenny Barrett, Department of Paediatrics, The University of Melbourne, Australia Karen Scott, Discipline of Paediatrics and Child Health, The University of Sydney, Australia
How [do] medical teachers in hospitals respond to the institutional context for their teaching
SUMMARY Aim: Following research about workplace constraints reducing the effectiveness of teaching and the motivation to teach, this study sought to understand how medical teachers in hospitals respond to the institutional context for their teaching of medical students. Methods: Through purposive sampling, younger and older male and female teachers in a range of medical and surgical paediatrics subspecialties participated in this qualitative study. We drew on ethnographic methods in interviews so that answers to the questions came from the teachers’ own emphases. The systematic
coding and categorising procedures used in the inductive analysis of the interview transcripts reflect the constant comparison approach of grounded theory, locating features, patterns and conceptual categories. Results: We identified four main concepts: teachers’ goals and motivations; their approaches to teaching; teachers’ preferences; and, finally, as discussed in this article, the teachers’ perceptions of contextual and institutional pressures in hospital-based medical teaching and related compromises. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and the paucity
of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional. Conclusion: We conclude that professional development is not enough to address these issues: the conditions for medical teaching and teachers in hospitals require workplace responses to enable a more productive connection between the students, curriculum and pedagogy. In particular, teachers’ responsibilities in teaching and curriculum development need to be acknowledged, and practising teachers need to be supported and included in the education mission.
340 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
tct_12190.indd 340
7/10/2014 5:53:53 PM
INTRODUCTION
The impact of the workplace on these teachers requires more consideration
I
t is now a decade since the publication of Seabrook’s ethnographic study, that identified medical teachers’ concerns about hospital conditions for teaching, the low value placed on teaching and the neglect of teachers by universities.1 In the context of continued system and curricula reform, and the associated attractiveness of new learning technologies and new non-tertiary settings for course delivery, the teaching of medical students in hospitals remains a feature of medical school curricula. However, in Australia and in other countries, sustaining the engagement of teachers in this environment remains a challenge,2 despite efforts to understand teachers’ experiences of changes in the health and education systems, and successful professional development for individuals.2–5
Professional development (‘faculty’ development) is often not enough, given the challenging environment in which hospital-based doctors teach.6 The impact of the workplace on these teachers requires more consideration, particularly the constraints that may reduce the teachers’ effect on student learning and their motivation to teach.7 We conducted this study to look beyond medical teachers’ views of the context for their teaching in order to highlight how their experiences of context influence their approaches to teaching.
METHODOLOGY In this pilot study we interviewed a purposive sample of eight medical teachers at one specialist Australian teaching hospital. The teachers who agreed to participate were identified from the medical student teaching timetable in the hospital’s university department: four males and four
females, aged between their late 30s and their mid-50s; three surgeons and five doctors, none of whom had university teaching appointments. The semi-structured interviews were audio-recorded and transcribed. Approval for the study was obtained from the hospital’s Ethics and Research Department. The interview transcripts were separately analysed by the two researchers. The qualitative approach enabled the researchers to focus on the people involved, integrating their knowledge of the context with their insights and perceptions, with the aim of expanding upon existing theory. The research was undertaken through the grounded theory methodology, involving a process of coding, constant comparison and pattern-seeking, with the two researchers initially analysing the transcripts separately and then jointly.8
FINDINGS We identified 64 categories in the data and grouped them into four broad concepts: the teachers’ goals and motivation in teaching; approaches to teaching; likes and dislikes about teaching; and perceptions of the contextual and institutional pressures in hospital-based medical teaching, and the resulting compromises. The concepts and a condensed
version of the categories are provided in Table 1. Although our findings provide insight into the beliefs of this group of medical teachers, we are concerned about the implications of the constraints and compromises they perceive. This article offers a discussion of this concept and illustrates the findings with quotations from the interviews. We then consider insights from the education literature that inform a productive response to the teachers’ experiences. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and a paucity of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional. Constraints In the interviews, a number of mismatches were described, particularly in relation to what are perceived as continuous changes in the curricula and education structures of medical schools and specialist colleges. One teacher wondered whether ‘there is a mismatch between how I teach and what I teach, and what [students and medical trainees] want to or need to learn’ (Dr F), and another suggested a sense of losing control:
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344 341
tct_12190.indd 341
7/10/2014 5:53:55 PM
An underlying tension that constrains teachers lies in the very nature of clinical teaching and the effect on doctor–patient rapport
Table 1. Concepts and categories Concepts (frequency)
Condensed categories
Goals and motivations (7)
• Educating future colleagues • Makes clinical work interesting, pleasant • Convey concepts and messages
Teaching strategies (22)
• Elicit contributions, involve students • Fair expectations • Distil information, teach for understanding and retention • Patient based • Try new strategies • Traditional strategies: osmosis and observation; master and apprentice; quiz; grilling, guiding, correcting; humiliation Influences: • Observation of teachers during training • Not professional development Good teachers: • Passionate, inspiring, interact with students
Preferences (10)
Teachers like: • Small group, patient-based/rounds, engaged, informal, in context • Getting students to question and argue, seeing them learn, trying new teaching techniques • Teaching trainees – finishing school, future colleagues Teachers dislike: • Lectures: little perceived value • Students disrupt relationships in out-patient clinics
Challenges and compromises (17)
Constraints: • Time, space, availability of patients • Spaces in clinical settings • Large student numbers • Balancing workload: teaching, clinical, research • Teaching not resourced • Need to refresh repeat sessions • Students and trainees with higher expectations • Teaching not considered fundamental, effort not acknowledged, time not allocated Compromises: • More attention to trainees than students • Race through content • No time for new strategies Implications: • Not involved in curriculum: do not know content or level • No feedback about content or delivery • No time to attend courses • Changes: e–learning
There seems to be a minirevolution in the programme every couple of years so that at training level and students’ level, everyone’s
on quicksand and you keep losing your ground. Dr E Others noted a change in the attitudes of students and trainees from contemporary
medical programmes, particularly the older graduate students who have ‘different learning experiences, different knowledge base’ (Dr E). These students and trainees ‘feel much more empowered to question’ (Dr F), and perhaps even feel more entitled:
We’ve gone from a model which I grew up in where you learnt from your professors and your mentors and they taught you as good will, to now where people expect that I should teach them. Dr H Also experienced as a constraint was the lack of support for teaching by institutions (universities, hospitals and colleges) so that teaching is ‘under-resourced…[and] underallocated’ (Dr C). There is ‘a mismatch…with no acknowledgement or remuneration or understanding at all how [teaching] is supposed to happen’ (Dr F). All but one of the teachers reported the demand for teaching exceeded the time allocated:
Mine is a fundamentally clinical role and the teaching allowance might be something like 10%…but what I actually do is way way way way way more. Dr A Finally, an underlying tension that constrains teachers lies in the very nature of clinical teaching and the effect on doctor–patient rapport:
I actually feel…[when] I’m actively teaching the student that I am taking away time that I should give to the patient…It just seems to impact on the doctor– patient thing. Dr G
342 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
tct_12190.indd 342
7/10/2014 5:53:57 PM
COMPROMISES Teachers are aware of compromises in their interactions with students and the institutions. Some teachers reported being frustrated in their efforts ‘to fit teaching in’ around other responsibilities (Dr E). Several participants acknowledged that they concentrate on vocational trainees instead of students because they are more certain of the required knowledge. Advocating for better conditions was something of a mission for some, but for others it has been relegated ‘low down on the priorities’ (Dr H), as the workplace generates some complacency:
There are a few things I’d die in a ditch for and this isn’t one of them. So there’s a certain acceptance that this is how it is and you make the best of it. Dr C The environment forces particular compromises in pedagogy. The absence of allocated time for teaching means that they ‘don’t have a lot of time exploring or playing around’ (Dr B) with teaching methods that might be more effective than current practices. Also, students’ time in clinics was restricted to observing, or they were sent to ‘go and read this up’ (Dr F) instead of taking time in clinic. In classrooms, some teachers keep the ‘pedal to metal…really racing’ (Dr C) because little time has been allocated for teaching the specialty, and preferred or popular teaching methods are practical:
Some people will stop the lecture and get them to workshop with their partner…I tend not to do that because of time pressure. Dr G
IMPLICATIONS FOR TEACHER PREPARATION AND SUPPORT Some teachers expressed concern that they are not prepared for teaching the reformed curriculum. For some, this is felt as a desire for feedback about whether they are teaching content ‘at the right level’ (Dr D). Others feel that they have not been involved in the changes, have no control over curriculum content and do not even ‘understand why change is happening’ (Dr E). None of these teachers had participated in workshops or courses that are sometimes available to medical teachers, and feel they have ‘nothing formal to fall back on’ (Dr A). Not having time or motivation, and not being prepared to sacrifice salary, were reasons given for not participating.
DISCUSSION The study highlights particular mismatches between curricula, students, and teaching and workplace practices. We identified mismatches between what the teachers want to do, what they feel able to do and what is required. In summary, they perceive constraints in relation to: curriculum change; the characteristics of graduating students’ sense of ‘academic entitlement’9; poor institutional support for teaching (particularly the absence of allocated time); and an impact on the rapport between doctors and patients. The teachers appear to compromise in two broad ways: they reduce their advocacy for teaching and focus on what appears to be more immediately relevant – the teaching of trainees rather than students; in terms of their pedagogical commitments, they do not try new or preferred teaching methods, and reduce students’ active involvement in clinical settings. The teachers want to be consulted and better informed about reforms to the
curriculum, and although they are aware of professional development opportunities, experience professional barriers to participating in them.
The environment forces particular compromises in pedagogy
The teachers’ perspectives on contemporary teaching and learning suggest that there are more social and organisational challenges than can be dealt with either in professional development programmes or by attending to individuals’ resistance to change.10 This is consistent with contemporary emphases on social and cultural factors in the professional development of medical teachers.11,12 Also, in the education literature we found classical and contemporary emphases on the importance of factors beyond the individual teacher’s attitudes or expertise.7,13 Berliner highlights the need to look beyond individual talent, and even further, beyond opportunities for deliberate practice: he notes the significance of workplace policies and conditions in the development of expertise in teaching.13 The policies in the education workplace, as well as the expectations of the institution’s community, ‘subtly but powerfully affect teachers’ attitudes, beliefs, enthusiasm, sense of efficacy, conception of their responsibilities and teaching practices’.13 As Mallki and Lindblom-Ylänne noted recently, teachers’ perceptions of curricular or organisational constraints may reduce their effect on student learning, possibly leading to burnout.14 Typical of qualitative research, the sample of this pilot study was small, enabling deep insight into the participants and their beliefs; however, both the diversity in the sample and the setting for the study make it not atypical of the usual arrangements for hospitalbased teaching of medical students in a number of countries, including Australia and the UK. The findings draw attention to a dominant value in the
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344 343
tct_12190.indd 343
7/10/2014 5:53:57 PM
We need creative efforts to support and develop practising teachers as members of a community
institutional culture for medical teaching that influences these teachers: the expectation that teaching, curriculum development, education advocacy and individual professional development are – in Dr H’s words – just ‘supposed to happen’. However, in the high-stakes field of medical student teaching and learning, a more intentional approach is required. Firstly, hospitals need policies to explicate teachers’ workplace responsibilities in teaching and curriculum development. Secondly, we need creative efforts to support and develop practising teachers as members of a community, a community in which their opinions count and they feel linked to the education mission.15 In our experience the second effort could be led by the university, and may be achieved more readily than the first. REFERENCES 1. Seabrook MA. Medical teachers’ concerns about the clinical teaching context. Med Educ 2003;37:213–222. 2. Peadon E, Caldwell PH, Oldmeadow W. ‘I enjoy teaching but …’:
Paediatricians attitudes to teaching medical students and junior doctors. J Paediat Child Health 2010;46:647–652. 3. Ash JK. A case of meaning: change in clinical education. Adelaide: Flinders University; 2010. 4. Calkins S, Johnson N, Light G. Changing conceptions of teaching in medical faculty. Med Teach 2012;34:902–906. 5. Foster K, Laurent R. How we make good doctors into good teachers: A short course to support busy clinicians to improve their teaching skills. Med Teach 2013;35:4–7. 6. Steinert Y, Mann KV, Centeno A, Dolmans D, Spencer J, Gelula M, Prideaux D. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education. Med Teach 2006;28:497–526. 7. Berliner DC. The development of expertise in pedagogy. Charles W Hunt Memorial Lecture. New Orleans: American Association of Colleges for Teacher Education; 1988. 8. Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks: Sage; 2002. 9. Cain J, Romanelli F, Smith KM. Academic Entitlement in Pharmacy Education. Am J Pharm Educ 2012;76:1–8.
10. Knight LV, Bligh J. Physicians’ perceptions of clinical teaching: A qualitative analysis in the context of change. Adv Health Sci Educ 2006;11:221–234. 11. Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, power and location. Hamstra SJ, ed. London: Springer; 2011. 12. O’Sullivan PS, Irby D. Reframing research on faculty development. Acad Med 2011;86:421–428. 13. Berliner DC. Learning about and learning from expert teachers. Journal of Educational Research 2001;35:463–482. 14. Malkki K, Lindblom-Ylanne S. From reflection to action? Barriers and bridges between higher education teachers’ thoughts and actions. Studies in Higher Education 2011;37:33–50. 15. Irby D. Motivation theory: Can it offer clues for engaging faculty in the educational mission? Keynote address ANZAHPE 2013; Melbourne. Australian and New Zealand Association for Health Professional Educators; 2013. Available at http://www.anzahpe.org/#!2013conference/c11ij. Accessed on 10 September 2013.
Corresponding author’s contact details: Dr Jenny Barrett, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. E-mail: [email protected]
Funding: None Conflict of interest: None Ethical approval: The interview-based project was approved by the Ethics and Research Department at the hospital where the interviews were conducted. doi: 10.1111/tct.12190
344 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 340–344
tct_12190.indd 344
7/10/2014 5:53:57 PM
