Medical Education. 1976, 10, 189-192
Teaching the teachers P. S. B Y R N E , C. M. H A R R I S *
AND
B. E. L. L O N G t
Department of General Practice, University of Manchester, *Department of General Practice, St Mary’s Hospital Medical School, London, and ?Department of General Practice, University of Manchester
exercise under the terms advice and counselling. Many have taught First Aid and lectured in Colleges of Further Education. None in 1966 had had any training in educational concepts, theory or practice. It was also recognized that there were at least two essential requirements for successful teaching : competence in general practice and a motivation to teach. The profession of teaching is concerned with learning. Such a truism implies that it is of little value merely to learn about teaching. The teacher is a ‘learning facilitator’. He must seek to learn how he is performing in order the better to facilitate learning. The first course did not reflect clear thinking about these points. The content represented an awkward compromise between what were seen then as the twin claims of ‘what’ should be taught, and ‘how’ one should teach it. The subject matter of the course was divided half and half into teaching content and teaching method. There were sessions on sociology and epidemiology on the one hand, and sessions on Key words : TEACHING/*methods; GENERAL small group teaching and audio-visual aids on the PRACTICE/*edUC ; *EDUCATION, MEDICAL, CONTINother. UING; CURRICULUM; LEARNING; PROBLEM SOLVING; There was also an experiment with a short piece of EDUCATION, MEDICAL, UNDERGRADUATE; ENGLAND closed circuit television-an interview between a social worker and her client. The social worker In March 1966 there was held in Manchester the first joined the course to take part in the later discussion of a continuing series of courses in teaching methods but this was more concerned with content rather for general practitioners. This paper traces the than with method. development of these courses. Both the course organizer (P.S.B.) and the course members were aware of the experimental nature of the occasion but other than the important stimula1966 of further thought the course achieved Iittletion It was recognized that all general practitioners have with one important exception. One of us (C.M.H.) to teach. They teach patients daily, masking the was sufficiently provoked to return to Liverpool and Correspondence: Professor P. S. Bpne, Department of mount his own extended course for teachers, General Practice, Darbishire House, Upper Brook Street, previously described (Harris, 1970). Manchester M13 OFW. SY This and the following two papers describe historically the development of courses for general practice teachers in Manchester from 1966. The first paper describes the early attempts to fashion an appropriate course, discusses the content of such courses and the methods used. The second and third papers then discuss a course on nondirective behavioural counselling as an educational tool and describe the evolution of a cycle of four courses, each dealing with separate aspects of teaching. The emphasis throughout is on person to person teaching, it being considered that this is the commonest teaching/learning situation in general practice. The second part of the first paper goes on to discuss the logistic needs for the preparation and maintenance of teachers in general practice.
189
190
P. S. Byrne. C. M . Harris and B. E. L. Long
Two other members of the early courses later became course staff and now organize their own courses: Peter Teebay in Liverpool and Paul Freeling at the RCGP. While the course was for general practitioner teachers and at least half of it was concerned with teaching methodology, there was much emphasis on the traditional lecture; teachers did not become really involved with the course members. A lecture on ‘Giving a lecture’ was used on three successive courses to demonstrate the relative ineffectiveness of the lecture as a learning occasion. Assessments before the lecture, immediately after and at the end of the week confirmed previous findings that a factual recall ofno more than 40% was achieved, that of this 40%, 80% of what was retained was presented in the first 20 minutes, and that the recall dropped to 20% at the end of the week. An important decision was taken-never again to mount a teaching methods course for a weekend only. In future such courses would last for 5 days, a minimum of ten sessions. 1968
In September 1968 a new pattern emerged. It was felt necessary to provide the course members with some insight into the new Manchester undergraduate curriculum and the concomitant methods of assessment. Three sessions were devoted to these topics. Then on the first afternoon of this ten session course there was a new venture: an introduction to the theory of small group teaching, succeeded then and on each other afternoon of the course with a variety of examples of small group work, mainly task orientated. But the ‘content’ of teaching was still formally inserted. There were sessions on respiratory physiology, renal tubular function, and social anthropological problems, for example. Two presentations on ‘The principles of epidemiology’ and ‘Epidemiological work in general practice’ were succeeded by a session termed ‘Epidemiological exercises’. The course members had been given three epidemiological papers by well-known general practitioners and were then required to criticize them in the light of the information previously presented. Then they were asked to construct a protocol for a study in a similar field such as could be undertaken in their own practice. A situation was reached where small group work
occupied two-fifths of the ten 3 hour sessions of the course, and the third author of this paper (B.E.L.L.) had become a member of the team. We introduced a long lunch hour-of 3 hoursin response to those course members living at a distance who wished to shop and take home a peaceoffering. Non-directive teaching methods were brought to the causes by B.E.L.L. Unfamiliar as they then were (1968) to the course organizer (P.S.B.) and the course members, initial hostility was replaced by enthusiastic acceptance. By 1970 a stage had been reached where the formal lecture played little part in the courses, where non-directive methods were the norm, where much use was made of an adult form of discovery learning, and experience seemed to have provided a base upon which the cycle of four courses (Harris et al., 1976) could be constructed. We had come to realize that for general practitioners the more common teaching/learning situation was that of ‘person to person’-one general practitioner, one undergraduate, or one trainee. There are of course other situations where many students, undergraduates, trainees or fellow practitioners form the members of a learning situation. There thus emerged the concept of ‘the practice’ and ‘the classroom’ teacher, a concept in which the two roles are by no means mutually exclusive (Byrne, 1976). The ‘practice’ teacher is using, as his main base, his daily work as the teaching/learning situation. He is concerned with person to person teaching. This, the oldest learning situation, the basis of the apprenticelearning on which medical education itself is traditionally based, was discovered to be the least well documented. Our experience in the field prompted two of us to write Learning to Care in an attempt to fill this gap (Byrne & Long, 1975). The same ‘practice’ teacher may well also be a ‘classroom’ teacher, who is skilled in leading the varieties of small and larger groups, in conducting tutorials and seminars, in using different teaching styles, in lecturing and in deploying audio-visual aids. 1969
In 1969 we experimented with some simple problem solving exercises. They seem now, in 1975, very like some of the material being used to determine clinical criteria for use in audit. We attempted to obtain concensus views of the treatment and management of common clinical conditions. This was intended to
Teaching the teachers demonstrate to the potential teachers that differences of opinion with trainees or other general practitioners might even be the norm, for there are so few prescriptive solutions to common problems. The method served also as an introduction to the use of clinical records as learning situations. Our use of VTR changed from the first occasion in 1966. Rather than, as then, using the medium as a device to permit larger numbers of people to observe, record, and comment on an interview, we taped either an individual course member in a role play consultation or a group of course members engaged in a task. The resultant play-back enabled the individual or group to view and criticize each his own performance. We favour this method as one of the most useful in the use of VTR. 1970
There was a useful incident in 1970 when we were attempting to provide course members with experience in setting and implementing learning objectives. One group was provided with two wooden tables and a set of child’s building materials. Their objective was to demonstrate to the remainder of the course ‘how’ to build a bridge across the chasm represented by the space between the tables. With the materials provided it was impossible to build the bridge. The amusing disaster of attempts to do so was recorded on videotape. Only then did the group discover that there was a difference between demonstrating ‘how to build a bridge’ (which meant that they had to demonstrate a principle-the use of the triangle), and actually ‘building’ the bridge. The members learned something of the need for accuracy in defining learning objectives. The Department of General Practice commenced in 1970 to teach 160 undergraduates in each of two years as its contribution to the new curriculum, introduced in 1968. This required an expansion in the number of teaching practices. Two courses, each of six sessions, were held on evenings in Manchester and in Preston and a total of eighty doctors attended the full sessions. From them emerged, as a substantial consensus shared with the whole time staff of the Department, the learning objectives for the second clinical year course in which these peripheral, ‘outer ring’ practices were to teach. It was felt that they would subscribe the more readily to the implementation of objectives which they themselves had helped to shape.
191
We had come to learn something of the requirements for an organizer of courses. Such an one must know of the methods of teaching both for the ‘practice’ and the ‘classroom’ teachers. He must, as must they, be cognizant of the concepts, and capable of their implementation, of educational aims and learning objectives, as well as being competent, as they should be, to determine whether or not the objectives have been attained. In consequence we feel that those who organize courses, of whatever nature, should themselves have been exposed to courses for teachers calculated to provide intelligence of these essentials. 1975
Two other papers (Harris el al., 1976; Long et al., 1976) tell of the changes in our courses in the period 1971-74. Our pursuit of the more detailed expansions of several facets of teaching methods, related in these papers, almost led us to ignore that we were in this ‘cycle’ providing what amounted to a postgraduate course. Accordingly we have gone back to first principles. In no way denying the need to provide continuing instruction and practice for the more dedicated and/or experienced teacher, we also recognize the needs of the neophyte, and attempt to provide for them. Until now, February 1975, some 450 individuals have attended our courses in the U.K.. They have come substantially from our own region, but there have also been many from all over the U.K. and -some from Australia, Canada, New Zealand, U.S.A. and a faithful small contingent from Holland. Yet in our own region alone we may expect some 150 trainees (by 1980) entering into general practice in each year, not to mention the requirement of our Department of General Practice to teach 275 undergraduates in both their first and second clinical years. The undergraduate department itself needs the services of around 150 teaching practices, of whom 149 are outside the Department’s own practice. It is proper that, while an individual is the designated ‘teacher’, each of the members of these teaching practices should be at times involved in the teaching of our undergraduates, and there is the same possibility in the postgraduate training situation. As, in our region, the numbers of undergraduates and of trainees has increased rapidly and nearly threefold over the past 5 years, so has the need to provide teachers in general practice increased. We believe
192
P . S. Byrne, C. M . Harris and B. E. L. Long
that this is a need which the Department must assist in meeting. There is now in our region a number of our colleagues who have gone a long way, and who have invested their time and effort in learning their new trade of teaching. There are also new recruits taking on a second profession-that of teaching-in addition to their primary profession of general practice. Thus we consider that we should continue to provide introductory courses in teaching methods as well as the more sophisticated cycle. Such courses must get down to basics: the psychological contract between teacher and learner, the agreement between the two of all agenda, the meaning and use of learning objectives, an overview of teaching styles and methods, and an initiation into the omnipresent problems of evaluation. While we have now reached a series of formats in our courses on teaching methods, we have not been neglectful of the learning content to be provided. It is obvious that the methods of teaching/learning must be tailored to fit the desired learning objectives. It is too facile to agree that our present provision of continuing education under Section 63 or from other sources is necessarily conceived, relevant, or proparly presented to meet known areas of deficit. It is therefore necessary to provide evidence upon which action may be taken. We are therefore conducting research into: (1) the content, learning situations, and learning objectives of the Section 63 courses provided in our region; (2) the presently accepted criteria in practice for diagnosis, treatment, management and cure of an initial series of common conditions; (3) the verbal behaviours exhibited by the general practitioner in his consultation; (4) the observed performance of the general practitioner teacher in the conduct of his daily care of patients. From these and other areas of enquiry we hope to be able to produce areas of teaching content derived not from specialist textbooks but from general practice itself. These studies contribute to the need for a ‘self audit’ by the general practitioner of his care of patients. They represent together the bases from which the content of our teaching will derive. Decisions have also to be taken on the learning objectives of the successive phases of the teaching/ learning continuum : undergraduate vocational,
training and continuing education. Our studies, aggregated with those of others in the field, may help to provide the presently-lacking information. George Miller has pointed out that learning objectives in medical educational programmes are of three types: the overall or ‘school’ objectives, the area or departmental objectives, and the specific objectives of individual instructional exercises. He points out that although they may be described independently they cannot be separated. The second grows out of the first, and the third out of the two which have preceded it. Yet, he says, it is helpful to categorize them because each provides an instructor with a point of departure for determining: (1) the scope and sequence of the subject matter to be learned; (2) the techniques and materials of instruction to be utilized; and (3) the appraisal devices which allow him to determine whether his students are in fact achieving these objectives of course and classroom. Because it is so fundamental the topic of ‘learning objectives’ is a seminal feature of our ‘Introductory course’ and the members of the course are given ample opportunity to construct, teach on, and evaluate their use of learning objectives. It is imperative that courses on ‘Teaching methods’ should stress the importance of learning objectives. Without their definition there can be no rational use of teaching methods nor of learning situations, nor can there be objective assessment. We have found in our growing experience, that our students, and in particular the undergraduates, applaud the striving for professionalism as teachers. We have been sad, but not perhaps surprised, that so very few colleagues from other medical disciplines have even suggested that they might join us in our dutiful quest for competence as teachers. References BYRNE,P.S. (1976) Lancet (in press). BYRNE, P.S. & LONG,B.E.L. (1975) Learning to Care: Person to Person, 2nd edn. Churchill Livingstone, Edinburgh. HARRIS,C.M. (1970) A teaching methods course in Liver-
pool for general practitioners. British Journal of Medical Education. 4, 149. HARRIS, C.M., LONG,B.E.L. & BYRNE,P.S. (1976) A teaching methods course in Manchester for general practitioner teachers. Medical Education, 10, 193. P.S. (1976) A method LONG,B.E.L., HARRIS, C.M. & BYRNE, of teaching counselling. Medical Education, 10, 198.
Teaching the teachers P. S. B Y R N E , C. M. H A R R I S *
AND
B. E. L. L O N G t
Department of General Practice, University of Manchester, *Department of General Practice, St Mary’s Hospital Medical School, London, and ?Department of General Practice, University of Manchester
exercise under the terms advice and counselling. Many have taught First Aid and lectured in Colleges of Further Education. None in 1966 had had any training in educational concepts, theory or practice. It was also recognized that there were at least two essential requirements for successful teaching : competence in general practice and a motivation to teach. The profession of teaching is concerned with learning. Such a truism implies that it is of little value merely to learn about teaching. The teacher is a ‘learning facilitator’. He must seek to learn how he is performing in order the better to facilitate learning. The first course did not reflect clear thinking about these points. The content represented an awkward compromise between what were seen then as the twin claims of ‘what’ should be taught, and ‘how’ one should teach it. The subject matter of the course was divided half and half into teaching content and teaching method. There were sessions on sociology and epidemiology on the one hand, and sessions on Key words : TEACHING/*methods; GENERAL small group teaching and audio-visual aids on the PRACTICE/*edUC ; *EDUCATION, MEDICAL, CONTINother. UING; CURRICULUM; LEARNING; PROBLEM SOLVING; There was also an experiment with a short piece of EDUCATION, MEDICAL, UNDERGRADUATE; ENGLAND closed circuit television-an interview between a social worker and her client. The social worker In March 1966 there was held in Manchester the first joined the course to take part in the later discussion of a continuing series of courses in teaching methods but this was more concerned with content rather for general practitioners. This paper traces the than with method. development of these courses. Both the course organizer (P.S.B.) and the course members were aware of the experimental nature of the occasion but other than the important stimula1966 of further thought the course achieved Iittletion It was recognized that all general practitioners have with one important exception. One of us (C.M.H.) to teach. They teach patients daily, masking the was sufficiently provoked to return to Liverpool and Correspondence: Professor P. S. Bpne, Department of mount his own extended course for teachers, General Practice, Darbishire House, Upper Brook Street, previously described (Harris, 1970). Manchester M13 OFW. SY This and the following two papers describe historically the development of courses for general practice teachers in Manchester from 1966. The first paper describes the early attempts to fashion an appropriate course, discusses the content of such courses and the methods used. The second and third papers then discuss a course on nondirective behavioural counselling as an educational tool and describe the evolution of a cycle of four courses, each dealing with separate aspects of teaching. The emphasis throughout is on person to person teaching, it being considered that this is the commonest teaching/learning situation in general practice. The second part of the first paper goes on to discuss the logistic needs for the preparation and maintenance of teachers in general practice.
189
190
P. S. Byrne. C. M . Harris and B. E. L. Long
Two other members of the early courses later became course staff and now organize their own courses: Peter Teebay in Liverpool and Paul Freeling at the RCGP. While the course was for general practitioner teachers and at least half of it was concerned with teaching methodology, there was much emphasis on the traditional lecture; teachers did not become really involved with the course members. A lecture on ‘Giving a lecture’ was used on three successive courses to demonstrate the relative ineffectiveness of the lecture as a learning occasion. Assessments before the lecture, immediately after and at the end of the week confirmed previous findings that a factual recall ofno more than 40% was achieved, that of this 40%, 80% of what was retained was presented in the first 20 minutes, and that the recall dropped to 20% at the end of the week. An important decision was taken-never again to mount a teaching methods course for a weekend only. In future such courses would last for 5 days, a minimum of ten sessions. 1968
In September 1968 a new pattern emerged. It was felt necessary to provide the course members with some insight into the new Manchester undergraduate curriculum and the concomitant methods of assessment. Three sessions were devoted to these topics. Then on the first afternoon of this ten session course there was a new venture: an introduction to the theory of small group teaching, succeeded then and on each other afternoon of the course with a variety of examples of small group work, mainly task orientated. But the ‘content’ of teaching was still formally inserted. There were sessions on respiratory physiology, renal tubular function, and social anthropological problems, for example. Two presentations on ‘The principles of epidemiology’ and ‘Epidemiological work in general practice’ were succeeded by a session termed ‘Epidemiological exercises’. The course members had been given three epidemiological papers by well-known general practitioners and were then required to criticize them in the light of the information previously presented. Then they were asked to construct a protocol for a study in a similar field such as could be undertaken in their own practice. A situation was reached where small group work
occupied two-fifths of the ten 3 hour sessions of the course, and the third author of this paper (B.E.L.L.) had become a member of the team. We introduced a long lunch hour-of 3 hoursin response to those course members living at a distance who wished to shop and take home a peaceoffering. Non-directive teaching methods were brought to the causes by B.E.L.L. Unfamiliar as they then were (1968) to the course organizer (P.S.B.) and the course members, initial hostility was replaced by enthusiastic acceptance. By 1970 a stage had been reached where the formal lecture played little part in the courses, where non-directive methods were the norm, where much use was made of an adult form of discovery learning, and experience seemed to have provided a base upon which the cycle of four courses (Harris et al., 1976) could be constructed. We had come to realize that for general practitioners the more common teaching/learning situation was that of ‘person to person’-one general practitioner, one undergraduate, or one trainee. There are of course other situations where many students, undergraduates, trainees or fellow practitioners form the members of a learning situation. There thus emerged the concept of ‘the practice’ and ‘the classroom’ teacher, a concept in which the two roles are by no means mutually exclusive (Byrne, 1976). The ‘practice’ teacher is using, as his main base, his daily work as the teaching/learning situation. He is concerned with person to person teaching. This, the oldest learning situation, the basis of the apprenticelearning on which medical education itself is traditionally based, was discovered to be the least well documented. Our experience in the field prompted two of us to write Learning to Care in an attempt to fill this gap (Byrne & Long, 1975). The same ‘practice’ teacher may well also be a ‘classroom’ teacher, who is skilled in leading the varieties of small and larger groups, in conducting tutorials and seminars, in using different teaching styles, in lecturing and in deploying audio-visual aids. 1969
In 1969 we experimented with some simple problem solving exercises. They seem now, in 1975, very like some of the material being used to determine clinical criteria for use in audit. We attempted to obtain concensus views of the treatment and management of common clinical conditions. This was intended to
Teaching the teachers demonstrate to the potential teachers that differences of opinion with trainees or other general practitioners might even be the norm, for there are so few prescriptive solutions to common problems. The method served also as an introduction to the use of clinical records as learning situations. Our use of VTR changed from the first occasion in 1966. Rather than, as then, using the medium as a device to permit larger numbers of people to observe, record, and comment on an interview, we taped either an individual course member in a role play consultation or a group of course members engaged in a task. The resultant play-back enabled the individual or group to view and criticize each his own performance. We favour this method as one of the most useful in the use of VTR. 1970
There was a useful incident in 1970 when we were attempting to provide course members with experience in setting and implementing learning objectives. One group was provided with two wooden tables and a set of child’s building materials. Their objective was to demonstrate to the remainder of the course ‘how’ to build a bridge across the chasm represented by the space between the tables. With the materials provided it was impossible to build the bridge. The amusing disaster of attempts to do so was recorded on videotape. Only then did the group discover that there was a difference between demonstrating ‘how to build a bridge’ (which meant that they had to demonstrate a principle-the use of the triangle), and actually ‘building’ the bridge. The members learned something of the need for accuracy in defining learning objectives. The Department of General Practice commenced in 1970 to teach 160 undergraduates in each of two years as its contribution to the new curriculum, introduced in 1968. This required an expansion in the number of teaching practices. Two courses, each of six sessions, were held on evenings in Manchester and in Preston and a total of eighty doctors attended the full sessions. From them emerged, as a substantial consensus shared with the whole time staff of the Department, the learning objectives for the second clinical year course in which these peripheral, ‘outer ring’ practices were to teach. It was felt that they would subscribe the more readily to the implementation of objectives which they themselves had helped to shape.
191
We had come to learn something of the requirements for an organizer of courses. Such an one must know of the methods of teaching both for the ‘practice’ and the ‘classroom’ teachers. He must, as must they, be cognizant of the concepts, and capable of their implementation, of educational aims and learning objectives, as well as being competent, as they should be, to determine whether or not the objectives have been attained. In consequence we feel that those who organize courses, of whatever nature, should themselves have been exposed to courses for teachers calculated to provide intelligence of these essentials. 1975
Two other papers (Harris el al., 1976; Long et al., 1976) tell of the changes in our courses in the period 1971-74. Our pursuit of the more detailed expansions of several facets of teaching methods, related in these papers, almost led us to ignore that we were in this ‘cycle’ providing what amounted to a postgraduate course. Accordingly we have gone back to first principles. In no way denying the need to provide continuing instruction and practice for the more dedicated and/or experienced teacher, we also recognize the needs of the neophyte, and attempt to provide for them. Until now, February 1975, some 450 individuals have attended our courses in the U.K.. They have come substantially from our own region, but there have also been many from all over the U.K. and -some from Australia, Canada, New Zealand, U.S.A. and a faithful small contingent from Holland. Yet in our own region alone we may expect some 150 trainees (by 1980) entering into general practice in each year, not to mention the requirement of our Department of General Practice to teach 275 undergraduates in both their first and second clinical years. The undergraduate department itself needs the services of around 150 teaching practices, of whom 149 are outside the Department’s own practice. It is proper that, while an individual is the designated ‘teacher’, each of the members of these teaching practices should be at times involved in the teaching of our undergraduates, and there is the same possibility in the postgraduate training situation. As, in our region, the numbers of undergraduates and of trainees has increased rapidly and nearly threefold over the past 5 years, so has the need to provide teachers in general practice increased. We believe
192
P . S. Byrne, C. M . Harris and B. E. L. Long
that this is a need which the Department must assist in meeting. There is now in our region a number of our colleagues who have gone a long way, and who have invested their time and effort in learning their new trade of teaching. There are also new recruits taking on a second profession-that of teaching-in addition to their primary profession of general practice. Thus we consider that we should continue to provide introductory courses in teaching methods as well as the more sophisticated cycle. Such courses must get down to basics: the psychological contract between teacher and learner, the agreement between the two of all agenda, the meaning and use of learning objectives, an overview of teaching styles and methods, and an initiation into the omnipresent problems of evaluation. While we have now reached a series of formats in our courses on teaching methods, we have not been neglectful of the learning content to be provided. It is obvious that the methods of teaching/learning must be tailored to fit the desired learning objectives. It is too facile to agree that our present provision of continuing education under Section 63 or from other sources is necessarily conceived, relevant, or proparly presented to meet known areas of deficit. It is therefore necessary to provide evidence upon which action may be taken. We are therefore conducting research into: (1) the content, learning situations, and learning objectives of the Section 63 courses provided in our region; (2) the presently accepted criteria in practice for diagnosis, treatment, management and cure of an initial series of common conditions; (3) the verbal behaviours exhibited by the general practitioner in his consultation; (4) the observed performance of the general practitioner teacher in the conduct of his daily care of patients. From these and other areas of enquiry we hope to be able to produce areas of teaching content derived not from specialist textbooks but from general practice itself. These studies contribute to the need for a ‘self audit’ by the general practitioner of his care of patients. They represent together the bases from which the content of our teaching will derive. Decisions have also to be taken on the learning objectives of the successive phases of the teaching/ learning continuum : undergraduate vocational,
training and continuing education. Our studies, aggregated with those of others in the field, may help to provide the presently-lacking information. George Miller has pointed out that learning objectives in medical educational programmes are of three types: the overall or ‘school’ objectives, the area or departmental objectives, and the specific objectives of individual instructional exercises. He points out that although they may be described independently they cannot be separated. The second grows out of the first, and the third out of the two which have preceded it. Yet, he says, it is helpful to categorize them because each provides an instructor with a point of departure for determining: (1) the scope and sequence of the subject matter to be learned; (2) the techniques and materials of instruction to be utilized; and (3) the appraisal devices which allow him to determine whether his students are in fact achieving these objectives of course and classroom. Because it is so fundamental the topic of ‘learning objectives’ is a seminal feature of our ‘Introductory course’ and the members of the course are given ample opportunity to construct, teach on, and evaluate their use of learning objectives. It is imperative that courses on ‘Teaching methods’ should stress the importance of learning objectives. Without their definition there can be no rational use of teaching methods nor of learning situations, nor can there be objective assessment. We have found in our growing experience, that our students, and in particular the undergraduates, applaud the striving for professionalism as teachers. We have been sad, but not perhaps surprised, that so very few colleagues from other medical disciplines have even suggested that they might join us in our dutiful quest for competence as teachers. References BYRNE,P.S. (1976) Lancet (in press). BYRNE, P.S. & LONG,B.E.L. (1975) Learning to Care: Person to Person, 2nd edn. Churchill Livingstone, Edinburgh. HARRIS,C.M. (1970) A teaching methods course in Liver-
pool for general practitioners. British Journal of Medical Education. 4, 149. HARRIS, C.M., LONG,B.E.L. & BYRNE,P.S. (1976) A teaching methods course in Manchester for general practitioner teachers. Medical Education, 10, 193. P.S. (1976) A method LONG,B.E.L., HARRIS, C.M. & BYRNE, of teaching counselling. Medical Education, 10, 198.
