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Medical education: Time to go back to school

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  • 2012; 34: 668


    Medical education: Time to go back to school


    Department of Plastic Surgery, Castle Hill Hospital, Hull, UK


    Continued professional development, teaching and leadership skills are recognised key attributes required by all doctors.

    However, the concentration on these skills has become unbalanced with greater emphasis placed on audit and research than

    learning to train or lead future generations.

    A fellow surgical trainee recently posed the following

    question: Why does the deanery put so much emphasis on

    research and so little on teaching, leadership and manage-

    ment? It is an interesting question since job application at the

    specialty training level (ST3) puts equal importance in eachof these qualities. In order to secure a place in specialty

    training and thereafter, you are pushed towards audit and

    research, presenting at scientific meetings and publishing your

    work. This is not to say these are not beneficial educational

    activities, but it does pose the question: Why should the ability

    to undertake audit or research mean more than being able to

    teach and inspire medical students and junior doctors, or to

    lead and manage a team well?

    The General Medical Council (GMC) recently published

    The State of Medical Education and Practice with the intention

    of being proactive in dealing with variations in the quality of

    medical education and training (GMC 2011). They identify the

    difficulty in balancing service delivery against teaching, and

    the need for positive role models with leadership skills to

    provide high-quality supervision.

    So what action is being taken? The Royal College of

    Surgeons (RCS) website advertise three of 118 courses (2.5%)

    aimed at teaching skills (

    courses), with none specifically aimed at leadership. The

    Royal College of Physicians (RCP) go much further and

    advertise links to a Masters accreditation in both Medical

    Education and Medical Leadership. There is also a Doctors as

    Educators programme which provides medics with the

    opportunity to attend a series of workshops aimed at tackling

    a range of issues around education, and the Boston Leahey

    programme promoting excellence in medical education

    ( Does this mean surgeons are stuck

    in the mindset of not needing to learn to teach? Is the variation

    in the quality of medical education the GMC report refers to

    specifically aimed at the surgical profession?

    Historically, surgeons have routinely practiced the teaching

    mantra of See one, do one, teach one. Whilst this approach

    has been long abandoned by other specialties, personal

    experience demonstrates that this is still very much the fall

    back, if not the mainstay, in surgical education. There are

    senior surgeons who place the onus of learning on the trainee,

    believing that the trainee is solely responsible for their

    education. However, in the post-Calmanisation era and

    following the shifts in training with Modernising Medical

    Careers (MMC) and the European Working Time Directive

    (EWTD), surgeons are starting to take a more proactive

    approach to provide high-quality supervision.

    Similarly, concepts of leadership are steeped in tradition,

    ingrained as a result of the rigid hierarchy that the surgical

    profession proudly takes its heritage from. The assumption

    that a consultant must also be a leader is both necessary on a

    simplistic level, and flawed on a more complex one. In an

    operating theatre it is important that someone be in control, for

    patient safety, but being in control is a rudimentary

    interpretation of leadership. One could argue that the specialty

    self-selects people with many of the attributes required in Trait

    theory but this, along with the Great Man theory of leadership

    where status and power equates to a leader, have been shown

    to be lacking (Zaccaro 2007), with preference for emotional

    intelligence and authentic leadership skills.

    Naturally gifted teachers and leaders exist in the medical

    profession, just as there are naturally gifted surgeons blessed

    with a sixth sense and sublime manual dexterity. Yet, we fail to

    realise how rare a commodity a natural teacher is, and how

    much better those of us who do not possess this skill could be

    with a little effort. Undertaking research is a skill, one that we

    spend years building up to and developing from small audits

    as junior doctors into major trials or projects. So, why is the

    same attention to development not applied to teaching and

    leadership? If awareness of the theory and the associated skills

    were integrated into our professional development to the same

    degree as research, perhaps we could address the issues raised

    by the GMC.


    GMC. 2011. The state of medical education. London: General Medical

    Council. Available from

    Zaccaro SJ. 2007. Trait-based perspectives of leadership. Am Psychol


    Correspondence: Philippa Jackson, Department of Plastic Surgery, Castle Hill Hospital, Castle Hill, Cottingham, Hull HU16, UK.

    Tel: 01482 622707; email:

    668 ISSN 0142159X print/ISSN 1466187X online/12/0806681 2012 Informa UK Ltd.DOI: 10.3109/0142159X.2012.687846



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