Medical education: Time to go back to school

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<ul><li><p>2012; 34: 668</p><p>PERSONAL VIEW</p><p>Medical education: Time to go back to school</p><p>PHILIPPA JACKSON</p><p>Department of Plastic Surgery, Castle Hill Hospital, Hull, UK</p><p>Abstract</p><p>Continued professional development, teaching and leadership skills are recognised key attributes required by all doctors.</p><p>However, the concentration on these skills has become unbalanced with greater emphasis placed on audit and research than</p><p>learning to train or lead future generations.</p><p>A fellow surgical trainee recently posed the following</p><p>question: Why does the deanery put so much emphasis on</p><p>research and so little on teaching, leadership and manage-</p><p>ment? It is an interesting question since job application at the</p><p>specialty training level (ST3) puts equal importance in eachof these qualities. In order to secure a place in specialty</p><p>training and thereafter, you are pushed towards audit and</p><p>research, presenting at scientific meetings and publishing your</p><p>work. This is not to say these are not beneficial educational</p><p>activities, but it does pose the question: Why should the ability</p><p>to undertake audit or research mean more than being able to</p><p>teach and inspire medical students and junior doctors, or to</p><p>lead and manage a team well?</p><p>The General Medical Council (GMC) recently published</p><p>The State of Medical Education and Practice with the intention</p><p>of being proactive in dealing with variations in the quality of</p><p>medical education and training (GMC 2011). They identify the</p><p>difficulty in balancing service delivery against teaching, and</p><p>the need for positive role models with leadership skills to</p><p>provide high-quality supervision.</p><p>So what action is being taken? The Royal College of</p><p>Surgeons (RCS) website advertise three of 118 courses (2.5%)</p><p>aimed at teaching skills (www.rcseng.ac.uk/education/</p><p>courses), with none specifically aimed at leadership. The</p><p>Royal College of Physicians (RCP) go much further and</p><p>advertise links to a Masters accreditation in both Medical</p><p>Education and Medical Leadership. There is also a Doctors as</p><p>Educators programme which provides medics with the</p><p>opportunity to attend a series of workshops aimed at tackling</p><p>a range of issues around education, and the Boston Leahey</p><p>programme promoting excellence in medical education</p><p>(www.rcplondon.ac.uk). Does this mean surgeons are stuck</p><p>in the mindset of not needing to learn to teach? Is the variation</p><p>in the quality of medical education the GMC report refers to</p><p>specifically aimed at the surgical profession?</p><p>Historically, surgeons have routinely practiced the teaching</p><p>mantra of See one, do one, teach one. Whilst this approach</p><p>has been long abandoned by other specialties, personal</p><p>experience demonstrates that this is still very much the fall</p><p>back, if not the mainstay, in surgical education. There are</p><p>senior surgeons who place the onus of learning on the trainee,</p><p>believing that the trainee is solely responsible for their</p><p>education. However, in the post-Calmanisation era and</p><p>following the shifts in training with Modernising Medical</p><p>Careers (MMC) and the European Working Time Directive</p><p>(EWTD), surgeons are starting to take a more proactive</p><p>approach to provide high-quality supervision.</p><p>Similarly, concepts of leadership are steeped in tradition,</p><p>ingrained as a result of the rigid hierarchy that the surgical</p><p>profession proudly takes its heritage from. The assumption</p><p>that a consultant must also be a leader is both necessary on a</p><p>simplistic level, and flawed on a more complex one. In an</p><p>operating theatre it is important that someone be in control, for</p><p>patient safety, but being in control is a rudimentary</p><p>interpretation of leadership. One could argue that the specialty</p><p>self-selects people with many of the attributes required in Trait</p><p>theory but this, along with the Great Man theory of leadership</p><p>where status and power equates to a leader, have been shown</p><p>to be lacking (Zaccaro 2007), with preference for emotional</p><p>intelligence and authentic leadership skills.</p><p>Naturally gifted teachers and leaders exist in the medical</p><p>profession, just as there are naturally gifted surgeons blessed</p><p>with a sixth sense and sublime manual dexterity. Yet, we fail to</p><p>realise how rare a commodity a natural teacher is, and how</p><p>much better those of us who do not possess this skill could be</p><p>with a little effort. Undertaking research is a skill, one that we</p><p>spend years building up to and developing from small audits</p><p>as junior doctors into major trials or projects. So, why is the</p><p>same attention to development not applied to teaching and</p><p>leadership? If awareness of the theory and the associated skills</p><p>were integrated into our professional development to the same</p><p>degree as research, perhaps we could address the issues raised</p><p>by the GMC.</p><p>References</p><p>GMC. 2011. The state of medical education. London: General Medical</p><p>Council. Available from www.gmc-uk.org/publications/10471</p><p>Zaccaro SJ. 2007. Trait-based perspectives of leadership. Am Psychol</p><p>62:616.</p><p>Correspondence: Philippa Jackson, Department of Plastic Surgery, Castle Hill Hospital, Castle Hill, Cottingham, Hull HU16, UK.</p><p>Tel: 01482 622707; email: drpcjackson@gmail.com</p><p>668 ISSN 0142159X print/ISSN 1466187X online/12/0806681 2012 Informa UK Ltd.DOI: 10.3109/0142159X.2012.687846</p><p>Med</p><p> Tea</p><p>ch D</p><p>ownl</p><p>oade</p><p>d fr</p><p>om in</p><p>form</p><p>ahea</p><p>lthca</p><p>re.c</p><p>om b</p><p>y L</p><p>ibra</p><p>ry o</p><p>f H</p><p>ealth</p><p> Sci</p><p>-Uni</p><p>v of</p><p> Il o</p><p>n 10</p><p>/27/</p><p>14Fo</p><p>r pe</p><p>rson</p><p>al u</p><p>se o</p><p>nly.</p></li></ul>