2012; 34: 668
PERSONAL VIEW
Medical education: Time to go back to school
PHILIPPA JACKSON
Department of Plastic Surgery, Castle Hill Hospital, Hull, UK
Abstract
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 (ST3þ) puts equal importance in each
of 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 (www.rcseng.ac.uk/education/
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
(www.rcplondon.ac.uk). 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.
References
GMC. 2011. The state of medical education. London: General Medical
Council. Available from www.gmc-uk.org/publications/10471
Zaccaro SJ. 2007. Trait-based perspectives of leadership. Am Psychol
62:6–16.
Correspondence: Philippa Jackson, Department of Plastic Surgery, Castle Hill Hospital, Castle Hill, Cottingham, Hull HU16, UK.
Tel: 01482 622707; email: [email protected]
668 ISSN 0142–159X print/ISSN 1466–187X online/12/080668–1 � 2012 Informa UK Ltd.
DOI: 10.3109/0142159X.2012.687846
Med
Tea
ch D
ownl
oade
d fr
om in
form
ahea
lthca
re.c
om b
y L
ibra
ry o
f H
ealth
Sci
-Uni
v of
Il o
n 10
/27/
14Fo
r pe
rson
al u
se o
nly.
Recommended
