These past few weeks
have been all about clinical teaching. I have run a couple of workshops based
on the topic of 'on-the-job teaching' for
a group of doctors and dentists studying for PgCerts in Medical and Dental
Education and I have also
had the joy of undertaking two workplace based teaching observations. One with
a dentist running a small group teaching session on dental implants for his
multidisciplinary team, the other an anaesthetist helping three FY2s understand
blood gasses. Both demonstrated the very best of clinical teaching, putting
shared concerns for patient care at the centre of their teaching activity,
working with their learners to develop their thinking and to shape their
practice. Neither involved whizzy learning technologies nor took the form of
slick, over-rehearsed 'presentations'...these were sessions based around
listening, dialogue, questioning (self and each other), prompting, guiding, rehearsing
ways of thinking and acting. They were authentic, democratic engagements with
colleagues.
I was reminded of
these teaching sessions, when I engaged in a brief twitter exchange with some
medical colleagues questioning the accessibility of educational theory. We
mused on its appeal (or lack thereof) and the ways in which it was possible to
put theoretical ideas to use, to ‘make sense’ of educational experiences in the
past or educational practices in the future. How might I make-sense of clinical teaching I observed, by drawing on educational theories and, in so doing, illustrate why I was so impressed?
Well, I might start
with Stephen Billett’s conception of ‘workplace affordances’ and consider the
extent to which workplace learning opportunities were evenly distributed in the
clinical settings I visited. My dental colleague did a fantastic session on
dental implants, engaging an experienced dental nurse just as equally as a
newly appointed dental receptionist. Here, learning opportunities were offered
to every team member, not just those with explicit learner status (student,
trainee) or particular professional roles (other dentists). Is this true of
every clinical workplace? Billett’s ideas lead me to question whether some
workers gain access to richer, more regular learning opportunities than others.
I consider the extent to which medical educators might (unconsciously) favour
those who they feel to be a ‘good fit’ to their chosen speciality, offering
more hands on experience, taking them under their wing to talk cases and in so
doing miss opportunities to invite others into their ways of thinking.
I might also turn to
Lave and Wenger’s work, looking for examples of ways in which ‘newcomers’ to
each setting are provided with opportunities for legitimate peripheral
participation. Their analytic viewpoint on
learning leads me to consider the extent to which students and trainees are
invited to become full participants in the communities they join, through
engaging in meaningful work activity.
This extends beyond practical work to cognitive work, in other words,
opportunities to rehearse ways of thinking like doctors.
A recent hospital
admission (as a patient) provided me with great opportunities for some
ethnographic activity! I saw nursing students, for example, lead drug rounds,
with the senior nurse at their shoulder to make sure all was in order. Here,
students were able to rehearse (with support) the types of work activity they
would shortly be undertaking as qualified nurses. I was left more troubled by
the day to day activity of the FY1s, who, a month in, seemed to be engaged in
medical work that was quite distinct (and often detached from) the work that
more senior colleagues were doing. FY1s took bloods, they chased after surgeons
(literally) writing up notes from the ward round consult, but they (unlike the
registrars) were never invited into the discussions about my care, nor invited
to ask questions (at least within my hearing).
Thankfully, the observed teaching session of FY2s a few weeks ago was
quite different. A complex session based on calculating blood gasses had
wonderful eureka moments, when ‘paper cases’ of patient presentations offered
new insights into the importance of these calculations and inspired those present to go back onto the wards to try out some calculations on their own.
Every discipline has
its own language and invites particular ways of thinking, education is no different
to medicine in that respect. Every worker makes choices about the tools or
instruments they use to do their job. Educational theories are, for me at
least, rich analytical and conceptual tools, which shed light on learning. Challenging
to grasp? Yes. Worth the struggle? Undoubtedly.
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Footnote: for those interested in ways of enhancing workplace based learning, visit the London Deanery website. In the linked e-learning unit, I draw on socio-cultural ideas about learning (including those mentioned above) to suggest some ways of developing clinical teaching practices.
