Training for medical teachers: a UK survey, 1993

Managing change in postgraduate medical education: still unfreezing?

BACKGROUND

Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors.

AIMS

To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change.

METHODS

We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change.

RESULTS

12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'.

CONCLUSIONS

At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.

A Description of a Validated Effective Teacher-Training Workshop for Medical Residents

A teacher-training program for residents was designed and piloted in the St. Elisabeth Hospital in Curaçao, Netherlands Antilles. The program comprised of six modules namely: effective teaching, self-knowledge and teaching ability, feedback, assessing prior knowledge, trouble shooting and time management.

METHOD

Instruction was provided during a two-day workshop with eight hours instruction time per day. Residents in the first three years of training participated, and the instructors were experienced clinicians. Lectures, group discussions, case simulations, video presentations and role-plays were the forms of instruction.

RESULTS

Using standardized questionnaires, the participants rated the quality of the workshop highly. They considered it to be a feasible and appropriate educational intervention and that it had a positive impact on their teaching skills.

CONCLUSION

This workshop was developed based on careful analysis of medical residents' perceived educational needs and systematically implemented and evaluated. The results show that it is a suitable and effective educational intervention.

Promoting effective teaching and learning: hospital consultants identify their needs

OBJECTIVES

The aim of this study was to help hospital consultants identify their needs in relation to teaching skills, leading to the development of a teacher training programme.

DESIGN

The study was directed at all 869 consultants in the region and initially involved a postal questionnaire which had a 60.5% response rate.

SETTING

Hospitals throughout Northern Ireland.

SUBJECTS

Hospital consultants.

RESULTS

Results from this questionnaire indicated that while the majority of respondents were interested teachers, only 34% had received any teacher training. The questionnaire was followed by a focus group study involving three groups of consultants drawn randomly from those who had responded to the questionnaire. Participants in these groups identified the following key areas of hospital education: qualities of hospital teachers; selection procedures; problems of teaching in hospitals; the need for teacher training and how it should be provided.

CONCLUSION

The study highlighted that hospital teachers need to acquire and update their teaching skills through attending courses that should include basic teaching and assessment/appraisal skills. These courses should last 1 or 2 days and be provided at a regional or subregional level. As a result of this study, teacher training courses have been developed in this region.

Teaching the consultant teachers: identifying the core content

OBJECTIVES

To determine the key themes for teaching hospital consultants how to teach.

DESIGN

1. In-depth interviews with a total of 19 experts, consultants and junior doctors to identify key topics. 2. Literature review from 1969 to obtain the main themes from the medical educational literature. 3. Analysis of the main themes in 11 'Teaching the teachers' courses. 4. Triangulation of interview data, literature themes and teaching courses content to generate 15 criteria for a questionnaire. 5. Questionnaire study to 593 senior and junior hospital doctors.

SETTING

Hospitals in the West Midlands Region in England.

SUBJECTS

Consultants and junior hospital doctors.

RESULTS

Overall, 441 doctors replied (74% response rate). The top five themes were giving feedback constructively, keeping up to date as a teacher, building a good educational climate, assessing the trainee and assessing the trainee's learning needs. Results showed no statistically significant differences in the order of themes for all groups analysed, including seniority, gender, specialty, origin by medical school and consultants of different ages.

CONCLUSIONS

Consultants need teaching in these topics. There are implications for funding and providing these courses for postgraduate deans, Royal Colleges and universities. Further research is needed to evaluate whether such an initiative does produce better teaching and learning, and a better educational climate in hospitals.

Rewards for teaching excellence: practice in South African medical schools

Excellence in teaching through recruitment of good teachers, rewarding good teaching and the creation of staff development programmes are priorities in the mission statement of most universities. Often, reality belies intention. At many universities serious attempts to ensure maximum teacher effectiveness, overt recognition of teaching excellence, and specific development funding are lacking. This study examines the extrinsic (i.e. financial) reward systems which operate at the eight medical schools attached to South African universities and reports on the current situation. Replies indicated that a reward system of some type operates within the university at seven South African universities which have faculties of medicine and embraces all faculties. One university rewards medical school teachers specifically but, at another, no reward system exists at all. The monetary value of rewards varies greatly. Significant criticism of all systems was the inability to meet their design aims. There was criticism of the criteria, such as they are and where they exist, used to identify teaching excellence and to reward recipients. All replies indicated support for an impartial and equitable system of reward for effectiveness and excellence in teaching.