Teaching the teachers | |
A practical guide for medical teachers. John Dent and Ronald Harden. Edinburgh: Churchill Livingstone, 2001 (452 pp). ISBN 0 443 06273 0. |
This book contains 39 chapters by 25 authors, of whom all but five work in the University of Dundee. The book's presentation is clean and pleasant, and the printing is excellent. The language is straightforward and clear. Topics included are the curriculum, learning situations, educational strategies, tools and aids, assessment and student support. All chapters are lucid and not overlong and each effectively covers the "what, when, where and how" of medical teaching. For medicos coming to teach for the first time, the book covers most of the educational bases that underpin a medical course. The material is, however, less a "practical guide" for teachers than a series of dot-point lists that summarise useful concepts and models, with pungent quotations and suggestions in the margins. The reader is not given much help in their unravelling and elaboration, or much guidance in thinking through ideas about teaching and how to apply them in practice. Chapter 6 has many tips for lecturers. Small group learning, in Chapter 7, omits group dynamics, but the management of tutorials in Chapter 14, on problem-based learning, fills some of the gaps. Chapter 23 handles the teaching of ethics well, and Chapter 24 does a good job of preparing young graduates for the busy world into which they will emerge. Only one chapter focuses on how students can be helped to learn and only one explains the experience of problem-based learning. The central educational philosophy espouses performance objectives expressed as task-based outcomes more than memorisation of knowledge inputs. These outcomes are, however, assessed by standardised testing of separate clinical skills in an objective structured clinical examination (OSCE) which was developed by Harden and is widely used internationally. No mention is made of examination within "real world", "whole patient" clinical practice. It may be unfair to criticise a book for what is not in it, but what is missing are some burgeoning fields that impact on practice, and consequently on medical education. The effects of the dramatic growth of bioscience and investigational technology; greater patient information and expectations; changes in health delivery with increased hospital procedural turnover and day surgery; corporatisation of practice; inexorable differentiation into subspecialties; and increasing professionalisation of others engaged in patient care are all ignored. One chapter explains the teaching of evidence-based medicine, but not the learning of how it links into clinical reasoning, judgement and decision-making operate.
Ken R Cox
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