To the Editor: We applaud the Journal’s new series to improve the standard of teaching within the medical profession.1,2 However, it seems ironic that a profession that relies so heavily on an experiential, apprentice-based model of learning should be running such a series.

Since the early nineties, we have seen a paradigm shift with regard to improving the quality of healthcare. However, this recent managerial preoccupation with systems, processes and outcomes has largely ignored the relationship between effective teaching and patient care. Clinical service work is given priority over training and education activities, and it is likely that, if it weren’t for the clauses in our employment contracts, all training, conferences and educational activities would occur out of work hours.

Although we have seen a number of structural interventions to promote ongoing education, such as the introduction of Continuing Medical Education programs, the idea that “any” education will do, and that “anyone” can teach, remains pervasive. The danger of promoting “teaching on the run” is to reinforce the view that teaching is not a specialised discipline that requires specific skills and training. It is astounding that no formal qualifications in education are required for teaching at the most senior level, whereas to be taken seriously as a researcher requires an MD or PhD.

It is a rare gifted teacher who instinctively performs well without formal training. High-quality teaching requires formal training, just as high-quality research does. Do we allow anyone in medicine to simply do “research on the run”? Would we ever consider a series called “Research on the run”? In medicine, we recognise that people are drawn to particular specialties because of their different knowledge, skills, interests and temperaments. This is not always the case in teaching, and names on a tutorial roster are too often allocated without regard for the style or ability of the teacher.

Lake points out that the majority of problems with teaching are related to the traditional culture of medical practice and health service delivery.2 Similarly, Quadrio has observed that “career advancement in medicine . . . depends primarily upon research productivity, less upon clinical work and teaching . . .”.3

In our view, medicine requires another paradigm shift towards competency assessment and promotion of our teachers in academic settings. Furthermore, the allocation of appropriate resources is paramount and is justified because of the likely spin-offs for improved quality of patient care. We look forward to the day when medical education is rewarded as a highly valued endeavour, rather than a burden for busy clinicians and academics. We eagerly await further instalments of this well intentioned series on teaching, and hope that it goes some way towards effecting a “Kuhnian revolution”.4 (US scientist Thomas Kuhn proposed that scientific knowledge proceeds according to popular paradigms that, every now and then, undergo “intellectually violent revolutions . . . in each of which one conceptual world view is replaced by another . . .”.)

In reply: As noted by Majoor and Ibrahim, teaching and learning, as a mission, are not well regarded when compared with research. Not only that, but changes in healthcare are making it harder to teach. Shorter patient stays and more complex patients result in “survival” learning by junior staff, rather than in-depth learning.1,2

Experts in medical education will be increasingly important in teaching, guiding curricula, and assessing trainees.2 However, professional learning occurs while doctors immerse themselves in clinical practice. “On the run” teaching doesn’t mean substandard teaching, but relates to doing it while delivering patient care.3 Although there is room for improvement, many clinicians teach well. Most are keen to teach and would like to have formal training,4 and evidence suggests that, with support, they can improve.2,3 How much support? Short workshops have been shown to have an impact, as has the provision of a few simple educational ideas.5 By not supporting our clinicians/teachers in ways that could be very simply put into practice, we risk losing in-context learning and wasting an enormous resource.

Along with focusing on the teacher, I believe we need an important shift in the way health services recognise (provide time for) and reward (see as important) the mission of teaching and supervision alongside their mission of excellence in delivery of care.