Teaching on the run tips: doctors as teachers

There is a tradition for doctors to teach their colleagues and students. The Hippocratic oath states, in part, that the duties of a doctor are “. . . to teach them this art, if they want to learn it, without fee or indenture”.1 Sharing expertise is regarded as a rewarding and enjoyable aspect of medicine. But it is becoming harder. The task is to maintain our teaching commitments while improving the quality of teaching and keeping it rewarding and enjoyable.2

Lack of time. With increased patient and administrative loads, the single most important factor clinicians cite is lack of time. The fact that there are fewer patients to teach on, shorter hospital stays and sicker patients also contributes to the problem. These pressures are unlikely to lessen.2

Lack of knowledge. Clinicians need to increase their knowledge about how to motivate the learner, assess competence, give constructive feedback, teach multiple trainee levels at the same time and deal with competing demands of patient care and education.3

Lack of training. Most of us who teach have never been taught how to teach, supervise or assess students, junior doctors or trainees.3

Criticism of teaching. Although we do our best to teach, we are told we do it poorly. Evidence suggests, even today, that there is still teaching by humiliation and sarcasm, teaching that is variable and unpredictable, and poor supervision and assessment, with little feedback.4 A recent inquiry into the clinical services at a tertiary hospital in Western Australia noted poor supervision and training and recommended all senior doctors should partake in “train the trainer”-type courses.5

Lack of rewards. Material rewards and recognition for the teaching we do are poor.

To cope with these challenges, we, as teachers, need knowledge and skills2,6 to teach effectively in the clinical setting “on the run”.

Junior doctors learn while caring for patients. Mistakes may occur and clinical decisions could sometimes be better. As teachers, we need to anticipate mistakes, minimise them, and, when they occur, ensure that a supportive environment allows junior doctors to reflect on their practice and learn from it, rather than feel blamed.8 A framework for thinking about how students, junior doctors or trainees learn and how we can help them learn — either in a discrete session or across a clinical attachment — is embodied in the learning cycle. 9,11 We will be better teachers if we can address each component of the cycle.