Creating Tomorrow’s Doctors

David Taylor

That is our taskQuite simply, to help our students learn to

be the type of Doctor

• that we would want them to be

• that we would want to treat our parents or children

• that we would want to treat us

Flexner• It is a hundred years since the first

major look at medical education, and internationally there is considerable interest in validation and re-validation.

• I serve as a “visitor” for the British General Medical Council, and the equivalent for the Republic of Eire.

Regulation

Outcomes• We have entered an era where we

need to show that we meet measurable outcomes

• This is true at undergraduate level but also licensing and re-validation

Standards• There is a real debate about what

constitutes competence.

• What is, in fact, “good enough”?

• How do we measure it?

• What is a pass mark?

• Who says?

So much has changed• We know much more than we did

• We know more about teaching than we did

• Patients expect more than they did

• It is not about “doing more”

• It is about “doing it cleverer!”

I come from Liverpool

I am from Liverpool• And we have developed our

programme around problem based learning

• Obviously we still have lectures

But• The route through the syllabus is

determined by a series of clinical vignettes, which the students discuss in small PBL groups

The Teacher role has developed

to include • being able to make small groups

work well• Giving students confidence to say

what they know• Giving students the responsibility for

determining what they still need to know

But• We are still expected to know what

we are doing

• We are still expected to challenge students

And• We get to know some of the

students very well

What do we know?• There have been huge

developments in our understanding of education over the past 50 years

• There is an unprecedented amount of information available

So what are the “big ideas”?

Everyone will have their own list, but, looking at the latest editions of my favourite journals:

• Delivery methods

• Predictors of success

• Professionalism

Delivery Methods• from “which” to “how best to do it”

• emphasised by two AMEE guides.• Taylor and Miflin in 2008 wrote about

the benefits and problems with PBL

• Edmunds and Brown in 2010 wrote about how best to run small groups.

Not only that• Language matters

• (Medical Education 44 (8) 2010)

• In the way that cases are presented to weaker candidates

• In academic performance

• In future career performance

And• There is an increasing interest in

the use of adult learning theories to shape the way that we plan medical programmes.

• There is going to be a series of papers published in Medical Teacher on this area.

learner

Extrinisic motivation

intrinsicmotivation

Task Learning style Stage of development

Prior knowledge

New learningobjective

planning

reflection

experience or articulation

OrganisationElaborationRefinementRestructuring

Relevance

Feedback

And• There is a huge literature on

whether students should perform dissection (and why/why not)?

• What is the role/value of clinical apprenticeships?

• What about outcome measures?

Predictors of success• Basically, do grades obtained

before medical school predict performance at medical school?

• It depends how you measure performance!

• But as Geoff Norman says-

“Good students do well”.

There is more to this, of course• Do we want to use clinical aptitude

tests as a filter?• Multiple mini interviews?• Do we want our students to have a

scientific or a more rounded education?

• Do we want them to have degree before they enter medical school?

Professionalism - (My current interest)

• What do we/students/public mean by professionalism?

• What constitutes a lapse?

• Is there any such thing as a private life?

• Is it caught or taught?

• Self care

What are the components?

Qualities

relationships

Competence

Competence Qualities RelationshipsAsk for help when necessary Altruism Altruism

Critical thinking Asks for help Asks for helpGive patients information they can understand

Blows whistle Blow the whistle

Good clinical judgement Caring CaringKnow limits of competence Compassion compassionate

reflective Courage LeadershipTechnical competence Gives patients information they

can understandProfessional conduct

Good clinical judgement Protect confidential information

Knows limits of competence reflective

Leadership Respect for others in the team

Professional conduct Respect patients right of shared decision making

Protect confidential information Teamwork

ReflectiveRespect for colleaguesRespects patients rights of shared decision makingSubmission to ethical code

TrustworthyReliability analysis (Cronbach’s alpha)“describes me” upper row“at this stage in my career” lower row0.69(staff)/0.61(students) 0.71(staff)/0.79(students) 0.60(staff)/0.71(students)0.77(staff)/0.66(students) 0.78(staff)/0.76(students) 0.67(staff)/0.68(students)

Then what?

Always

Stu

dent

sco

re

Expectation

Never

EssentialUnimportant

Self care• There is real interest, and research

into the effect of stress upon medical students and trainees

• And more importantly on ways of dealing with it (social support, autonomy, “integrated medicine”)

What to remember• Medical Education is changing, and

changing quickly

• It can be overwhelming, but exciting

• And there is a lot out there to help

• But it is what you do here that matters!