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Clinician Educator: The agent for change in medical education

2016-11-11T19:20:56+00:00

Socrates_and_PlatoSome people consider teaching and learning much more difficult than rocket science. 1 Teaching and learning is such a complex process that researchers are still having debates in different areas including: how it works, how to assess it, and how to research it. For the most part it is safe to presume that different people have different learning philosophies and this is, most likely, how they teach. 2 Because we are a product of our past and form strong habits, these might inadvertently impede the search of more effective and efficient educational activities. Research in education, just like research medical practice, may challenge our most held beliefs and bring to light better educational practices.

Does educational research make a difference?

Conducting and implementing educational research findings in and outside of the learning environments is quite challenging. Learning is very complex with numerous variables and confounding factors. Although we can theorize and hypothesize how learning occurs we don’t have direct evidence of this complex process. We can only predict that learning might occur under certain situations or infer it has occurred via evidence from certain assessments. The reliability and validity of assessments as evidence of learning is another complex topic widely covered in education and beyond the scope of this post. Most people, formally trained in education or not, might base their teaching and assessment practices on how they were taught or common beliefs. However, sometimes these practices may be outdated, misunderstood, and even erroneous. 3

Educational research plays an important role in improving practice, dispelling misbeliefs, and debate different points of views. For instance, in a manuscript by Kirschner et al advocate why direct instruction works as an approach to learning, while stating that minimally-guided instruction does not. 4 In reply Schmidt et al. defended minimally-guided problem based learning as an effective instructional method. 5 In contrast, Billett has done extensive work on community of practice and how apprenticeship leads to construction of knowledge in a situated learning environment. 6 These studies and opinions demonstrate the existence of different points of views and evidence when it comes to teaching and learning.

One size does not fit all

One of the principles of competency medical based education (CBME) is recognizing that education is not one-size-fits-all. It is recognized that students learn differently and at different rates. The model of CBME is based on individualized learning and differentiation of students’ learning. As stated by Gruppen et al 7 :

“Competency-based education promotes a necessary flexibility in the time and sequence of what is to be learned that is regulated by the needs of the learner. Therefore, CBE allows for a highly individualized learning process rather than the traditional, lock-step, one-size-fits-all curriculum.”

This suggests that educators should be more skilled in fostering a professional practice that benefits every learner in his/her own development. Individualized learning should be supplemented with differentiated teaching practice to foster long-term, self-regulated learning habits. In addition, new emerging pedagogical practices and learning environments might pose a great challenge in if learning conditions are not optimized.

Pedagogical practices in how we teach are not standardized

McLeod et al found a discrepancy in opinion between clinical teachers and educator experts on the importance of which pedagogical practices should have priority in medical education.8 Differences in practice have been categorized into several factors such as location and years of practice, indicating that clinical teaching is not standardized.9 Unfortunately, even at the professional level, practitioners do not see eye to eye when it comes to pedagogical practices. Wide variations exist, maybe even at the local level.

That being said, the basics in pedagogical knowledge may be taught.10 Teachers can learn pedagogical practices and integrate it in their daily teaching routines. For instance, teachers can practice in an informed way if they practice in a scholarly manner 11 :

  • Implement evidence-based teaching practices
  • Make observations and reflect on their practices
  • Discuss their practice with others and obtain peer evaluations

Scholarship of Teaching and Learning

Scholarly educational practices are important, because it dispels bias, myths, misconceptions, or not optimized practices. Furthermore, the scholarship of teaching and learning (SoTL) takes scholarly teaching to a higher level where the practitioner conducts research while educating and publishes the results adding to the existing body of knowledge and for others’ consideration. In this video, education experts explain what scholarship of teaching and learning means to them and the key characteristics of its practice:

The Clinician Educator

Although the practice of SoTL has been around for some time, its recognition and implementation have not been as successful as other practices delineated in Boyer’s scholarship framework. Sherbino et al identified key roles and competencies of the Clinician Educator which expand beyond bedside teaching. 12 These role and competencies may be able to help implement the principles behind the SoTL and disseminate its practice. The table below is extracted from the study and identifies important competencies of the Clinician Educator which support important aspects of teaching and learning.

Clinical Educator Competencies

Conclusion

We all have beliefs, evidenced or not, about how we learn, we are also under the influence of tradition (“we have always done it this way”). Tradition and tradition of “new” discourse might be reasons why some might find it difficult to “get off the carousel”. 13 It is very easy to think of teaching and learning as just “transferring” knowledge from a textbook or from one person to another, but we have come to understand that the process is much more complex than a simple word or theory can describe. 5 Educational research, scholarly teaching, and the scholarship of teaching and learning can bring a better informed, effective, and efficient practice to the world of medical education. We also have to keep in mind that not everything discovered in research is practical, which again brings into play the importance of context and professional judgement. The Clinician Educator can be the agent who connects the whole in medical education.

 Image credit

2.
Weimer M. What’s Your Learning Philosophy? Faculty Focus | Higher Ed Teaching & Learning. http://www.facultyfocus.com/articles/teaching-professor-blog/whats-learning-philosophy/. Published March 26, 2014.
3.
Kirschner PA, van Merriënboer JJG. Do Learners Really Know Best? Urban Legends in Education. Educational Psychologist. 2013;48(3):169-183. doi: 10.1080/00461520.2013.804395
4.
Kirschner PA, Sweller J, Clark RE. Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching. Educational Psychologist. 2006;41(2):75-86. doi: 10.1207/s15326985ep4102_1
5.
SCHMIDT HG, LOYENS SMM, VAN GOG T, PAAS F. Problem-Based Learning is Compatible with Human Cognitive Architecture: Commentary on Kirschner, Sweller, and Clark (2006) . Educational Psychologist. 2007;42(2):91-97. doi: 10.1080/00461520701263350
6.
Billett S. Situated learning: Bridging sociocultural and cognitive theorising. Learning and Instruction. 1996;6(3):263-280. doi: 10.1016/0959-4752(96)00006-0 [Source]
7.
Gruppen L, Mangrulkar R, Kolars J. The promise of competency-based education in the health professions for improving global health. Hum Resour Health. 2012;10:43. [PubMed]
8.
McLeod P, Steinert Y, Chalk C, et al. Which pedagogical principles should clinical teachers know? Teachers and education experts disagree Disagreement on important pedagogical principles. Medical Teacher. 2009;31(4):e117-e124. doi: 10.1080/01421590802335900
9.
McLeod P, Meagher T, Steinert Y, Schuwirth L, McLeod A. Clinical teachers’ tacit knowledge of basic pedagogic principles. Med Teach. 2004;26(1):23-27. [PubMed]
10.
McLeod P, Brawer J, Steinert Y, Chalk C, McLeod A. A pilot study designed to acquaint medical educators with basic pedagogic principles. Med Teach. 2008;30(1):92-93. [PubMed]
11.
Richlin L. Scholarly Teaching and the Scholarship of Teaching. New Directions for Teaching and Learning. 2001;2001(86):57-68. doi: 10.1002/tl.16
12.
Sherbino J, Frank J, Snell L. Defining the key roles and competencies of the clinician-educator of the 21st century: a national mixed-methods study. Acad Med. 2014;89(5):783-789. [PubMed]
13.
Whitehead C, Hodges B, Austin Z. Captive on a carousel: discourses of “new” in medical education 1910-2010. Adv Health Sci Educ Theory Pract. 2013;18(4):755-768. [PubMed]