The golden age ofmedical education?Kieran Walsh, Editorial Registrar, BMJ Publishing Group

‘Did you enjoy the confer-ence?’ asked one delegate.

‘It was great. We are lucky. Thepast ten years have been thegolden age of medical education,’said the other.

This is a short summary of aconversation that I had at arecent conference on medicaleducation. And it was a greatconference. There were tens ofplatforms and hundreds of postersand over a thousand delegates.Many medical meetings are lowkey events: the poor ones sinkinto festivals of whingeing aboutpatients or drug companies or thegovernment. The upbeat feelingat this conference was unmistak-able. But as I headed towards theairport I started to wonder aboutthis golden age that started aboutten years ago.

About ten years ago I was asenior house officer in generalmedicine. The head of thedepartment where I worked askedme if I would like to become a

mentor to medical students. I saidthat I would be delighted andasked what my extra duties wouldbe. His reply: ‘Oh, you don’t haveto do anything – it’s justsomething good to put on yourcurriculum vitae.’ But being aneager beaver I set up sometutorials for them in any case.A month later my consultant tookme aside: ‘Cancel those tutorials,’he said, ‘we’ll put a squeeze onthe university to get more money.We can use the students as abargaining tool.’

A few years later I became aregistrar at a different hospital andset up teaching sessions for myjunior colleagues. But there was aproblem with the rota: there weretoo few juniors and middle gradesfor much learning and teaching toget done. Attempts to fill the gapwith staff grade doctors founderedas few doctors applied for theseposts. A management meeting wascalled to look for solutions. ‘Whydon’t we scrap the name staffgrade and call the new doctorsclinical teaching fellows?’ asked a

manager. ‘This would surely gen-erate some applications.’ And whatwere to be the teaching duties ofour new fellows? Well, they coulddo teaching in their own time ifthey wanted – after they hadfinished their clinical duties. Butmy interest in teaching must havebeen noticed by someone as I wasasked if I would like to become thejunior tutor at this hospital. WhenI asked what I would have to do, Iwas told, ‘Oh, not much; and nearlyanyone can do not much.’ And whotold me that? The senior tutor, ofcourse.

But despite these setbacks myinterest in learning and teachingcontinued and I asked for careeradvice from an academic at aprestigious teaching hospital. ‘I’dlove to work in medical educa-tion,’ I started off.

‘What a brilliant idea – it’s agrowing field.’

‘We need people in this area.’

‘What have you got to offer?’

‘It’s justsomething good

to put on yourCV’

PersonalExperience

2 THE CLINICAL TEACHER June 2005 | Volume 2 | No 1| www.theclinicalteacher.com

No, he didn’t say any of thosethings. He said: ‘Why do you wantto do work in medical education?Has there been some sort of

catastrophe in your working life?Didn’t you know it’s just for socialworkers who can’t get a properjob?’

This happened earlier thisyear. And these are not isolatedphenomena – many of my friendsand colleagues have experienced

Teaching in the 21st century: advanced paediatric life support training.

Teaching in 1898: has medical education moved on?

‘Why do youwant to work inmedicaleducation?’

‘teaching shouldget as muchkudos asresearch does’

June 2005 | Volume 2 | No 1| www.theclinicalteacher.com THE CLINICAL TEACHER 3

similar setbacks. But it’s easy tosit back and criticise – what canwe do about it? First of all wemust take ourselves seriously. Theabove incidents are doubly sadbecause the people involved areteachers themselves. Put simply,people who have no interest orenthusiasm for teaching shouldn’tbe responsible for teaching. Atpresent in the UK there are lots ofprofessional teaching courses forhealthcare professionals andjournals are increasingly accept-ing articles about medical educa-tion. People who have done orwho are doing these courses, orwho have a substantial publica-tion record in the area of medicaleducation, should jump to thefront of the queue when theyapply for teaching jobs. They have

demonstrated an interest andenthusiasm in medical education.The researcher who squeezes a bitof teaching into his or her time-table must become a thing of thepast: teaching should get as muchkudos as research does from uni-versities. This, more than anyother single action, would raisethe status of medical teaching.

But medical education that isdelivered by teaching profession-als will not happen overnight. Inthe meantime, what can we do toprevent some of the above inci-dents happening in our depart-ment tomorrow? Interdisciplinarylearning may be one way forward.If the manager who wanted to callhis staff grades clinical teachingfellows attended the same

teaching sessions as the clinicians,would he be so misinformed?Probably not. Similarly clinicianswould not make ill-judged com-ments about using their teachingskills as a bargaining tool to besold to the highest bidder. Indi-viduals who learned togetherwould quickly understand thelearning needs of other groups andalso the learning needs of theorganisation as a whole.

And what if we look up from thedetails and think about the futureof medical education? What willlearners and teachers be achievingin ten years’ time? What will theybe complaining about? Whether itis problem-based learning orinterdisciplinary learning, onething that medical education willbe is more evidence-based than ithas been in the past. There is anenormous amount of research intomedical education at the momentand we must adopt the methodsthat are proven by research to beuseful and stop doing things thatdon’t work. This seems obvious,but clinical medicine has beenslow to change itself in response tochanges in the evidence, and wemust try to ensure that the samething does not happen in medicaleducation.

But the first step in all this istaking ourselves seriously – onlywhen we do this will others startto do the same. Then maybe someof my early scrapes with theeducational establishment mightbecome a thing of the past. Ilaugh at these scrapes now, but Iam still not quite splitting mysides. They are funny until you area medical student waiting aroundfor teaching that never happens.You then become an inadequatelytrained doctor; and your patientsmight not appreciate the darkside of medical humour. Thingsare certainly improving quickly inmedical education but whether weare in a golden age or about toenter one is another matter. Butwe are moving out of the StoneAge. Here’s to the next ten years.

‘the first step inall this is taking

ourselvesseriously’

4 THE CLINICAL TEACHER June 2005 | Volume 2 | No 1| www.theclinicalteacher.com