INTERNATIONAL TRENDS

Some challenges in the clinical teaching

Algunos retos en la enseñanza clínica

A. Wojtczak

Exdirector del International Institute for Medical Education (IME)
Expresidente de la Association for Medical Education in Europe (AMEE)
E-mail: wojtczak@cmkp.edu.pl

The Pre-Conference Workshops that are organized before the opening of the Annual Association for Medical Education in Europe (AMEE) Conferences are the places of lively discussions on different aspects of medical education that are of great importance for medical teachers.

One of such topic that is securing the competences of medical graduates is a clinical teaching. It is a complex task that demands a high qualification of the teachers. However, unfortunately, these tasks are too often assumed by the young clinicians without proper teaching experience. Although, most of them are receiving the rigorous training in medical knowledge and skills, they have no at all or a very little training in clinical teaching where the clinical environment depends on various factors such as a kind of patient illness and his or her emotional state as well as the learner receptiveness. It demands a great teachers' personal experience. It was interesting that during a lively discussion all participants, both teachers and students, have similar views on factors influencing the effective teaching/learning of physical examination skills. It was said that the clerkships leave the significant gaps in possessed clinical skills. The solution has been seen in the organization of clinical skills laboratories that help in filling the confidence gaps in students' clinical performance and cover the differences in teachers' behavior that is deciding factor in decreasing the students' motivation and impede their learning.

The other topic discussed in depth that has a crucial significance in effective teaching/learning processes was an issue of feedback. Without feedback, mistakes are uncorrected, good performance is not reinforced, and clinical competence may suffer. Although both, learners and teachers, have recognized the importance of feedback, yet most learners said that their feedback is inadequate as many of them have difficulty in giving feedback, especially when it centers on problem areas. They suggested the specific educational activities that would help faculty to develop these skills.

There also was no doubt that the communication skills are a core competency in medical education worldwide. However, teaching communication skills is still a challenging area as in too many medical schools these skills are left to be learned after graduation, during internship or when in practice. Hopefully there are good examples of growing efforts to develop learning programs for students. The evaluation of how medical graduates are able to exercise their communication must be part of examination at the end of the undergraduate training program.

Another discussed issue that influences the quality of education is the student ratings of teachers' performance. It was strongly stressed that although it is necessary, it is definitely not sufficient as a source to measure teaching effectiveness. The triangulation of multiple sources can provide a more accurate and reliable base for formative (teaching improvement) and summative (contract renewal, promotion) decisions than any single source. The spectrum of various measures includes such as: student and peer ratings, external expert ratings, self-ratings, alumni ratings, teaching awards, learning outcome measures, teaching portfolio. As faculty, your future depends on the fairness of these decisions.

Finally, a very interesting discussion took place on a scholarship as a fundamental mission of all medical schools. It was stressed that an educational scholarship differs from educational excellence and although many educators are involved in scholarly activity, they are often not able to translate the efforts in teaching, curriculum development and innovation, and educational leadership into scholarship. It has been said that 'scholarship serves as the building block for knowledge growth' and is an important issue to be discussed in an academic environment.

All above presented issues should be taken into account when planning the faculty development programs with aim of enhancing the educational skills, foster leadership and scholarship of academic teachers. The faculty training programs in medical education are only feasible strategy for fostering the teaching excellence, necessary in time of growing competitions between the medical education institutions.