D. Brigden

Mentoring in medical practice.

Summary Previous articles in this series have defined words and concepts that guide our thinking in the areas of teaching and learning, set in the greater world of education; but what happens in the quiet and often lonely world of individual practice? As we reflect upon our pasts, many of us recognise that we have at some point in time engaged with a significant figure who has had a long term and positive influence on our personal development; someone who has the unusual and valuable qualities that mean that whatever else is happening to them personally, they maintain a genuine interest in at least one other persons development. All too frequently, this becomes an isolated event; a lost activity from which there is limited gain. This article explores how, as busy practitioners, we may think of using the principles implied in this experience and build upon them to facilitate a powerful and cost effective method that encourages personal development. “To know someone with whom you feel there is understanding in spite of distances or thoughts expressed… that can make this life a garden”—Johann Wolfgang von Goethe (1749–1832)

The Education versus Training and the Skills versus Competency debate

Summary The essence of modern medical education lies in the ability of defining and developing its terminology, which all too often is used in a less than thoughtful and inappropriate manner. Educationalists place emphasis upon the concept of learning rather than teaching; learning which is specifically student centred and student directed learning rather than teacher centred didactic teaching. However within this change environment we still prefer to use the word training, as in vocational training, to describe a specific programme and aspire to levels of competency that hopefully match the learning outcomes of the programme. This article opens the debate on whether the satisfactory completion of a learning programme is sufficient (cf completion of vocational training) or whether we should be assessing the learner through levels of defined competency relevant to their professional career. “Personally I am always ready to learn, although I do not always like to be taught” Sir Winston Churchill.

Feedback: The educational process of giving and receiving

Summary The report of the Standing Committee on Postgraduate Medical Education in the United Kingdom stated in 1995 1 that “all those involved in teaching can contribute by creating a positive educational environment, helping learners to achieve their goals by providing support and constructive feedback…They need to understand more about the need for, and the ways of achieving feedback, appraisal, openness and trust.” Over a number of years, many surveys have shown that a lack of feedback is the most common complaint students, interns and registrars make about their teaching and training. In many ways it is the most serious, for feedback is essential to progression in learning. The purpose of this article is to describe the concept of feedback, its triangulation with effective teaching and learning and to demonstrate its potential in maximising any teaching activity that is encountered within practice. It will also explore how, because of its close proximity to appraisal, feedback may provide personal drive and motivation. “Think like a wise man but communicate in the language of the people.” William Butler Yeats1

From learning portfolios to personal development plans.

Previous articles have focused on the need to recognise and implement modern educational theory in practice, to make learning a continuous, lifelong activity, and to relate learning to outcome measures. For each of these, the medical practitioner has to develop the appropriate tools for these concepts to be implemented and to be successful. But how do practitioners appraise what they have been involved with or map what they intend to carry out in the future, or make themselves ready for a future when accreditation and re-accreditation are realistic outcome measures? In this article we put forward, for discussion, the use of modified learning portfolios, which, when combined with a personal development plan, act as an educationally directed developmental tool to identify educational and training needs, as well as to record individual progress and success. We will draw a comparison between this type of portfolio and the standard curriculum vitae, whilst demonstrating the potential for a learning portfolio to be a useful adjunct to a curriculum vitae.

Assessment and evaluation in medical education

Summary Previous discussion has focused upon the educational process, specifically, the basis for “good” medical education, the methods of learning and teaching used and the relationship between undergraduate, postgraduate and life-long learning; continuing professional development. All these would appear to be, in the first instance, linear processes, with a beginning that commences with a specific teaching and learning activity and an end, often an end-point examination, hopefully testing how much we remember, apply and use. As part of any educational programme, assessment and evaluation feature frequently. The purpose of this article is to not only equip the reader with an understanding of the terminology used in assessment and evaluation, but to demonstrate that, as for many other aspects of medical education, the processes of assessment and evaluation bring cyclical and dynamic actions which can be used and built upon to improve the efficiency of the training model and even oneself. “Examinations, sir, are pure humbug from beginning to end. If a man is a gentleman, he knows quite enough, and if he is not a gentleman, whatever he knows is bad for him.” Oscar Wilde

Effective teaching through active learning

Summary There can be very few practitioners whose daily working life is not involved someway in teaching or learning. Used in its broadest sense, we engage teaching everyday in our advice to patients, and conversely we learn from each of our patients. As we move inexorably towards compulsory reaccredidation for all practitioners, purposeful and effective continuing professional development takes over from the previously passive continuing medical education model. As Universities and Medical Schools recognise where most healthcare occurs and see the benefits of community-based education, increasing numbers of undergraduate and postgraduate students pass daily through our surgery doors. No doubt, the majority of busy practitioners see these activities as an increased workload rather than an opportunity, a stress factor rather than a possibility to develop in their personal lives. In this article, we wish to suggest how some of our daily practice activities can be seen as opportunities to teach and learn; how by using the principles of being an effective teacher, we can create learning situations for all. “Learning and teaching should not stand on opposite banks and just watch the river flow by; instead, they should embark together on a journey down the water. Through an active, reciprocal exchange, teaching can strengthen learning how to learn”. Loris Malaguzzi1