Tim Swanwick

Informal learning in postgraduate medical education: from cognitivism to 'culturism'

Education is not simply a technical business of well managed information processing, nor even simply a matter of applying ‘learning theories’… It is a complex pursuit of fitting a culture to the needs of its members and their ways of knowing to the needs of the culture. 1

What is clinical leadership…and why is it important?

Background:  The ‘invitation’ for clinicians to participate in leadership practices, previously considered the province of the professional health service manager, is driven by a number of international policy and professional agendas. This article, the first in a short series, considers definitions and theories of clinical leadership and management, and explores leadership roles and responsibilities of the clinician in terms of levels of engagement. Recent developments in the UK’s National Health Service (NHS), the largest health care organisation in the world, are used as illustrations of how theory has informed clinical leadership development.

Clinical leadership development requires system-wide interventions, not just courses

Background:  This is the third article in a series on clinical leadership and medical education. In the first two articles in this series we looked at the nature of leadership and examined professional outcomes, standards and competency frameworks from around the world that describe what it is we are trying to instil in medical students and doctors in postgraduate training. In this article we explore current trends in leadership development and describe broad approaches to clinical leadership development, highlighting those strategies that are likely to be more (or less) successful.

Leadership development for clinicians: what are we trying to achieve?

Background:  The role of all health practitioners is changing as a result of social, technological and demographic shifts, and clinicians are increasingly required to participate in leadership activities. Worldwide, there are emerging examples of policy agendas, professional standards and competency frameworks and approaches to leadership development for clinicians.

Web‐based faculty development: e‐learning for clinical teachers in the London Deanery

Background:  The London Deanery has provided a web‐based resource for supporting the educational development needs of clinical teachers since 2002. This forms part of a range of resources supporting the professional development of clinical teachers and postgraduate supervisors. Following a review in 2007, the deanery commissioned a series of new e‐learning modules designed as an introduction to clinical teaching.

Shifting conceptions of learning in the workplace

Two papers in this month’s Medical Education point up the rich opportunities for learning provided in that widespread social practice in medical education, the ‘round’. Each of these well-crafted pieces of qualitative research provokes us into thinking about the nature of interactions between teachers and learners in the clinical environment and into questioning the assumptions about learning brought to the workplace by both parties.

Junior doctors: the best kept secret in the NHS?

In designing a web-based tool to evaluate the knowledge and attitudes of foundation doctors in relation to patient safety, Jean Robson and her colleagues highlighted a fundamental disconnect between junior doctors and the organisations in which they work.1 In this pilot study, published in the November 2011 issue of the journal, trainees who reported patient safety incidents were ‘an unusual occurrence’; 48% of trainees surveyed believed that most safety incidents were due to things that they could not do anything about. Perhaps this is not surprising as a similar proportion reported that they had failed to be involved in any subsequent discussions about the prevention of similar events and only one-third had received any feedback following the incidents investigation. The authors proposal that an annual attitudinal survey would provide valuable information which to build more effective patient safety incident reporting structures may be missing a more fundamental point. The problem is deeper rooted than that. Writing in the Journal of the American Medical Association last year, Robert Brook argues that physicians need to work beyond the reactive scope of traditional clinical practice …

Developing medical leadership: a comparative review of approaches in the UK and New Zealand

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

Twelve tips for integrating leadership development into undergraduate medical education

Abstract Healthcare systems need effective leadership. All healthcare professionals can and should “learn to lead” and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors’ expertise and the latest “thought leadership”, these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional’s identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

Postgraduate medical education: the same, but different

There is a tendency in medical education at the moment to bring together the postgraduate and the undergraduate into a set of unified frameworks. We see examples in regulatory standard setting—for instance, the UKs General Medical Council has recently released a single framework for the approval of trainers1 and is developing a unified set of training standards2—and in curriculum design where CanMeds 2015 aims to service the continuum of medical education from undergraduate years to continuing professional development and beyond.3 Despite this comforting homogeneity there are some issues, challenges and practices that, although not absolutely unique to postgraduate medical education, arise from a particular set of relationships between trainee, trainer, the training institution, employer, commissioner, regulators (both those of service and education) and, of course, patients and carers. At the heart of the matter is a managed tension between service and training with the learner as employee. Unlike undergraduate students, postgraduate trainees are registered professionals carrying a particular set of expectations on their shoulders while necessarily performing at the limits of their competence. Including learners within the workforce raises some complex issues about workforce planning, recruitment and selection as well as the construction of training programmes. Training ‘in-service’ brings with it a concern for patient safety, so there is a need for supervision and a particular set of educational approaches. In addition, the learners employed status brings into play some thorny human resource issues as well as a complex triangular relationship with those who ‘own’ the training. All of this is played out within a set of organisational structures that, because of their proximity to politics, are subject to regular review and reform. The purpose of postgraduate medical training is to provide a particular geography with a workforce that will serve the future health needs of …