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Postgraduate Medical Education

Improving Postgraduate Training

The long-established system of clinical education is one in which senior physicians serve as instructors to their junior colleagues. This apprentice system may be flawed by the fact that mentor physicians often lack formal training as educators. This weakness impacts directly on the atmosphere and ultimate success of the learning process. As a result of the increased awareness that many physicians are deficient in teaching skills, a few medical schools, residency programs, and continuing education seminars are providing opportunities to remedy this situation. Physicians are learning the basics of good teaching, such as how to create a positive learning climate, how to enhance learner retention, and how to evaluate learner performance.

There are many skeptics, especially among older physicians, who question the need and value of teaching physicians how to teach. Some of the younger doctors believe that clinical teaching is a basic medical skill that is as valuable as physical diagnosis or history taking.

Providing teaching skills to physicians is hampered by the fact that it is not a grant-funded area and does not generate patient revenue. In addition, it is not formally encouraged by the medical establishment but is the driving force of some individual medical school faculty members. While not yet widespread, support for their efforts is gaining momentum.

One of the approaches used, in addition to a discussion of teaching skills, is videotaped role-play exercises. Each role-play is a sort of skit that is designed to demonstrate common, yet troublesome, scenarios in clinical teaching. After the role-play is completed, participants review the tape and analyze their performance.

Since the majority of physicians-in-training do not yet have access to teaching skills training, they are forced to learn how to teach on their own. While this is difficult to accomplish, they can seek help at the Office of Medical Education at their hospital or school. Also, information on clinical teaching may be available in a medical library. The best sources are the following short books: The Physician as Teacher and Residents as Teachers by T. L. Schweml and N. Whitman and Teaching during Rounds: A Handbook for Attending Physicians and Residents, by J. Edwards and D. Weonholtz.

Finally, improvement in teaching skills can even be obtained by so simple an approach as identifying and listing the attributes of the most skilled clinical teachers one has been exposed to and trying to emulate them. Similarly, the weaknesses of poor clinical teachers can be identified so that those deficiencies can be avoided.

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