Faculty Development

For the junior student in medicine and surgery, it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself.

Osler’s statement of 1905 is as true today as it was then, but medicine has come a long way since the days of patients being used just as ‘teaching material’. Caring for the patient and working through interesting clinical cases are still the core reasons why doctors practise medicine, but a recent BMA discussion paper (BMA, 2008) highlights the need for a shift in the relationship between doctor, learner and patient towards patient-centered learning, a more active role for patients and involving patients as partners in the education process.

One of the main challenges for clinical teachers is to achieve a balance between ensuring good patient care and enabling the learner to acquire the skills, understanding and behaviours of an effective professional practitioner. A number of recent trends in healthcare are important in this regard:

• shifts in clinical care, such as less in-patient care with shorter stays in hospital: patients who are in hospital may be very ill or frail
• increased student and trainee numbers leading to reduced opportunities to learn from large numbers of patients
• patients more assertive about being ‘used’ as ‘teaching material’, especially by large numbers of students/trainees
• introduction of patient pathways and integrated care leading to reduced opportunities for learners to take histories and clerk patients
• changing roles of healthcare professionals have reduced learning opportunities in practice.

(Spencer, 2003; Ker & Bradley, 2007)

In the next sections we will explore how clinical teachers can meet some of these challenges through using alternative teaching and learning approaches while still ensuring the needs of both learners and patients can be met.