The power of one: Looking beyond the teacher in clinical instruction

Abstract

Background: Research on clinical teaching in medicine tends to focus on preceptors and senior attending physicians as the primary source of learning for medical students. As a result, there is an artificial separation of ‘teacher’ from context in much of the research on clinical teaching in medicine.

Aims: The central aim of this study was to challenge the taken-for-granted assumption that student learning can be attributed primarily to a preceptor or attending physician on a rotation.

Methodology: Twenty-two medical students and forty-one clinical faculty members generated explanations for a study that showed a positive effect on NMBE results for 3rd year clerkship students who had at least one highly effective clinical teacher during their clinical rotation in medicine.

Results: Student and faculty explanations resulted in fourteen factors and six propositions describing the nature of highly effective clinical teaching. Students believed contextual factors influenced their own learning, but did not comment on that possibility in the study (Griffith CH, Georgesen JC, Wilson JF. 2000. Six-year documentation of the association between excellent clinical teaching and improved student examination performance. Acad Med 75(10): October Supplement). Most clinical faculty did question the assumption that one teacher could have that effect.

Conclusions: We recommend refocusing research on clinical instruction toward engagement within a community of professionals, rather than attributing ‘power’ to a single clinical teacher.

Additional information

Notes on contributors

Daniel D. Pratt

DAN PRATT is Professor of Adult Education and the Acting Director of Clinical Educator Fellowships in Medical Education in the Faculty of Medicine at the University of British Columbia. For the past twenty years he has conducted research on the teaching of adults in different contexts and cultures.

Peter Harris

PETER HARRIS is Senior Lecturer, School of Public Health and Community Medicine, University of New South Wales in Sydney, Australia. He maintains special interests in medical education and particularly in the types of learning activities preferred by final year medical students and in systems for post-graduate course review and curriculum restructuring.

John B. Collins

JOHN COLLINS is Adjunct Professor in the Department of Educational Studies at the University of British Columbia. His research focuses on measuring and evaluating teaching and learning in medicine, nursing, pharmacy, physiatry, and on transitions into practice in a variety of health-related preceptorship settings.