Making a difference

Oh, it makes a difference, I thought. And if it doesn’t make a difference you will make it make a difference.

So muses a distracted Asher, the gifted child in Chaim Potok’s literary masterpiece My Name is Asher Lev, while being talked at by a community elder.[1] Few of us will make the difference that Potok’s fictional character Asher makes but making a difference is what we all aspire to and is something of a theme that runs through many of the papers in this issue of Education for Primary Care.

In his editorial in which he puts the case that transformational leadership is for everyone, not just the few, Amar Rughani puts a central focus on this concept when defining leadership in the GP context ‘The use of our personal influence in socially acceptable ways to make a difference to the communities that we are part of’.[2] The challenge however of ‘teaching leadership’ is laid bare by a study from Yorkshire and Humber by Fowler and Gill.[3] Educators reported more teaching and training in this area than trainees reported receiving and educators and trainees questioned whether leadership can really be taught. Perhaps we should not be surprised. The importance of role modelling and ‘learning by doing (i.e. being involved in leading)’ are foregrounded as important conclusions.

Sandars and Patel, in discussing the challenges of putting the findings from medical education research into educational practice, retain a clear focus on research that can provide ‘useful knowledge’, the findings of which are more likely to be scalable, applicable and transferrable. In other words, findings that can make a difference to everyday educational practice.[4]

Hydes and Ajjawi focus on the explicit standards for undergraduate medical education as set out in Tomorrows Doctors, and in particular how GP community teachers in the UK are selected, initially trained and assessed.[5] Perhaps unsurprisingly, the result of their survey reveals a mixed picture and as Neil Johnson emphasises in his accompanying commentary there is an opportunity to do better, not least ‘given the increasing emphasis on preparing future doctors for a system in which much more care will be delivered in community-based settings’.[6]

The added value of experienced educators in managing trainees in difficulty is explored in a small but interesting local study by Bevis Heap, with the suggestion that these educators work at an ‘unconscious competence’ level using expert scripts and emotional intelligence.[7] These are educators that are making a difference in some of the most challenging educational circumstances.

As ever, the Three Papers, Innovations and Teaching Exchange sections of this issue are peppers with ideas for educators to reflect on, possibly implement in their practice and make a difference for their learners.

In terms of making a difference, few can compare with Luisa Pettigrew, a member of our editorial Board who has worked with me over the last number of months in establishing this journal’s International Series. Luisa has played a key role in bringing forward two fascinating and important linked papers in this issue about primary care education in Rwanda, papers which clearly describe the difference that the authors and their co-workers are making in establishing primary care and primary care education in that part of Africa.[8] Luisa has been awarded a British Empire Medal in the 2015 Queens’ Birthday Honour List for services to international Primary Care. She makes a difference!

Ronald MacVicar
Centre for Health Science, NHS Education for Scotland Inverness, UK[email protected]