Teaching clinicians to teach

Clinical teaching skills are highly transferable across health disciplines and learning contexts. But sensitivity is needed in delivering the message, writes Jeremy Gilling.

When in the late 1990s clinicians in Perth were searching for someone to provide staff development for doctors who were responsible for imparting clinical skills to medical students and new graduates, they couldn’t find anyone local with the skills for the job.

Moreover, says UWA’s professor of medicine, Fiona Lake, there wasn’t even any suitable learning material to be found in Australia. So the decision was taken to bring a highly regarded clinician teacher over from Britain, at considerable expense, to do the job. It was immediately clear that there was a need, and the potential demand, for local capacity, both people and resources.

That was the genesis of UWA’s Teaching on the Run staff development program, which aims to increase the teaching skills and confidence of professionally experienced doctors charged with passing their skills onto junior doctors and medical students in a clinical setting.

The second breakthrough, says Lake, was the realisation that most of the teaching skills these doctors needed were the same skills that any teacher needed in a clinical setting in any health discipline.

“But it’s a message that requires sensitivity to deliver,” she says. “Community doctors, for example, might think that their teaching is different from the teaching at the bedside other doctors do in a hospital setting. Similarly, vets who specialise in large animals may think that they need different teaching skills from those with a mainly domestic animal practice.

“It’s only when you get them together in mixed groups that they come to realise that perhaps as much as 99 per cent of the clinical teaching and supervision skills they require are directly transferable to other clinical health contexts.”

With support initially from the federal Department of Health and Ageing, Lake and her colleagues sought to adapt and disseminate the Teaching on the Run program not just to other states and territories, but subsequently to several other health disciplines that had heard about the program and were keen to adopt it. The ALTC has provided Lake with the additional funding that is needed to achieve this through a fellowship award.

“Clinical experience is a critical aspect of learning in all health disciplines,” says Lake. “The people who are charged with imparting that learning want not just to provide a rich experience for their students; it needs also to be a tolerable and manageable experience for the teachers themselves – people who are generally very busy and very involved with their own professional practices.

“Unfortunately, as far as doctors are concerned – and it’s probably also true of the other professions – the teachers have generally been thrown straight into the deep end.”

Lake heads the ALTC project in partnership with colleagues from UWA, Curtin, Murdoch and UQ, and the Queensland and WA health departments. The project links with other projects that are addressing the same issue. Lake says medical training tends to be fragmented, with universities providing the theory to undergraduates, the postgraduate medical councils in each jurisdiction imparting the prevocational training to new graduates, and the colleges offering mid-career professional development.

“Historically there’s been no serious effort to achieve vertical integration between the three learning phases – although the Commonwealth-funded bridging project under the auspices of GPET [General Practice Education and Training] seeks to achieve this by identifying and removing gaps and duplication between the three phases of ‘doctor as educator’ training. The aim is to develop a single competency role.

“We see our project as fitting well within this larger agenda. We’re developing the tools and resources that we think will neatly fit each discrete stage.”

During the ALTC project, the team has worked with clinicians across a range of health disciplines to develop materials – including videos, case scenarios and role-plays – and run workshops for five discipline groups: nurses, physiotherapists, veterinarians, multi-professional groups (one in Canada) and interprofessional groups. Although only point of delivery evaluation results are available so far, participants across all the discipline groups have given a strong positive response to the experience. The results of longitudinal evaluations – pre-workshop and four to six months after the workshop – should be available later this year.

Lake says the next step is to disseminate the material and the workshops more widely, relying especially on Moodle open source software through the virtual TELL (Teach, Educate, Learn, Lead) centre, to be launched shortly. The material is published under a creative commons licence, and is available at cost for non-commercial purposes when linked with facilitator training.

Lake received an ALTC citation award in 2006 for outstanding contributions to student learning, and is using the funds to translate the Teaching on the Run material into Vietnamese and run the program at Da Nang hospital in central Vietnam. She has also run the program, in English, for ophthalmologists in Burma.

Go to www.meddent.uwa.edu.au/teaching/on-the-run