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The best teachers I’ve encountered were at Medical School.

Brimming with enthusiasm, outstanding in their professionalism, students who didn’t want to have a beer with them wanted to be their House Officer. I met my worst teachers at medical school too – they would arrive late with no idea of who their target audience was (and even less idea of what they were supposed to be teaching them) before leaving five minutes into the session to answer their bleep.

We all have our heroes and villains. I can trace the effects of both on my practice as a clinician today. Recently, I started to consider what made some of these doctors so good and others bad. How many of them had insight into just how influential their teaching was?

I started to reflect upon my own teaching. I enjoy teaching – I find the personal interaction with my students highly rewarding and I often find my own understanding substantially improved when I have taught a subject. I have always had positive feedback from my students. Despite this, I really don’t know what I am doing.

Before coming to Medical School, students are taught by teachers with varying degrees of aptitude but a common grounding in Education theory and practice. Upon arriving at Higher Education, the variability of aptitude remains the same but is balanced by an almost universally poor grounding in Educational theory. This is a situation with which students have every right to be dissatisfied as they consider their large fees and rapidly mounting student debt.

Thinking about this, I decided to enrol in the Masters of Medical Science in Clinical Education at the University of Nottingham. With the snappy abbreviation of MmedSciClinEd this may possibly have the highest ratio of letters to student effort of any Masters Course. The degree takes a modular format: one year’s part-time study achieves a Certificate, two years brings students to Diploma level. Candidates may take up to four years to produce a dissertation to complete the Masters Degree.

The amount of time spent away from clinical work is relatively small – two days per month during University term-times. The out-of-hours commitment is student dependent, although sufficient time needs to be devoted to produce a piece for summative assessment of each module. This might range from a 5000 word essay for the Teaching and Learning module, to a functioning educational webpage for the Informatics module. This is not to mention the significant undertaking of a dissertation based upon original work. Feedback from previous years would suggest that a return to essay writing after a prolonged break is quite a stretch for most clinicians and that most students start off devoting a less than optimal amount of time to their studies.

Our cohort is made up of 31 students who range from physiotherapists and nurses, through Foundation Year 1 doctors to consultants. The majority are SpRs. Specialties represented include Geriatrics, Acute Medicine, Radiology, General Surgery and Anaesthetics. Some of the consultants with academic commitments have had their fees met by their departments. Two of the SpRs have undertaken teaching fellowships which meet the cost of the course. Most of the group, however, have tried unsuccessfully to source financial support and are self-funding. It is worth emphasising that there are relatively few funding opportunities available for taught Masters Courses and little prospect of funding becoming available in the near future.

So far, the course doesn’t seem to have dwelt unnecessarily on abstract theory but has tried to relate teaching to practical applications. Sessions have been dedicated to lecture delivery, small group teaching and problem-based learning, for example. The curriculum goes on to cover assessment, continuous professional and personal development, informatics, simulation and action research, with optional modules to flesh out areas of interest during the second year.

The experience so far has been very positive. I have had my own preconceptions regarding teaching and learning challenged and have had the opportunity to challenge those of colleagues. I have begun to reflect upon my own teaching practice and understand what people are doing, or should be doing, when they teach. I have started to critically appraise my own learning experiences and evaluate the strengths and weaknesses of these. The biggest revelation for me has been a more thorough understanding of curricula and the realisation that many of the errors and successes which I would previously have placed at my teachers’ feet are the result of planning at a more fundamental level. How, for example, do you teach to achieve an unachievable learning objective?

Similar opportunities are available at several Medical Schools around the UK. Before applying for the course in Nottingham, I researched degrees in Edinburgh, Dundee and Newcastle and found sufficient similarities between courses to plump for the geographically convenient location.
For those who find the prospect of a Masters Degree or Higher Certificate daunting, many departments run short courses in Clinical Education (in Nottingham the Teaching Improvement Project-TIPS Course). These provide a shorter, less formal exposure to teaching in Clinical Education. Several of our group started out on one of these courses before proceeding to the Masters.

As doctors we all teach, whether as part of a curriculum or through our obligations to the undergraduates, colleagues, patients and carers we meet in our clinical work. Many of us teach well but this is largely based upon personal aptitude and less upon an understanding of what we do. Arguably even remarkable teachers could perform better, by better understanding their practice. We should all demand an ever higher quality of education and we should provide ourselves with the skills to deliver this. Further study in Clinical Education represents an interesting and potentially fun way to do so.

More details of the MMedSciClinEd at The University of Nottingham can be found at http://www.tiny.cc/3vG5M. If considering doing a degree you should check the webpage of your local Medical School.

Adam Gordon
SpR in Health Care of the Elderly
Queen’s Medical Centre, Nottingham