A long time between posts

When I started this blog, a colleague of mine said he liked the idea but surely I would run out of topics pretty soon.  Over fifty posts later, here I am, possibly about to run out of topics and with over a year since the last post.  I have probably dipped into most topics in a standard medical education textbook but, hopefully, in a more informal and concise way (and influenced by changing events).  I retired from clinical practice just before Covid struck so now feel that perhaps I am less in touch with on-the-ground clinical experience.

I am still involved with medical education in terms of having written multiple modules of a Certificate in Clinical Teaching and Supervision – General Practice over the last three years.  There are now ten modules (each in two parts) which can be found on Canvas online at the University of Newcastle website (or enquire at gpcertificate@newcastle.edu.au) . I am still delivering these modules and marking assignments.

Our medical and teaching environment has changed profoundly and unexpectedly in the last couple of years but basic educational principles tend to remain. The evidence probably doesn’t change as quickly as in clinical medicine – just think fomites versus aerosol regarding advice about Covid transmission over the last two years – but it isn’t all “common sense” or instinct either.  Being a good teacher is more than being a good doctor, even though this is rarely acknowledged in terms of career structures.

As all good comedians say “you’ve been a lovely audience” but I probably know fewer of you than I did at the start as the turnover in medical education staff in Australia has been considerable and the training environment remains unpredictable.

I was writing this blog at the same time as I ventured into learning botanical art (with coloured pencil) so I have been able to reflect on being a learner as well as a teacher.  It seems I learned some of these  skills in a similar way to engaging with CPD in medicine and medical education.  I attended occasional workshops and online courses (with and without feedback) and continued to practice.  I watched other people’s efforts and felt inspired by them.   I don’t have a qualification but family members have noticed a difference between my early and later attempts at grapes, amongst other things! 

Interestingly I started with an intention to do “botanical” art.  I embarked on flowers, then fruit and vegetables.  But then I moved on to birds and a few animals, even some landscape.  It’s the GP in me, being interested in many things and reluctant to specialise.  My GP career had moved, like many, with my patients.  From kids and women’s health to geriatrics and complex comorbidities.  The nature of general practice is such that it is too broad for everyone to be good at everything and one is always trying to improve and master new skills as required by patient needs.  I think being an educator is similar.  In both areas you may develop different skills at different times (and others in the educational team may be better skilled at some things) and you always see improvements that can be made in the way you might do things “next time”.  But that’s not a bad thing necessarily.  And now it appears to apply to botanical art also!

My conclusions after forty years of involvement in medicine and medical education are that you are kidding yourselves if you say that either medicine or education can be practised apolitically.  Everything is political. You can be the most enthusiastic supervisor but if you are struggling to meet the needs of a large patient load or the financial constraints of the practice then the quality of your supervision will probably not be as great as you would like it to be.  You may be a highly qualified and gifted educator but if the organisation coordinating the training is more concerned about the bottom line or the requirements of the funder then the educator to learner ratio may mean you lose the crucial interpersonal aspects of education.

A training organisation that engenders poor morale amongst its staff will result in greater turnover and therefore trainers with less corporate knowledge and experience.  Tertiary institutions may have staff with no job security, no time to “think” or support to attend conferences and this will obviously affect the learning environment. It may all work in terms of corporate outcomes but not in terms of quality training or the learner experience.  The recent decision to de-fund a well-used, evidence-based prescribing resource is also evidence of the effect of political decisions. All these issues of the broader context, the total learning environment, depend on policies made and implemented at a higher level and often by people with non-educational values and priorities.

If quality training is to continue there need to be passionate and skilled individual teachers but these teachers need to be encouraged by the system.  This requires some educators to venture out of their bubbles into the policy and political realm, despite not always being encouraged and even though this can sometimes be discouraging.  Sadly, institutions are less and less likely to be fans of people speaking out.

I suspect this chasm between management (and decision makers) and the professionals delivering the relevant service has grown larger across many areas and institutions (not just medicine or education) and is a tendency determined by specific ideologies.  There is a challenging divide to be crossed by the new generation of educators and this requires cooperation and respect rather than conflict and a set of new skills (in addition to medical or education skills).

Cathy Regan

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