Definition

Clinical teaching is teaching that focuses on real patients in clinical settings. The setting may be the hospital ward, out-patient department or surgical theatre, or the community.

Changing perceptions of clinical teaching

Clinical teaching should be at the heart of medical education but how it is delivered is sadly often ignored. Traditionally the training of a doctor was based on the apprenticeship model where the trainee was attached to a reputable physician and worked with the physician in the day-to-day care of patients. This approach provided a relevant and practical training but had two disadvantages. There was a perceived lack of scientific underpinning of

Fig 24.1 Clinical teaching.

the education and the quality of the training varied with the trainer’s capacity and conscientiousness. For these reasons, as described earlier in the book, in the early part of the twentieth century training was moved to medical schools and associated with a defined curriculum. A greater emphasis was put on the scientific basis for medicine and this played a key role in the early training of a doctor and lectures were widely adopted. In the past two decades there has been a move to return an emphasis in training to the clinical context, with the provision of authentic learning experiences from the early years of the undergraduate curriculum. Changes have also taken place in postgraduate education with the recognition that the education of the trainee does not need to conflict with his or her service role in the delivery of health care. With an appropriate curriculum and planning, learning can be managed ’on the job’ in the context of the trainee’s work.

The importance of clinical teaching

The advantages of clinical training are obvious:

The student

Key players in clinical teaching are the student, the teacher and the patient. The role of the student in the clinical setting varies depending on their seniority and their stage in the curriculum. A junior student may actively engage in learning while not being a member of the team delivering the patient’s care. Students may visit the ward in groups of six to ten and be taught on one or more selected patients by an assigned clinical teacher. Students observe the teacher taking a patient’s history or examining the patient and may have the opportunity to do so themselves. The students are then questioned on the findings and required to reflect on the patient’s case. Feedback is given to the student.

A more senior student participates in a clerkship as a member of the healthcare team. The teaching is integrated into the care of the patient. Students move from a peripheral role to one of participating as members of the medical community of practice. Students learn from working alongside experienced practitioners and other members of the healthcare team. In the process they are socialised into the practice of medicine. The ward round and patient care conferences are typical learning opportunities.

In postgraduate training, work-based learning is the norm with the trainees developing their competencies as junior members of the healthcare team with certain assigned responsibilities. Short courses relating to specialised aspects of the work or procedures can be scheduled

The teacher

The role of the clinical teacher is particularly challenging as it encompasses the range of roles highlighted in Chapter 1. These include information provider, role model, facilitator, mentor, assessor and planner. Clinical teachers assume multiple roles when they interact with their students. They need to be ’the expert’ and a source of knowledge while at the same time facilitating the students’ learning by having an understanding about the teaching and learning process. Both senior and junior doctors serve as role models for students. Many studies have explored the attributes of a good clinical teacher and these are summarised in Table 24.1.

Table 24.1 Features of the good clinical teacher