The Doctor as Teacher - archived policy document

September 1999

Introduction

1. 1.  In our Recommendations on the Training of Specialists, we acknowledge that the example of the teacher is the most powerful influence upon the standards of conduct and practice of every trainee, whether medical student or junior doctor.
2. 2.  Our recommendations about the pre-registration year, The New Doctor, and about training at senior house officer grade, The Early Years, discuss in some detail the arrangements that should be made for the supervision of new medical graduates and those in the early stages of training for specialist practice.
3. 3.  The guidance in this pamphlet supplements that in our recommendations about general clinical and general professional/basic specialist training. It sets out our expectations of those who provide a role model by acting as clinical or educational supervisors to junior colleagues, and of the bodies under whose auspices this task is undertaken. The guidance applies equally to those who supervise medical students, as they begin to acquire the professional attitudes, skills and knowledge they will need as doctors.

The educational obligations of all doctors

1. 4.  All doctors have a professional obligation to contribute to the education and training of other doctors, medical students and non-medical healthcare professionals on the team 
2. 5.  Every doctor should be prepared to oversee the work of less experienced colleagues, and must make sure that students
3. 6.  Teaching skills are not necessarily innate, but can be learned. Those who accept special responsibilities for teaching should take steps to ensure that  they develop and maintain the skills
4. 7.  We expect doctors to be honest and objective when assessing those they have supervised or trained. Patients may otherwise be put at risk.

The professional attributes of the doctor with responsibilities for clinical training/educational supervision

1. 8.  Every doctor who is appointed to provide clinical or educational supervision for a doctor in training, or who undertakes to provide  clinical training and supervision for medical students, should demonstrate commitment to our professional guidance in Good Medical Practice. This will involve:
   • maintaining a high standard of professional and personal values in relation to patients and their care
   • being available and accessible to patients
   • maintaining a high standard of clinical competence
   • an ability to communicate effectively
   • a commitment to personal, and professional, development as a doctor
   • a commitment to professional audit and peer review
   • a commitment to team working in a multi-professional environment
   • an understanding of the multi-cultural society in which medicine is practised.

The personal attributes of the doctor with responsibilities for clinical training/educational supervision

1. 9.  The attributes of the doctor with teaching responsibilities will include:
   • an enthusiasm for his/her specialty
   • a personal commitment to teaching and learning
   • sensitivity and responsiveness to the educational needs of students and junior doctors
   • the capacity to promote development of the required professional attitudes and values
   • an understanding of the principles of education as applied to medicine
   • an understanding of research method
   • practical teaching skills
   • a willingness to develop both as a doctor and as a teacher
   • a commitment to audit and peer review of his/her teaching
   • the ability to use formative assessment for the benefit of the student/trainee
   • the ability to carry out formal appraisal of medical student progress/the performance of the trainee as a practising doctor.

The roles and responsibilities of the undergraduate and postgraduate training bodies

1. 10.  The universities, Royal Colleges and Faculties, the Specialist Training Authority and the Joint Committee for Postgraduate Training in General Practice should publish clear statements of the outcomes of training provided under their auspices for junior doctors. These will include not only the attitudes, skills and knowledge to be acquired but also an indication of the kind of doctor they expect their training programmes to develop. They should ensure that their philosophy is understood by teachers and trainers within both academic medicine and the health service.
2. 11. Criteria for the selection of clinical and educational supervisors (including those with responsibility for the clinical training of medical students) should also be drawn up and published. These should make explicit the professional and personal qualities needed by the training bodies’ role models. There should be formal arrangements both for reviewing the performance of supervisors and clinical teachers and providing feedback, and for addressing any problems identified.
3. 12. The universities should ensure that formal training in teaching skills, and in the facilitation of student learning, is provided for all new appointees. Satisfactory completion of such training, and evidence of competence in teaching, should be required before probationary appointments are confirmed. The training needs of staff already in post should also be addressed.
4. 13. Changes in undergraduate education have emphasised learner-centred education, problem solving and the acquisition of clinical and communication skills within hospital and community settings. For this reason, more hospital doctors and general practitioners are likely to be involved in teaching and the facilitation of learning, including the provision of feedback about performance, than hitherto.
5. 14. Training should therefore be offered to NHS employees with honorary university appointments and to others with substantial commitments to the clinical training of medical students. The postgraduate training bodies should ensure that the training needs of those providing clinical and educational supervision for junior doctors only, who may not have the opportunity to benefit from university-organised courses, are met.
6. 15. Large group teaching within the formal environment of a lecture theatre is a particular skill which needs to be taught and practised. Different demands are made of those with responsibilities for tutoring or facilitating the learning of small groups of students or trainees, whether in a clinical or a problem-solving environment. Staff development programmes should be designed to meet the on-going needs of doctors with a range of different teaching responsibilities. Within the  universities, particular expertise can usually be provided by Medical Education Units, staffed by professional educators.
7. 16. Small group teaching in general practice is well established, and has been extensively reported in the literature. As general practice has found, the time and resources to provide training for the trainers are critical to the successful outcome of programmes of teaching and learning.
   

The responsibilities of National Health Service employers

1. 17. Teaching has traditionally formed a large part of the workload of full-time medical academic staff but increasingly, those working in the NHS are undertaking teaching and supervision of students and junior doctors as part of their job plans. While consultants have a contractual requirement to teach, clinicians in all grades may now have to combine service to patients with teaching duties.
2. 18. NHS Trusts should recognise that employees with responsibilities for teaching and training our future doctors need time to learn how to carry out their duties effectively, and time to discharge these functions. 
3. 19. Uniquely in the NHS, the contribution of general practitioners selected to train others is nominally acknowledged in financial terms, presently through a ‘one session’ grant. However the conscientious trainer will often devote considerably more than one session per week to the trainee. Increasingly, the entire practice, with its extended primary health care team, is being viewed as the training environment and the commitment of all members to high professional standards taken into account for accreditation purposes.