This is the second of our posts this week looking at teaching, this time in the post graduate medical setting. This piece offers a challenging perspective of classsroom based education at postgraduate level, and suggests we change our terminology to reflect the positions we adopt with our colleagues in training. We would love to hear from other health educators about their view of teaching and learning.
You cannot teach a man anything: you can only help him find it within himself.
So said Galileo who lived between 1564 and 1642. A more relatable way of saying the same thing struck me as a young, newly qualified teacher in 1993. I went to a talk by Ian Crichton Smith, a Scottish poet and writer who had also been an English teacher in his time. In the intimate setting of our local library, Crichton Smith told of a colleague who had retired in Oban, on the west coast. People had come from far and wide to celebrate his career, and because he was known as a great raconteur. As the colleague took the stage, and the audience hushed, the retiring teacher said: “Teaching- what a colossal waste of time.”
As a young, eager and somewhat experimental educator, I was shocked at such insurrection. But once I joined the world of medical education, not very many years later, I began to revisit Crichton Smith’s story. And to agree with it.
When I heard of novice doctors in training rushing out of theatre during a rare case, because they had “teaching” to go to, which amounted to the weekly lunchtime session on whatever topic the expert volunteer had offered to address, I wondered why it was called teaching, when the vast majority of the people in the room would be listening, hearing, eating a sandwich, catching up on texts and emails, note taking, perhaps asking a question, perhaps not. The last thing that the doctors in training were doing here was teaching.
And then it struck me.
All educational endeavour in medicine was so labelled for and by the people in charge. It was called teaching because that is what the bosses did. They taught. They talked, they read aloud, they showed pictures and lots of text, they might ask questions, rhetorical, often closed questions. But they decided. They prepared the content, they were the experts in that content and much of the time the purpose behind such events was to transmit the content from the teacher, the expert, to the novices in the room. Mostly aurally. But sometimes with visual stimulation.
Teaching is big business in medicine. From a one day tips style course to a whole masters programme, clinicians can now gain qualifications in teaching. Many who do take postgraduate programmes comment on the transformative effect such study has had, not just in their practice but in the way they view the world. Many spend much of their time during such courses conflicted between the old world of “master knows best” and the newer one of learner centredness.
There are parallels with medicine: just as ‘patriarchal’ medicine and ‘matriarchal’ nursing have given way to patient centred care, so educators are attempting to put learners centrally. The conflicting but ultimately transformative experience of those who delve deeper into education and what it means, is often the result of realising that teaching is in fact a waste of time if it does not result in learning. And that learning is less likely to happen if the people with the power, the experts, are thinking of their content, their knowledge, their experiences, their performance when engaged in this strange drama that they call ‘teaching.’ Indeed many of the shorter courses in teaching focus on the performative rather than transformative – how to look and sound the part they are playing as though teaching was acting. The assumption being made, albeit subliminally, is that as long as the person at the front, with the power and position, is knowledgeable, appears certain and strong and confident, can entertain and ‘hold attention’ then all is well. As a trainee teacher I learned that we don’t hold attention through our personal magnetism, we do it through our well crafted learning activities, but lesson planning has yet to feature in any teaching course for clinicians that I am aware of.
I try to explain my support for the assertion that teaching is a waste of time by asking people to visualise a river, with a teacher on one side and a group of learners on the other. No amount of telling, advising, sharing of experience, shouting, lecturing, showing or repeating by the teacher will empower the learners to get across the river if they do not want to, or are not able to do so. It is not the teacher’s previous crossing of the river or knowledge of how to do so which will equip the learners with the ability to do so. They have to learn it – find it within themselves, as Galileo said.
So what is the point of the teacher?
My metaphor suggests that as the teacher has already crossed the river, so they should cross back onto the same side as the learners. To start the process of discovery, they could ask the learners to undertake a group assessment, identifying what knowledge and skills they have collectively, and considering how such collective talent can be used. Even if there were only one learner this activity is integral to learning as it builds on prior experience and constructs new practice. The teacher’s role is then to support, suggest, assist and respond, taking care to find a balance between being proactive and reactive. After all, whether the learners cross the river or not – and their chance of success is higher working together, building on what they already have in their self efficient toolboxes – the learning process is as valuable as the outcome, if not more so. Elements of the learning here can be transferred to learning elsewhere, and the sense of achievement, of utilising previous knowledge and skill, builds confidence as well as competence. The teacher is not actually teaching here, they are co- learning.
And so I wonder again about Crichton Smith’s colleague’s view. I suspect that the drive to teach instead of the permission and space to allow others to learn is the result of the time limited culture we have created and work within and is also part of the outcome driven systems we have politically had thrust upon us. Teaching is quicker. Always tying your child’s shoes laces is quicker than waiting forever while they learn to do it themselves, until the day you realise you have spent 24 years doing it when a little effort expenditure in the beginning could have yielded great time saving ever since.
Teaching is, I have decided, largely a colossal waste of time in the contexts we use the term in medicine. Enabling novices to develop takes more than just sharing one’s own prowess. The possession of knowledge and skill can make a professional – but they do not make a teacher.
Trying to transfer knowledge and skill by being knowledgable and skilful is not education and is not enough. Experts being experts beside novices being novices does not lead to effective or efficient learning. There is a raging torrential river between the two.
The skills required to facilitate an effective and efficient learning process are in somewhat direct opposition to those required to be a teacher. They come from the same side of the river. These skills are co-learning skills. The skills to walk beside, support and challenge, question and confirm. It is co- learning we should be focusing on. That’s what matters, that’s what makes the difference. Not how great the expert is but how great the novices are becoming.
Let’s turn this language on its head, stop talking about teaching and start focusing on co-learning. It could turn out to be the most valuable, and rewarding time we have ever spent.