Medical teacher의 성장(Med Educ, 2005)

Medical teacher의 성장(Med Educ, 2005)

The development of medical teachers: an enquiry into the learning histories of 10 experienced medical teachers

Jane MacDougall1 & Mary Jane Drummond2

INTRODUCTION

의사들은 전통적으로 다음 세대의 의사를 가르쳐야 할 책임이 있었다. 그러나 그들은 가르치는 내용에는 전문가였을지 몰라도, 대부분은 어떻게 가르쳐야 하는가에 대해서 거의 배운 바가 없었다.

Doctors have traditionally been responsible for teaching the next generation how to be doctors. Yet, although they are expert in what they teach, most have little or no training in how to teach.1–3

Medical teacher의 발달에 대한 대부분의 연구는 공식/(일반적으로)단기 과정에 참석함으로서 교육스킬을 습득, 향상시키는 것에 집중해왔다. 그러나 공식 과정의 영향을 제한적이다. 그리고 어떻게 개별 trainer들이 어떻게 그 스킬을 습득해왔는지에 대해서는 연구된 바도 없고, Medical teacher의 발달에 대한 명확한 이론적 프레임워크도 없다.

Most of the literature relating to the development of medical teachers concentrates on the acquisition and improvement of pedagogical skills by attendance at formal, generally short courses.6–8 Formal courses, however, may have limited impact.9 There has been little or no examination of how individual trainers have acquired the skills they have and no clear theoretical framework exists to describe how medical teachers develop.10

교사의 퀄리티를 향상시키기 위한 - 공식과정 외에 - 다른 방법이 있을까?

Are there other ways, apart from formal courses, of improving teacher quality? To answer this question we need to examinehow current medical teachers have learned to teach.

방법

METHODS

전반부에는 다음에 대해 질문. 다음의 것들의 역할과 가치

Questions were then asked about the role and value of

• 공식과정 formal courses,

• 멘토링 mentoring,

• 롤모델 role models,

• 피드백 feedback,

• 기관의 서포트 institu- tional support,

• 수월성에 대한 보상 rewards for excellence, and

• 연구 참여 involve- ment in research.3,5,12,13

 

후반부에서는 교수-학습에 대한 자신의 접근법을 성찰하게 했다.

In the second half of the interview, these medical teachers were asked to reflect on their approach to teaching and learning.

인터뷰는 40~60분간 진행됨

Interviews lasted between 40 and 60 minutes.

 

연구대상

Consultants were selected from different specialties (including surgery, psychiatry, gynaecology, medi- cine, paediatrics, radiology and public health). Six were men and 4 were women; their ages ranged from 35 to 60 years. All were experienced teachers working in a large teaching hospital and currently involved in teaching and training undergraduates, postgraduates or both. All currently or had held positions of responsibility in teaching (in the deanery, clinical school or hospital) or were members of the local or regional teaching faculty for trainers’ courses. None had completed any postgraduate training in medical education. They had been recruited individually following an informal approach and explanation of the project by the researcher (who was at the time a clinical tutor). No one thus approached refused to be interviewed.

 

연구방법: 시기, 동의, 기록

The interviews took place between December 2001 and April 2002. Consent was obtained verbally prior to starting the interview. A commitment was made to anonymise data, thus maintaining confidentiality. The interviews were taped; notes were also taken. There was 1 interviewer (JM), increasing reliability, and interviews were con- ducted in depth to increase their validity.15–17

분석방법

Data were analysed as they were collected using grounded theory (where theory is derived from the data18), and narrative analysis (the use of life or career histories19). Transcribed data were studied (data immersion) and key categories identified. Data were reduced and coded (Appendix 2).20 Coded data were then grouped into themes. Care was taken to use data equally from all 10 interviews. Comments resulting from the use of the pictures were included in the analysis. We used local ethical guidelines for educational research.

결과

RESULTS

교육 지식과 스킬의 습득

Acquisition of educational knowledge and skills

 

(1명을 제외하고는 모두 공식 teaching course를 참석했음에도) 교육이론에 대한 지식은 적었고, 그것을 습득할 레퍼런스도 적었다.

Knowledge of educational theory was limited and there was little reference to its acquisition, despite all interviewees, except 1, having attended formal teaching courses:

'학습자의 요구'를 자주 언급했으며, 그러한 지식은 커리어에 걸쳐서 관찰을 통해 습득했음을 시사했다.

The teachers made frequent references to learners’ needs, which suggests that such knowledge is acquired on route, possibly from observation, in a medical career:

환자 또는 동료와의 대화경험도 학습자를 이해하는 한 가지 방법이었다.

One way in which doctors may acquire this under- standing of learners is from their experience of communicating with patients and colleagues:

공식과정은 성찰을 할 수 있는 귀중한 시간이었다. 비슷한 생각을 가진 동료들과 토론할 기회가 되었다.

Formal courses were valued for the time they allow for reflection; they also provide opportunities to discuss issues with like-minded colleagues.

그러나 과연 공식과정 참석이 교육능력을 향상시켰는지를 평가할 성과척도가 부족함을 우려했다. 

However, many were concerned over the lack of outcome measures to assess whether attendance had improved teaching ability:

교육연구의 역할은 미미했다. 교육연구를 해본 교수는 거의 없었고, 중요하지 않은 것으로 치부하기도 했다. 

The role of educational research in medical teacher development was limited. Few had done any educa- tional research and those who had often dismissed it as unimportant:

higher qualifications 의 가치는 2명만이 언급했다.

The value of higher qualifications was discussed by only 2 interviewees.

교육스킬의 모델링과 실천

Modelling and practice of teaching skills

(교육자의) 학습자로서의 경험(그리고 이 경험이 자신의 교육 스타일에 미친 영향)과 교육선호teaching preference가 핵심 주제였다. 교사들의 학습 스타일은 매우 달랐다. 그러나 학습 경험은 매우 비슷했다. 가장 기억에 남는 학습경험을 물어봤을 때 모든 사람이 강의나 BST를 언급했다.

Teachers’ experiences as learners (and the influence this has on their teaching style) and teaching pref- erences were identified as key themes. The learning styles of these teachers varied considerably. Learning experiences, however, were similar. When asked to reflect on their most memorable learning experien- ces, all identified either lectures or bedside teaching, or both.

의과대학에서 경험한 교육은 기대치 이하였다.

Experiences of being taught in medical school were often suboptimal.

거의 모든 사람이 Poor teaching method를 인지하고 있었지만, '더 나은 방법'이 무엇인지에 대한 언급은 거의 없었다. 아마 이에 대해서는 modelled 된 경험이 없기 때문일 것이다.

Despite this almost universal recognition of poor teaching methods, there was little comment on a better way, perhaps because this had not been modelled:

교육 스타일은 비슷했다. 대부분은 자신을 learner facilitator, promoter of critical thinking이라고 묘사했다. 대부분 강의하는것은 별로 안 좋아하고 소그룹으로 가르치는 것을 선호했다.

Teaching styles used now were similar. Most of these teachers described themselves as learner facilitators andpromoters of critical thinking. Most disliked giving lectures and preferred teaching in small groups:

거의 모든 interviewee는 자신들의 medical teaching에 긍정적인 영향을 준 롤모델이 있었다. 또한 많은 경우 부정적인 롤모델도 있었다.

Role models who had positively influenced their approach to medical teaching were identified by all the teachers. Many, also identified negative role models:

OTJ 트레이닝 경험이 상당했다. 대부분은 다양한 교육 테크닉을 경험해봤다.

On-the-job training and experience was considerable. Most had experience of different teaching tech- niques, ranging from lectures to small group work and one-to-one supervisions.

격려해주는 것, 동기부여 요인

Encouragement and motivation of teachers

medical teacher의 커리어에서 멘토와 co-teacher는 자주 등장하지는 않는다. 피드백은 교사의 발달에 중요하나, 피드백이 오는 경우는 별로 많지 않고 별 도움이 되지 않는 경우도 많다. Interviewee는 피드백을 overt(대부분 특별히 요청해야 받을 수 있음)와 covert로 구분했다.

Mentors and co-teachers feature infrequently in medical teachers’ careers. Feedback was recognised as being important in teacher development, but rarely given and often unhelpful. Some interviewees subdivided feedback into the overt (which had to be specifically requested in most cases) and the covert (for example, being asked back to speak):

시상과 보상은 거의 없다. 

Prizes and rewards are rare.

일부 영역(특히 행정)에 대해서는 조금 있긴 하나 기관 차원의 서포트는 별로 없다.

Institutional support was limited, although there was recognition that some areas of teaching, particularly administrative,

 

긍정적인 감정적  경험(열정, 동기부여, 자신감)을 말했다.

Positive emotional dimensions of learning and teaching were described by all the doctors. These included enthusiasm, motivation and confidence.

대부분이 도전Challenge은 긍정적인 측면이라고 했다.

Challenge was almost universally considered as a positive aspect of medical teaching that could gen- erate its own rewards and enthuse teachers:

교수개발의 한계: 교육의 딜레마

Constraints on teacher development: the dilemmas of teaching

내적 제한요인으로는 두려움/내용에 대한 지식 부족/프로세스에 대한 이해 부족 등

Internal constraints deterring teachers include fear, lack of knowledge of content and poor understand- ing of process:

교육환경은 교사가 가르치는 것을 얼마나 즐기는지에 영향을 준다. 시간의 부족 역시 주요한 제약

The teaching environment was perceived as impacting on teachers’ enjoyment of teaching. Lack of time was seen as a major constraint by several consultants:

기관 차원의 제약도 있었는데, 특히 '교육이 별로 대접받지valued 못한다'는 느낌이 있었다.

Institutional constraints on teaching were discussed by all the doctors. There was a general feeling that teachers were not valued enough:

 

고찰

DISCUSSION

 

모든 교사는 과거에 학생이었다. 교사가 학습한 방법과 그들이 학습자로서 했던 경험이 그들의 교육에 영향을 준다. 분석 결과를 보면 개개인은 학습 스타일이 매우 다르지만, 어떤 의과대학에 다녔는지와 무관하게 모든 의사들은 비슷한 학습경험이 있었고, 그 대부분은 부정적인 것이었다. 유사하게, 교육 스타일과 선호 역시 (배경/전공/연경/성별과 무관하게) 그룹간 매우 비슷했다. 이는 학습자로서의 스타일보다 학습경험이 미래의 교육스타일을 결정지음을 제시한다.

There was a strong sense of narrative as these doctors described their development as teachers in parallel with their development as clinicians. All teachers have been learners first. The way that teachers learn and their experiences as learners inform their teaching.21 Analysis suggests that individuals have very different learning styles. In contrast, and regardless of which medical school they had atten- ded, all the doctors interviewed had had similar learning experiences as students, most of which had been negative. Likewise, teaching styles and prefer- ences were remarkably consistent across the group, despite their different backgrounds, specialties, ages and gender. This suggests that it is learning experi- ences rather than learner styles that influence future teaching styles.

롤모델은 medical teacher의 발달에 중요하다. 성인학습자와 성인학습자의 니즈에 대한 이해는 두 가지 방법으로 이뤄진다. 첫번째는 직접적 관찰이며, 두번째는 환자 및 동료와의 의사소통 경험이다. 지식과 스킬을 습득하는 것(어떻게 무엇을 가르칠 것인가)는 보다 어렵다. 인터뷰에 응한 모든 의사들이 교육과 수련에teaching and training 상당한 OTJ경험을 가지고 있었다. 그러나 거의 항상 unsupervised 였고 rarely assessed였다.

Role models are important in medical teacher development4,22,23 and this study confirms this. It also suggests that an understanding of adult learners and their needs is acquired in 2 ways: firstly, from direct observation, and, secondly, from the experience doctors have of communicating with patients and colleagues. Acquiring knowledge and improving skills (the what and how of teaching) may be more difficult. All the doctors in this study reported having acquired considerable on-the-job experience of both teaching and training. This was nearly always unsu- pervised and rarely assessed.

연구자들은 피드백, 멘토, 코-티칭을 활용한 스킬 향상을 주장한 바 있다. 그러나 본 연구는 이러한 것들이 거의 사용되지 않았음을 보여준다. Elton은 의학교육이 달라지고 향상되려면 연구가 필요하며, 연구는 '질문을 던지게' 해주기 때문이다. Interviewee들에 따르면 의사들은 educational research를 거의 하지 않는데, 이는 educational and social research의 원칙에 대한 이해가 부족하기 때문이며, 그렇기 때문에 더 marginalize된다.

Previous authors have advocated the use of feedback, mentors and co-teaching to improve the skills of medical teachers.3,24 However, this study suggests that these rarely featured in the development of these medical teachers. Elton (1998) also suggested that in order to  do  medical education differently and better, research is necessary, in that it encourages individuals to go on asking questions. According to the teachers interviewed here, educational research is rarely performed by doctors, possibly due to a lack of understanding of the principles of educational and social research, and when it is, it is marginalised.1

Teacher들의 커리어에 감정emotion이 중요하다는 것이 주류로 등장하는 것은 매우 느린 과정이었고, medical teaching에서는 다뤄진 바가 없다. 본 연구는 school teaching에서와 마찬가지로 medical teaching에서도 감정적 차원이 있음을 보여준다. 많은 medical teacher들은 동기부여가 되어있고, 열정이 있으며, 다른 non-teaching 동료들보다 스트레스를 덜 받는다. 이것은 아마도 교육으로부터 오는 긍정적 감정 때문일 것이다. interviewee들은 흥분/도전/즐거움/좌절/화 등의 감정을 묘사했다. Nias는 school teacher들로부터 비슷한 감정을 묘사한 바 있으며, 이것은 가르치는 것은 사람간 상호작용을 포함하기 때문일 것이다. 의학 역시 사람(환자/학생/동료)와의 소통을 필요로한다. 따라서 이 의사들이 teaching에 관한 emotion을 말한 것은 놀라운 일이 아니다.

Recognition of the importance of emotion in teach- ers’ careers has been slow to develop in mainstream teaching21,25,26 and has not been described in med- ical teaching. This study demonstrates that, as in school teaching, there is an emotional dimension to medical teaching. Many medical teachers remain motivated and enthusiastic, and less stressed than their non-teaching colleagues,27 perhaps because of the positive emotions resulting from their teaching. This small sample of consultants described emotions that included feelings of excitement, challenge, enjoyment, frustration and anger. Nias (1996), who described similar emotions in schoolteachers, sug- gested this is because teaching involves interactions among people.26 Medicine also involves communi- cation with people, be they patients, students or colleagues. So it is unsurprising that these doctors described emotions related to their teaching.

이들은 열정이 있었지만, 이것을 꺾는 제약사항도 있었다. 교육이 devalued되는 것, 중요성이 인정받지 못하는 것 등. Nias는 teacher의 감정에 political bias가 늘어난다는 것을 보여주었다. 즉 부정적인 감정이 peer와 superior를 향한다는 것이다. 이 연구에서 대부분의 긍정적 코멘트는 교육 그 자체와 관련된 것인 반면, 부정적 코멘트는 동료와 기관 차원에서 교육을 인정하거나 보상하는 것이 없음을 지적하는 것이었다.

Although these consultants were all enthusiastic about teaching, their enthusiasm was tempered by the constraints, mostly institutional, that they saw acting on all areas of teacher development. There was a particularly strong view that teaching is devalued within medicine and that its importance goes unrecognised. Nias (1996) described an increasingly political bias to teachers’ emotions, where their neg- ative emotions are directed towards peers and superi- ors.26 In this study, most positive comments were related to teaching itself, whereas negative comments were directed at the lack of rewards and recognition for teaching by peers and institutions.

Implications for faculty development

CONCLUSIONS

APPENDIX 1

Interview structure

Introduction

• Outline reasons for interview

• Structure of interview

• Tape recording ⁄ note taking

• Drawing

• Use of material: anonymised, confidential

• Verbal consent

Question areas

1. Tell me about your career history as a teacher? When did you start, etc.?

2. Role models?

3. Mentors?

4. Feedback from others? Have you ever received this? How did you feel about it?

5. Attendance at formal courses? Views on these if attended. Value of courses?

6. Institutional support: local, regional, national? Have you received this in the past or currently?

7. Have you ever received any rewards for your teaching (excellence)?

8. Have you ever done any educational research? If so, was this easy, useful, supported, and did it help your development as a teacher?

Self-reflection

Now, I want to spend some time on some reflection of you as a teacher...

1 Draw me a picture of your career as a doctor (graph); show example

 

2 Draw me an annotated picture of yourself being taught as a medical student

 

3 Draw me a picture of yourself teaching; choose your favourite way of teaching ⁄ the way you do it best

 

4 Which of these pictures best illustrates you as a teacher? If none does, can you send me one that does? Show several pictures ⁄ cartoons

 

5 Which of these verbal images best describes you as a teacher?

• Fairy godmother

• Promoter of critical thinking

• Co-learner with students

• Juggler of theory and practice

• Collaborator with experienced colleague

• Rescuer

• Learning facilitator

 

6 When you started teaching, which best described you?

• Adventurer ⁄ survivor

• Changing from child to adult

• Bird learning to fly

• Chrysalis

APPENDIX 2

Coding categories

1. Knowledge of educational theory

2. Knowledge of learners

3. Educational research as a development tool

4. Formal courses

5. Teaching experience (on-the-job training)

6. Role models

7. Mentors

8. Feedback

9. Prizes and rewards

10. Institutional support

11. Type of learner

12. Learning experiences

13. Positive emotional dimensions of learning and teaching

14. Negative emotional dimensions of learning and teaching

15. Type of teacher

16. Preferences in teaching

---

Med Educ. 2005 Dec;39(12):1213-20.

The development of medical teachers: an enquiry into the learning histories of 10 experienced medical teachers.

MacDougall J1, Drummond MJ.

Author information

• 1Postgraduate Medical Education Centre, Clinical School, Addenbrooke's Hospital, Cambridge, UK. jane.macdougall@addenbrookes.nhs.uk

Abstract

AIM:

The aim of the study was to explore the different ways in which doctors have learned to teach and train.

INTRODUCTION:

There is no coherent theory of medical teacher development. Doctors are experts in what they teach; most have had little or no training in how they teach. Research has mostly concentrated on the acquisition and improvement of pedagogical skills by attendance at formal, generally short courses. These may have limited impact.

METHODS:

We carried out semistructured interviews with 10 experienced medical teachers. A review of the literature had suggested areas to explore. Interviews were transcribed and coded and thematic analysis and grounded theory used as the framework for qualitative analysis.

RESULTS:

Four areas were identified as important in teacher development: acquisition of educational knowledge and skills; modelling and practice of teaching skills; encouragement and motivation of teachers, and constraints on teaching and learning.

DISCUSSION:

The results suggest a model for teacher development that begins with doctors as learners, learning to learn and watching teachersteach. They then start to teach, acquiring and practising skills, and subsequently move on to reflect on their teaching. They can be encouraged to teach but may also be prevented from teaching.

CONCLUSIONS:

This inductive study proposes a model for medical teacher development that attempts to explain how doctors learn to teach and train. More research is needed to clarify the findings. There are implications for faculty development.

PMID:

 

16313580

 

[PubMed - indexed for MEDLINE]