왜 의사들은 교육을 하는가: 받은 것을 돌려주기 (Med Educ, 2015)

왜 의사들은 교육을 하는가: 받은 것을 돌려주기 (Med Educ, 2015)

Why physicians teach: giving back by paying it forward

Yvonne Steinert1 & Mary Ellen Macdonald2

도입

INTRODUCTION

미래 의사의 교육은 의사가 임상 환경, 경쟁 요구 사항, 상충되는 우선 순위 및 환자 치료의 지속적인 압박으로 특징 지어지는 환경에서 학생 및 거주자를 교육 할 때 매우 중요합니다. 그러나 의료환경의 속도와 강도, 그리고 교육이 종종 경제적 보상이나 인정을 받지 못한다는 인식에도 불구하고 많은 의사들이 의대생과 레지던트를 가르치기 위한 시간을 carve out하고 있습니다. 이게 왜 그렇게?
The education of future physicians is highly depen- dent upon physicians teaching students and resi- dents in the clinical setting, an environment marked by competing demands, conflicting priori- ties, and the constant pressure of patient care. Yet, despite the pace and intensity of this environment, and the perception that teaching is often not finan- cially rewarded or recognised, many physicians carve out time for the teaching of medical students and residents. Why is this so?

많은 연구가 외래 진료 환경에서 학생들을 가르치는 일차 진료의 의사의 동기를 조사했습니다. 이 연구들은 개인적인 만족, 가르침에 대한 사랑, 그리고 직업에 대한 동기 부여를 1 차적인 동기 부여로 포함하는 내재적 보상을 강조했습니다. 지역 사회 기반의 환경에 관한 다른 연구 7,8은 의사들은 교육이 환자의 치료에 대한 즐거움을 높이고 임상 진료의 질을 향상시키는 것으로 의사가 믿는다 고 제안했습니다.
A number of studies have examined primary care physicians’ motivations for teaching students in ambulatory settings. These studies have highlighted intrinsic rewards including personal satisfaction, a love of teaching, and giving back to the profession1–6 as primary motivators. Other research in community-based settings7,8 has suggested that physicians believe that teaching enhances their enjoyment of patient care and improves the quality of clinical practice.

1 차 진료 의사의 가르침에 대한 동기를 조사한 연구는 서베이 설문지에 크게 의존하면서 기술적 인 수준에서 그렇게 해왔다. 아무도 가르침의 본질을 탐구하지 않았거나 왜 의사들이 많은 임상적 책임에도 불구하고 가르치기를 선택했는지 이해하려고 시도하지 않았습니다. 의사들에게 있어 교육의 의미에 대한 심층적 인 탐구와이 경험이 그들에게 의미하는 바는 의사들이 임상 환경에서 가르치는 이유에 대한 우리의 지식을 향상시키는 데 도움이 될 것입니다.
The studies that have examined primary care physi- cians’ motivations to teach have done so at a descriptive level, with a heavy reliance on survey questionnaires. None have delved into the essence of teaching or sought to understand why physicians choose to teach despite their many clinical responsi- bilities. An in-depth exploration of the meaning of teaching for physicians, and what this experience signifies to them, would help to advance our knowl- edge of why physicians teach in the clinical setting.

이 연구의 목표는 의사가 입원 환자 환경에서 학생과 레지던트를 가르치는 것이 무엇을 의미하는지 탐색하는 것이 었습니다. 이러한 맥락에서 의사 교육의 본질을 이해하는 것은 임상 교사의 채용 및 유지, 교육 우수성을 인정하고 보상하는 정책 개발, 교수진 개발의 설계 및 전달에 도움이 될 수있는 미래의 의료 교육의 열쇠입니다 의사의 요구를 충족시키는 프로그램.
The goal of this study was to explore what it means for physicians to teach students and residents in the in-patient milieu. Understanding the essence of teaching for physicians in this context is key to the future of medical education as it can help in the recruitment and retention of clinical teachers, the development of policies to recognise and reward educational excellence, and the design and delivery of faculty development programmes that meet physi- cians’ needs.

방법

METHODS

방법론

Methodology

We approached our research question ‘What is the meaning of teaching?’ using interpretive phenomenology (IP). This is a research methodology that builds upon a rich philosophical tradition9,10 to address ontological questions of human ‘lived expe- rience’.11,12 In IP, the goal is to delve into the meaning of an experience as it is articulated or enacted by the research participant. Both data gath- ering and analysis require the researcher to dwell on the phenomenon under scrutiny in order to uncover its essence. Essential to this methodology is the process of stripping away theoretical presupposi- tions in order to uncover layers of meaning. Explor- ing the meaning of teaching required the researchers to resist deductive theoretical constructs and encourage participants to explore concepts brought into the conversation, to truly understand why and how teaching matters.

모집

Recruitment

We recruited participants from three academic departments (internal medicine, surgery and paedi- atrics) at McGill University (Montreal, QC, Canada). Recruiting from these three specialties also allowed us to sample diverse perspectives in line with maximum variation sampling.13

At this time, we confirmed data saturation,14 the point at which additional data do not reveal new aspects of the phenomenon under study.

맥락

Context

This study took place in a research-intensive university, which is marked by a strong spirit of volunteer- ism for teaching.15,16 In this setting, the majority of clinical teachers do not receive a salary for teaching. Moreover, although small stipends have been recently allocated by the provincial government for certain teaching activities, many teachers still believe that teaching is neither rewarded financially nor recognised for advancement or promotion. In addition, although teaching is an expected part of physicians’ responsibilities in our context, the amount of teaching required is not systematically prescribed.

자료 수집

Data collection

Data were collected through audio-recorded semi- structured interviews conducted by a research assis- tant with graduate training in qualitative research. The research assistant also recorded field notes describing non-verbal communication and contex- tual information (e.g. a busy environment was noted in field notes that described interviews being interrupted by telephone calls and pagers; the joy of teaching was signalled through notes of participants’ facial expressions and the vocal tones used when discussing former learners). Interviews averaged 45 minutes. The initial interview guide, based on findings from the literature, was piloted and refined at the Centre for Medical Education at McGill University. Through an iterative process, the interview guide was modified as interviews pro- ceeded in order to capture the essence of teach- ing, a common practice given the emergent nature of qualitative inquiry. The guide (Appen- dix 1) explored the meaning of teaching by addressing perceived rewards, challenges, motiva- tions and expectations, reflections on teaching medical students and residents, and observations on how faculty development could enhance teach- ing experiences.

분석

Analysis

• Analysis followed Benner’s interpretive framework,11 which is premised on a conception of human expe- rience in which meaning is understood to be rooted in the context in which it is lived. The role of the researcher is to make sense of the participant’s artic- ulation of his or her own experiences. This approach is attentive to a dialectic tension which exists between an appeal to commonalities across cases (e.g. pattern recognition) and the need to be attentive and responsive to the unique features of individual cases. Every encounter is co-constructed through the researcher–participant relationship and is shaped by previous experiences and the socio-cultural system within which experiences are lived.

• We also used Conroy’s pathway12 for interpretive synthe- sis, especially the hermeneutic spiral in which induc- tive interpretations of both the participant and researcher build off each other; doing so ensured that we ‘spiralled’ back to earlier comments while being attentive to building our understanding of the individual’s unique meaning as well as our grow- ing understanding of the dataset.

• Finally, Geertz’s interpretive notion of ‘thick description’17 was used to richly contextualise the participants’ thoughts and experiences within their institutional work envi- ronments.

To conduct this analysis, each investigator read the transcripts in their entirety to get a sense of the evolving dataset. Following this, both investigators re-read each transcript, using multiple close read- ings to understand participants’ experiences vis  a vis the phenomenon of interest: the meaning of teaching. Initial codes were emergent, inductively generated from the data; this contributed to an open-ended dialogue between the researchers, with careful attention to participants’ words and phrases.

 

The interpretive process moved between the foreground (the literal meaning of the words) and the background (the meaning and intention behind the literal utterances).

As the analysis proceeded, we categorised emerg- ing codes into Benner’s five components (situa- tion, meanings, concerns, embodiment, temporality)11 and Conroy’s sixth component (par- adigm shift).12 We then sought across-case patterns (themes), with attention to recurring meaning (as expressed in the ideas and feelings of the partici- pants) relating to salient items for each individual participant (e.g. what matters to them). We built thick descriptions of institutional contexts from the field notes and transcripts by embedding par- ticipants’ thoughts and experiences within social, cultural and personal components of their work environments.

강건

Rigour

The following steps were used to ensure methodological rigour:

• the primary researchers checked the transcripts, prepared by a third party, for accuracy;

• an audit trail was maintained to capture the evolution of the interpretive process, and

• prelimin- ary findings were presented to members of the Centre for Medical Education for feedback and discussion.

RESULTS

교육 맥락

The context for teaching

참가자들은 모두 15 개의 사례에서 임상 환경을 복잡하고 까다로우며 여러 가지 의무와 책임으로 가득 차 있다고 설명했습니다. 학생과 주민들의 가르침에는 계획된 교훈적인 강의, 침대 옆에서 가르치고 가르치는 일이 포함되었습니다. 대부분의 참가자는 교실 환경에서 강의했지만, 이러한 상호 작용을 위해 임상 환경을 기준점으로 선택했습니다.

In all 15 cases, participants described their clinical environment as complex and demanding, replete with multiple obligations and responsibilities. The teaching of students and residents included planned didactic lectures, bedside teaching and teaching ‘on the fly’. Although most participants also taught in classroom settings, they chose the clinical environ- ment as their point of reference for these inter- views,

참여자들은 가르침의 의미와의 관련성을 가정하고 싶지 않기 때문에 가르침에 대한 재정적 보상에 관해 특별히 질문하지 않았다. 그럼에도 불구하고, 15 명의 참가자 중 13 명이 왜 가르치냐고 물었을 때, 자발적으로 가르침에 대한 지불 부족에 대해 언급하면서, 보수는 중요한 동기가 아니라고 강조하였다.
Participants were not specifically asked about financial remuneration for teaching because we did not want to assume its relevance to the mean- ing of teaching. Despite this, 13 of the 15 partici- pants spontaneously referred to the lack of payment for teaching when asked why they teach, stressing that remuneration was not a key motiva- tor.

마찬가지로, 어떤 참가자도 가르침에 대한 보상에 관한 질문에 대한 재정적 보상에 대해 언급하지 않았으며, 가르침의 동기로서 진급이나 승진을 확인하지 못했습니다. 그럼에도 불구하고, 참가자들은 그들의 작업 환경에 대해 깊은 감사를 표했으며,
Similarly, no participant mentioned financial remu- neration in response to a question about the rewards of teaching, nor did they identify advance- ment or promotion as an incentive to teach. Despite this, participants expressed a profound appreciation of their work environment,

가르침의 의미

The meaning of teaching

우리의 표본에 다양한 교육 환경과 특수성이 있음에도 불구하고, 다섯 가지 주제가 모든 의사의 내러티브에서 입원 환자 환경에서의 교육의 의미를 밝혀주었습니다. 참가자들에 따르면 :

• (i) 가르침은 정체성의 필수적인 부분이었습니다.

• (ii) 가르침은 그들 자신의 훈련을 위해 이전 교사들에게 갚을 수있게했다;

• (iii) 가르침은 차세대 의사의 발전에 기여할 수있는 기회를 제공했다;

• (iv) 가르침을 통해 그들이 배우고,

• (v) 가르침이 개인적으로 활력을주고 기쁘게하는 것으로 경험되었다.

 

중요한 것은, 개인과 사회 차원이 이 주제들에 걸쳐 실행 되었음 :

• 참가자들이 도덕적으로나 사회적으로 가르침에 시간과 노력을 들일 동기부여가 되어있었고 (예를 들어, 자신의 특권을 지불하고 다음 세대를 개발하는 데 도움을주기 위해),

• 가르침은 또한 성취감을 느끼게합니다(예를 들어, 젊은 마음을 빚어서mould 유산을 남기는 것을 허용함으로써) .
  Despite the variety of teaching settings and special- ties in our sample, five themes elucidated the mean- ing of teaching in the in-patient setting across all physicians’ narratives. According to participants: (i) teaching was an integral part of their identity; (ii) teaching allowed them to repay former teachers for their own training; (iii) teaching gave them an opportunity to contribute to the development of the next generation of physicians; (iv) teaching enabled them to learn, and (v) teaching was experi- enced as personally energising and gratifying. Importantly, personal and social dimensions ran across these themes: while participants were morally and socially motivated to give time and effort through teaching (e.g. to pay forward their own privilege and thereby help to develop the next gen- eration), teaching also gave them a sense of per-sonal fulfilment (e.g. by allowing them to mould young minds and thereby leave a legacy).

 

1. 의사의 정체성의 핵심 요소로서의 교육
Teaching as an integral part of a physician’s identity

 

거의 모든 참가자들은 가르침이 그들의 정체성의 필수적인 부분이라고 말했다.

대부분의 참가자들은 스포츠 코치, 교사 또는 캠프 카운슬러처럼 어린 나이부터 가르쳤으며, 과거의 경험을 연장하여 현재의 역할을 보았습니다. 몇몇은 선생님이었던 부모님을 언급하고 가르침은 '피 속에'있다고 말했습니다.

 

거의 모든 참가자들은 의대생과 레지던트를 이전에 가르쳤으며, 그들이 계속 가르 칠 수 있기 때문에 학업 환경에서 일하기로 선택했습니다. 다양한 방법으로 참가자들은 대학 병원에서 일하는 것이 핵심 책임이자 기대라고 느꼈습니다.

 

많은 참가자들은 또한 '의사 - 교사'가 '의사가 되는being a physician' 필수 요소라고 했다. 실제로, 그들이 가르치지 않는 것을 상상할 수 있는지 묻는 질문에 대한 응답으로, 아무도 그럴 수 있다고 답하지 않았다.

Almost all participants stated that teaching was an integral part of their identity.

Most participants had been teaching from a young age, as sports coaches, tutors or camp counsellors, and they saw their current role as an extension of these past experiences. Several mentioned a parent who was a teacher and said that teaching was ‘in their blood’.

Almost all participants had previously taught as medical students and residents, and they had delib- erately chosen to work in an academic setting because it would allow them to continue to teach. In diverse ways, participants felt that teaching was a core responsibility – and expectation – of working in a university hospital, and one that they valued.

A number of participants also conveyed that being a ‘physician-teacher’ was integral to ‘being a physi- cian’. In fact, in response to a question asking if they could imagine themselves not teaching, none felt that they could,

2. 돌려주기 : 전직 교사에게 상환

Giving back: repaying former teachers

이 연구의 의사들은 가르침이 교사와 그들이 훈련 한 기관에 대해 상환하도록 허용한다는 정서를 꾸준히 표명했습니다. 이 개념은 탁월한 전문 교육의 사이클을 지속하기 위해 직업에 '환원'하기 위한 도덕적 헌신으로 전달되었습니다. 참가자들은 자신이 얼마나 잘 배웠으며 자신의 학생과 레지던트를 위해 똑같이하고 싶었는지 분명히 기억했습니다. 그들은 교사의 능력과 열정에 대해 깊은 인상을 심어 주었고 그들의 학습자도 최고의 교육을 받을 자격이 있다고 느꼈습니다.

'돌려주기'에 관해 이야기 할 때, 많은 참가자들이 'paying it forward'라는 구절을 사용했는데,이를 통해 cycle of excellence를 유지하기위한 도덕적 헌신이 강화되었습니다.

The physicians in this study consistently expressed the sentiment that teaching allowed themto repay their teachers and the institutions in which they had trained. This notion was conveyed as a moral commit- ment to ‘give back’ to the profession in order to con- tinue the cycle of excellent professional training. Participants clearly remembered how well they had been taught and wanted to do the same for their stu- dents and residents. They expressed deep apprecia- tion of their teachers’ abilities and passion and felt that their learners also deserved the best.

In talking about ‘giving back’, a number of partici- pants used the phrase ‘paying it forward’, which fur- ther reinforced a moral commitment to maintaining the cycle of excellence.

3. 차세대 육성

Developing the next generation

'paying it forward'이라는이 개념에 연계 된 것은 차세대 의사 양성에 기여할 사회적 욕구와 개인적인 욕망이었습니다. 실제로, 참가자들은 양질의 환자 치료를 보장하는 도덕적, 사회적 약속 인 것처럼 가르치는 것에 관해 이야기했습니다.

 

동시에,이 감정은 덜 이타적으로 표현되기도 하였는데, 교육이 (자신의) 성공을 위한 계획의 일부 였고, 누군가가 자신을 노후에 돌보아 줄 보험처럼 보기도 하였다

 

일부 참가자들은 차세대 교육에 대한 그들의 참여가 그들이 유산을 남겨 둘 수 있다고 느꼈습니다.

유산의 개념은 임상 지혜를 공유하고, 환자 치료를 개선하고, '당신이 중요한 기여를했다'고 느끼는 강한 욕구와 관련이 있습니다.

 

Tied to this notion of ‘paying it forward’ were both a social and a personal desire to contribute towards developing the next generation of physi- cians. In fact, participants talked about teaching as if it were a moral and social commitment towards ensuring high-quality patient care.

At the same time, this sentiment was also framed in less altruistic terms, as if teaching was part of succes- sion planning and a personal insurance that some- one would take care of them in their old age.

Some participants also felt that their involvement in teaching the next generation allowed them to leave a legacy,

The notion of legacy was related to a strong desire to share clinical wisdom, improve patient care and feel that ‘you have made a significant contribution’.

4. 배움으로서 가르침

Teaching as learning

많은 참가자들의 의견은 Joseph Joubert가 '가르치는 것은 두 번 배우는 것'이라는 강경을 반영했습니다. 그들은 학생과 레지던트가 가진 unjaded, youthful 시각과 통찰력있는 질문을 가치있게 여겼다. 또한 참가자들은 '학생들의 눈을 통해 세상을 보았다'는 이점을 누렸다 고 지적했다.

모든 참가자들은 학생과 레지던트들과 함께하는 것이 그들이 배우고 새로운 정보를 찾고 최신 정보를 얻도록 촉구했다고 말했다.

 

다양한 방법으로, 가르침은 참가자들이 young inquisitive mind를 keeping up하면서 참가자가 지식, 경험 및 열정을 나눌 수있는 상황을 만들었습니다.

 

Many participants’ comments reflected Joseph Jou- bert’s adage that ‘to teach is to learn twice’. They valued students’ and residents’ unjaded, youthful perspectives as well as their insightful questions; fur- ther, participants noted that they benefited from ‘seeing the world through students’ eyes’.

All participants commented that being with students and residents inspired them to learn and ‘pushed them’ to seek new information and keep up to date.

In a variety of ways, teaching created a context in which participants could share their knowledge, experience and passion while ‘keeping up’ with young inquisitive minds.

5. 활력을주고 기쁘게하는 것으로 가르침
Teaching as energising and gratifying

 

참가자들은 가르침에 기인 한 여러 보상에 대해 많은 긍정적 인 감정을 표했다. 실제로, 가르침은 그들에게 '활력을 불어 넣고' 속도를 바꾸고changing the pace 그날을 깨는 것breaking up the day였다. 또한 그들이하는 일에 활기를 느낄 수있었습니다.

 

참가자들은 또한 학습자와의 상호 작용을 중요하게 생각했습니다. 그들은 지식과 열정을 공유하고 학습자들의 가르침에 대한 피드백을 받음으로써 활력을 얻었습니다.

 

또한, 가르침을 통하여 참가자들은 학생들과 레지던트가 스스로 배워가며 성취에 자부심을 갖는 것에 깊은 만족감을 느꼈습니다.

 

Participants expressed many positive sentiments about the multiple rewards they attributed to teach- ing. In fact, teaching was seen to give them an ‘en- ergising boost’, changing the pace and breaking up the day; it also allowed them to feel invigorated by what they were doing.

 

Participants also valued the interaction with learn- ers. They were energised by sharing their knowledge and passion and by receiving feedback from learn- ers about their teaching,

In addition, teaching gave participants a deep sense of satisfaction as they could watch students and resi- dents learn and take pride in their accomplish- ments.

고찰

DISCUSSION

 

임상 교사는 의대생과 레지던트에 대한 성공적인 교육에 필수적인 귀중한 자원입니다 .18 우리는 경험적 경험의 주관성에 기반을 둔 이러한 현상학적 탐구를 통해, 복잡한 환자 프로필, 다양한 수준의 학습자 교육, 여러 교육 장소의 사용으로 특징 지어지는 입원 환자 환경에서의 의사의 신념/교육 동기/인식에 대한 더 깊은 이해를 얻을 수 있었습니다

Clinical teachers represent an invaluable resource essential to the successful teaching of medical stu- dents and residents.18 Through this phenomenolog- ical inquiry, grounded in the subjectivity of lived experience,19 we were able to gain a deeper under- standing of physicians’ beliefs, motives and percep- tions of teaching in an in-patient setting, which is often marked by complex patient profiles, the teaching of learners at different levels, and the use of multiple venues for teaching.

 

이전의 연구자 4-6,18은 외래 환자 환경에서 학생들을 가르치는 일차 진료 의사에게 동기 부여 요소로서 내재적 요소 (예 : 교육의 즐거움)의 중요성을 보여주었습니다.

Previous researchers4–6,18 have shown the impor- tance of intrinsic factors (e.g. the enjoyment of teaching) as motivators for primary care physicians teaching students in out-patient settings.

 

이번 연구에서 우선, 우리는 가르침의 의미에 대해 깊이 파고 들었고, 다른 저자들이 '동기'라고 부르는 것의 더 미묘한 뉘앙스를 이해하였습니다.

It also adds to prior research. To begin, we delved into the meaning of teaching, thereby nuancing the understanding of what other authors call ‘motivations’.

 

'의사의 정체성에 필수적인 교육' 이라는 개념은 우리 데이터 전반에 걸쳐 반복되는 주제였습니다. Starr 등은 커뮤니티 기반의 의사들 사이에서 선생님의 정체성에 대한 개념을 탐구하면서 많은 공통된 요소들을 강조했다. 우리의 연구는 병원 환경에서 의사를 연구함으로써 이러한 결과에 기반하고 있습니다.

The notion of teaching as integral to the physician’s identity was a recurrent theme across our data. Starr et al.2 explored the notion of teacher identity among community-based physicians, highlighting a number of common elements:

• 내재적 만족 intrinsic satisfaction;

• 가르침에 관한 지식과 기술 knowledge and skills about teaching;

• 가르치는 책임감 feeling a sense of responsibility to teach, and

• 의사가 된다는 것은 교사라는 것을 의미한다는 신념 the belief that being a physician means being a teacher.

Our study builds on these findings by studying physicians in hospital settings.

마지막으로, 우리의 연구는 재정적 보상이나 승진 및 승진을 포함하는 외적 요인이 가르침을 위한 '보상'이나 동기 유발 요인으로 인식되지 않는다는 사실을 더욱 강조했습니다.

Lastly, our study further highlighted the find- ing that extrinsic factors, including financial compensation or advancement and promotion, were not perceived as ‘rewards’ or motivators for teach- ing.

 

외래 환자 환경에서 학생들을 대상으로 한 이전의 연구에서 의사의 다음 세대를 'give back'하고 발전시키려는 욕구가 보고되었습니다 .1,5 예를 들어, Kumar et al. 의사는 미래의 의사들에게 의학이 무엇인지를 보여주고 싶고 좋은 의학을 어떻게 실행해야 하는지를 보여주고 싶다고 말했다 .1 우리의 연구에서, 입원 환자의 전문가들은 차세대 교육이 그들의 책임임을 느꼈고, 사회적인 도덕적인 필요성을 다시 한번 제안하면서, 깊은 의무 의식은 물론, 이 개념은 전문직과 사회에 대한 책임을 포함하여 의사의 프로페셔널리즘에 대한 sense과 관련 될 수도있다.

The desire to ‘give back’ and develop the next gen- eration of physicians has been reported in previous studies with students in out-patient settings.1,5 For example, Kumar et al. noted that physicians wanted to show future physicians ‘what medicine is all about’ and demonstrate how ‘good medicine should be practised’.1 In our study, in-patient specialists felt that teaching the next generation was their respon- sibility and reflected both a quid pro quo as well as a deep sense of obligation, again suggesting both a social and a moral imperative. This notion may also relate to physicians’ sense of professionalism, including their responsibility to the profession and to society.20

우리의 연구는 학업 환경에서 가르치는 즐거움을 강조합니다. 의사들 사이에서 직업 선택을 탐구하는 이전 연구에서, 주로 연구 및 연구 중심 프로그램에 대한 노출이 역할 모델 및 멘토와 함께 학술 의학 경력과 관련된 핵심 요소로 밝혀 짐에 따라 놀라운 결과였습니다. 사실, Hatem 등 26)은 'AHC는 종종 교육을 부가적인 역할로 인식하고 있으며', 이는 여전히 무시당하고 있다. 우리의 연구 결과는 참가자들이 가르치는 것에 대한 애정을 추구하기 위해 학업 환경에서 일하기로 선택한 것과는 다른 시각을 제공합니다. 우리의 연구 결과는 또한 대학 병원에서 가르칠 수 있는 기회가 고용recruitment 및 유지retention에 대한 강한 인센티브가 될 수 있음을 시사하며, 이는 의학 교육에서 종종 도전적이라고 언급됩니다 .27-29

 

Our study highlights the joys of teaching in an aca- demic environment. This was a surprising finding as previous studies exploring career choice among physicians21–23 have primarily identified exposure to research (and research-oriented programmes), together with role models and mentors, as key factors associated with a career in academic medicine. Few have emphasised teaching as a determining var- iable in career choice.24,25 In fact, Hatem et al.26 have said that ‘academic health centres have often perceived teaching as an add-on role’ that remains neglected. Our findings offer a different perspective as our participants chose to work in an academic environment in order to pursue their love of teach- ing. Our findings also suggest that opportunities to teach in a university hospital can represent a strong incentive for recruitment and retention, issues that are often cited as challenging in medical educa- tion.27–29

의학교육정책에 함의

This study holds a number of implications for medi- cal education policy and development,

채용 및 유지

Recruitment and retention

몇몇 연구자들은 임상 교사를 채용하고 유지하는 것과 관련된 어려움과 academic medicine에서 인력의 활기vibrant를 유지할 필요성에 대해 설명했다 .28-31 우리의 연구에 따르면 academic 환경에서의 교육은 기쁨과 성취 감을 가져올 수 있으며, 의사의 모집과 유지를 향상시킵니다. 또한 좋은 교사는 훌륭한 교사를 영감을주는 것처럼 보이기 때문에 학생들과 레지던트을 가르치는 것이 모집의 한 형태가 될 수 있다고 제안합니다. 실제로, 현재의 학생들은 자신의 선생들에게 받은 것을 미래에 '갚고repay' 싶어한다. 결과적으로, 학생들에게 이른 시기에 가르치기(교육 경험)를 격려하는 것 그 자체가 채용 전략이 될 수 있습니다.

Several authors have described the challenges associ- ated with recruiting and retaining clinical teachers, as well as the need to maintain a vibrant workforce in academic medicine.28–31 Our study shows that teaching in an academic environment can bring a sense of joy and fulfilment to physicians and help to enhance recruitment and retention. It also suggests that teaching students and residents may represent a form of recruitment as good teachers seem to inspire good teachers. In fact, it is possible that cur- rent students may wish to ‘repay’ their teachers in the future; as a result, encouraging students to start teaching early in their careers may, in itself, serve as a recruitment strategy.

교사와 교육 인정 및 보상

Recognising and rewarding teachers and teaching

연구 결과는 또한 우리가 선생님을 인정하고 가르치려는 본래의 욕구를 키워야하며 가르침의 기쁨을 더 잘 드러내야한다고 제안합니다. 탁월한 교육을 경축하는 것은 교육 관행의 긍정적 인 특성을 인식하는 강력한 방법이 될 수 있습니다. 학생과의 관계, 'see the light bulb go on'의 기회와, 개인적인 노력의 결과를 목격 할 수 있는 기회와 같은 내재적 보상intrinsic rewards을 인정하는 것도 가치가있을 수 있습니다 .32 의사들에게 교육에 대한 의미를 부여해주는 요인을 이해하는 것은 동료 교수들이 이 중요한 활동에 참여하도록 유도하는 데 도움이 될 수 있습니다.

Study findings also suggest that we should acknowl- edge our teachers, nurture their inherent desire to teach, and make the joy of teaching more visible. Celebrating teaching excellence can be a powerful way to recognise the positive attributes of educa- tional practices. Recognition of the intrinsic rewards, such as the relationships formed with stu- dents, and opportunities to ‘see the light bulb go on’ and to witness the results of personal efforts, can also be worthwhile.32 In multiple ways, under- standing the factors that give meaning to teaching for clinicians can help us to encourage colleagues to engage – and remain engaged – in this critically important activity.

증거 기반의 FD 촉진

Promoting evidence-informed faculty development

교수진 개발은 전통적으로 효과적인 교사가되기 위해 필요한 지식, 기술 및 행동에 중점을 두었습니다 .33 우리의 연구 결과에 따르면  FD는 내재적 동기부여intrinsic motivation와 교수의 의미meaning of teaching에 초점을 맞추어야한다고 생각합니다. 실제로 기술 기반의 FD에서 벗어나서, 이제는 교사의 동기와 가치를 통합하고, (임상가를 위한) 교육의 본질을 토대로 작업 할 때가 될 것입니다. 다양한 방법으로, 우리의 연구 결과는 의학 교수 인력의 효과성을 높이기 위해 FDP의 설계에 활용 될 수있다 .18 Stone et al.34는 교수 개발에서 지금까지 무시되어 온 Teacher identity(+교사의 정서적 구성 요소)에 초점을 둘 것을 제안했으며, 우리의 연구 결과는이 권고를 지지하고 있습니다.

Faculty development has traditionally focused on the knowledge, skills and behaviours required to be an effective teacher.33 Based on our study’s findings, we believe that faculty development should also focus on intrinsic motivators and the meaning of teaching. In fact, it may be time to move away from a primary focus on skill-based faculty development and work to incorporate teachers’ motivations and values, building on the essence of teaching for clini- cians. In multiple ways, our findings may be utilised in the design of faculty development programmes to enhance the effectiveness of the medical teaching workforce.18 Stone et al.34 have suggested that we focus on teacher identity (and the affective compo- nent of teaching) in faculty development, an area that has been neglected to date. Our findings sup- port and build on this recommendation.

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Med Educ. 2015 Aug;49(8):773-82. doi: 10.1111/medu.12782.

Why physicians teach: giving back by paying it forward.

Steinert Y1, Macdonald ME2.

Author information

• 1Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
• 2Centre for Medical Education, Faculty of Medicine, and Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.

Abstract

CONTEXT:

Despite the pace and intensity of the in-patient clinical setting, physicians carve out time for teaching medical students and residents.

OBJECTIVES:

The goal of this study was to explore what it means for physicians to teach students and residents in the in-patient setting.

METHODS:

We conducted semi-structured interviews with 15 practising physicians from the departments of internal medicine, surgery and paediatrics in three university teaching hospitals at McGill University, using an interpretive phenomenological methodology.

RESULTS:

Five themes elucidated the meaning of teaching for physicians in the in-patient setting: (i) teaching was perceived as an integral part of their identity; (ii) teaching allowed them to repay former teachers for their own training; (iii) teaching gave them an opportunity to contribute to the development of the next generation of physicians; (iv) teaching enabled them to learn, and (v) teaching was experienced as personally energising and gratifying. Participants were morally and socially motivated to give time and effort through teaching (e.g. to pay forward their own privilege and thereby help to develop the next generation); teaching also gave them a sense of personal fulfilment (e.g. by allowing them to mould young minds and leave a legacy).

CONCLUSIONS:

This study holds a number of implications for medical education with relevance to the recruitment and retention of clinical teachers, recognition of clinical teaching, and evidence-informed faculty development. The findings also suggest that teaching in an academic setting can bring joy and fulfilment to practising physicians.

© 2015 John Wiley & Sons Ltd.

PMID:

 

26152489

 

DOI:

 

10.1111/medu.12782

[PubMed - indexed for MEDLINE]