#KeyLIMEPodcast 203: To teach is to learn twice … and also to do better because of it?

Reference:

Smith et al. Those Who Teach, Can Do: Characterizing the Relationship Between Teaching and Clinical Skills in a Residency Program J Grad Med Educ. 2018 Aug;10(4):459-463

Reviewer: Linda Snell (@LindaSMedEd)

Background

Those who can, do.  Those who cannot, teach. Those who cannot teach, teach teaching.

There is a small literature in med ed suggesting that ‘to teach is to learn twice’ (French moralist and essayist, Joseph Joubert). Not surprising as teachers and clinicians have many parallel activities and skills – gathering data, making a diagnosis and management plan, and parallel attributes – communication and organizational skills.

Perhaps students with a better understanding of teaching and learning principles will become better learners – some evidence from metacognition for this.

Purpose

To examine the relationship between the professional roles of residents as teachers and as physicians (clinicians), as well as how learning about teaching may enhance clinical skills.

Key Points on Method

2 stages:

1. Exploratory.(a) Literature search to identify attributes of physicians and clinical teachers, then used narrative comments to devise a thematic framework explaining concepts relating to relationships between teaching and clinical skills.
   (b) Examined narrative data from 300 resident in-training assessments to systematically identify and index the qualitative components. Included comments on clinical and teaching skills.
   
   Analysis: Framework analysis*, a structured and systematic form of thematic analysis that facilitates examination of qualitative data sets through the perspective of a priori – defined concepts and relationships.Each researcher analyzed the narrative comments and identified key concepts and recurring themes. They then met as a group to compare the literature to the resident evaluation data concerning teaching and clinical care.  The resident data was used to refine the thematic framework by identifying and indexing corresponding phrases and sections of commentary.Continued until no new themes were identified.
2. Confirmatory. Focus group with 6 volunteer graduating residents from the clinician-educator track ( a highly selected cohort) – question ‘‘what are the attributes and skills of good teachers that enhance clinical skills?’’ Goal was to ‘confirm that sufficiently identified the teaching attributes and actions that contributed to residents’ provision of clinical care, to determine if there were other themes that had not been captured and to further refine the framework.’ Transcript was coded according to the thematic framework.

Key Outcomes

Four main themes emerged from the synthesis of the evaluation data and focus group discussion, with 18 sub-elements.

1. Relationships – Reciprocity, Virtue, Openness, Availability, Consideration, Advocacy, Leadership.
2. Communication – Focuses on being understood, Establishes safe environment, Enthusiasm and compassion.
3. Relation to Self – Receptivity, Confidence, Flexibility, Conscientious.
4. Relationship with Knowledge – Organization, Application, Curiosity, Reflectivity.

These help characterize the relationship between teaching and clinical skills and identified practices that can foster both learner-teacher and patient-physician relationships.

Key Conclusions

The authors conclude ‘Themes that link clinical and teaching skills are similar for both patient-physician and learner-teacher relationships. They suggest that improving residents’ teaching skills may not only benefit their education but also improve the care of patients.’

Spare Keys – other take home points for clinician educators

Authors promise two things – look at the relationship between the roles of residents as teachers and as clinicians,  – this they do, and look at how learning about teaching may enhance clinical skills – this is not as clear.

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