Teaching and learning on busy post-take ward rounds
Editor – I read with interest the article by Graeme Dewhurst (Clin Med June 2010 pp 231–4). In the article, Dewhurst investigates those factors which are considered by junior doctors to hinder and encourage learning and teaching opportunities on post-take ward rounds. Ward rounds have always been an essential part of postgraduate medical education since first described in 1660.1 In the mid-1980s a survey reported that 58% of senior house officers’ learning occurred on ward rounds.2 However, medical education has been turned on its head in recent years with the adoption of the European Working Time Directive and the implementation of Modernising Medical Careers and the foundation year (FY) programme. In a recent study I found that only 18% of FY doctor learning occurs on ward rounds and I suspect that the issues outlined by Dewhurst play a major role in this decrease, noticeably, reduced time, reduced team cohesion and lack of awareness of learning and teaching skills.
I disagree with two commonly held views on how to improve ward-based teaching, the first is that all doctors should be teachers and therefore should learn teaching skills. There is no doubt that all experiences can provide an opportunity to learn, even the bad ones but, suggesting that all activities should have a focus on education, or an element that is taught, is an inefficient way of using a sparse resource. In the case of post-take ward rounds I believe there should sometimes be a focus on ‘getting the work done’, and at other times emphasis on teaching, as the most inefficient ward rounds are those in which the focus is placed on teaching but there is simply too much ‘service provision’ to allow learners to focus and absorb their experiences.
Teaching, like all specialties, is a skill that few are excellent at, most are reasonable at and some are terrible at. The challenge is identifying those who are good at teaching, and then promote their education activities by providing the time, recognition and financial reward that will encourage them to pursue this rapidly evolving area.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- Royal College of Physicians
References
- Baron JH
- Grant J
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