Learning that matters

As The Clinical Teacher (TCT) celebrates its 20th birthday this year, there is something about the doughty little journal that resonates with its readership.

Much like the readers on whom the journal is focused—clinicians who teach—TCT is a practical, hands-on sort of publication that is committed to bringing about changes to improve performance.

A casual glance at the journal's website,¹ however, shows that the journal's most favoured articles are not just recipes on how to teach in the clinical setting. Some of the most accessed articles have been excellent guides to undertaking educational research, indicating that TCT is a valued resource for those who are curious about what is going on in the learning relationship between the clinical learner and their teacher.^2-4

As a personal observation, clinicians who are the most effective teachers tend to be as committed to the quality of the educational experience they provide as to the quality of their clinical service. It is no surprise that many will look for evidence to underpin their teaching, just as they do with their clinical work.

It is disappointing, therefore, that most are kept in service roles by clinical education providers and not given the chance to spread their scholarly wings.^{5, 6} Full credit to those clinicians who fit a clinical education master's degree into their busy lives, and I hope TCT's accessible and practical articles on undertaking educational research prove useful to their efforts.

I had the joy of editing the journal for 4 years from 2010 aligning with its ‘troubled adolescent’ phase I suppose, although my successor in Jill Thistlethwaite has already claimed that phase.⁷ Certainly, I never experienced any of the angst and ennui that usually marks those years. TCT had grown from a lusty infant delivered by John Bligh in 1994 into a thoughtful child under John Spencer's editorship. The journal has always had a pleasantly casual style and was intended to be ‘… easy to read and difficult to put down’.⁸

TCT has achieved this vision, in my view, growing into adulthood under the wise parenting of editors-in-chief Thistlethwaite, Ross, Barrett, Burgess and Crampton. It continues to be a valuable resource for clinical teachers globally.

Apart from a focus on research, simulation and interprofessionalism, some themes that have emerged over the years are reminders that there are precedents for most things in life.

Although the recent COVID-19 pandemic turned education for the health professions upside down—more of that later—the keen-eyed TCT reader would have seen premonitions in articles about education being impacted by other viruses causing severe respiratory symptoms in the SARS pandemic some 15 years earlier.^{9, 10} We cannot say we were not warned.

Speaking of premonitions, I was intrigued to publish an article by Mastoridis and Kladidis in 2010 that noted the growing adoption of audience response systems or ‘clickers’, with universities investing considerable sums on purchasing fleets of the devices in an attempt to enliven the otherwise dull diatribes that constitute most medical lectures.¹¹ I used the article to convince my then-boss to do the same.

This intriguing concept of teaching actually being interactive and dynamically tailored to the needs of the learner pricked the ears of many clinical teachers, for whom the bedside was their classroom and lecture theatres a distant place of mass somnolence. What was not anticipated was the sudden arrival of the smart phone, making those expensive trays of clickers as redundant as 35-mm slide carousels and bringing the faceless authority of thousands of experts onto the ward round to rattle the clinical teacher.

But even the smart phone was not as effortlessly disruptive to clinical teaching as the COVID-19 pandemic, which made the 2002 SARS outbreak look like the coronavirus's equivalent of clearing one's throat.

As an inhabitant of one of the world's most locked-down cities (not a banner that welcomes new arrivals at Melbourne Airport), I saw clinical placements collapse with students sent home under the pending onslaught of COVID casualties and the need to minimise ‘non-essential personnel’ in the workplace. Clinical teaching pivoted overnight to online delivery with all the deftness of an Australian breakdancer, but we managed.

In fact, many clinicians were eager to keep busy with online teaching, as their elective lists were cancelled and visits to the hospital became necessarily brief and task-focussed. And they missed the students.

Placements were shakily re-established, often with useful new roles to assist the clinical team. Perhaps this was the first time medical students had been viewed like nursing and allied health students in having valid participatory roles that both accelerated their learning and enhanced clinical service delivery.

While this deeper engagement in work-based learning was lauded at the time as an innovation in clinical teaching born from the pandemic's exigencies, others viewed it as a timely return to the origins of clinical teaching with the apprentice standing at the elbow of the master clinician and helping with the work.

Of course, this has been the nature of vocational training for centuries, and the new focus on work-based learning is really just the application of well-established training principles to the entry-to-practice level learner.

Clinical students are discerning consumers and, while some express a wistful longing for the spoon-feeding of campus-based education, the majority seem to have embraced hands-on learning in the clinic to such an extent that simple observation no longer satisfies them.

‘Seeing my own patients’ has become the standard expectation for medical students going into GP placements in Australia thanks to the success of longitudinal integrated clerkships, with both students and their GP teachers expressing increased satisfaction with this style of clinical learning. Satisfaction that is shared by their patients, most importantly.^{12, 13}

The medical student's expectation to have their own consulting room and patient list while on supervised placement in general practice has created a problem for medical schools to solve—How to manage the infrastructure logistics of enabling students to learn while being of use? Being besieged by students clamouring to learn by delivering health care in the community is wonderful problem to have, if we want our medical students to graduate with an understanding of where the vast majority of healthcare is delivered.¹⁴

A letter to the editor from one of the first issues I edited in 2010 was again prescient of things to come. Neel Sharma, then a recent medical graduate, called for increased clinical exposure for health learners to learn by doing rather than by standing and watching. With his permission, I am borrowing a quotation from his letter with which to end:

Stephen Trumble: Conceptualization; writing – review and editing; writing – original draft.

I have no conflict of interest, either perceived or actual.

The author has no ethical statement to declare.