British Journal of Medical Education, 1971, 5, 138-141

Teaching methods in the faculty of medicine JOHN LOWE Department of Educational Studies, University of Edinburgh

A school teacher is commonly required to spend at least one year undergoing training and, indeed, in some circumstances he may not be allowed to teach at all without a recognized professional qualification, as is the case in the State system of education in Scotland. Why is it that university teachers are not also expected to undergo even a perfunctory period of training in teaching methods ?

Several reasons may be adduced. To begin with the emphasis in universities has traditionally been laid upon research, the belief that the over- riding duty of the academic is to extend the frontiers of knowledge. Secondly, there has been a tendency to suppose that students who have survived a highly competitive selection process should be sufficiently able to fend for themselves. Thirdly, even when students’ needs or demands as learners have become a matter for concern, university teachers have seldom considered training for themselves as one means of ensuring more effective teaching. Moreover, many of them have found their low estimate of the value of training reinforced by adverse, frequently ill-informed, comments on the sylla- buses and products of teacher training institu- tions. Fourthly, pride has played its part, for who would want voluntarily to submit to an experience that might expose one’s imperfections ? Supposing, in the light of allegedly objective criteria, one was revealed as a thoroughly bad teacher; would one be expected to resign O m ’ s post? Fifthly, training would absorb time better spent on preparing lectures and research. Finally, if the case for training were to be conceded, who should be responsible for it? Within most universities there has traditionally been either overt or veiled distrust of the schools and departments of education to which it would be logical to assign responsibility. But if not edura- I38

tion departments, what then’? In practice, the usual answer has been that no one has assumed the responsibility.

Desirability of training courses More and more people are questioning whether the above reasons justify the continuing rejec- tion of training courses. The answer would seem to be a firm no. Students have long complained about the poor teaching to which they are sub- jected and their complaints have recently become loud and urgent. Rightly or wrongly, there is also a feeling among lay critics of universities that a large part of the prevailing discontent is directly attributable to the students’ resentment of incompetent teaching methods. The govern- ment, too, is beginning to expect universities to show themselves more aware of and more ob- viously responsive to the immediate practical needs of the community; it has also become acutely concerned about the cost-benefit factor. This together with the planned increase in intake to medicine means that teachers must be seen to be effective - that is, their effectiveness should in some way be measurable. Then, there is the sheer size of the modern university, with its large student population and the proliferation of new disciplines brought about by the accelerat- ing extension of knowledge. The kind of intimate staff-student relationship that used to exist in the small universities is now more and more difficult to attain. Lastly, throughout the whole field of education there is growing a new-found respect for technology and an awareness of the availability of new techniques of communication which at least deserve to be tried. In short, un- precedented pressure is today being put upon university lecturers to improve their teaching efficiency.

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The universities would be unwise, of course, to rush headlong into introducing training courses modelled on those already provided in university departments and colleges of ed uca- tion and designed for primary and secondary school teachers. Similar methods to secondary school methods are obviously called for when the goals happen to be similar-for example, when the transfer of information is the primary concern. But there are significant ways in which the objectives and teaching methods and habits of study encouraged by a university differ from those in a school, and these must be taken into account when devising training courses for university teachers.

Courses in Edinburgh At the University of Edinburgh, the faculties of science and medicine have not wanted to be forced into improving their teaching methods but have anticipated pressures for change by dealing with the problem on their own initiative and in relation to their own particular goals. The experience of the faculty of science, now dating from four years ago, is being reported elsewhere. One inter-faculty residential seminar has been held and others arranged. Here we are concerned with the experience of the medical faculty, which, under the inspiration of the present and former Deans, is very much aware of the need to keep under review the teaching methods used throughout the faculty.

With a view to improving teaching methods as such two special courses were offered during the session 1967-1968, the first for senior staff and the second for junior staff. They were devised by the executive Dean of Medicine in collaboration with the Department of Adult Education, whose Head largely conducted the individual meetings. The professor of phonetics and several members of the medical faculty dealt with specialist topics. Both courses were over-subscribed. Moreover, despite some forecasts to the contrary, the course for senior staff attracted and retained the interest of professors and readers.

Regular courses are now to be held in which the medical teachers themselves will take a larger part and where class participation will be an increasingly important feature. These will be the subject of a further communication and the object of this paper is to describe the early courses which formed the foundation for thisdevelopment.

The aims of the first two courses were modest. For the senior staff, the object was to provide an opportunity for an exchange of views about practical problems in the hope of modifying existing practices. For the junior staff, nearly all of whom had only recently been appointed, the object was to provide an introduction to the variety of teaching situations with which they might be confronted. For both groups there was also an opportunity to make acquaintance with the range of teaching methods and aids now available.

During the opening session, which was devoted to an examination of the university teacher’s duties qua teacher, it was suggested that there are theoretically three categories of university academic staff. The first category consists of those who will probably never be able to teach effectively because of a personality defect; such people should be encouraged to concentrate upon research and the supervision of individual students. Secondly, there are those rare beings who seem to be brilliant teachers to the manner born. Finally, there is the overwhelming majority who can teach more or less adequately. It is this third group which can profit most from initial and refresher courses in teaching methods, though even the brilliant teachers can benefit from the opportunity for a formal exchange of views about methods and techniques.

Aims of teachers and of courses An attempt was then made to identify the aims of the university teacher. These, it appeared, could be summarized as follows:

to encourage students to think for themselves and to perceive relationships between concepts and apparently discrete facts: to encourage students to work on their own; to inspire students with enthusiasm for their subjects ; to purvey information; to impart skills. In short, the aim is to produce graduates who

will not only be proficient in their chosen fields in the short run but who will have been so stimulated as to continue to learn about their subjects throughout their lives.

Clearly in a brief course it was impossible to consider all the ways in which the above aims might be implemented. Neither could it be anticipated that striking changes would result

140 John Lowe

either in personal attitudes towards teaching or in the methods currently in use. At least, how- ever, there was an opportunity for each par- ticipant to reflect on his own particular aims and problems and to consider whether or not he could become more effective if he were to experiment with some of the teaching methods that were discussed. More specifically, the aims of the courses could be summed up as follows:

to provide a forum for discussion ; to classify and describe various teaching methods ; to help eliminate minor faults in teaching; to suggest practical hints for improving techniques.

Procedure The senior course was spread over 10 meetings, held once a week in the evening from 5 to 6 o’clock. The timing and frequency of the meetings, carefully chosen in the light of the daily routine of medical teaching staff, seem to have been suitable, since the level of attendance was consistently high. The junior course was concentrated into an intensive three-day period. The participants in each course were restricted to 15 so that the group could operate as a seminar and so that those conducting the course could practise what they preached. Ideally, the number should probably have been no more than 12 but it was felt desirable to allow a slightly larger enrolment in order that too many would- be applicants should not be turned away. In order to facilitate the broadest possible exchange of ideas, the number of participants from a single department was limited to two.

At each session, apart from the practical ones, the procedure was for the group leader to talk for between 15 to 30 minutes, and for an open discussion to begin thereafter. The sessions were arranged as follows :

The implications of the Hale Report and the role of the university teacher. The range of teaching methods. Teaching in the hospital. A clinical teaching session in the Department of Surgery, Teaching in the laboratory. A tutorial demon- stration in the Department of Bacteriology. The lecture. Discussion methods. Using audio-visual aids. Using the voice.

Discussion of special problems related to teaching in the faculty of medicine Course evaluation Probably the most productive feature of the

course was the way it served to elicit details of the methods already in use and to identify practical needs and problems. The key points to emerge from the interchange of views and in- formation were as follows :

1. There is a surprisingly wide range of teach- ing methods already in use. Individual lecturers have experimented with a specific teaching method often with great success and often with- out informing anyone else. In other words, many of the participants were astonished to find how much they could learn from their own colleagues.

2 . Many avenues of discussion came to an abrupt end because it was discovered that objective evidence was lacking. Clearly there is scope for numerous scientifically based investi- gations into the whole teaching-learning process.

3. Clinical teachers had fewer problems than pre-clinical teachers. This seemed to be due to two factors : (a) their aims were more vocationally orientated; (b) students are more highly moti- vated during the clinical phase of their training.

4. Both concern about and methods used in teaching differed strikingly from department to department. It would have been possible to construct a continuum with a department at one end that simply ignored the question of teach- ing methods and at the other end a department that was highly innovative.

5. Many arrangements for teaching students are dictated not by learning criteria but by administrative expedience or a basic shortage of staff.

6. There is a frequent lack of effective consul- tation between departments offering joint courses and between lecturers sharing teaching duties on the same course.

7. A significant proportion of students have difficulty in adapting to the university environ- ment.

The participants were especially interested in group discussion methods. Though slavish adherence to the lecture was rightly rejected, there was honest doubt about the ability of many teachers efficiently to conduct seminars and tutorials in their stead. Another topic that evoked much discussion was the question of

Teaching methods in the facidty of medicine 141

student assessment. Though exclusive reliance upon terminal examination papers was deplored, there was uncertainty about what to put in their place. How to evaluate each lecturer’s own skill as a teacher was also a question that kept cropping up. There was a keen desire to know more about the psychological aspects of teaching and learning -just what promotes learning and what hinders i t? And, not least, there was curiosity about the newer teaching aids. For example, can programmed learning really help the student and facilitate the most economical use of staff?

The unanimous opinion of those who attended the courses was that the experience had been a valuable one. Several participants confessed that they had not previously attached much importance to the teaching methods they em- ployed. Most participants had not heard of several of the methods referred to or, at least, had not felt confident enough to adopt them. Subsequently, a number of participants, in- cluding one or two departmental heads, reported that they had changed their methods to ad- vantage as a direct result of attending the course.

There was general agreement that all newly appointed university teachers should be obliged to attend a short teaching methods course either

at the outset of their teaching careers or as soon as possible thereafter. They should also have frequent opportunities to test their effectiveness as communicators by resorting to such devices as closed-circuit television and video-tapes.

Conclusions If these two courses are any indication, there is no lack of concern among at least some univer- sity teachers about the urgent problem of how to ensure good teaching. The two groups, rep- resenting opposite ends of the age and career scale, were equally earnest and concerned, equally prepared to question their existing methods and to welcome any innovation or hint that would help to raise standards. They had the advantage, of course, of being homogeneous in the sense that they had a common interest in preparing doctors. Nevertheless, it may be that when their critics allege that university lecturers are indifferent to how they teach, they are making a false inference. Most university lecturers are bothered about how they teach. The trouble is that they have no formal outlet for either ex- pressing their concern or for learning how to become more effective. Such courses as these we have described can perhaps help to provide such an outlet.