This article focuses on the complex issues surrounding the need for adequate training in medical education for all clinicians. Many recent landmark papers, including guidance from the General Medical Council, have expressed the importance of formal training. Although the article points out that the majority of clinicians will probably not need to attend such courses, a few generic skills in teaching large and small groups may be of benefit to most. The authors call for the recognition of teaching duties in psychiatrist’s contracts and discuss the wider implications of sound medical teaching for the recruitment and retention crisis in psychiatry.

Until relatively recently, the old adage of ‘see one, do one, teach one’ was the mainstay of the apprenticeship system in medicine. But is being an effective medical educator an innate talent - a true case of nature over nurture? Apprenticeship still continues, but recent changes in educational practice have made an increasingly structured approach necessary.

The past 10 years have seen a number of landmark publications concerning medical education. The Standing Committee on Postgraduate Medical Education (SCOPME) reports focused on improving the standards of clinical teaching (SCOPME, 1994). The World Psychiatric Association (1999) has produced an outline curriculum for undergraduates, which ties in with a similar work by the Royal College of Psychiatrists (Reference Ring, Mumford and KatonaRing et al, 1999). The General Medical Council (2002) states that ‘ teaching and learning systems must take account of modern educational theory and research and make use of modern technologies where evidence shows that these are effective’. However, the majority of doctors teaching psychiatry, whether to undergraduates or postgraduates, in a university or clinical setting will have little formal training in these concepts. Do they need to?

Since the 1997 Dearing Report into Higher Education (National Committee of Inquiry into Higher Education, 1997), universities have been expected to provide specific courses to enhance teaching practices (including within medicine). These courses must be validated by a regulatory body such as the Institute of Learning and Teaching in Higher Education (ILTHE), and there is good evidence that such programmes improve student learning. Gibbs & Coffey (Reference Gibbs and Coffey2004) showed that course participants delivered teaching that was more student-centred, better communicated, and was retained for longer.

Although we recognise that not all clinicians need to attend such courses, some generic skills may be useful to all medical teachers. As well as ILTHE-approved courses, there are a number of courses available locally (usually within the deanery) which may provide focused training. The majority of clinicians need the skills to be able to deliver teaching at some level during their medical careers. Since the introduction of the new consultant contract, teaching activities including ‘training, medical education and formal teaching’ are listed under the umbrella term ‘supporting professional activities’ (Department of Health, 2003). Consultants are encouraged to take an active part in their own job planning, and teaching duties often form a considerable part of this.

This article focuses on practical ways to improve the use of two such key teaching skills that are commonly needed by clinicians: first, how to present to a large group and second, how to arrange small group or tutorial teaching.

Presenting to large groups

Lecturing or presenting to an audience is a daunting and at times a terrifying experience for most of us. Attempting to get one’s points across clearly, as well as maintaining the interest of the audience, are paramount to this process. Psychiatrists are usually asked to give presentations as part of an undergraduate or postgraduate educational course, in an academic expert capacity, or more recently during part of a structured interview process. As in most other aspects of medical training, there is no substitute for practice. We have attempted to present a few practical tips for addressing large groups, under the chronological headings: ‘before presentation’, ‘during presentation’ and ‘after presentation’. These concepts have been summarised in Box 1.

Teaching small groups

Balanced styles of teaching which incorporate small-group teaching as a central component have been recommended for medical undergraduates (General Medical Council, 2002). This type of teaching is said to allow clinicians to develop the skills of enquiry and reasoning (Quality Assurance Agency for Higher Education, 2002).

As psychiatrists, most of our small-group teaching is in the form of ‘ bedside teaching’, or one-to-one teaching in out-patient clinics or ward rounds. Many of the generic skills that are important in teaching larger groups also apply to tutorials. These include good time-keeping, attention to structure and maintenance of participant interest through interaction. There are other skills however that are more specific to small-group teaching. These can be summarised as follows and are highlighted in Box 2.

1. • Get to know your students and allow them to get to know one another. A small amount of time spent at the beginning of a session or placement goes a long way in enhancing their, as well as your own, experience of teaching. Simple measures such as providing name badges or asking the students to introduce one another by name and give an amusing fact about themselves can help act as ‘ice-breaking’ tools.

2. • The presentation format may change in small groups. Obviously in one-to-one tutorials the teaching will be primarily aural. However in small groups, one may choose to make use of the OHP, interactive whiteboard, or flip charts. These are simple to use and any tasks that are given to the small groups can be prepared using these formats.

3. • Encourage participants to bring their own subjective experiences into the teaching groups. Base your teaching around their examples. This tends to work particularly well when discussing clinical scenarios.

4. • As psychiatrists, we should be better able to pay attention to the group dynamics. You can discourage the formation of ‘cliques’ for example, by allocating groups randomly. Group boundaries and acceptable and unacceptable behaviour should be made clear from the start. Behaviour such as favouritism or bullying within groups should not be tolerated. Whereas punctuality and expecting each group member to contribute equally should be rewarded.

Conclusion

Although most clinicians will probably not need to obtain a postgraduate qualification in teaching, use of a few generic skills for teaching large and small groups may be of benefit. Many clinicians have a recognised regular teaching commitment in their contracts. It is important that teaching activities are encouraged in our professional roles, as this will both enhance our teaching efficacy as well as the students’ experience of psychiatry. Good teaching may have far-reaching consequences for the whole of medicine, and not least for psychiatry. The incorporation of good evidence-based teaching methods may be partiuclarly relevant, given the problems of recruitment and retention (Reference PiddPidd, 2003) currently facing our speciality. It is notable that students often interested in the psychosocial aspects of patient care on entry to medical school seem to lose interest in these areas as graduation approaches. It is felt that positive, focused and well-delivered psychiatry teaching at an undergraduate level could do much to attract medical students into the specialty at its ‘coalface’ and stem the drain into other medical specialties. The learning curve for psychiatry teaching is it seems just as steep as ever.