Teaching in the clinical environment: Guide supplement 34.2–Viewpoint

The recent paper by Ramani and Leinster (2008) describes the various challenges for clinical teachers in the clinical environment and with the use of relevant educational theories in the clinical context provides practical teaching tips for clinical teachers. The authors have used two behaviour-based general teaching models: the Stanford faculty development model for clinical teaching and the 1-min preceptor for teachers; together with the Dundee outcomes model as a user-friendly approach to communicate learning outcomes for medical teachers. Although the information given in the guide is comprehensive and the authors have reviewed many of the challenges encountered in clinical teaching, I would like to give some general comments on the usefulness of the guide for clinical teachers and offer some suggestions in providing tips for clinical teachers. In terms of general comments, I believe the organization and content in the guide is appropriate, however, the guide could be more concise and the content significantly shortened to give clinical teachers a more user friendly version on the approach and tips for clinical teaching. In addition, the guide would be improved if the description of models and theories that addressed the same educational issues is put alongside one another instead of appearing at different points throughout the text. Furthermore, the guide will be more practical for busy clinicians if fewer theories were described. For example, it is easy to get distracted and confused in the section on ‘applying the Dundee model on teaching’ when the authors used other educational theories other than those that were described as the two main models of clinical model of teaching, making the content hard to follow at times. First, the guide would be improved if these two general educational theories were used in the application of outcomes model for teachers in the clinical environment. Second, in the abstract, although the authors stated that this guide was to concentrate on the hospital setting, there is however, little mention within the guide why the same principles could not be used in community or outpatient/ ambulatory settings. Indeed, the guide can also be used for community teaching if the tasks of a clinical teacher within the Dundee outcomes model also include community teaching as one of its tasks. Third, for the tasks of a clinical teacher, the distinction between inpatient teaching and bedside teaching is not clear to me as I often think that bedside teaching is conducted within the domain of in-patient teaching. Indeed, the issues, challenges and solutions for bedside teaching, inpatient teaching and outpatient teaching have many similarities and I wonder if these challenges and practical tips can be further simplified to have a general, easy to understand approach for them, e.g. preparation is essential, teachers should obtain timely and specific feedback, there should be observation of learners and reflection on the part of the teachers. Similarly, although there is separate description of ‘the approach to teaching’ (the second circle in the Dundee 3-circle outcome model) and ‘the clinician as a professional teacher’ (the third circle), some of the approaches to teaching have already been described in the section on ‘tasks of a clinical teacher’ which included the importance of provision of feedback, using appropriate teaching strategies for different levels of learners and modelling good, professional behaviour and selfreflection. I believe many of the challenges for teachers in the clinical environment have been described in this article adequately, and can be summarized as key challenges for teachers working in the clinical environment.