When I started in medicine it was all pretty simple. Anyone who knew more than the students could teach them and this was achieved by giving them a lecture – in my case generally in one of the steeply tiered Edinburgh medical school lecture theatres, in which the memory of previous generations seeped from every worn and battered seat.
Doctoring was simple too, you asked the respectful patient what was wrong with them, came up with a diagnosis and treatment and told them what to do. If the outlook was bad, you might talk vaguely about “a bit of a lump” whilst quietly advising relatives to prepare for the worst.
I practised medicine and taught all kinds of health workers on three continents, but words like Pedagogy did not cross my path until around mid-career when I embarked on a Masters in medical education at Dundee. I heard about “deep” learning, “awakening prior knowledge”, “communities of practice” and “legitimate peripheral participation- a world of things that rang true to my own experience as both learner and teacher.
As I moved to the then brand new Peninsula Medical School, we espoused Problem-based Learning and much else besides. Our students had and still have an education completely unlike my own, much more patient-centred, much more globally oriented and including things like tolerating ambiguity that is part and parcel of modern practice.
The dual revelations in doctoring have been shared decision making, along with the recognition that “communication skills” are needed and can be taught - and that the humanities have as much to teach medics as the sciences. Often the doctor is as much part of the treatment as any drug or operation, and one can learn about and get better at doing it. There are often no “right” treatments, tests or procedures, but a range of complex choices to be shared.
In a world of inequality and threats to public health, advocacy is a key doctoring skill and helping to impart a sense of agency is often more important than prescribing.
I have been part of a sea change in how we behave as doctors and in the education that students receive. Both are very much for the better.
In chronicling this journey for my National Teaching Fellowship application it has been exciting to reflect on how much has changed. In the UK we desperately need the young doctors and other healthcare professionals that we produce, we need them to have the skills and resources to survive in an incredibly stressful but wonderful job - and most of all to go to where they are most needed. They are certainly much better prepared than I was!
Dr Richard Ayres is a senior clinical academic at Plymouth Peninsula Schools of Medicine and Dentistry and Lead for Population Health. He also works as a GP in Stonehouse in Plymouth in a practice that provides outreach services to the homeless in the city and education for students in substance misuse and exclusion health.