Making sense of global issues

One of the striking things about medical education as a discipline is that – wherever you go – the same issues keep cropping up. Even in countries with very different cultures, climates and health care systems, clinical teachers will be grappling with many of the same quandaries. The seventh Asia Pacific Medical Education Conference (APMEC) was held in February, and it is likely that the themes that dominated discussions in Singapore will re-emerge at next month’s Association for the Study of Medical Education (ASME) conference in Cambridge, UK. Not because the attendees are the same, but because we are all doing much the same work. Patient safety, simulation, interprofessional learning and professionalism are all big topics internationally, and all are featured in this issue of The Clinical Teacher. ‘Professionalism’ is a frequently used term in medical education for which a neat definition remains elusive. ‘Patient-centred’ is similarly widely used, and even more widely interpreted. In this issue, a paper by Rosie Illingworth from Manchester aims to help clinical teachers clarify their thinking about the patient-centred consultation, so as to better help their students understand it.1 She hasn’t wrestled the complex concepts that define patient-centredness into a single trite sentence; rather, she explains how the twin threads of discovering the patient’s perspective and sharing control of the consultation wind together. Simulation and interprofessional education come together in article from Hazel Cuene-Grandidier and colleagues, from Belfast,2 Describing their approach to using high-fidelity paediatric simulation manikins with combined groups of medical and nursing students, the authors show that it is possible to teach vital clinical skills along with communication and teamwork, professional identity and role awareness, and attitude to shared learning. The high-fidelity simulation technology was able to be adapted to the level of the learners, meaning that neither student group felt overwhelmed by the challenges presented. Audience response systems or ‘clickers’ are by no means new technology. Many readers will have used them at conferences or at continuing professional development events. Students seem to enjoy them and, as fifth-year UK medical student Sotiris Mastoridis writes, ‘Rarely in a clicker session would one see students doze off, an otherwise not uncommon experience’.3 He and his co-author outline some of the advantages of clickers for both lecturers and students, but sound a warning that the technology should not overwhelm the content, nor allow lazy lecturing. Social networking websites are another form of technology that has taken hold amongst younger people especially. ‘Facebook’ is one of the most popular, and it offers unprecedented opportunities to connect with people and to share personal information. In their article on Facebook and the professional behaviours of undergraduate medical students, Garner and O’Sullivan, from Liverpool, provide a fascinating insight into the risks students are taking by displaying their candid behaviour online.4 To quote one of their respondents: ‘Several of my colleagues have been shown in a poor light on Facebook, and if this was seen by members of the public it would seriously undermine their professional practice if they were then seen in clinical practice too’. But another was of the opinion: ‘...at the end of the day we are normal people, we curse, we get drunk and we have embarrassing photos of ourselves, these things should not make us less of a doctor’. Clinical teachers should think hard before accepting a Facebook ‘friendship request’ from their students. On the topic of relationships between clinical teachers and their students, Abramovitz and Notzer, from Tel Aviv, have provided a thought-provoking article on improving interactions between the two groups by changing the way clinicians respond to their students’ challenges.5 The scenarios used in their staff training workshop – such as the student who is reluctant to visit the wards, or who dresses inappropriately for the clinical setting – will resonate with readers from all regions. Meanwhile, Joanne Carling, from the UK, moves beyond professionalism to ask a question about basic clinical competence: are graduating doctors adequately prepared to manage acutely unwell patients?6 As she points out, newly qualified doctors are often first on the scene in an emergency situation, and we need to know that their life-saving skills are up to the task. Without stealing her thunder, it is fair to say that the students who had been through an acute illness teaching programme at least felt they’d been adequately prepared for the job. From Quebec, Lehmann and colleagues have questioned the orthodoxy of having hospital residents learn to perform procedures during on-call shifts when supervision is less available.7 Whereas being first on-call provides good learning opportunities in domains such as decision making, autonomy and self-confidence, the lack of direct supervision after hours means that other learning is limited. Other papers in this issue of The Clinical Teacher address the use of peer tutors in clinical skills training;8 describe peer-led teaching on cases presented as ‘Morning Reports’;9 and raise the issue of preparing medically qualified refugees to return to clinical practice in their new country.10 All are important topics for clinical teachers, and all will continue to challenge medical educators internationally as we strive to produce safe, competent and confident practitioners. The editorial team at The Clinical Teacher looks forward to receiving your submission on any topic that would be of interest to clinicians who teach. Editor in Chief

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