Abstract
For over four decades, there have been efforts to specify the types of knowledge that medical students need, how that knowledge is acquired and how its constituent parts are related. It is one of the areas of continuing concern underlying medical education reform. Despite their importance to medical students’ learning and development, the perspectives of medical teachers in hospitals are not always considered in such discourse. This study sought to generate an understanding of these teachers’ values, perspectives and approaches by listening to them and seeing them in their everyday teaching work, finding and understanding the meanings they bring to the work of medical teaching in hospitals. In interviews, all of the teachers talked more about the optimal forms of knowledge that are important for students than they talked about the form of the teaching itself. Many revealed to students what knowledge they do and do not value. They had a particular way of thinking about clinical knowledge as existing in the people and the places in which the teaching and the clinical practice happen, and represented this as ‘real’ knowledge. By implication, there is other knowledge in medical education or in students’ heads that is not real and needs to be transformed. Their values, practices and passions add texture and vitality to existing ways of thinking about the characteristics of clinical knowledge, how it is depicted in the discourse and the curriculum and how it is more dynamically related to other knowledge than is suggested in traditional conceptualizations of knowledge relationships.
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References
Bernstein, B. (2000). Pedagogy, symbolic control and identity: Theory, research, critique. Oxford: Rowman and Littlefield.
Biggs, J., & Tang, C. (2007). Teaching for quality learning at university: What the student does. Berkshire: Open University Press.
Bines, J. E., & Jamieson, P. (2013). Designing new collaborative learning spaces in clinical environments: experiences from a children’s hospital in Australia. Journal of Interprofessional Care, 27, 63–68.
Bleakley, A. (2012). The proof is in the pudding: Putting Actor-Network-Theory to work in medical education. Medical Teacher, 34, 462–467.
Bleakley, A., Bligh, J., & Browne, J. (2011). Medical Education for the Future: Identity, power and location. London: Springer.
Bloom, S. W. (1989). The medical school as a social organization: The sources of resistance to change. Medical Education, 23, 228–241.
Cooke, M., Irby, D. M., & O’Brien, B. C. (2010). Educating Physicians: A call for reform of medical school and residency. Stanford: Jossey-Bass.
Cooke, M., Irby, D. M., Sullivan, W., & Ludmerer, K. M. (2006). American medical education 100 years after the Flexner report. The New England Journal of Medicine, 355, 1339–1344.
de Bruin, A. B. H., Schmidt, H. G., & Pikers, R. M. J. P. (2005). The role of basic science knowledge and clinical knowledge in diagnostic reasoning: A structural equation modeling approach. Academic Medicine, 80, 765–773.
Denzin, N. K., & Lincoln, Y. S. (2005). Introduction: The discipline and practice of qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed.). Thousand Oaks: Sage.
Dornan, T., Boshuizen, H. P., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students’ workplace learning. Medical Education, 41, 84–91.
Edwards, R., & Miller, K. (2007). Putting the context into learning. Pedagogy, Culture and Society, 15, 263–274.
Entwistle, N. (2009). Teaching for understanding at University. London: Palgrave Macmillan.
Eraut, M. E. (1994). Developing professional knowledge and competence. London: Falmer Press.
Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26, 247–273.
Fenwick, T., & Edwards, R. (2010). Actor-network theory in education. Abingdon: Routledge.
Goldszmidt, M., Minda, J. P., Devantier, S. L., Skye, A. L., & Woods, N. N. (2012). Expanding the basic science debate: the role of physics knowledge in interpreting clinical findings. Advances in Health Science Education, 17, 547–555.
Hammerness, K., Darling-Hammond, L., Bransford, J., Berliner, D. C., Cochrane-Smith, M., Mcdonald, M., et al. (2005). How teachers learn and develop. In L. Darling-Hammond & J. Bransford (Eds.), Preparing teachers for a changing world: What teachers should learn and be able to do. San Fransisco: Jossey-Bass.
Henriksen, A., & Ringsted, C. (2014). Medical students’ learning from patient-led teaching: experiential versus biomedical knowledge. Advances in Health Science Education, 19, 7–17.
Irby, D. M. (1994). What clinical teachers in medicine need to know. Academic Medicine, 69, 333–342.
Jolly, B. C., & Rees, L. (1998). Medical education in the millenium. Oxford: Oxford University Press.
Kulasegaram, K. M., Martimianakis, M. A., Mylopoulos, M., Whitehead, C. R., & Woods, N. N. (2013). Cognition before curriculum: Rethinking the integration of basic sciences and clinical learning. Academic Medicine, 88, 1578–1585.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park: Sage.
Maclure, M. (1993). Arguing for your self: Identity as an organising principle in teachers’ jobs and lives. British Educational Research Journal, 19, 311–322.
Malterud, K. (2001). The art and science of clinical knowledge: evidence beyond measures and numbers. The Lancet, 358, 397–400.
McColl, G. J., Bilszta, J., & Harrap, S. (2012). The requirement for bioscience knowledge in medical education. Medical Journal of Australia, 196, 1–4.
Mulcahy, D. (2006). The salience of space for pedagogy and identity in teacher education: Problem-based learning as a case in point. Pedagogy, Culture and Society, 14, 55–69.
Nair, K., Coughlan, J. L., & Hensley, M. J. (1998). Impediments to bedside teaching. Medical Education, 32, 159–162.
Norman, G. (2012). The basic role of basic science. Advances in Health Science Education, 17, 453–456.
Patel, V. L., Evans, D. A., & Groen, G. J. (1989). Reconciling basic sciences and clinical reasoning. Teaching and Learning Medicine, 1, 116–121.
Patton, M. Q. (2002). Qualitative research and evaluation methods. Thousand Oaks: Sage.
Pratt, D. D. (1998). Five perspectives on teaching in adult and higher education. Malabar: Krieger Publishing.
Rees, C. E., Knight, L. V., & Wilkinson, C. E. (2007). Doctors being up there and we being down there: A metaphorical analysis of talk about student/doctor-patient relationships. Social Science and Medicine, 65, 725–737.
Rikers, R. M. J. P., Schmidt, H. G., & Moulaert, V. A. (2005). Biomedical knowledge: encapsulated or two worlds apart? Applied Cognitive Psychology, 19, 223–231.
Teunissen, P. W., & Wilkinson, T. J. (2011). Learning and teaching in workplaces. In T. Dornan, K. Mann, A. Sherpbier, & J. Spencer (Eds.), Medical education Theory and practice. Edinburgh: Churchill Livingstone.
Towle, A., & Godolphin, W. (2011). Patient involvement in health professional education. In T. Dornan, K. Mann, A. Sherpbier, & J. Spencer (Eds.), Medical education: Theory and practice. Edinburgh: Churchill Livingstone.
Vosti, K. L., Bloch, D. A., & Jacobs, C. D. (1997). The relationship of clinical knowledge to months of clinical training among medical students. Academic Medicine, 72, 305–307.
Wolcott, H. F. (1994). Transforming qualitative data: Description, analysis, and interpretation. Thousand Oaks: Sage.
Woods, N. N. (2007). Science is fundamental: The role of biomedical knowledge in clinical reasoning. Medical Education, 41, 1173–1177.
Young, M. F. (2008) Bringing knowledge back In: From social constructivism to social realism in the sociology of education. Routledge: Abingdon.
Young, L., Orlandi, A., Galichet, B., & Heussler, H. (2009). Effective teaching and learning on the wards: easier said than done? Medical Education, 43, 808–817.
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We acknowledge the doctors who gave their time to participation in this study and to Professor Dan Pratt for his critical comments on the presentation of the findings in the doctoral dissertation.
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Barrett, J., Yates, L. & McColl, G. Medical teachers conceptualize a distinctive form of clinical knowledge. Adv in Health Sci Educ 20, 355–369 (2015). https://doi.org/10.1007/s10459-014-9532-6
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DOI: https://doi.org/10.1007/s10459-014-9532-6