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MSc in Medical Education: Meet the course director

Dr Jonathan Cartledge, academic lead for Year 5 MBBS at UCL and consultant HIV physician at the Mortimer Market Centre, Central and North West London (CNWL), talks about his role leading the RCP/UCL Medical Education programme.

When did you decide to get involved in medical education in a formal way, and what influenced your decision?

When I was a senior registrar in my clinical specialty I went on a teaching skills course which was run locally. During this course, one of the facilitators encouraged me to get more involved with education.

I subsequently became one of the teachers on that course and as a result became more interested in education. This led me to successfully apply to be a Senior Lecturer in Medical Education at UCL, responsible for building the staff development programme for clinicians working at UCL and its partner trusts with the aim of up-skilling the whole of the clinical faculty to be more confident about their teaching skills.

I subsequently helped set up the RCP ‘Doctors as Educators’ programme, training the early cohorts of facilitators. As a result of collaborating with Winnie Wade (director of education at the RCP) we decided that we wanted to offer something at the next level. It was then that we developed a postgraduate certificate in Medical Education, and subsequently a diploma year and master’s thesis year.

You have a particular interest in team-based learning, and have recently published on this innovative approach. Can you tell us about this, and why you find it particularly valuable?

Team-based learning (TBL) is a technique that was pioneered by Larry Michaelsen, initially used to teach non-medical audiences and is now increasingly used within medical education. It’s a technique whereby a large group of learners are sub-divided into smaller teams to teach and challenge each other.

Each smaller team is provided with pre-reading materials, which they are encouraged to discuss with each other on a teaching day. The sessions are built around ‘quizzes’ which teams complete competitively against each other. They discuss and teach particular areas with each other, raise questions, and are encouraged to explore topics they are uncertain about. It is quite efficient as you only have one facilitator, but you achieve a lot of learner interaction. A lot of the benefits of small-group teaching are made available even though you are teaching in a large group session.

They are also a lot of fun, I use TBL with groups of students on Friday afternoons and they are very enthused and energised which is rare to find at the end of the week! I would encourage anyone who has large groups to teach, but wants audience engagement, to try this technique.

What do you enjoy about leading and teaching on the joint RCP/UCL Medical Education programme?

I enjoy that we have brought together two world class institutions with fantastic reputations for education in medicine, to deliver what I believe to be one of the best postgraduate programmes in Medical Education. We are able to draw upon the expertise within the RCP and its associated membership as well as UCL and its expertise in medical education, whilst working with people at the cutting edge of the field who understand how to teach well.

... we have brought together two world class institutions with fantastic reputations for education in medicine, to deliver what I believe to be one of the best postgraduate programmes in Medical Education

What particular challenges are there to teaching and learning in medical education?

One of the first challenges is balancing the need to keep the patient safe with the needs of a learner to be able to grasp a new procedure. That balance is something at the centre of our thinking about education in a medical context and has become much more so over the last 10 – 20 years, so that the need to practise prior to seeing a patient is much more tangible to us now.

The other challenge is one of time and the ability to be able to incorporate or prioritise education above the other job pressures. Developing ways to be able to simultaneously deliver service with an educational strand is a key challenge for clinicians.

The third challenge is one of funding. The ability of organisations to pay specifically for people to teach, as well as the money that is available to pay trusts for teaching is reducing so it would come as no surprise that the financial crisis has had its implications for medical education.

Do you think that education has the profile that it deserves in medicine?

Increasingly, being an educator is being recognised as a scholarly activity rather than an assumption that any clinician can teach.

When I started in education, workplace-based assessment had not yet been thought of. Formal curricula with objectives and constructive alignment were just being developed and assessment methods were being considered. When thinking back to how far particular ideas have travelled in the last 10-15 years it is quite phenomenal. In the academic sphere I think there is work to be done to raise the profile of education because the pendulum has swung far too far towards the research agenda. A lot of the activity of universities is educational but that does not seem to be recognised as much as it should be.

What are the opportunities for doctors with an interest in education?

Broadly speaking I think there are two different avenues you can pursue, either an undergraduate or postgraduate route.

Within the undergraduate route, doctors can get involved in designing teaching resources and exams, and then move on to being a representative in undergraduate modules, module leads, year leads and sub-deans for specific areas of practice. There are increasing opportunities to take on roles within undergraduate education at all levels of training.

Within the postgraduate route doctors can become involved with educational supervision, become a training programme director, a director of education within a particular trust and on to postgraduate deanery positions.

These career pathways do not have the same feel as the career paths within clinical specialties; however there is still a much clearer route to follow than there was 10 years ago when these roles were less easy to navigate.

What benefits does your involvement in medical education bring to your job?

My educational roles benefit my clinical work by enabling me to network much more widely. This benefits my patients in terms of referral to and advice from colleagues in different specialties and keeps me updated in fields that are no longer a part of my own practice.

I find educating, face-to-face teaching and organising of education extremely satisfying. I get a lot of satisfaction out of direct contact with learners whether those are undergraduate medical students or postgraduate students on the RCP/UCL Medical Education programme.

What, in your view, makes a good medical educator?

The key to being a good educator is enthusiasm and the ability to see things from the learners’ perspective.

The ability to grasp the meaning of learner-centred education is the key foundation upon which everything else rests. Being able to appreciate where the learner has come from, thinking how to pare down the knowledge of the expert in order to convey the key message the learner needs to go away with, and also to think about how best to achieve those outcomes for the learner. That whole approach of learner centred teaching is absolutely fundamental.

Alongside that there needs to be an enthusiasm for teaching itself beyond enthusiasm for your own specialty; being enthusiastic about that person learning your subject and how you can help that person.

In RCP programmes, clinicians and educationalists teach together. How does that influence the learning experience?

Most doctors are reassured to have a jobbing clinician as part of the teaching team to make them feel that the ideas being conveyed are grounded in the reality of what is achievable in the workplace. They also recognise that the expertise the educationalists bring is extremely valuable in synthesising some of the key theoretical ideas that inform good educational practice.

What one wish do you have for the future of medical education?

Most people feel enthusiastic about teaching but are struggling to cope with the overwhelming burden of their clinical and other commitments. It would be fantastic to identify ‘ring fenced’ time for teaching and to help people fill that time with something meaningful for their learners.