Barriers to Effective Teaching in Medicine

I think there is no better or more rewarding job than being an educator, especially in the field of Medicine.

There are, however, significant financial, societal, curricular, and environmental barriers which prevent optimally effective teaching in Medicine. In a commentary piece in Academic Medicine, the authors review the barriers and some forward-thinking recommendations for our leaders in medical academia. While the focus of the article is on undergraduate medical education, many concepts apply to graduate medical education as well.

Recommendations

Establish and measure desired education outcomes of graduates. We need to agree upon and articulate what common skills and knowledge we expect from our medical school and residency graduates. For instance, should ALL medical students be proficient in a lumbar puncture? There are differences in opinion.
Determine acceptable evidence of performance proficiency and use. “Longitudinal performance-tracking systems” should be in place to ensure learners achieve key benchmark goals.
Build systems into the curriculum that will increase the capacity for strong patient–learner and teacher–learner relationships. Medical students should establish strong longitudinal ties with faculty mentors and have early clinical learning experiences during medical school. Extrapolating this to the GME arena, residents should find faculty mentors and start building their career track.
Involve other health professionals as collaborators in the education mission. This enhances interdisciplinary collaboration and communication, while also reducing the need for clinical faculty time.
Require systems that recognize and reward excellence in teaching and educational scholarship and hold faculty accountable for the quality and amount of teaching. Academic faculty are expected to teach, as part of their academic responsibilities, and should be held accountable. Also, faculty development opportunities need to be available to help substandard performers improve their skills.
Allocate adequate space, budgets for supplies, professional resources, equipment, and compensation to optimize the education mission. We need to invest more in our educators, who often are uncompensated for their time to teach medical students and residents.
Recruit educational specialists with the appropriate expertise to optimize faculty efforts as clerkship or residency directors, course directors, or teachers. Even our educational leaders need mentorship. We can always get better. At UCSF, we have the Office of Educational Research and the Academy of Medical Educators to help educators with problems, faculty development, and mentorship. Take a look at your institution to see what’s available.
Develop a national or global health care professions institute whose aim is to advance the development of health professions educators and educational research. Medical educators do not have a national organization for the specific purpose of improving faculty development and the quality of educational research. A national organization might offer certificate or degrees upon completion of a series of workshops or courses (such as the Medical Education Research Certificate (MERC) program hosted by the AAMC). By bring physicians from across specialties and sites, this would enable easier coordination and collaboration for large-scale multi-institutional studies.
Increase grant dollar availability for educational development and research in health professions education at the federal and local level. Show me the money.
Create an international health professions education statistics database. This would expand beyond the US Department of Education’s National Center for Education Statistics (NCES) to identify common educational issues on the global level.

Research
Darosa DA, Skeff K, Friedland JA, Coburn M, Cox S, Pollart S, Oʼconnell M, Smith S. Barriers to Effective Teaching. Academic Medicine. 2011 – in early release. PMID: 21346500