- Email: [email protected]
Complexities of anaesthetic training in the UK
ARTICLE IN PRESS Current Anaesthesia & Critical Care (2003) 14, 169
c 2003 Published by Elsevier Ltd. doi:10.1016/S0953-7112(03)00106 - 6
EDITORIAL
Complexities of anaesthetic training in the UK Michael Clapham University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
There have been large changes in the organization and delivery of anaesthetic training within the UK in the last few years. There is now real structure to the training programme that is based on the teaching and assessment of competencies.This has been achieved from two directions. One has been by quality guidance from above by Royal College of Anaesthetists. The second and equally important has been the hard work at the coal face by those anaesthetists who deliver the training. This has been particularly challenging because this change has been achieved against a background of decreasing numbers of hours each week spent in training and a shortened time for training. The people responsible for delivering the teaching are already busy clinicians who have increasing demands placed on their time due to increase in their clinical workload.These demands produce many tensions and stresses. A further confounding issue is the ever increasing amount of knowledge and facts that are generated and need to be considered. One only has to look at the World Wide Web and enter a key word such as anaesthesia to see how many sites are available. The amount of information contained within each of these sites is enormous. When this is considered against the background of the increasing number of courses available and the number of hours available to our trainees to learn it is mind boggling. Therefore it is critical that their formal learning opportunities are maximized. When I ask trainees what they want to learn about teaching they invariably ask for guidance on giving lectures and running small groups. Despite the widespread use of both methods of teaching there are still many examples of these being used poorly or inappropriately. This is why these topics are both included in this issue of the journal. In both cases they give a good solid and practical introduction to those readers who are beginning to use these approaches. At the same time they act as valuable aide memoirs to the more experienced. Lectures still form the basis of much of our formal postgraduate training, whether this is in the form of a full 1h lecture or a small 5 min didactic presentation.The un-
derlying principles of delivering at either end of this spectrum are the same. Goodwin bases the approach on sound educational principles. Furthermore, many common sense ideas of how to make one’s delivery more effective are included, as are tips for both novices and more experienced lecturers. Price starts her article on small group teaching by considering the principles of how adults learn. This educational theory underpins the value of small groups and how they can be used to facilitate learning. There is an overview of the different types of small groups and suggests when each may be put to effective use. She emphasizes the importance of planning, as with any educational encounter, and the qualities required of a good facilitator. She concludes that while this is a particularly challenging approach to teaching the effort is worthwhile. One of the recent introductions into medical education has been the use of professional portfolios. Greaves and Gupta introduce their article with a clear def|nition of a portfolio as ‘acollection ofmaterialscollectedbyalearner that, in their judgement, exemplify the breadth and quality of their performance’. They consider what types of materials can be included in a portfolio and commend it as a way of aiding doctors to plan their continuing professional development. However, they advise caution in the use of portfolios for summative assessment as their educational value may be diluted. One of the down sides of the changes in structure has been the apparent increase in ‘problem trainees’. Whether this is a real increase or the system is now identifying doctors with diff|culties at an earlier stage in their careers waits to be seen. Cooper places the management of problem trainees f|rmly within the framework of educational supervision and assessment. She emphasizes the importance of identifying these trainees early. One of the diff|culty aspects is to separate those trainees with temporary problems from those with permanent problems. Perhaps the most challenging is identifying the trainee who is unsuited to a career in anaesthesia and then managing the situation sensitively.
c 2003 Published by Elsevier Ltd. doi:10.1016/S0953-7112(03)00106 - 6
EDITORIAL
Complexities of anaesthetic training in the UK Michael Clapham University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
There have been large changes in the organization and delivery of anaesthetic training within the UK in the last few years. There is now real structure to the training programme that is based on the teaching and assessment of competencies.This has been achieved from two directions. One has been by quality guidance from above by Royal College of Anaesthetists. The second and equally important has been the hard work at the coal face by those anaesthetists who deliver the training. This has been particularly challenging because this change has been achieved against a background of decreasing numbers of hours each week spent in training and a shortened time for training. The people responsible for delivering the teaching are already busy clinicians who have increasing demands placed on their time due to increase in their clinical workload.These demands produce many tensions and stresses. A further confounding issue is the ever increasing amount of knowledge and facts that are generated and need to be considered. One only has to look at the World Wide Web and enter a key word such as anaesthesia to see how many sites are available. The amount of information contained within each of these sites is enormous. When this is considered against the background of the increasing number of courses available and the number of hours available to our trainees to learn it is mind boggling. Therefore it is critical that their formal learning opportunities are maximized. When I ask trainees what they want to learn about teaching they invariably ask for guidance on giving lectures and running small groups. Despite the widespread use of both methods of teaching there are still many examples of these being used poorly or inappropriately. This is why these topics are both included in this issue of the journal. In both cases they give a good solid and practical introduction to those readers who are beginning to use these approaches. At the same time they act as valuable aide memoirs to the more experienced. Lectures still form the basis of much of our formal postgraduate training, whether this is in the form of a full 1h lecture or a small 5 min didactic presentation.The un-
derlying principles of delivering at either end of this spectrum are the same. Goodwin bases the approach on sound educational principles. Furthermore, many common sense ideas of how to make one’s delivery more effective are included, as are tips for both novices and more experienced lecturers. Price starts her article on small group teaching by considering the principles of how adults learn. This educational theory underpins the value of small groups and how they can be used to facilitate learning. There is an overview of the different types of small groups and suggests when each may be put to effective use. She emphasizes the importance of planning, as with any educational encounter, and the qualities required of a good facilitator. She concludes that while this is a particularly challenging approach to teaching the effort is worthwhile. One of the recent introductions into medical education has been the use of professional portfolios. Greaves and Gupta introduce their article with a clear def|nition of a portfolio as ‘acollection ofmaterialscollectedbyalearner that, in their judgement, exemplify the breadth and quality of their performance’. They consider what types of materials can be included in a portfolio and commend it as a way of aiding doctors to plan their continuing professional development. However, they advise caution in the use of portfolios for summative assessment as their educational value may be diluted. One of the down sides of the changes in structure has been the apparent increase in ‘problem trainees’. Whether this is a real increase or the system is now identifying doctors with diff|culties at an earlier stage in their careers waits to be seen. Cooper places the management of problem trainees f|rmly within the framework of educational supervision and assessment. She emphasizes the importance of identifying these trainees early. One of the diff|culty aspects is to separate those trainees with temporary problems from those with permanent problems. Perhaps the most challenging is identifying the trainee who is unsuited to a career in anaesthesia and then managing the situation sensitively.