Eliciting the learners’perspective

As a teacher of communica-tion, I seem to spend aninordinate amount of time

exhorting learners, both studentsand practising doctors, to elicit‘the patient’s perspective’. Thisinvolves asking patients abouttheir ideas (what they think isgoing on), their concerns (whatthey are worried might be goingon) and their expectations (whatthey’re imagining might be goingto happen, or what they want tohappen). A growing body of evi-dence indicates that this opensthe door to an array of usefuloutcomes: patient satisfaction,increased concordance, physicaloutcomes such as pain relief,empathy and reassurance, and

reduction of error.1 I find itperplexing that this should not beseen as an integral part of aroutine medical history. Yet, forwhatever reason, many clinicians,students and doctors alike, omitthis line of inquiry altogether.There are a number of reasons forthis: they feel they don’t have thetime; they fear they might open ‘acan of worms’, when the patientspills their heart out and theydon’t know how to respond; orthey simply don’t think it’simportant – doctor knows best,and all that. It’s an uphillstruggle.

What has all this got to dowith Issue 2, Volume 6 of The

Clinical Teacher? Well, there is atheme running through severalpapers about the analogous issueof eliciting the learner’sperspective. We start withprogramme evaluation, and twopapers that describe very differentapproaches. Iqbal and Khizarreport a study from Islamabad, asurvey of students’ views aboutthe purposes of evaluation,which, in their medical school,has the traditional and familiarformat of an end-of-term ques-tionnaire, with some interestingresults.2 The setting is one inwhich ‘Students...tend to besubmissive and still not aware oftheir rights as stakeholders in theeducation process’, reminding us

Editorial

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that much of what we do ineducation (and perhaps take forgranted) is culturally grounded.Meanwhile, Hammond and col-leagues at Hull and York, a newmedical school, describe a novelapproach they term ‘responsiveevaluation’.3 This comprisesteaching students how to evaluate(their clinical placements),including getting them to definethe criteria for evaluation, as wellas carrying it out and givingfeedback to tutors. The majorityof students reported benefits, notonly reflecting on what they aretaught, but also on how theylearn. The paper reports a pilotstudy, but the process is appar-ently now a routine part of theevaluation process at the school.

Three other papers explorelearners’ experiences in the post-graduate arena. Thompson andcolleagues from North Tynesideinterviewed a sample of juniordoctors who were possibly expe-riencing stress, as identified bythe General Health Question-naire.4 Respondents talked aboutboth immediate and long-termthreats to their well-being, citinghigh levels of responsibility andfeelings of isolation. There was afeeling that reductions in workinghours, somewhat paradoxically,had created a more intense workexperience. Stress was furthercompounded by uncertaintiesabout careers. The need for seniorsupport was highlighted, particu-larly in the early stages of the job.

The authors call for a change inculture and for organisations suchas health care trusts to introducepolicies to help doctors developeffective strategies for coping,and for managing their careers.

A doctor who is not copingwith stress may become an un-derperforming doctor. Black andWelch’s paper5 offers a perspec-tive on underperformance,describing the system for identi-fying and supporting underper-forming trainees in apostgraduate deanery. Theyemphasise the crucial importanceof ‘infrastructure’, and of earlyidentification and resolutionthrough educational interven-tions. They describe how healthand personal issues add to thecomplexity of the situation, andthat at the end of the day therewill be a small number ofinstances of serious professionalmisconduct that are not amenableto intervention. They remind usthat ‘Managing the underper-forming trainee is time consumingand complex’. The third paper,also from the North of England,6

reports a qualitative cross-specialty study looking at spe-cialist registrars’ perceptions oftheir preparedness for the role ofconsultant. The step up wasacknowledged to be challenging.One reason might be that boththe registrars and their trainerswere prioritising clinical learning(understandably) over otherdimensions of the role of

consultant, such as managementand leadership. The authorscome to the inevitable conclusionthat ‘Training in practicalaspects of management andleadership should be integratedinto training earlier allowingmore opportunities for practice,support and feedback fromsupervisors’.

John SpencerEditor in Chief

REFERENCES

1. Silverman J, Kurtz S, Draper J. Skills

for communicating with patients (2nd

edition). Radcliffe Publishing,

Oxford, 2005.

2. Iqbal M, Khizar B. Medical students’

perceptions of teaching evaluations.

The Clinical Teacher 2009; 6: 69–72

3. Hammond A, Collins C, Booth J, Kalia

S. Learning from evaluation: a

descriptive student-informed

approach. The Clinical Teacher 2009;

6: 73–78

4. Thompson N, Corbett S, Hammond L,

Welfare M, Chiappa C. Contemporary

experience of stress by Foundation

level doctors in the UK. The Clinical

Teacher 2009; 6: 83–86

5. Black D, Welch D. The underperform-

ing trainee- the concerns and the

challenge for medical educators. The

Clinical Teacher 2009; 6: 79–82

6. Morrow G, Illing J, Redfern N, Burford

B, Keegan C, Briel R. Are specialist

registrars fully prepared for the role

of consultant? The Clinical Teacher

2009;6: 87–90

66 � Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 65–66