A #meded Ronin: Do You Teach Outside The Lines?

By Damian Roland

Dr. Donald Freeman is one of the few remaining general clinicians left at The Maidhup General Hospital. In a time of increasing super-specialisation, “The Don” still leads clinics that include patients with problems ranging from headache to hiccoughs. The Don was one of the first physicians employed by the hospital when it opened 35 years ago and he has performed many management roles. However, his blunt, honest style started to grate with the executive committee and he now concentrates solely on clinical practice.

 He is famous at the local university amongst the medical students. They speak affectionately of being “Don’d,” which describes his special way of being able to gently chastise lack of knowledge without being derogatory or belittling. His lectures are consistently highly rated, yet the university struggles with his lack of engagement with objective setting, diary planning and examination invigilating. Where possible he still uses chalk and a board and has somehow managed to avoid being recorded for any of the university’s lecture repositories. He shuns both social media and the hugely expensive bespoke learning platform that was designed specifically for tutors to engage with students. He has been voted clinical teacher of the year for 3 out of the past 5 years.

The ronin were samurai warriors in feudal Japan who became outcasts due to their own indiscretions or the death of their masters. The fact that they were samurai, and the association with a major Hollywood title of the same name has given them a slightly mythical and potentially revered quality. The term actually means ‘wave man’ and is associated with being a drifter. Many ronin unable to access honourable work turned to crime or eventually became vagrants.

I prefer the use of ronin as a ‘rogue’ warrior – someone with immense skill and flair, but who operates outside of normal convention. My suspicion is that there are ‘Dons’ in every hospital. These ‘educational’ ronin do not tow traditional faculty lines yet they have a huge impact on the education of students and doctors. Educational ronin can be extremely challenging for directors of education or faculty leads. They create a tension between role modeling professional values (it is usually very apparent to the students that ‘the Don’ doesn’t play ball with the medical school) and allowing the creative freedom in pedagogy that all institutions who deliver curriculum need.

I have previously talked on #meded #donoharm  bemoaning the fact that we don’t really have a list of education interventions or methodologies to avoid. This makes it easy for educators who get positive feedback from their students (regardless of their overall outcomes) to remain unchallenged about their practices. But are educational ronin such a bad thing? In fact is it useful to have rogues pushing the boundaries and potentially raising others faculties games? Allowing dyscompetent physicians through the system has been has been cited as breaking our commitment to patients, but educational ronin are not necessarily dyscompetent educators.

In what ways may you be considered an educational ronin?  And, are you going to do anything about it?

Thanks to @ketaminh who I think first coined the term educational ronin.