Peer to Peer Education

(From the E-i-C: This post is a redux of a post from Damian’s blog:  The Rolobot Rambles)

By Damian Roland

There is a great deal written and discussed about the ‘art’ of teaching. Numerous theories, articles, strategies and anecdotes are available, but teachers (of any discipline) typically follow their own path and practice. This is not due to arrogance or cynicism (although this exists), but generally because teachers are lone practitioners. Whether by lecture or workshop, the teacher often educates alone. Feedback is available from the learners, but this is an infrequent exercise, steeped in issues of hierarchy and lack of objective mechanisms to determine poor practice. In medical education there is also a third arm, the patient, who witnesses the interplay between doctor and student but often has even less of an opportunity to have their observations taken into account.

There are two situations in which peer observation and feedback is commonly available. The first is at conferences. Powerful narrative with effective presentational style forces attendees to reflect on their own practice. But even in this setting feedback may be constrained. At conferences you are unlikely to witness anything other than a very traditional lecture vs. audience approach to education.

The other opportunity is during short, workshop-based, multi-faculty courses, such as ACLS, ATLS or PALS.  Such courses make you concentrate on good teaching practices that are easy to let slip in day-to-day un-observed practice. For example, timing is key. If you over-run, the course over-runs which is clearly apparent to the other faculty members. If you don’t know core knowledge, the students suffer, and again it will be obvious to other faculty this is the case.

I learn as much from these courses as I think the candidates do. You watch others demonstrating core material (these courses often have a prescribed format) but in subtly different ways. The best educators will enhance, but not deviate from the objectives, by using memorable cases or twists of context to clear effect. You observe how experienced faculty deal with candidates who are struggling or not engaging, and you learn the critical importance of well delivered feedback. Being able to witness good and bad teaching practice, inhibits complacency and helps you realise there are always things still to learn. (On a recent course I misinterpreted a candidate’s nervousness for over-confidence and continue to appreciate I still have work to do on the pace of my delivery.)

Taking pride in your teaching is important but there is only so much you can learn from theory and irregular feedback from participants. In an isolated world of clinical practice, the observation of others’ teaching and your own is vital for development as a Clinician Educator.