BRIEF COMMUNICATION Year : 2022  |  Volume : 35  |  Issue : 1  |  Page : 16-19

Clinicians' perceptions of medical student teaching in a tertiary hospital

Nick S R Lan1, Sana Nasim2, Seng Khee Gan3, Gerard T Chew4
1 Department of Internal Medicine, Medical School, The University of Western Australia; Postgraduate Medical Education Department, Royal Perth Hospital; Department of Cardiology, Fiona Stanley Hospital, Australia
2 Department of Internal Medicine, Medical School, The University of Western Australia, Australia; Postgraduate Medical Education Department; Department of Trauma Surgery, Royal Perth Hospital, Australia
3 Department of Internal Medicine, Medical School, The University of Western Australia; Department of Endocrinology and Diabetes, Royal Perth Hospital, Australia
4 Department of Internal Medicine, Medical School, The University of Western Australia; Department of Endocrinology and Diabetes, Royal Perth Hospital; Department of Internal Medicine, Royal Perth Hospital, Australia

Date of Submission05-Aug-2021Date of Decision01-Aug-2022Date of Acceptance03-Aug-2022Date of Web Publication29-Sep-2022

Correspondence Address:
Nick S R Lan
Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150
Australia

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/efh.efh_312_21

Background: Medical student placements in teaching hospitals are a cornerstone for gaining clinical experience. However, the ever-evolving nature of health care has also changed the delivery of student education. Few studies have examined clinicians' perspectives toward teaching students in this setting. We sought to explore the attitudes of clinicians involved in teaching medical students at an Australian tertiary hospital. Methods: Clinicians were invited by email to complete an anonymous online survey developed using a combination of questions from previously validated surveys. The questions utilized 5-point Likert scale statements and were based around the themes of “personal purpose and enjoyment of teaching” and “barriers and challenges to teaching.” Results for each question are presented as frequency and percentage. Results: Of 490 invited, 67 (13.7%) consultant clinicians from various specialties responded. The majority (>92%) enjoy teaching and see it as part of their work. However, approximately half thought that medical student teaching was under-recognized and half did not have adequate time to teach due to workload. Approximately 60% responded that there was insufficient time to get to know students to provide feedback and approximately 40% indicated that the scope of student knowledge and desired outcomes are not clearly defined by medical schools. Discussion: Our contemporary survey identifies modifiable factors which should be targeted. If these factors are addressed successfully, it may allow the hospital and university medical school to harness the valuable resource of clinical teachers. This could enhance the medical student experience and promote a culture of teaching and learning in hospitals.

Keywords: Education, medical, perceptions, students, survey

How to cite this article:
Lan NS, Nasim S, Gan SK, Chew GT. Clinicians' perceptions of medical student teaching in a tertiary hospital. Educ Health 2022;35:16-9
  Background 

Hospital placements are a cornerstone of medical student teaching and learning, enabling students to gain invaluable clinical experience in preparation for future medical practice.[1] In hospitals, medical student education is generally delivered by clinical staff as part of their professional obligations and responsibilities, and not just by those with academic positions within university medical schools. Unfortunately, the ever-evolving and dynamic nature of contemporary health care poses increasing challenges for clinical education and training. Increased workload pressures, such as greater patient numbers, more complex and acutely unwell patients, escalating service demands, and training of postgraduate/junior doctors, can reduce the time and resources clinicians have available for medical student teaching.[1] In addition, higher medical student numbers and shorter placement rotations can impact negatively on student–teacher and student–patient continuity.[1]

In this environment, support from the medical school and hospital for ongoing teaching undertaken by clinicians is crucial. However, there often exists an administrative divide between medical schools and hospitals that can hinder communication between the organizations. Moreover, hospital clinicians often believe that medical student teaching lacks financial support compared with patient care and research,[2],[3],[4] and clinicians may not feel (or be) adequately trained, resourced, prepared, or confident to teach and mentor students.[2] Changes to medical school curricula can result in clinicians being unclear about learning needs or expectations of medical students.[2],[3] This underscores the importance of the symbiotic relationship between the university and hospital in facilitating an integrated clinical environment and culture of teaching and collaboration.[4]

Despite many studies evaluating medical student experiences in tertiary hospitals,[5],[6] there is very little contemporary research examining clinicians' perspectives toward teaching students.[3] Therefore, we explored the attitudes and experiences of consultant clinicians involved in medical student teaching in order to identify modifiable barriers that could be targeted to improve the clinical teaching and learning experience.

  Methods 

With institutional approval (GEKO Quality Audit: 39083), we conducted a cross-sectional survey of consultant clinicians in an Australian tertiary hospital over the period of December 10, 2020–January 19, 2021. The hospital is a 450-bed tertiary teaching hospital that receives students from three university medical schools for clinical placements across various year groups. Each university coordinates clinical placements with the hospital, as there is no dedicated clinical school at the hospital. We developed the online survey using a combination of questionnaire items from published validated surveys, and hosted it via SurveyMonkey (SVMK Inc.), accessible by weblink.[3],[7],[8]

Consultant clinicians of all specialties (n = 490) were invited by email from the hospital executive team to participate in the survey, with the assurance that their participation was anonymous. The survey comprised 4 initial questions regarding demographic details, 17 questionnaire items comprising statements rated using a 5-point Likert scale (”strongly agree,” “agree,” “neither agree or disagree,” “disagree,” and “strongly disagree,” with “not applicable” if required), and a final free-text question for comments. The questionnaire items were based around the themes of “personal purpose and enjoyment of teaching” and “barriers and challenges to teaching,” the latter subdivided into “hospital factors” and “university factors.” Descriptive data for each questionnaire item response are presented as frequency count and percentage of the total number of responses.

  Results 

Of 490 clinicians invited, 67 (13.7%) completed the survey. Respondents represented a wide variety of specialties, the most common being emergency medicine (14.9%), radiology (11.9%), internal medicine (10.4%), and general or trauma surgery (9.0%) [Table 1]. Over two-thirds worked full-time at the hospital (68.2%), or held a position with a university medical school (67.2%). Survey results are shown in [Table 2].

Almost all (>92%) respondents strongly agreed/agreed with the statements: “I enjoy clinical teaching,” “I am confident to teach,” and “I see the teaching of medical students as part of my work commitments.” While a quarter (25.7%) strongly agreed/agreed that: “Medical student teaching is sufficiently valued in the current work environment,” over half (51.5%) disagreed/strongly disagreed. Likewise, few (13.4%) strongly agreed/agreed that: “Medical student teachers are sufficiently recognised in the current work environment,” whereas the majority (58.3%) disagreed/strongly disagreed.

More than half (53.0%) of respondents disagreed/strongly disagreed with the statement: “I have the time to prepare adequately for teaching medical students,” and 35%–45% disagreed/strongly disagreed with the statements: “I have sufficient time to teach medical students on the wards,” “I have sufficient time to teach medical students in the clinic,” and “I have sufficient time to teach medical students with my administrative work” (if participants who responded “not applicable” were excluded, this increased to 47%–53%). Moreover, greater than half (53.0%) disagreed/strongly disagreed that “Medical student teaching activities are appropriately resourced.”

The same proportions (28.8%) of respondents agreed with, or were equivocal regarding the statement: “I am given sufficient information about medical students before I meet them,” whereas a greater proportion (41.0%) disagreed/strongly disagreed. A similar proportion (40.6%) disagreed/strongly disagreed with the statement: “I have received sufficient guidance with regard to what medical students need to know,” compared with 21.9% who agreed, and 32.8% who were equivocal.

The majority (58%–63%) disagreed/strongly disagreed with the statements: “Sufficient time is available to get to know the medical students I am teaching” and “I have sufficient time and opportunity to provide adequate feedback to medical students on their progress.” Moreover, most (71.2%) disagreed/strongly disagreed with the statement: “I have received feedback of my teaching to medical students.”

Overall, 26 (38.8%) comments were received. Select examples are shown in [Table 3].

  Discussion 

Almost all the clinicians surveyed at our tertiary university teaching hospital enjoy teaching, are confident to teach, and regard teaching as part of their work commitments. However, medical student teaching was perceived to be undervalued, and most felt that their roles as teachers are under-recognized. In addition, many reported that they did not have sufficient time to prepare for or deliver teaching and were not resourced, and most did not receive feedback regarding their teaching. Furthermore, many clinicians felt that they did not receive sufficient guidance regarding student learning objectives, and most indicated that there was insufficient time to get to know students and provide feedback, which is an essential part of the teaching and learning process.[9] Therefore, there appears to be a mismatch between the expectations of university medical schools, the hospital, and clinical teachers.

Our contemporary results echo those of previous studies around the world, some dating back several years, suggesting that despite high levels of goodwill and enthusiasm among clinicians, there remain ongoing challenges in addressing established barriers to medical student education.[3],[4],[7],[8] Potential mitigation strategies would need to target a variety of curricular (e.g., learning needs/objectives), cultural (e.g., student/teacher attitudes and institutional support), and environmental/financial (e.g., time, resources/funding, and service commitments) factors.[2] Our results support the implementation of previous recommendations, such as the need to “recognise and reward excellence in teaching and educational scholarship and hold faculty accountable for the quality and amount of teaching,” “allocate adequate space, budgets for supplies, professional resources, equipment, and compensation to optimize the overall teaching and training,” and “build systems into the curriculum that will increase patient–learner and teacher–learner relationships.”[2] Importantly, strategies need to be facilitated by enhanced collaboration, communication and coordination between university medical school educators/administration, like-minded hospital executives/administration, and committed “coal-face” clinicians who are prepared and willing to champion clinical education.

This broader “clinical education coordination” could be supported by dedicated clinical staff in a liaison role between the university and hospital, who engage with and advocate for their clinician colleagues, to enable effective delivery of clinical teaching aligned with the requirements of the medical school curricula. With their clinician perspective, they would be well-positioned to work with the university to review and reform traditional clinical teaching methods, and perhaps develop innovative workplace-based models of teaching delivery more aligned with, and integrated within, clinical workflows that can enable clinicians to more efficiently meet both their clinical and teaching commitments. Their role could also involve raising the profile and importance of education among clinicians, and promoting greater recognition of the valuable contribution of clinical teachers, thereby cultivating a positive collaborative culture of integrated clinical teaching between the hospital and university.

Our study was limited by its small sample size, and we only surveyed consultant clinicians in one hospital. Surveys inherently rely on subjective information provided by respondents, and may be subject to participation bias (e.g., those more interested in teaching may be more likely to participate). Since this survey was anonymous, it is hoped that respondents were able to answer the questions truthfully and freely.

  Conclusion 

Our survey results, which uniquely emphasize the clinicians' perception of medical student teaching, do reveal that clinical teachers, by in large, are enthusiastic about teaching, but their ability to do so is hampered by time and resource constraints, coordination issues between the university and hospital, and general under-recognition of their contribution. If some of these factors were able to be addressed successfully in future work, it would allow both the hospital and university to harness this valuable resource of clinical teachers to enhance the medical student experience and promote an integrated teaching and learning culture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Ash JK, Walters LK, Prideaux DJ, Wilson IG. The context of clinical teaching and learning in Australia. Med J Aust 2012;196:475.  
    2.DaRosa DA, Skeff K, Friedland JA, Coburn M, Cox S, Pollart S, et al. Barriers to effective teaching. Acad Med 2011;86:453-9.  
    3.Hendry RG, Kawai GK, Moody WE, Sheppard JE, Smith LC, Richardson M, et al. Consultant attitudes to undertaking undergraduate teaching duties: Perspectives from hospitals serving a large medical school. Med Educ 2005;39:1129-39.  
    4.Seabrook MA. Medical teachers' concerns about the clinical teaching context. Med Educ 2003;37:213-22.  
    5.Stark P. Teaching and learning in the clinical setting: A qualitative study of the perceptions of students and teachers. Med Educ 2003;37:975-82.  
    6.Parry J, Mathers J, Al-Fares A, Mohammad M, Nandakumar M, Tsivos D. Hostile teaching hospitals and friendly district general hospitals: Final year students' views on clinical attachment locations. Med Educ 2002;36:1131-41.  
    7.Norman RI, Dogra N. A survey of the practice and experience of clinical educators in UK secondary care. BMC Med Educ 2014;14:229.  
    8.Schiekirka-Schwake S, Anders S, von Steinbüchel N, Becker JC, Raupach T. Facilitators of high-quality teaching in medical school: Findings from a nation-wide survey among clinical teachers. BMC Med Educ 2017;17:178.  
    9.Bing-You R, Hayes V, Varaklis K, Trowbridge R, Kemp H, McKelvy D. Feedback for learners in medical education: What is known? A scoping review. Acad Med 2017;92:1346-54.  
    

 
 

  [Table 1], [Table 2], [Table 3]