Faculty of Education - Theses
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ItemMedical teachers in Australian hospitals: knowledge, pedagogy and identity( 2013)This research aimed to generate a better understanding of the teacher identities and pedagogical perspectives of medical teachers in hospitals. The study focuses on understanding the personal theories of teaching that the teachers bring to their teaching and the ways they think about themselves as teachers. These two factors, known to affect the environments that teachers create for learners, have received little attention in medical education research. A qualitative methodology was employed featuring data collected from audio-recording twenty-five medical teachers in a range of clinical and classroom settings with medical students, as well as data from semi-structured interviews with all participating teachers. The interview and observation data were analysed and interpreted iteratively: through back and forth movements from specifics to general meanings and from the data to theory. The study found that for these teachers, teaching is about knowledge and their pedagogical role in the students gaining a particular form of knowledge. They see this knowledge as deriving from work with individual patients who cumulatively and one-by-one provide the doctor (and student) with particular knowledge that is never forgotten. The teachers also perceive that this knowledge resides in the places where practice and teaching happens. It is intricate, messy, uncertain and dynamic. Thus conceptualized, this knowledge is regarded as superior to formal (‘textbook’) knowledge which is orderly, static and appears in the form of lists and stable sets of instructions. The teachers describe their engagement in contextualising and transforming students’ formal knowledge through making links and bridges between knowledge types and knowledge sources. A second finding concerns pedagogy. The teachers in the study placed primary value on their knowledge, but emphasized and valued too the personal and interpersonal factors associated with teaching. The enjoyment in medical teaching is a reward in itself, and for some a pleasant change from the routine of clinical work. Key to that enjoyment is a preference for a connectedness with students and a commitment to pleasant and friendly interactions. In the absence of other professionalizing influences, many of the personal theories of teaching that these teachers developed when they were students persist into the present. There is a sense of teaching as a commonplace and a commonsense activity – important and pleasant but not complex or difficult. The thesis contends that this understanding is a potential obstacle to developing medical teachers’ understanding of and expertise in teaching. On identity, the study identified four elements in these teachers’ ways of thinking about themselves as teachers. Firstly, central to the ways they think about themselves as teachers is their belief that they possess a particular form of clinical knowledge that is at the heart of being a doctor. Secondly, their teacher identities are connected to the enjoyment that teaching offers and the sense of being a teacher as natural, just a part of being a doctor. Thirdly, the low status of teaching and the inferior status of medical teaching relative to research – influences how they think about themselves as teachers. Finally, the value these teachers place on their relationships with students, contrasts starkly with a sense of disconnectedness from the university. The thesis contends that these medical teachers have understandings of clinical knowledge and medical teaching that are not well appreciated in the literature or in medical education practices and discourses. This situation contributes to their feelings of being isolated – even alienated – from the university, and it also obstructs aspects of curriculum reform and affects teachers’ development as teachers. The thesis suggests a need for revitalised descriptions of the intricacies of clinical knowledge and its construction – a need to re-value the places and the patients as sources of knowledge and to re-value the teachers. A new approach to judgements about medical teaching is also required, particularly an approach based on a broad understanding of the relational and technical aspects of pedagogy. Many of these teachers would respond positively to appropriate support to develop more informed approaches to their teaching and greater technical expertise. To be useful, that support and development requires an appreciation of the culture of heroic individualism in medicine and a fundamental sensitivity to medical teachers’ values, perspectives and teacher identities.