Surgery is a “full-contact sport” with the learning being both physically and mentally demanding. A surgical educator must appreciate this unique characteristic and be sensitive to the emotional toll it takes on the learner. During these difficult times an effective clinical teacher must be able to find the intrinsic motivation that each student has to elevate his or her performance. The teacher must also provide energy, enthusiasm and even humor in order to reinvigorate the learner and keep them in the game. At the level of graduate medical education, the learner is much like a talented athlete. They are self-motivated and seek out progressively greater challenges. Unfortunately, many learners do not fully understand their maximal potential and frequently underestimate it. The teacher must work to improve an individual’s understanding of this potential and the importance of fully exploiting it. As adult learners, medical training needs to satisfy the minimal requirements for graduation but must also be tailored to meet the individual’s future professional goals. Once these goals are developed and an understanding of their potential is achieved, the student and the teacher need to build a mutual partnership that will push the limits of the student’s knowledge, skills and abilities. At times the student may not be comfortable being pushed this hard and it is the teacher’s responsibility to maintain a challenging, but not abusive learning environment. To avoid confusion and personality conflicts, educational expectations need to be reasonable, clearly stated in advance, and frequently reinforced. To avoid the negative connotations of a master or slave driver, an effective teacher must be able to balance being demanding with being respectful, and insistence on excellence with the realities of human frailties. Students must feel that achieving their maximal potential is an objective the teacher also shares.
Training residents in surgery is fundamentally different than almost any other educational endeavor. To begin, the surgical educator is not only a coach but is in fact a player-coach, who must be able to provide effective teaching about surgical disease while simultaneously not jeopardizing the patient’s well-being. This is probably the most challenging aspect of surgical education. It requires the educator to fully understand the nature of the clinical problem while at the same time comprehend the learner’s abilities. In order for the student or resident to progress, the educator has to be able to relinquish control but not the responsibility for the patient. The second way clinical teaching is different is that the number, types and acuity of patients being evaluated at any given is constantly changing. This inherent variability requires the effective clinical teacher to be flexible, innovative and knowledgeable in the full spectrum of surgical disease. Under these conditions there is no time to develop a comprehensive lesson plan and the educator must be able to present an up-to-date, accurate, organized approach to a wide variety of problems. The clinical situation does not excuse poor quality teaching or teaching material that is wrong or outdated.
Finally, my greatest accomplishment is watching students and residents become successful at the next level. Being an effective teacher is not about being a master, a slave driver or even popular for that matter. It is about coaching the learner to their highest level of performance that will have a positive and lasting effect in the future.
- P.J. Schenarts, MD, FACS