A framework for developing excellence as a clinical educator E A Hesketh,1 G Bagnall,2 E G Buckley,3 M Friedman,1 E Goodall,4 R M Harden,1 J M Laidlaw,1 L Leighton-Beck,5 P McKinlay,6 R Newton7 & R Oughton7 The current emphasis on providing quality undergra- duate and postgraduate medical education has focused attention on the educational responsibilities of all doc- tors. There is a greater awareness of the need to train doctors as educators and courses have been set up to satisfy this need. Some courses, such as those on how to conduct appraisal, are specific to one task facing a medical educator. Other courses take a broader view and relate educational theory to practice. In this paper we describe an outcome-based approach in which competence in teaching is defined in terms of 12 learning outcomes. The framework provides a holistic approach to the roles of the teacher and supports the professionalism of teaching. Such a framework provides the basis for the development of a curriculum for teaching excellence. It helps to define important competences for different categories of teachers, communicate the areas to be addressed in a course, identify gaps in course provision, evaluate courses, as- sist in staff planning and allow individuals to assess their personal learning needs. The framework is pre- sented to encourage wider debate. Keywords Curriculum education, medical, graduate, methods education, medical, undergraduate, methods faculty, *standards *professional competence *teaching. Medical Education 2001 35:555���564 Background Recognition of the need for training the trainers The importance of providing quality undergraduate and postgraduate medical education has been recog- nized for a long time, but perhaps never more than at present, with today���s climate of increased account- ability. Recently, interest in medical education has focused on the teachers/trainers themselves and the quality of the educational experience they offer students and trainees. In 1991 a report to the Scottish Office1 recognized that: ���a major factor influencing the quality of training is the competence of the trainer as a teacher. The training needs of trainers should be recognised and met. The report suggested some aims of a staff develop- ment programme specifically for educators and trainers. Other reports by the Standing Committee on Postgra- duate Medical and Dental Education (SCOPME)2���4 and the British Medical Association (BMA)5 focused on similar issues. Recent General Medical Council (GMC) publica- tions such as The New Doctor,6 The Early Years7 and now The Doctor as Teacher,8 also focus on the doctor as a teacher/trainer. The first two publications specify the educational responsibilities of all involved in the provision of training, be they postgraduate clinical tu- tor, educational supervisor, or simply other medical staff who work with the trainee. The third draws attention to the professional and personal attributes required of doctors with responsibilities for clinical training/educational supervision. Other developments in the NHS have also led to an increased emphasis on doctors as educators. The Cal- man reforms have resulted in the reduction of the length of specialist training. This, combined with the 1Education Development Unit, Scottish Council for Postgraduate Medical and Dental Education, Dundee, UK 2West of Scotland Deanery, Glasgow, UK 3 Scottish Council for Postgraduate Medical and Dental Education, Edinburgh, UK 4 Royal College of Physicians and Surgeons of Glasgow, Glasgow, UK 5 Postgraduate Medical Department, Aberdeen, UK 6 Lister Postgraduate Institute, Edinburgh, UK 7 Postgraduate Medical Office, Dundee, UK Correspondence: Mrs E Anne Hesketh, Education Development Unit, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK Learning outcomes �� Blackwell Science Ltd MEDICAL EDUCATION 2001 35:555���564 555

New Deal, has meant that training has become shorter and must become more effective.9,10 In higher education too, as a result of recommenda- tions by Dearing11 and Garrick,12 there is now a move to require all new lecturers in the UK to complete an accredited course in teaching or to have equivalent experience. This is leading the medical profession to think in the long term about appropriate certification and accreditation for doctors involved in teaching/ training at various levels. There are also sound educational developments which underpin this increasing recognition of the need for training doctors as educators. These include: ��� an acceptance of the need for more systematic plan- ning of the learning experience ��� the move away from the ���apprenticeship��� model to experiential learning for work-based learning ��� newer approaches to teaching and learning, including the use of new technologies and simulators which require specific skills for effective usage ��� changes in assessment and appraisal techniques, including the use of a range of new performance assessment instruments ��� approaches to standard setting based on the use of reliable and valid instruments ��� recognition of the importance of education strategies to support on-the-job learning. The increase in course provision A key problem is that, for the most part, those engaged in medical training activities have little or no formal training as educators, although courses in medical education have been available for many years. Challis and colleagues,13 for example, specifically identified a need for further training and support for those involved in educational supervision. However a significant step forward has been the development of a range of courses aimed at all with an education role ��� not just the enthusiast. Many of the courses on offer have been developed in response to the well-documented, immediate needs of the trainer, e.g. courses in appraisal and assessment. Some courses are task-specific, focusing on teaching tasks such as small group teaching. Others emphasize the wider concept of teaching in clinical practice, cov- ering issues such as learner support, sensitization to the needs of individual doctors and the creation of a learning environment.14 Some courses address these issues and, for example, incorporate some learning theory as well as specific teaching tasks. Learning outcomes for the good teacher The process of teaching is sometimes distinguished from education or training. Often the three different words are used interchangeably. Many doctors and educators have strong and differing feelings with regard to the use of the terms ���teacher���, ���trainer��� and ���edu- cator���. We have adopted from this point forward the word ���teacher��� to describe the doctor���s varying educa- tion roles as used in the GMC document The Doctor as a Teacher.8 There is, however, enormous diversity in the teaching responsibilities of doctors and the skills re- quired of them. The 12 different roles of the medical teacher have been described.15 The doctors��� roles and responsibilities will depend on whether or not they have a ���formal��� teaching role, e.g. educational supervisor, in addition to their ���informal��� teaching role, e.g. con- sultant working with junior members of the health care team. The responsibilities will also depend on the position the doctor holds for that ���informal��� teaching role, e.g. whether they are a senior house officer or consultant. Added to this they will all have diverse personal qualities and characteristics which will influ- ence their approach to teaching and training. Their needs for developing their teaching skills are therefore likely to be quite different. Training provision should match these individual needs. Learning outcomes for courses on teaching should therefore be clearly stated in order that doctors can make choices appropriate to their needs.14 This paper identifies a holistic set of learning outcomes which embraces the full range of teaching competences which contribute to teaching excellence ��� one that provides a framework for the effective training of doctors as tea- chers. Outcome-based education Outcome-based education is ���a way of designing, developing, delivering and documenting instruction in terms of its intended goals and outcomes���.16 In Key learning points Competence in teaching is described in terms of a framework of 12 learning outcomes. The framework identifies the teaching tasks undertaken by doctors, how the doctor approa- ches these tasks and the professional aspects of being a teacher in the medical setting. The framework can be used to evaluate teaching skills and training provision. �� Blackwell Science Ltd MEDICAL EDUCATION 2001 35:555���564 A framework for developing excellence as a clinical educator ��� E A Hesketh et al. 556