Work-based, accredited professional education: Insights from medicine

Abstract

It is part of the professional ethic of medicine that doctors should teach fellow doctors and doctors-to-be. This chapter first explores the types of knowledge that are used in medicine and how they are assessed. Traditionally, there has been a strong emphasis on acquiring and being assessed in esoteric codified knowledge. Much of medical practice, however, depends on a very different skills set. Competency-based education has been avidly adopted in medicine in recent years because it gives an explicit place to a more applied set of skills. In an era when professions are being held more accountable to society, making professional proficiency explicit as a set of learning outcomes has been seductive to professional leaders. But the simplicity of competencies may be no more authentic than esoteric declarative knowledge. They are two different way of making the complexity of practice teachable and testable. The chapter applies Eraut’s eight trajectories of professional development (Chap. 3) to medicine and finds a close fit. Important attributes, which doctors use in practice, include personal and contextual knowledge, which defy codification and testing. The final part of the chapter considers how doctors learn to teach other doctors and finds, again, that a complex and contextualised skills-set is reduced to a set of competencies that are amenable to teaching and testing. The realities of being a doctor or teaching other people to be doctors, we conclude, lend themselves well to workplace, experiential learning, and badly to codification for the purposes of teaching and testing.