Utilising registrars as teachers

We have a six year long undergraduate medical course at Stellenbosch University, after which the successful candidates receive the MBChB degree. The clinical teaching takes place from the third to the sixth year and is divided into the early, mid- and late clinical phases respectively. The latter phase, the student intern phase, consists of the last 15 weeks of the fifth year with another 45 weeks in the sixth year. During this period, each student intern will rotate through Obstetrics and Gynaecology for three weeks each. Individual students join one of five clinical service groups (a firm) for the period where they will work very closely with a registrar. A registrar is a qualified doctor who is currently specialising in Obstetrics and Gynaecology. They are registered as postgraduate students. Student interns spend more than half of their time during the rotation with the registrars, much more than with the consultants. Historically, registrars were very involved with clinical teaching student interns.

Over the last few months, I have been asking student interns to complete questionnaires about their experiences in labour ward during their student intern rotation. They are asked to comment on how much they learned from their registrars. The responses varied from very enthusiastic appreciation to much more reserved “not as much as one had hoped for” to a very blunt “nothing”. Some students, where registrars changed from firms during the student’s rotation, were very aware of how much teaching depended on the individual registrar. Students clearly value good teaching. They also offer possible explanations of why some registrars are less likely to be good teachers. These reasons include perceptions that some registrars are incapable of teaching because of lack of ability or of confidence, or both.

We have never formally assessed how capable our registrars are to teach undergraduate students. The readiness of registrars to fulfil their role as tutors to undergraduate students is crucial in meeting student interns’ expectations. Readiness is task specific and in this context refers to the extent to which the registrars have the ability and the willingness to act as tutors for student interns.

Ability to teach is a function of knowledge of teaching, experience of or related to teaching and skills in teaching. Knowledge and skills do not only refer to basic pedagogic principles, but also to knowledge of and skills in the field of obstetrics and gynaecology. Recently our registrars had to write the same WebCT test as the student interns had done earlier that day. One of the registrars failed while another four had grades below 60%. It is quite clear that not all registrars are adequately equipped to teach student interns. What is less clear, is whether registrars understand what is expected from them? Other skills required from lecturers, such as proficiencies in interpersonal relationships and conflict management are also essential. It would be safe to assume that teaching experience of most newly appointed registrars are low. Proven performance, not potential, is the only test of ability. Willingness to teach, on the other hand, relates to the effort put out by individuals and is a function of confidence, commitment and motivation.

There are several reports in the literature on registrars’ role in teaching, also specific to Obstetrics and Gynaecology. They allow the reader to make some conclusions. One is that the ability to teach is a required skill for all doctors. It is also clear that some form of teaching of the teachers is required – registrars will need some formal preparation for this task. Various models have been proposed, ranging from a three month rotation to a short half day course. There are several considerations which may influence the selection of a similar course Stellenbosch University. However, the sequence of rotations of the registrars through their own course is of importance. Registrars will normally begin their careers in labour ward, where they will be responsible for student interns from the first day. Any course aimed at improvement of teaching skills will therefore have to be done early in the registrar’s career. Furthermore, the working activities of junior registrars, specifically labour ward calls, make it almost impossible to bring them together for a formal course. Ideally, this module should be available for the registrars to complete in their own time, but within a set time frame.

I am planning a course for registrars to improve their teaching skills. Given the facts above, I think that a course on WebStudies or on DC-Rom will be the best option. Any comments? If not, I will return to ask new comments on my further suggestions.

Nice day.

Wihelm.