What can initial teacher education learn from medical education?

Leah Ginnivan

Learning First’s new report, Australia’s Primary Challenge, explores why primary teachers should develop more specialist expertise and how they can do so.

This post examines another model for instilling greater content expertise in our teachers, especially during their initial teacher education.

Initial teacher education reformers often invoke the medical model of training as a framework for improving initial teacher education. But what exactly about this model applies to teaching teachers?

Practising medicine and teaching a class of schoolchildren differ in many ways. Yet both professions are based on skilled decision-making, both require practical application of academic knowledge to people with different levels of functioning. A beginning teacher might understand fractions and theories of child development, but the test is whether he knows them deeply enough to be able to help a frustrated eight-year-old make sense of a problem and choose a strategy to solve it. Similarly, a junior doctor might be able to recite the risks and benefits of an anti-clotting medication, but she won’t be judged as competent if she can’t then advise, prescribe, interpret tests and communicate with patient and their families.

Building the right kind of practical skills and academic understanding is therefore a challenge for both teacher education and medical education. Just as no doctor can learn all that must be known in a lecture theatre, expertise in teaching comes from experience. Both medical and teacher education programs are under pressure to fit more into a short few years. Both must make trade-offs about what’s essential to teach early on and what can be learned on the job.

Medical schools are widely seen to integrate this practical knowledge in a more coherent way than most teacher education programs. Although pedagogical approaches vary widely among medical schools, our understanding of what should constitute initial medical education is well defined. Every medical school in Australia must show that its graduates have the skills to “practise safely and efficiently under supervision as interns’ as well as ‘a strong foundation for lifelong learning and for further training in any branch of medicine”.

Under standards developed by the Australian Institute for Teaching and School Leadership, graduate teachers are expected to “demonstrate knowledge and understanding of the concepts, substance and structure of the content and teaching strategies of the teaching area,” as well as strategies for differentiating teaching according to student needs, among other things. Yet teachers in Australia are often unsupported in their early years of practice, and supervision is nominal. Too often, ongoing professional development is perfunctory. Most worryingly, as we show in our new report, Australia’s primary challenge, too many teachers are entering classrooms lacking a strong foundational knowledge in the subjects they are teaching.

How does medical education ensure that a junior doctor is safe to practise under supervision? Firstly, selection into medical education is rigorous. In Australia, students must demonstrate academic capacity, general reasoning ability (measured through an aptitude test) and often sit an interview to be granted admission. Many medical schools require entrants to have scientific ability, including scores on the aptitude test, and prerequisites in biomedical sciences. While selection processes are contested, attrition rates in medical school are very low in Australia (an average of 2.1 per cent a year for domestic students in the first year and 1 per cent in subsequent years). By contrast around 40 per cent of undergraduate teaching entrants will not complete their course.

In Australian medical schools, foundational knowledge is developed through a mix of lectures, practicals, and clinical exposure. Most students are given many opportunities to consolidate knowledge and skills by practising in clinical environments. Skills such as differential diagnosis are taught through group work, clinical teaching, and in a classroom or seminar setting. Generally, active clinicians have a central role in teaching, and medical schools actively foster close ties with hospitals and research institutes to create a pool of expertise for teaching staff and student mentorship.

Assessment includes both exams on basic scientific content, as well as mock physical examinations, attendance at practical sessions, portfolios demonstrating clinical reasoning, and assignments. In the Objective Structured Clinical Exam, for example, clinicians examine students on an aspect of clinical skill, for instance taking an accurate blood pressure or a drug and alcohol history from a ‘patient’ (usually an actor). The range of assessment at medical school is intended to create a richer picture of how a student is progressing.

Perhaps most importantly, medical education is never complete. Medical graduates must complete an internship year before attaining general registration with the Medical Board of Australia. Internship is a formal process involving structured teaching as well as compulsory rotations in medicine and surgical wards, and close supervision. This is generally followed by another year as a resident, before being accepted into a specialty training program, which generally lasts for two to seven years. Further education, and demonstrated mastery as judged by clinical peers, is needed to progress into senior roles. Although the calibre of clinical teaching and supervision certainly varies, the breadth and scope of experience of young doctors is intended to make it clear which areas of knowledge and skill need further development. 

In contrast, a first-year graduate teacher in a primary school is often responsible for 20 or more young students at different stages of learning. She or he may have contact with mentor teachers, but they will rarely collaborate on specific strategies and opportunities for feedback and supervision are limited. Australia’s Primary Challenge details how four high-performing systems – Finland, Hong Kong, Japan and Shanghai -- provide this kind of support for new primary school teachers.

Lastly, academic research into medical education is a thriving field, with ongoing attempts to refine what constitutes effective education both at the initial level and throughout a medical career. Despite the profound importance of teachers, we know comparatively little about the specific techniques ITE providers should employ. The good news is that revived interest in improving teacher quality means that universities, schools, and individual teachers can experiment and contribute greatly.

Classroom teaching is hard work. It should also be viewed as highly skilled work, but too often it is not. The task for educators is to emulate the medical profession and develop rigorous processes, both during teacher education and in schools, that would fully equip teachers with the skills they need to properly do their job.

Leah Ginnivan, a former associate of Learning First, is a medical student.