British Jorrrnal of Medical Education, 1975, 9, 291-293
Role of Canadian family medicine teacher in continuing medical education G.
D. H. McQUITTYI University of Calgary
Key words MEDICAL, CONTlNUING FAMILY PRACTICE/ ‘educ PHYSICIANS, ‘EDUCATION, INTERNSHIP AND RESIDENCY FACULTY, MEDICAL ROLE ALBERTA
In writing a paper such as this it is usual to start by reviewing the past and then proceed to project how the role will develop in the future. This is difficult to do because the family medicine teacher only recently appeared on the scene. When he appeared he had no wellestablished discipline to serve as a firm foundation. Instead he found himself a pioneer, going into unknown country and having to improvise and develop as he went along. His efforts were dispersed; but he quickly won a place as a teacher of undergraduate medical students and a rapidly expanding role preparing graduate students for their entry into family practice. I n both areas he quickly developed skills and expertise and somewhat to his astonishment established a reputation as an excellent teacher at all levels of undergraduate and graduate education. When one considers his role as a primary care physician it is not surprising that he has done so well. The word ‘doctor’ is derived from the Greek word for teacher and the competent family physician always spent a large part of his career ‘teaching’ his patients to overcome or live with their problems. In his daily dealings with them he acquired a skill in communicating and explaining to them the mechanisms that were affecting their mental or bodily well being.
FAMILY
TEACHING
early to recognize the need for good programmes. In order to emphasize and ensure the importance of continuing medical education it made continuing medical education a condition for membership in or certification by the College. (Members and certificants are required to accumulate a certain number of study credits each year.) The responsibility for setting u p and running continuing medical education courses for family physicians has been carried largely by physicians in the community under the auspices of the College of Family Physicians of Canada. Practising physicians are. however, beginning to look more and more to the family medicine programmes for guidance and help in this task.
When I started to consider our role I looked to see if there was any way I could simplify and diagrammatically represent the education needs of the family physician. Education, we have been told, is the process of bringing about a change in the behaviour, skills, knowledge, and comprehension of an individual. For the educational process to occur it is necessary to receive input through one of the senses. The two main input pathways are sound and sight, with touch and smell and taste playing a much smaller part. Usually a combined audiovisual input ensures the best reception. Because I I n the continuing medical education field the personally respond to and enjoy visual stimuli College of Family Physicians of Canada was more than auditory stimuli, I have tried to illustrate graphically the educational processes affecting a family physician. Knowledge is ‘Requests for reprints to Dr G . D. H. McQuitty, initially received by the student in a mirrored Division of Family Practice, Faculty of Medicine, form. That is. he reads or hears about knowUniversity of Calgary, 2920, 24 Avenue N.W., ledge which has been acquired by other people. Calgary, Alberta, Canada T 2 N 1N4. 29 1
G.I). H . McQriitfy
292
importance of accelerating this process medical school by increasing patient contacl and using more comprehensible methods sucl as systems teaching. When the newly qualifie, physician goes out into practice. compreher. sion, experience, and in some cases, additional reading, all work to convert the ‘referred knowledge’ through ‘rectified knowledge’ into ‘practice ability’. However, these are not the only factors at work. Referred knowledge rectified knowledge, and practical ability are a, Transmutation of “referred tnowledqe”(A) ro‘proctice ability” subject to decay. Probably the greatest decay srepl>; Co 9nition rate occurs in ‘referred knowledge’ which is not used, and the next greatest in ‘rectified knowledge’. ‘Practice ability’ suffers the least decay Referred knowledqe Recti fled knowledqe because it is used regularly. In some cases the quality if not the quantity of ‘practice ability’ Step 2 + k i e n c e x continues to increase throughout the physician’s career. Having described the natural history of these processes let us look at the effect of Fig. 1. intervention at various stages of the physician’s career. First, in the undergraduate years: in Having produced these symbols I crave in- this area progressive medical schools are dulgence while I follow their evolution from developing methods to convert the ‘referred the time of a physician’s entry into medical knowledge’ into the ‘rectified knowledge’ and school up to the time when he retires from then into ‘practice ability’. The use of systems medical practice. Fig. 2 traces the natural teaching speeds up the conversion because the history of education at a traditional medical student has to comprehend and logically think school. It shows the student during his under- out what he learns. The early introduction to graduate years acquiring a considerable and patients acts as a catalyst in the conversion of ever-increasing amount of ‘referred knowledge’, ‘referred knowledge’ and ‘rectified knowledge’ some of which by the process of comprehension into ‘practice ability’. But even with these and thinking he gradually converts to ‘rectified advantages, when he finishes his undergraduate knowledge’, and even developing a little ‘prac- career, the new physician’s knowledge consists tice ability’. Already some of the more largely of ‘referred knowledge’. I believe the advanced medical schools have recognized the main function of postgraduate family practice programmes is to speed up the mutation of knowledge to ‘practice ability’. There will also be opportunities to increase the amount of referred knowledge but this must never become the main objective of programmes. Fig. 3 illustrates the situation.
Later, as a result of personal experience or reasoning processes the knowledge becomes rectified from a mirror image to a true image. I therefore represent, ‘referred knowledge’, by a mirror image of K and ‘rectified knowledge’ by K. When the two are put together they produce a symbol which I have taken the liberty of calling ‘practice ability’. Fig. 1 illustrates this process.
-K
>I
My diagrams show what is needed in continuing medical education. In the early part of the curve there is still plenty of ‘referred knowledge’, knowledge that can be converted into ‘practice ability’, but as time goes on decay of knowledge first slows down the increase in ‘practice ability’ and eventually because of the out-dating of knowledge may cause a decline in ‘practice ability’.
Role of Canadian fc imiiy medicine teacher 30
25
’
‘* 20 L
=
15
3
10
’
5 X Practice ability 1
5
10
15
20
25
30
35
40
45
Career years
Fig. 3. Levels of practice ability and age.
In an ideal situation the practising physician should secure a revitalization of his supplies of ‘referred knowledge’. If this is delivered in a comprehensible manner he may even simultaneously achieve conversion to ‘rectified knowledge’. Most practising physicians become adept at converting the two types of knowledge to ‘practice ability’. Defining what the teaching physician needs has not defined what the role of the teacher of family medicine in continuing medical education should be. Mostly, I feel his role is to make available to the practising physician regular doses of intelligible and upto-date ‘referred knowledge’. I am sure that the experienced practising family physician can expertly complete the cycle. However, I have ignored the important gap between ordering a prescription and ensured compliance. One way to aid compliance is involvement. I would suggest development of the ‘expanded university’. Teaching centres in the past were places dedicated to knowledge and learning where wise men lived a leisurely and scholarly life. This may still be the concept in many places but I would like to see a breaking down of physical limits which identify teaching centres. One of the paradoxes of education has always
293
been that the teacher learns more than the student he tries to’ teach. It seems that the establishment of a symbiotic system where the undergraduate and graduate student and the practising physician combined to form the ‘expanded university’ has much to commend it. The University of Calgary, Department of Family Practice, believes such a system pays dividends. We lind practising ’physicians can aid students at all levels in the conversion of ‘referred knowledge’ and ‘rectified knowledge’ into ‘practice ability’. In return the practising physician receives and is stimulated to seek up-to-date knowledge. The Head of the Division of Family Practice, Dr W. M. Gibson, has arranged for clinical clerks and family practice residents to spend part of their time in practice experience in smaller communities. The educational and other benefits of this imaginative scheme, both to practising physicians and to students, have exceeded expectations and the concept is being further developed. In the future it should and must include the bringing of physicians to family practice centres and the visiting of practices by family medicine teachers.
Summary This article is an attempt to illustrate diagrammatically and analyse the continuing medical education needs of the family physician throughout his entire career. It goes on to suggest how these needs may be met and puts forward the theory of the ‘expanded university’ which would include practising physicians in the community as members of faculty. This would encourage an osmotic-like interchange of students, full-time faculty, and practising physicians. Reference Gibson, W. M. (1974). General practice and the medical student a Canadian experiment. British lorrrnal of Hospital Medicine, 561.
-
Role of Canadian family medicine teacher in continuing medical education G.
D. H. McQUITTYI University of Calgary
Key words MEDICAL, CONTlNUING FAMILY PRACTICE/ ‘educ PHYSICIANS, ‘EDUCATION, INTERNSHIP AND RESIDENCY FACULTY, MEDICAL ROLE ALBERTA
In writing a paper such as this it is usual to start by reviewing the past and then proceed to project how the role will develop in the future. This is difficult to do because the family medicine teacher only recently appeared on the scene. When he appeared he had no wellestablished discipline to serve as a firm foundation. Instead he found himself a pioneer, going into unknown country and having to improvise and develop as he went along. His efforts were dispersed; but he quickly won a place as a teacher of undergraduate medical students and a rapidly expanding role preparing graduate students for their entry into family practice. I n both areas he quickly developed skills and expertise and somewhat to his astonishment established a reputation as an excellent teacher at all levels of undergraduate and graduate education. When one considers his role as a primary care physician it is not surprising that he has done so well. The word ‘doctor’ is derived from the Greek word for teacher and the competent family physician always spent a large part of his career ‘teaching’ his patients to overcome or live with their problems. In his daily dealings with them he acquired a skill in communicating and explaining to them the mechanisms that were affecting their mental or bodily well being.
FAMILY
TEACHING
early to recognize the need for good programmes. In order to emphasize and ensure the importance of continuing medical education it made continuing medical education a condition for membership in or certification by the College. (Members and certificants are required to accumulate a certain number of study credits each year.) The responsibility for setting u p and running continuing medical education courses for family physicians has been carried largely by physicians in the community under the auspices of the College of Family Physicians of Canada. Practising physicians are. however, beginning to look more and more to the family medicine programmes for guidance and help in this task.
When I started to consider our role I looked to see if there was any way I could simplify and diagrammatically represent the education needs of the family physician. Education, we have been told, is the process of bringing about a change in the behaviour, skills, knowledge, and comprehension of an individual. For the educational process to occur it is necessary to receive input through one of the senses. The two main input pathways are sound and sight, with touch and smell and taste playing a much smaller part. Usually a combined audiovisual input ensures the best reception. Because I I n the continuing medical education field the personally respond to and enjoy visual stimuli College of Family Physicians of Canada was more than auditory stimuli, I have tried to illustrate graphically the educational processes affecting a family physician. Knowledge is ‘Requests for reprints to Dr G . D. H. McQuitty, initially received by the student in a mirrored Division of Family Practice, Faculty of Medicine, form. That is. he reads or hears about knowUniversity of Calgary, 2920, 24 Avenue N.W., ledge which has been acquired by other people. Calgary, Alberta, Canada T 2 N 1N4. 29 1
G.I). H . McQriitfy
292
importance of accelerating this process medical school by increasing patient contacl and using more comprehensible methods sucl as systems teaching. When the newly qualifie, physician goes out into practice. compreher. sion, experience, and in some cases, additional reading, all work to convert the ‘referred knowledge’ through ‘rectified knowledge’ into ‘practice ability’. However, these are not the only factors at work. Referred knowledge rectified knowledge, and practical ability are a, Transmutation of “referred tnowledqe”(A) ro‘proctice ability” subject to decay. Probably the greatest decay srepl>; Co 9nition rate occurs in ‘referred knowledge’ which is not used, and the next greatest in ‘rectified knowledge’. ‘Practice ability’ suffers the least decay Referred knowledqe Recti fled knowledqe because it is used regularly. In some cases the quality if not the quantity of ‘practice ability’ Step 2 + k i e n c e x continues to increase throughout the physician’s career. Having described the natural history of these processes let us look at the effect of Fig. 1. intervention at various stages of the physician’s career. First, in the undergraduate years: in Having produced these symbols I crave in- this area progressive medical schools are dulgence while I follow their evolution from developing methods to convert the ‘referred the time of a physician’s entry into medical knowledge’ into the ‘rectified knowledge’ and school up to the time when he retires from then into ‘practice ability’. The use of systems medical practice. Fig. 2 traces the natural teaching speeds up the conversion because the history of education at a traditional medical student has to comprehend and logically think school. It shows the student during his under- out what he learns. The early introduction to graduate years acquiring a considerable and patients acts as a catalyst in the conversion of ever-increasing amount of ‘referred knowledge’, ‘referred knowledge’ and ‘rectified knowledge’ some of which by the process of comprehension into ‘practice ability’. But even with these and thinking he gradually converts to ‘rectified advantages, when he finishes his undergraduate knowledge’, and even developing a little ‘prac- career, the new physician’s knowledge consists tice ability’. Already some of the more largely of ‘referred knowledge’. I believe the advanced medical schools have recognized the main function of postgraduate family practice programmes is to speed up the mutation of knowledge to ‘practice ability’. There will also be opportunities to increase the amount of referred knowledge but this must never become the main objective of programmes. Fig. 3 illustrates the situation.
Later, as a result of personal experience or reasoning processes the knowledge becomes rectified from a mirror image to a true image. I therefore represent, ‘referred knowledge’, by a mirror image of K and ‘rectified knowledge’ by K. When the two are put together they produce a symbol which I have taken the liberty of calling ‘practice ability’. Fig. 1 illustrates this process.
-K
>I
My diagrams show what is needed in continuing medical education. In the early part of the curve there is still plenty of ‘referred knowledge’, knowledge that can be converted into ‘practice ability’, but as time goes on decay of knowledge first slows down the increase in ‘practice ability’ and eventually because of the out-dating of knowledge may cause a decline in ‘practice ability’.
Role of Canadian fc imiiy medicine teacher 30
25
’
‘* 20 L
=
15
3
10
’
5 X Practice ability 1
5
10
15
20
25
30
35
40
45
Career years
Fig. 3. Levels of practice ability and age.
In an ideal situation the practising physician should secure a revitalization of his supplies of ‘referred knowledge’. If this is delivered in a comprehensible manner he may even simultaneously achieve conversion to ‘rectified knowledge’. Most practising physicians become adept at converting the two types of knowledge to ‘practice ability’. Defining what the teaching physician needs has not defined what the role of the teacher of family medicine in continuing medical education should be. Mostly, I feel his role is to make available to the practising physician regular doses of intelligible and upto-date ‘referred knowledge’. I am sure that the experienced practising family physician can expertly complete the cycle. However, I have ignored the important gap between ordering a prescription and ensured compliance. One way to aid compliance is involvement. I would suggest development of the ‘expanded university’. Teaching centres in the past were places dedicated to knowledge and learning where wise men lived a leisurely and scholarly life. This may still be the concept in many places but I would like to see a breaking down of physical limits which identify teaching centres. One of the paradoxes of education has always
293
been that the teacher learns more than the student he tries to’ teach. It seems that the establishment of a symbiotic system where the undergraduate and graduate student and the practising physician combined to form the ‘expanded university’ has much to commend it. The University of Calgary, Department of Family Practice, believes such a system pays dividends. We lind practising ’physicians can aid students at all levels in the conversion of ‘referred knowledge’ and ‘rectified knowledge’ into ‘practice ability’. In return the practising physician receives and is stimulated to seek up-to-date knowledge. The Head of the Division of Family Practice, Dr W. M. Gibson, has arranged for clinical clerks and family practice residents to spend part of their time in practice experience in smaller communities. The educational and other benefits of this imaginative scheme, both to practising physicians and to students, have exceeded expectations and the concept is being further developed. In the future it should and must include the bringing of physicians to family practice centres and the visiting of practices by family medicine teachers.
Summary This article is an attempt to illustrate diagrammatically and analyse the continuing medical education needs of the family physician throughout his entire career. It goes on to suggest how these needs may be met and puts forward the theory of the ‘expanded university’ which would include practising physicians in the community as members of faculty. This would encourage an osmotic-like interchange of students, full-time faculty, and practising physicians. Reference Gibson, W. M. (1974). General practice and the medical student a Canadian experiment. British lorrrnal of Hospital Medicine, 561.
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