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It has been said that “He who can, does. He who cannot, teaches.”
I have often wondered whether there is any truth behind this
frequently quoted expression, which surgical students hear from
the early days of their clinical training. To find the answer, one
must look at the origin of the phrase itself—back to the Irish
playwright George Bernard Shaw (1903). Shaw, however, was
referring to revolutionaries, not teachers. The phrase is, therefore,
used out of context.
Most of us, looking back over our training, can attribute our
choice of specialty to one or more mentors—teachers so
enthusiastic and inspirational that they instilled within us the
desire to better ourselves and thereby better serve our patients.
They taught us to think for ourselves. Most of us will also admit
that these inspiring individuals were not just devoted teachers but
had notably inquiring minds and were almost always exceptional
clinicians.
Charles H Mayo (1865-1939), one of the founders of the
internationally renowned Mayo Clinic, once said: “The safest
thing for a patient is to be in the hands of a man involved in
teaching medicine. In order to be a teacher of medicine the
doctor must always be a student.” Therefore, the next time you
hear Shaw quoted out of context, perhaps you might respond by
quoting Mayo, a man described not only as an inspirational
teacher but also as a “surgical wonder.”
Perhaps those who don’t teach it can’t do it as well as they
think. Farhad B Naini consultant in facial deformity, St George’s Hospital
and Medical School, London
There is a kernel of truth in that old chestnut "Those who can,do and those that cannot do teach".As a sports fan,I notice that almost all the great coaches were average players when they played.Whereas,the great players ,upon becoming coaches,sometimes donot understand why the game does not come as easily to their players as it did to them.Plus,the great players relied on instinct.The average player,on the other hand,relied on brains and a keen eye to squeeze every drop of talent out of themselves,so when they become coaches,these folks know the game.Where the analogy tends to veer off is this:.Usually,teaching pods do not have a mainstream practice.however,they work out of hospitals and research centers so that the general public knows that they are going to a research/experimental situation.These doctors,too,tend to have access to all the publications.They also have access to other doctors.So to recap...There is a grain of truth to this old saw..but maybe only a grain.
As an aside there is a distinct difference between what is taught and what student's learn. Education is a balance between what the teacher is willing to impart and what the student is willing to internalise. I wish I had a dollar for everytime I have heard "that is what I was taught." To be more accurate that should read "that id what I learned no matter what was taught (and sometimes inspite of what was taught)." Something which has been of concern to many over the years is the way biomechanics has been taught in podiatry schools. An editorial in Podiatry Today about a decade ago echoed these sentements with a chilling observation that often the mediocre students of biomechanics became "overnight experts" practitioners. My own research of undergraduates demonstrated no significant association between knowledge of anatomical pathomechanics and capability to undertake a physical examination of a human; whereas there was a clear significance between motivation to care for patients and the clinician's ability to conduct a biomechanical assessment. There was no relation between cognitive command of biomechanics/pathomechanics theory and motivation to treat.
I also recall a court case many years ago where the plaintive was suing for damages after a disastrous event with cryosurgery. The probe had been held next to the sikin for over half an hour and the practitioner's defense was that was what they had been taught as undergraduates. When the teacher was called as a witness and lecture material was closely examined it was found the class were clearly told to hold the probe next to the skin for approximately three to four minutes. Despite being written in the accompanying lecture notes, the student continued with the thought he said 34 minutes.
EBP now requires all practitioners keep abreast of known experience.
I do not have an eg as extreme as CK's, but am forever amazed at what we do not apaprently teach the students. I would hate to think the number of times I have been approached by clincians about us not teaching something ..... on every occasion we did actually teach it !!! ... don't figure. But as CK said, there is a big difference between teaching and learning.
One eg was a few years back, the Association used to interview a couple of new grads about their experiences in the first few months of their clinical practice .... one in particular has stuck in my mind .... one comment made by this grad was the lack of preparation we gave students in dealing with all the paperwork from DVA --- this comment was prominent in the interview .... funny thing is we get someone from the DVA to come and talk to the students about this every year and attendance is compulsory !!!! .... TM - I guess you were asleep?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Also meant to comment on the those who can't do it, teach it.
I hear those comments often and regularly say to the students that if they ever hear anyone say that, ask them what they actually know about my clinical skills. Do they really know anything about my clinical skills? As I have only been here for 7 years after moving countries, no one here has any idea what my clinical skills are like - they may be good or they may be bad --- the point I make to students is that they have no idea ---- certainly makes the person making the comment look silly.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
I can vouch for how good those clinical skills are
Think you will keep him as an associate, Mimi, as long as he behaves?
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Getting some hours up in practice off the Uni site is invaluable to maintaining current experience......the lack of volume of some types of patients at the Uni clinic is part of this discussion.....you can't show students stuff that never turns up...or in fact deal with it yourself if it never happens where you work. It's a real challenge to be good at everything...particularly if you are not naturally interested in everything.....much easier to chase what you like. I spent 5 yrs doing quite a bit of locum work expressly because I thought it would give me greater diversity of experience in a shorter time....I registrered at 39 yo so I was in a bit more of a hurry than some. I think 25 plus health centres, hospitals and private practices gave me a broader perspective than I would otherwise have had.
Tough to be a "full time" anything and keep up the breadth of your expertise. But on the other hand maybe I'm a jack of all trades and master of none.
regards Phill
Maybe its 'if you can't do it and don't understand it - have a shot at teaching it
This is a abstract from a email sent to me last week - 3rd med student
We had a module entitled "Observational Gait Analysis" and I have a few questions which I have not been able to resolve searching on Pubmed, Sportdiscus or CINAHL.
We had been taught that the toes pointing toward each other was supination, and pointing away from each other was pronation. We were also taught that this excessive pronation was the result of a tight piriformis, as this muscle controls external rotation of the leg. I have not been able to find support for this anywhere. Can anybody offer some info on this please?
In relation to sports performance: The same lecturer had also taught that supinated athletes will sprint faster than pronated athletes, which is why a pigeon would win a race with a duck.
We had a module entitled "Observational Gait Analysis" and I have a few questions which I have not been able to resolve searching on Pubmed, Sportdiscus or CINAHL.
We had been taught that the toes pointing toward each other was supination, and pointing away from each other was pronation. We were also taught that this excessive pronation was the result of a tight piriformis, as this muscle controls external rotation of the leg. I have not been able to find support for this anywhere. Can anybody offer some info on this please?
In relation to sports performance: The same lecturer had also taught that supinated athletes will sprint faster than pronated athletes, which is why a pigeon would win a race with a duck.
I too got that email; it came via biomch-l. They weren't a med student, but 3rd yr in a BSc (Hons) Sports Therapy course .... I just responded to them with a "you weren't taught very well"
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Is, I believe, a misquote. Can't find the reference but a famous general putting together a malitia of civilians and ex army combatants, said that everyone (ex army) should participate in the battle. He instructed that - Those who can (who are able to fight) do, those who can't (who are unable thru age or injury) teach (others to fight).
"Who dares to teach must never cease to learn" is a quote by John Cotton Dana and is more apt and accurate I believe.
Cheers Dave
PS Ah! I found the ref G.B. Shaw, "Maxims for Revolutionists" in
_Man and Superman_ (1903)
Those who can do (those who are able to participate / fight in the revolution do)
Those who can't teach (Those who are unable to fight can teach those who are able but not educated in the ways of fighting and revolution)
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Doing and teaching are two different skills. I have known supurb clinicians who cannot pass their skills and knowledge on very well and very average clinicians who can teach what they DO know wonderfully well!
I suspect the saying "those who can't do, teach" arises from those who, not being able to do, resort to teaching as an alternative. There are certainly a few of those about. However to suggest that this is the ONLY motivation to move from doing to teaching is absurd!
I like models. Triplanar motion is tricky to understand at best when first encountered. Trying to grasp it from biplanar paper diagrams is even harder!
In truth Robert you are indeed exceptionally gifted at sharing your knowledge.
I am always impressed by those who have the skill, talent & ability to stand before a group & talk with confidence.
Personally I am one of the group who quake at the thought of presentations etc.
(I was in a play many years ago. Emperor Jones, where I played a corpse. {starring role. Not!} I suffered from terrible stage fright which rendered me the most animated 'dead' person on stage. Alas my days of 'treading the boards' were very short lived.
I have come to the conclusion that like a true artist, the skill of teaching/presenting is an innate ability with can seldom be learned.
Just my thoughts.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
If we consider that we are in a 'practical' profession, and we are, then a balance between theoretical and practical learning is essential.
The old route to becoming a specialist, apprentice-journeyman-master, had much to commend it. Now, the time spent on theory could well be overemphasised and this results in 'teachers' being more academic then practical.
Knowing much does not mean you have the skill to put this knowledge into practice. From a book you could teach all there is to know about 'how to ride a cycle' but the chances are you`d fall off at first attempts.
I remember a fine old 'teacher' saying that he feared the move to an imbalance of theory to practice could result in spending years practicing your mistakes !
Since I trained the practical component of the course has reduced by more than half. This has mainly been economics driven.
I wonder if others have observed the change in emphasis, as I have.
Last edited by rosherville : 29th July 2008 at 06:46 AM.
I did have the opportunity to visit many educational units in several countries in the not too distant past and was able to study their currulum in depth. The core elements of all 'Commonwealth" podiatry programs remain the same, despite how these were packaged into three or four year programs. Hence I would suggest the core elements have remained unchanged since the introduction of podiatry degrees over a quarter of a century ago. One potential reason for this is the amount of program cloning which took place after the early success of pioneering educational centres who developed degree programs in the UK. A few then went onto sell their models to others institutes in the UK and elsewhere. As these programs morphed into different institutional settings they retained the common core of podiatry which has prevailed for the last century. No real evidence of radical thinking in instructional design has left the study of podiatry not that much different from the old diplomas. Granted there is more information to process.
The main problem with podiatry curriculum today is it is overstuffed with needless repetition and non essential information.
This is problem common to many vocational degrees where the predominent fear is the course does not contain enough information. Teaching time is finite which increases pressure on less able students who become dependent on remedial help from rather over-worked teaching staff. Much of this unrecognised responsibility falls to the non career academics to provide leaving their fast tracking colleagues to develop their own curriculum vitae in a short space of time. Either way this leads to high burnout in teaching.
Identifying professional competencies which has been a subsequent movement and further investigation mirrors more what has been tradtionally taught as opposed to define what needs to be taught and so the status quo in podiatry curriculum remains.
>Since I trained the practical component of the course has reduced by more than half. This has mainly been economics driven.
Now training is an interesting concept which I would suggest is a different animal entirely to education and skill development. Given a proper program, the training of a podiatrist in basic skills could be achieved in one year (or less!).
'I would suggest the core elements have remained unchanged since the introduction of podiatry degrees over a quarter of a century ago'.
I would agree with that too but how that translates out and the end of the courses at different institutions is widely varied.
My experience has been with training at post-grad level and at times it has been hard to believe that core elements have been completed, although they may be on the syllabus. There has been quite a difference between the various institutions.
'Now training is an interesting concept which I would suggest is a different animal entirely to education and skill development. Given a proper program, the training of a podiatrist in basic skills could be achieved in one year (or less!).'
That`s a very provocative statement, it could take quite a time to agree on what was meant by education, skill development and training. I would suggest that training is education and skill development combined. I would not necessarily disagree that basic skills could be taught in less than a year but whether they could be fully aquired I would doubt, they would need to be defined of course.
In my apprenticeship scenario the point of aquisition of basic skills would be half way through the traditional term (5 years). There`s a difference between being able to pass an exam, on what has been taught, and being competent to the point of being safe to let loose.
>That`s a very provocative statement, it could take quite a time to agree on what was meant by education, skill development and training.
Fortunatlely the arguments are well throdden, so I cannot claim originality but I agree it is imperative to define meaning clearly before embarking on an extended debate.
>I would suggest that training is education and skill development combined.
Most certainly to become educated would infer cognitive command of appropriate (discipline specific) information combined with a value complex (motivation and attitude), appropriate for a professional person.
In a practical based degree, mastery of psychomotor skills matched to job requirements would also be axiomatic.
Choosing the levels (cognitive, affective and psychomotor) is usuallly where parties disagree in program developments causing pressure to overstuff the curriculum. All three have equal value in my opinion but traditonal universities are more comfortable with cognitive develpment and less well equipped to propigate well defined development in affective and psychomotor areas. This is the domain of training which universities are very uncomfortable with. In the UK that element has been passed 'lock stock' to placement. In theory this is an ideal combination of education and on-site training but in reality presents many challenges, most of which are unspoken, and somewhat ironically can result in an ill defined apprentiship. Under these circumstances students might argue they graduate despite their programs.
In this reductionist model of vocational education a further error is often compounded by treating normative assessment (theory) with criterion refereenced assessment (skill aquisition). The two animals are quite different and necessitate in my humble opinion the need to separate the education from the training. Depending on the model this may be done concurrently or sequentially.
> There`s a difference between being able to pass an exam, on what has been taught, and being competent to the point of being safe to let loose.
I agree. If I am honest after thirty years in education I would ban all exams simply because to teach to the test is not a true perspective of learning. The pressure to do so is all too evident in today's institudes driven to produce graduates. I also agree no matter the test there is no substitute for experience. So I suppose I would embrace the need for life long learning.
I conducted a national study of pods in Australia a few years back to gauge the need for post basic education and the format it should take. Previoiusly I had polled pods from WA and was able to compare their responses. Respondents (had a diverse range of qualification ranging from associate diploma to undergraduate degree) were asked to rate their ability to intigrate into the job situation as new starts. Without exception all reported success and many cited their 'training' as the key factor. When asked did they feel new graduates required induction courses to enter the industry, a significant number answered in the affirmative.
Now I accept you can read many things into this but my spin would prefer there is a general fear 'new grads' are ill prepared for the job whereas it would appear the vast majority sail smoothly into vocational podiatry.
Reading your final two paragraphs and associated 'spin', I feel you would have had a fine career in the diplomatic service.
I`m informed by heads of NHS departments that new grads are not of the same level of competence as a generation ago and need supervision for a year to eighteen months before being 'safe' to let loose. A couple of heads of schools have confirmed this to me, off the record of course. I have observed this myself having had student placements and in post-grad tutoring (incl. two of your own countrymen).
Now I don`t necessarily have a problem with this as early years of employment could be regarded part of an apprenticship (but so often they are left on their own). However, the thing that worries me most is that so many believe that they are highly skilled and super competent. There is nothing wrong in not knowing, the danger is in 'not knowing that you don`t know'. This failing must be laid at the teachers, who as you say are 'driven to produce graduates', they fail to impress on students where they are up to, (perhaps they don`t know themselves).
Trying to pull together what we`ve said in relation to your 'Do those who can't do it, teach it ?' and not withstanding generalisations and the fact that there are always exceptions.
There are new pressures on teaching institutions so that all activities are primarily accountant driven, rather than in a quest for excellence. This will reflect on the balance of teaching and inevitably produce a generation of teachers with, can we say, a less than optimum balance of teaching abilities ?
My observation is not restricted to Podiatry, I now hear the same thing from medical colleagues. Where once a newly qualified practitioner valued every second with a Consultant, it is not unknown for a Consultant to be told he is wrong; when queried the answer is 'that`s what I learnt at training school'.
The danger is that you spend your professional life practicing your mistakes. This partly justifies the inexact process of appraisals and re-validation. My cynical mind suggests that the wrong people will be responsible for these processes.
Do those who can't do it, teach it?
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