A study in progress

C. Ruth Wilson

To hold him who has taught me this art as equal to my parents … and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

Hippocratic oath

The Hippocratic oath enjoins us to be teachers. And there is clearly scope for teachers in Canada, with overall 9000 Canadians currently enrolled in Canadian medical schools and more than 1900 family medicine residents in the country. The call for expanded medical school enrolments to meet the shortage of physicians has increased the need for educators in this country even more.

The College of Family Physicians of Canada has supported teachers through its Section of Teachers of Family Medicine, which has been in existence since 1978. From that time, the Section has grown to 1000 members and includes physician and nonphysician teachers of family medicine. The largest activity of this Section is the Annual Workshop, which focuses on faculty development. It is held during the Family Medicine Forum. This meeting consists of many small group seminars and workshops directed toward enhancing teachers’ skills. In addition, a regular newsletter and a number of excellent resources for teachers are posted on the Section of Teachers portion of the College’s website.

These are challenging times for teachers. Many are in the midst of change and renewal in their own practice environments, incorporating electronic medical records and negotiating new roles with other health care professionals as the primary care team expands, as well as feeling the pressure of the unmet needs of those individuals who do not have family physicians. Stressed or unhappy preceptors send loaded messages to medical students about future career choices; conversely, a teacher who is a shining exemplar of all that is best in our discipline can have a profound effect on future family physicians.

Greener pastures

University-based and community-based teachers tend to look at each others’ lives somewhat enviously. University teachers covet the wealth of experiential learning that community-based teachers are able to offer their students—a rich, “real world” environment, where motivated learners can almost teach themselves. As Osler said, “Do not listen by day to that which you can profitably read by night”—a strong admonition in favour of experiential learning followed by critical reflection. The community is also an ideal place to learn Virchow’s principle: “All diseases have two causes; one is pathological, the other is political.” The community-based nature of family practice allows learners to discover this precept about the broad determinants of health for themselves.

Community teachers, on the other hand, imagine the luxury of having time to read, write, and research, which university-based teachers are able to do. Having worked in both environments, I can testify that each setting has its rewards and its challenges like anything else. Community-based teachers are sometimes poorly remunerated and poorly supported in their important work; university-based teachers have the seemingly never-ending pressure of patient care being dependent on their scholarly activities. All of us, as family medicine teachers, are responding to the increased numbers of international medical graduates in our system, who varyingly challenge our comfortable teaching routines.

So be it

If, then, we need cadres of happy, fulfilled, and effective teachers for our discipline, well remunerated and well supported, what is the ultimate motivation to be? The motto of our college, “In study lies our strength,” gives the answer. Acquiring new knowledge for its own sake and for the sake of the patient care we provide makes us part of a community of lifelong learners. Teaching, in my own experience, is the single best guarantee that we will make ourselves members of that community.