BJD Talks
The official podcast of the British Journal of Dermatology
BJD Talks
Episode 10 - Dermatology Medical Education
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Teaching and training are part of every dermatologist's working life. But what of the scholarship of education? In this episode, Dr Jonny Guckian discusses the legitimacy of MedEd as a science with Prof Mini Singh and Dr Laksha Bala, as they highlight key educational issues facing our patients, workforce and learners.
Hello everyone and welcome to BJD Talks, the official podcast of the British Journal Dermatology. This is the first episode of BJD Talks in 2023. And whilst it's all changed at the journal with a new publisher, we'll still try to continue to provide you with the best quality dermatology research. Therefore, in this podcast, we will still look beyond the published studies and explore real-world implications for dermatology research in a way that we hope to be accessible and interesting. My name is Dr. Johnny Gucky, and I'm a dermatology registrar in Leeds in the UK, as well as the BJD's Podcast Associate Editor. In this podcast, we dive into a range of issues which matter within dermatology. And this year is no different. As well as addressing important concepts within dermatology, we'll look at more topical issues, as well as trying to encourage debate within scholarship in dermatology. Medical education has a rich history across a variety of medical specialties, and dermatology is no exception. However, good medical education practice must be backed up with excellence in medical education science. So today, we're going to chat about medical education scholarship within dermatology. To do so, I'm really pleased to welcome Professor Minnie Singh, Professor of Medical Education and Consultant Dermatologist at the University of Manchester. Hi, Minnie.
SPEAKER_01Hi, thank you for inviting me.
SPEAKER_03I'd also like to welcome Dr. Lakshabala, Clinical Research Fellow in Medical Education and a general practitioner at West London. Welcome to the podcast Laksha.
SPEAKER_00Hi, Jenny. Thank you for having me.
SPEAKER_03Thank you both for joining and welcome to BJD Talks. I'd just like to ask, first of all, can you tell me a bit about your journey within medical education and dermatology?
SPEAKER_01So my journey in medical education may be regarded as a bit later in my career, but at the time it was really unusual to consider medical education as something to pursue as a doctor. So I really got into it in my final year as a registrar in dermatology. A lot of us say that we really enjoy teaching and things like that, you know, and we say that in our CVs and stuff. But actually, I was very lucky, or fate meant that one of my consultants in my medical training happened to be Tim Dornen, who many in the education world, medical education world know is a guru, international guru of medical education. And he was my consultant. And he saw that I was interested in it, asked me to do a PhD. I panicked and said, no, no, no, I want to be a dermatologist. What are you talking about? And went off and did dermatology. And then about six years later, post-children, I went, oh, Professor Dawn actually knew something in me that I didn't, and then got in touch with him, and that's how I got involved. So I did a little bit with as an honorary lecture at the University of Manchester as a registrar, and was fortunate to persuade people to let me continue that as a consultant. So 12 years later, that evolved into an academic career in medical education along with my clinical practice.
SPEAKER_03Fantastic. Thank you. What about you, Laksha?
SPEAKER_00So um my journey in medical education began when I was applying for GP training. Luckily at the time, there were academic placements in medical education available. So I applied and got one of those posts in London. And I had six months whereby I was able to explore medical education research, specifically in the primary care context at the time, but also in the undergraduate medical education context. And from there on, it's just something I absolutely loved because I think it's so empowering our ability to conduct research within education and actually make changes to the way in which we are taught and assessed. So when I finished my GP training, I took a year out as an education fellow at Imperium in London and did a certificate and then subsequently a diploma, and now a second-year PhD student in medical education at Imperial College. And I do that alongside my clinical work as a GP, whereby I've developed an interest in dermatology. And that's how the two sort of married together.
SPEAKER_03Fantastic. I love the kind of parallels, but also differences in the two journeys because it represents a lot of the experiences that you see within MedEd. You've got the connections and networks that you build and the chance interactions that we have, and just going with it and that and how that influences your career. But then also the other side of the coin, those formalized posts that are becoming more and more common. And we're seeing that with the more formalization of medical education within our kind of training continuum. And we'll talk a bit more about that, I guess, later on in the episode. One thing I wanted to chat about is that in my introduction, I mentioned excellence in medical education as a science. Like, from my personal journey as a medical educator and dermatology trainee, I've had lots of clinicians from various different backgrounds try to tell me that MedEv's not a real science. We don't need to study it, we don't need to research it. What would you guys say to the doubters?
SPEAKER_01I think that's a really interesting concept, actually, Johnny. And I think it's one, first of all, I think we should continue to challenge, but also open up people to other perspectives about the world of education. My first question is, what is science? What do you mean by the definition of science to the doubters if we sort of name that group? And then then my second question is Is the science you're talking about the same science as I'm talking about? And should it be? Does it need to be? Because actually, medical education is rooted in deep science. It happens to be probably the social sciences rather than the ones that we're trained in and still continue trained in, which is the scientific sciences. But they are all sciences and equally valid and bring so much to healthcare. To me, it's a BJD podcast, so I'm gonna say the notable change in that we have a qual qualitative section in the BJD now, which did not exist when I started as registrar. So that is a form of science that we now accept and the literature that we now accept. So I wonder if it's more a lack of familiarity rather than not valid.
SPEAKER_03Yeah, it's like suspicion and yeah, lack of recognition or something's different. Yeah.
SPEAKER_01We talked about this in a recent CD um sort of editorial with uh Alexa Shipman and I debated this. And it was really interesting when Alexa and I first um started our conversation about writing the editorial and doing a supplement which included some articles which you can be contributed to. But I think the point that we were trying to make was let's open up the space, let's include other avenues because ultimately it doesn't matter what the science is, the purpose is for the greater good of society. And I think that there's definitely space for education in that, and I think we can learn a lot from it that's going to help us with some of the ongoing challenges of what healthcare needs to deliver. Otherwise, why are we in the arena of inviting public opinion, populations, and engagement in our research work? Educational research has done that for decades because it's about the people.
SPEAKER_03Absolutely. And educational research has been going on whether we like it or not for a long time. And I think that sometimes medics, we've just been a bit late to the party. And a lot of our approaches are actually taken from what n nursing education has been doing for much longer than us. So I I think that's a kind of an interesting change. And that's actually you know your your some of the roles that you've been doing represents how that change has been taken a bit more seriously now, isn't it?
SPEAKER_00I mean, I think in my opinion, education research is a science in every respect because similar to clinical work, you identify a problem, you conduct exploration in the area, and you try and identify an evidence base to support changes in educational practice. And as Minnie said, that exploration can be, you know, within the social sciences, certainly. And it's an area that's unfamiliar to most. And that's why perhaps the less accessible to many of us.
SPEAKER_03Well, hopefully we can make things a bit more familiar, starting with this podcast. Why should dermatologists care? Like, why does medical research matter to dermatologists?
SPEAKER_01Okay, thinking about it on a big scale, we've got big problems delivering the care we need to to our patients. Lack of workforce is now a big political agenda, but for dermatology, this has been an issue for us for 15 to 20 years. We also have concerns about the ability for patients with skin problems to get timely care because of lack of education from the beginning in undergraduate curricula, whether it be medicine, nursing, even dentistry, for mucosal involvements, things like that. So delayed detection of serious and chronic diseases, particularly. Cancer diagnosis is very much early diagnosis of melanoma, is still the only way to improve outcomes. So the reason we should care is because what we're talking about here is the application of educational sciences so that our patients can get timely care as early as possible. Now, without understanding how people learn, that is, those people that make the diagnoses, the clinicians, especially the non-dermatologists, in the constructs we have in the NHS about how patients are seen, I don't think we can move forward. So that's why we should care, because it matters to our patients and it will impact on our patients' care.
SPEAKER_00Absolutely. And I think, particularly from a primary care perspective, the lack of training that we receive, you know, I had my token one week in dermatology as an undergraduate. And then even as a GP trainee, very few placements actually have a dedicated dermatology post. It's almost unheard of. And yet, as a non-dermatologist, you're often the first person who encounters a lesion and needs to screen as to whether it's something that needs to go on a two-week rate or not. So I think to improve patient outcome and patient care, you really need an investment on all fronts, especially.
SPEAKER_03So what might that investment look like?
SPEAKER_00I think it should start off at the undergraduate stage, not only for those that actually go on to pursue a career in dermatology, but we know that the vast majority go on often to general practice. So actually increasing exposure within the curriculum and in particular the time dedicated for dermatology for undergraduates. And then as GP trainees, there's many ways in which this training can take place. It's through taster weeks, it's through actual dedicated lots in dermatology, it's through having dermatologists come in and teach GP trainees when we're having our weekly teaching sessions. Um I think it can take all sorts of different shapes and sizes.
SPEAKER_01I totally agree with you, Laksha, but looking at it from my one of my many hats, including curriculum director and at medical school, it's a real challenge. And I'm very cognisant of myself as what's considered a Cinderella specialty. Um, no, I don't like that term. But, you know, to make sure that I am balanced in what needs to go in the curriculum. And it's really interesting. Today I've received two emails about what should be in the curriculum and in our curriculum because it's not in our curriculum. And I actually think that we need to, like we talk about healthcare delivery, we need to be clever. And in order to be clever, we need to think of educational strategies and teaching methods that are effective, not efficient, but effective. And that comes back to the beginning of this conversation of why educational research is absolutely crucial. Because unless we know the work that we're doing is helping those learners progress in their understanding of patients and their disease processes, why are we doing it? And therefore, there is actually, I think, decades of really fascinating work to do in dermatology education and research. And we can be at the forefront of this internationally, let alone nationally. And I think some of the work that we're trying to do in the BCD, which I can talk about later, it may help us. But more importantly, having podcasts like this and encouraging colleagues to be part of that change would be the way forward. And that will self-perpetuate.
SPEAKER_03Yeah, so I guess it's that there's such a crowded curriculum. And if you want to start thinking differently and creatively about a paradigm shift in how we deliver medical education, either undergrad or postgraduate, you can't really do that without following an evidence-based approach or a scholarly approach, like you would do in any other field. And yet it seems, I mean, uh to me as a as a as a observer with and as someone who's been a trainee and at various different training programs over the years, that a lot of what we do within both undergraduate and particularly postgraduate medical education isn't all that evidence-based. And there's a bit of a disconnect between educational policy, healthcare policy, and then the evidence that that exists. Is that something that you guys have found?
SPEAKER_01Yeah, I think that's where we need to move to if we're not already there. I'm feeling more optimistic than I ever have, actually, Johnny, about this because I think that we are now very fast realizing that, you know, education is on the back foot compared to research, and we need it to come up pretty fast to where research is in its approach and its um weighting value amongst healthcare. For example, just just now, I've received an email from my research colleague saying, what do you think about education, dermatology education, AFPs? There's a new, you know, new arm. By the way, for people who don't know, Donny was clapping just now. Um, there's a new criteria in the NIHR applications for AFPs for the next round. So that's why I'm feeling really optimistic. I would have never envisaged this as a first-year consultant in 2009 when I was trying to justify why I wanted to be a specialist in education rather than a subspecialty in dermatology. So there are avenues where I think this will grow and grow and the momentum's already started. Policy and education, I think that's really, really important. I do see a difference because I work intimately in both undergrad and postgrad, and I do see a difference in how educational research and educational scholarship is translated. But I think that's to do with the structures. This is my personal view or it or only or reflecting on this, is that undergraduate programs deal with the quality assurance, the curriculum development, and the implementation all in one go. So there is a possibility for us to develop pedagogic and constructive alignment across the board. I think it's quite difficult in postbad because those three roles fit under three different organizations royal colleges, deaneries, and trusts for dermatology, because we're in a Q.
SPEAKER_02For not for now, as of as of as of February 2023. Who knows what's going to happen in the next year?
SPEAKER_01But that doesn't mean there are advantages to that because the vast number of workforces you are training up, the disadvantages is it can feel disconnected and you may not get that scene through with scholarship. But watch this space. You know, you could be doing this podcast in 10 years as a very experienced consultant, Johnny, and we were having a different conversation about it. I personally am going to be optimistic and say I think we will do. But the way forward to do that is to integrate NHS policy with what we need to do in education and really be thinking about that upfront.
SPEAKER_03I think if I'm still doing this podcast in 10 years, then it must have been wildly successful. So I'll I guess I'll take that. Okay, but that that's really interesting. And um there's a lot of conversation we could have about some of, again, we've mentioned before, the formalization of roles, and that's one way to legitimize medical education. And the AFP roles is a good example. Now I find the international parallels quite interesting because in Canada, it's a culture of clinician educators, it is a legitimate consultant role. You can be a consultant in medical education. And I feel that I mean with with maybe just speaking within dermatology, apart from yourself, Minnie, there's not that many dermatologists that I've seen in it publicly kind of in that sphere, I guess, and who can who combine this as their main role, medical education and dermatology. How do you think that we can better legitimise these dual careers in the future? I'd be interested in both your thoughts on that.
SPEAKER_01I'm gonna ask Laksha first because you're at a different stage, and it'd be really interesting to hear your thoughts on that if that's okay.
SPEAKER_00I think formalizing it in these posts is very helpful. Not only does it highlight the opportunity to do education research for those who may have not been considering it in the first place, but it does legitimise this interest that a lot of us have. So I was fortunate enough that by the time that I applied to GP training, medical education academic posts were in place. Um but that certainly wasn't the case when I was an undergraduate. We didn't have a medical education society, medical education research was almost unheard of. So I think formalizing it is certainly the first step forwards. And I think also publicising the work that we do is really important. So through journals and publishing and giving presentations and just getting the word out there about what education research is, why it is important, and how people can get involved is crucial in the process.
SPEAKER_01I concur with everything you said, and and it is so very different in a good way. I'm now seeing students in our optional components asking to do projects on medical education. So I'm trying to think of a medical school who doesn't offer those options rather than ones that do. It's very widespread, actually. And I therefore think that the juniors coming through are going to be of a different vein. They are going to be seeing medical education as a professional career. And I was gonna say, you talk about formalized. I actually think, if I may use this word, is it's professionalization of medical education that's happening. Yay, go for it. For no other reason, I think we genuinely need it because to me, education and research are the foundations of clinical practice. I visualize literally, you know, in the the Roman baths where you had those pillars underneath the baths and the as hot air goes through. Where are those pillars with the lovely baths on top?
SPEAKER_02Absolutely.
SPEAKER_01Now maybe a random analogy to other literally do it on one head.
SPEAKER_03I think that's really interesting because I mean I I've seen that as well. There's really enthusiastic. I I was gonna say generation after me, um, I because because that's slightly that depresses me lightly, but yes. Um the medical students here who've coming through and the kind of core trainees and foundation doctors, they're doing so much um right now. And I I think there's a conversation to be had as to whether that's all for you know good reasons or whether they feel they have to, but that's a different chat. But even if you take Durham socks, for example, if since I graduated, they're everywhere. I I think I've had about three emails this week asking if I can come and talk for some Durham socks, um, which is lovely. I'm always very flattered, but they're so enthusiastic compared to other specialties. I don't see that quite as much in other specialties, which is really, really quite inspiring. And we have a generation of teaching fellows as well. I was a teaching fellow for for um for two years in in the northeast. And I know at one point in the northeast England we had 100 teaching fellows in the region, and which is incredible. And that it's a that's a real culture of teaching. And I think finally, from from that, is there's something about role modelling to make things seem legitimate. And I hope many doesn't mind me sharing this this um story of one of the first time I've I met many face to face was at the BAD conference in 2019, and I I was at the dermatology teacher session, and I sat there and I just thought, it was my first BAD, it's quite intimidating. I looked around and I thought, these are my people. I feel like I I belonged. So I I I went down at a many and I just said, This is gonna sound a bit odd, but how do I become you? Um and I don't realize in my head that how creepy that sounded, so I had to like rephrase it. But I think that role modelling matters, and it's our responsibility as uh, you know, it was we become senior educators to make sure that we forge a path for those coming after us.
SPEAKER_01You said it absolutely beautifully. What's really funny is Johnny, that wasn't creepy to me because I sent to somebody else with I wasn't registered. But I didn't I didn't hear what I talk about. I literally said how do I become you? I want to be you. That was that was programme director for the um masters of medical education I did, Jonathan Cartilage at UTL. And he obviously didn't quite take it the right way because he stood back and went, uh but it's okay. Jonathan Jonathan and I are still actually very much in touch, so it wasn't too creepy. But I absolutely agree. It's it's no different to any other specialty. You you know, role models inspire us, role models make us feel like we belong, role models make us realize that it's possible. And so is something I'm absolutely passionate about, whether it be a school child, university student, registrars, non-dermatologist. I mean, Egan, you'll know about the International Dermatology Alliance, it's things like that that you know the British College has supported, is that which the next step for me and my interest is exactly that role modeling, getting the word out there about this is what modern medical education is, this is why it's so crucial to dermatologists, and actually no other specialties doing it in the way we are. Would you like to be part of it? I'm delighted to say we just put a call out for resident committee membership to the International Dermatology Alliance, and we had stuff from all over the world. And, you know, we got a couple of trainees who'll be residents who'll be joining from other countries to be part of this. So I'm hoping that will perpetuate it and they will role model. And it's about it's not just the role modeling, it's role modeling and facilitating opportunities for those people. We're at the stage where that facilitation needs to keep going for quite a while. And then it'll be self-perpetuating, I feel.
SPEAKER_00Johnny, what makes me laugh is I had a similar interaction with Minnie, but I didn't even get to meet Minnie. I just emailed her out of the blue and found her online, literally type dermatology, medical education, and revenue congress. So um I think role modeling is so important because it just tells you what can be achieved. And even with these, you know, professionalized, formalized posts as part of academic and training programs. It was only when it was by chance on a post state war drown that it was being led by the head of the medical school now at Imperial, Professor Amir San, who's a consultant endocrinologist. And he said to me, GPs always have a special interest. What's yours? And I said, Education, I love it. And you're like, Well, we have a fellowship program here, you should get involved. And it was Only through his inspiration, really, that I heard about Minnie, got to meet Mini, got interested in education as well. And so I think identifying these people and creating opportunities for each other is absolutely key to progressing in the field.
SPEAKER_03I've met Professor Sank once at the Developing Excellency Medical Education Conference last year, and he gave one of the best talks I've ever heard about the SJT situational judgment test. And I have very strong opinions which align with his about that. But that might be less meaningful to some of our international audiences. But I think I know you did a paper together on that in academic medicine. Could you tell us a little bit about the work you did and what that involved?
SPEAKER_00Absolutely. So that was a piece of research that we did a couple of years ago, whereby we looked at data for about 35,000 doctors within their first five years of qualified practice to see whether there was any link between their performance in medical school, as measured by the educational performance measure, and their performance in a situational judgment test, which the international listeners is an assessment that we take in the final year of medical school, looking at all these different ethical scenarios and asking about what we would do in those circumstances. And those two scores together determine where we rank nationally and what jobs we get in our first year of professional practice. And specifically, we looked at the likelihood of receiving disciplinary action within your first five years of professional practice. And actually, there was no statistical significance between performance in the SJT and the likelihood of disciplinary action within your first five years, whereas there was with the educational performance measure. And, you know, veering off topic from dermatology slightly, it begs the question, you know, is what we're doing at the moment the right thing? And I think that question can be applied much more broadly in education. You know, the way that we're currently being taught, the way that we're currently being trained, the way that we're currently being assessed, is that the right thing? Just because we've been doing it so far, does that mean it's the right thing to do? And that's where evidence-based research and medical education research really comes into play. Can I connect up to that, Johnny?
SPEAKER_01Do you mind? I know I've sort of jumped in because this is so relevant to current challenges in NHS and global workforce crises. Because we are desperately trying to retain our doctors, whether it's here in the UK, Canada, India, everywhere. You know, this is an issue that was predicted by the WHO. And if we're putting forward educational markers of progress that actually don't benefit these people, we are going to put them off. Because the amount of workload, the amount of pressure, the impact it has on their welfare, on top of the pressures of running services when you're short of colleagues is significant. So there is a moral obligation, I feel, that you have to do the kind of research that Laksha's talking about, let alone other wider research in medical education. And if I bring that now down to the dermatology field, then that's even more so because our workforce pressures have been for a number of years having direct impact on patients and their outcomes.
SPEAKER_03Absolutely. And you know, when you mention workload and retention, that's without even talking about differential attainments. Um, when you introduce any assessment into um you know into the mix when you're talking about selection or recruitment, you are you are introducing that risk of differential attainment, a phenomenon which we feel like we sort of understand, but not entirely. So yeah, many shaking her head saying Greeks um as being generous. Um but I I know the in the UK that the General Medical Council are currently doing some work in that domain, but there's so much that needs doing. Because there's so much that we don't understand at the moment, and there's so much, as you say, I said earlier, there's decades worth of work to be done. And I think that should be something that shouldn't necessarily be intimidating, but should be exciting and so and inspiring because there's so many opportunities to make your name in this field. So hopefully that will be um of interest to some of some of our of our listeners. We've talked about one paper, and I'm glad we did because uh it's a really interesting one. Just because we're a research podcast, I like to um ask our guests about papers. It doesn't have to be BJD, because I don't actually think we we publish a great deal of of education uh pieces, and that's a you know that's something we can talk about. But if you could recommend any papers regarding medical education, whether in dermatology or not, to buddy educators within our specialty, what might you recommend?
SPEAKER_01So I am actually going to say that my interest very much lies in a number of areas, but they all have a theme, which is about experience in the workplace and learning in the workplace. They probably have that link up. Whether it's um you two will know my interest in diagnostic error and decision making and and my views on how that is crucial to understand for dermatologists and relating to some service things around AI and you know the tools we use. But also I would say that if anybody wants to learn about or wants to understand the space which we practice education mostly in, which is as doctors, is in our workplace, then you should be reading Tim Dornan's work on experiential learning. There was a relatively recent article that Tim and his colleagues wrote on experience-based learning. He calls it the EXBL model. I'm trying to remember which journal it was in. I think it was medical teacher. Yes. It was medical teacher. And it's called uh medical education for the 21st century. And the reason that really spoke to me is because uh Tim and his colleagues talk about the challenges of the 21st century workplace in terms of learning and education, and moving away from this idea of the our responsibility as clinicians to teach, but more of a joint participatory experience and what it takes for particularly medical students in this article to be truly engaged in the environment in clinical environment and to learn from it. And actually, we need to do less than we think we do as teachers. I think we put on ourselves high expectations. That's probably not surprising for doctors to say that. But he as teachers, we expect more of ourselves than is possible to deliver in the clinical environment, all the other pressures, but it doesn't take that much. And he talks about understanding that it's a relationship and it's actually just saying welcome and you're part of the team, enables the medical student who is very bright, to learn so much more. So if there's anything I would say is have a look at the medical teacher article by Tim Dornen and his colleagues in 2019, experience-based learning, clinical teaching for the 21st century. And the main thing is that actually we can use the tools around us that are part of our everyday practice to help them learn, but it doesn't mean we have to be there holding the hand all the time. And how the model he describes, they call it the Spark model, is moving from being an individual student to participating in the learning environment and the clinical environment to then becoming more independent in your practice. And it is the simple things like including them, introducing yourself, giving them ideas of what they can do and letting them fly.
SPEAKER_03Absolutely. I'm sure I read a paper, I think it was during the pandemic. I can't recall the name of the paper or the authors, unfortunately, but I'll I'll put it in the link when I share when I share this this episode. It's quality of study on how students feel that they are a burden and they get in the way all the time when they're on the ward, and the shame that they experience with that, and that could completely just disrupt and distort that participatory relationship that you described. Um so I I will share that.
SPEAKER_01Yeah, do. And if you can give a link to Tim Dorner's paper, because it's about being organized, and we can be controlled and control of being organized. It doesn't mean being organized in clinic, because that is opportunistic learning, and it's really crucial for healthcare students to have opportunistic learning. He's talking about being organized prior to that and organized in our thinking about what our role is as a teacher. And this comes back again to the need for medical education research, then we need to support clinical teachers. None of us have been taught to teach unless we choose to go and learn those skills. But educational and educational skills need to be learned. They are not given.
SPEAKER_03Absolutely. And Laksha, I'm going to ask you about your paper in a wee second, but just one final thought on that was that what I see um when I speak to more junior trainees is obviously in the UK at the moment, there's a lot of distress and disquiets regarding, well, just life in general, uh, um, but particularly regarding medical training and medical education. And lots there's lots of factors uh affecting that. But I think that there's a bit of a a misperception that you're not being taught unless someone has sat down directing knowledge into your brain, and there's so much more happening as part of a genuine educational experience. And part of that is how you are treated on the ward, what the culture is of the department um that that you're in is an educational-enabling culture. Are you taken seriously? What is the hidden curriculum? And are you being powered to go and do some independent study and for example, or go and you know, do some work yourself and then come back and debrief? People think that unless you're getting lectured to, sometimes you're not actually getting trained. And I wonder whether that we we need to deliver our message better to our target audience, all right, our our our students.
SPEAKER_01Yeah.
SPEAKER_03To to improve that in that bi-directional way.
SPEAKER_01So I I think you're right, but I also think there's a factor in here that we should consider is that we're talking about significant changes in generations, both in the clinical workplace, but in medical education, but also outside in society in general, and acknowledging that that it's okay that those differences exist. I was of an era where it was just going with it, and I expected myself to go out and get everything. I didn't know any better. If I needed an experience, I needed to ask for it. Whereas whether it's social media, I'm not an expert in any of this, whatever people call gen, whatever it is. I don't even like the letters, I'll be honest. It's just all that labeling does my head in. But we just have a different perspective from those that we are learning with and teaching. And it's actually saying that I think that that we need to be much more explicit about how to learn, not just what to learn. And that's what we're realizing at undergraduate level. I'm not sure we're there in postgraduate level, that we need to articulate how can you learn in this very difficult environment. And I suspect that if we could emphasize that more, we would open up these incredibly engaged individuals to know how to make the most of very difficult situations day-to-day in terms of learning. So I would love to see some work that we could do around that. But we, I mean, you think about it, when you have induction as junior doctors and stuff, you never get told about how to make the most of the environment to learn from it. You get told what to do. You get given instructions on how to manage patients. So maybe there's a gap there we could address. Just a thought.
SPEAKER_03I'm gonna put a pin in that now because otherwise I'll just end up talking to you for about half an hour about my about my master's research. There's lots of cogs turning in my brain. Um, Laksha, what paper would you recommend to to our listeners?
SPEAKER_00So I would recommend going to the December 2022 issue of the CED, the Clinical Experimental Dermatology Journal, because there were four papers there which I read and just came across by chance, which I thought were a brilliant way of demystifying medical education and dermatology. It's literally a how-to on how to get started and what to do. I promise you it wasn't it's not a plug, but it's by chance. Completely by chance. So, firstly, it's about identifying opportunities for education research in in dermatology and the gaps that could be addressed. But not only that, it's a how-to on how to actually go about conducting education research, thinking about the importance of medical education theory when designing your research studies and then thinking about what you hope to gain and what you hope to answer. And then thinking about all the processes you have to go through, the ethical approval process, which is as arduous as um, you know, any other clinical science, and also the importance of qualitative research versus quantitative. And I think that's an area which is very much progressing in all aspects, not only just in educational research, but also in clinical research as well. There's a reliance because of the way that we're trained, perhaps from an undergraduate, from the undergraduate days, on the emphasis on quantitative data, actually, the importance of qualitative data, particularly when you're thinking about education and understanding its grounding in the social sciences as well, and the psychological sciences. So I think I direct you all to that journal. I can't pick one of the four papers, but I think they're all brilliant, and you should read all of them for a great introduction on the importance of education research and how to get started.
SPEAKER_03I recommend the ethics paper. I think that's written very well. I'm glad you mentioned that lecture because I think that is a is a big step for dermatology journals to have a special issue on um medical education, because that's it's not necessarily always been all that represented in a kind of very specific space and very always very easily accessible across the general dermatology journals. Within medical education, there are journals, just for for those who may not be aware, there are quite a few. We've mentioned the medical teacher journal already. There's medical education um journal, there's academic medicine, there's the the clinical teacher, there are just a few. And I could recommend a few textbooks, declaration of interest. I am on the board of directors of ASNI, which is the Association for the Study of Medical Education. Um and we we are a charity looking at the scholarship behind MedEd. And we produce textbooks and we run medical education and clinical teacher journals. And I really recommend understanding medical education and researching medical education textbooks. There's a one's really bright orange, and there's a new issue of researching medical education, which I strongly recommend. I've been told I need to say at some point. And they're really good for um if you're if you're doing a certificate in MedEd or you think about doing a master's, but even if you're just starting to do a little bit of research, um, some of the concepts, particularly within understanding medical education, are in there. Are there any other resources that you would recommend in terms of those who are looking to get involved in med-ed and don't know where to start?
SPEAKER_01I don't think of a specific resource. I would like to plug something that again, I think is a real positivity is the NIHR now have a clinical education research incubator. And it's been sort of set up and based in Newcastle. But to me, in the UK, that's a real step change, positive step change. And that supports that parallels what we're seeing with the NIHR actually saying that clinical educational research is one of the arms of AFP potentially. So what I'd say is if it's something you're interested in, do it. Don't be afraid, there's so much opportunity out there for you in America, in Canada, in the UK, in in some parts of Europe. I know they're a little bit ahead, but if you're one of our international listeners, then reach out to us over here. We'd love to hear from you and make those connections and collaborations. I'm gonna put a plug in. If you're going to the World Congress as international um listeners, then come join the session we're doing about growing global educators in Singapore in summer. So I just feel that there's a dynamism going on right now that, you know, please join that momentum if you feel interested. Even like as Lukasha says, we all started going to somebody. This is what I want to do in education, but I don't know how to. And we're at various stages of the journey. But I don't know, guys, what do you think? I love the world of Meded. It's a very, very creative and collaborative space. Whenever you go to conferences or whenever we have conversations, I remember the conversations both of you when we first met, where there is virtually the I remember the first conversation we had online after you emailed me, Laksha. So they stay with me. So I would just encourage it. There are lots and lots of resources. I have to say, you know, the research, the new edition that you're saying, the research in medical education. I used the earlier edition to write my thesis. It was a how-to guide for writing things.
SPEAKER_03I'm glad there's a new edition. I think the edition now. It's it's it's good. Laksha, what about you? Is there any tips um that you commend for um those who are looking to get started in this area?
SPEAKER_00Absolutely. So I think it's first of all, explore your local environment and see who's around. Any teachers that you found particularly inspiring, or anyone that you know who's got an interest in education, just talk to them, find out what they've done, where they've been, who they know. That would be the first step, just to see what opportunities are actually on your doorstep that you may not be aware of. Thereafter, I think don't be afraid to get to know other people and reach out to people you've never met before, people whose papers that you've read, or people who've inspired you um from anything you read online or heard about. As Minnie said, uh, as a community, we're we're so welcoming and as new people and we're eager to provide opportunities for other people to get involved. And then of course, there are lots of formal pathways in place now as well. So um the clinical education incubator from the NAHR was actually um, I think started a few years ago. And as it started is when I was sort of applying for my PhD. So I actually turned to them for a lot of advice around my application and all those sorts of things. And that was brilliant because it instantly put me in touch with a network of people across the country. So I would highly recommend all those resources.
SPEAKER_03What I think is a really positive sign is that I think for the first time in many years, the ASMI and BAD conferences are not happening at the same time this year. So you can go to both now. And in fact, um the ASME conference registration opened today, so do go on to that. I always had to divide my time between two, because I obviously as a as a trainee wanted to go to the BAD, but I was helping to organize the Adme conference, so couldn't not go to that. So I remember in 2019, post-night shift, going to Liverpool for a day and a half of a conference, and then getting on a train and hurtling up to Glasgow for another day and a half or two days at Asme. And by the end of the week, I think I had my sister's graduation in Edinburgh at the end of that week, and it was my birthday on the Sunday. So I sat, I got home late on the Sunday, and I had a burger sat in front of me, and I just sat and was like, I'm exhausted, I need to go lie down in the dark room. So I'm very glad personally that um we've managed to separate the two out. You know, the dermatology community might be able to enjoy um a bit more MedEd this year. I just wanted to, before we finish up the conversation, just ask about what are the hot topics or maybe the really important and even controversial issues happening within MedEd that might impact dermatology going forward in the future. And what are the issues that people should be getting interested into or getting involved in if they're thinking about entering this sphere?
SPEAKER_01How do you narrow it down? It's gonna be biased by what by what I'm interested in.
SPEAKER_02What annoys you most?
SPEAKER_01Okay, what annoys me most in my in my world of dermatology and dermatology education is not thinking about the educational aspects of any service implementation annoys me the most. What I mean by that is it can't I really feel we need to change the language on the purpose of education in healthcare. And the work I'm interested in is using education as a QI tool, as a quality improvement tool for patient care. So some of that arena is very much around diagnostic error and accuracy and diagnosis and improving that, particularly from non-dermatologists. So one of our registrars in my department has done a really lovely piece, whether you call it order. It's difficult because there are no gold standards in this field. So you can really do anything you want, but thinking about how non-clinicians on why non-clinicians and in what way they refer patients to us, and looking at it from an educational lens. So we've looked at it from a clinical reasoning and decision-making lens, and it is really clear when you use some of the literature in the educational field on how clinicians make diagnoses, why we're getting referrals that are unnecessary, that we should not be getting. And when you correlate that with curricula that are put out by the colleges at junior level, you say, hang on a minute, the colleges say you should know this stuff, but clearly from the referrals we're getting, you don't know this. So there's something happening between standards in curricula, implementation, and turning into practice. So that's the area I think would be fascinating. Translational education, if you want to call it that.
SPEAKER_03I'm surprised you didn't say the MLA.
SPEAKER_01Well, I could that's very UK paper. This is actually this, I I could talk about the national license exam in the UK, but internationally, I have talked to colleagues in New Zealand, talked to colleagues in San Francisco and in Singapore and other places, and this resonates a lot with dermatologists in these different countries, irrespective of whether you have a gateway system like the UK does, where patients are seen first by primary care and then ask. Even in countries where that's not happening, how clinicians are making decisions, diagnostic decisions, we now understand that in the educational literature, but clinical practice doesn't know that work. So if there was something I would do in dermatology where we can change the narrative around us being easy or spot diagnosis, I really worry about the spot diagnosis. For us, radiology, the visual specialties, we do ourselves a disservice about the quality of our diagnostic acumen by promoting teaching through pictures. That's my little pitch.
SPEAKER_03Brilliant. So I I do enjoy giving dermatology talks without any pictures because it really freaks people out. The students don't know what to do. Laksha, what about you? What bothers you and in or inspires you within the current events in education?
SPEAKER_00I completely agree that clinical reasoning is an area that really needs to be focused on. In that having come through from the primary care perspective, our exposure is essentially, you know, all visual exposure, all pictures, all thinking about this is eczema, this is psoriasis, very clear cut. But actually in clinical practice, it was the complete opposite where you were faced with a lesion and you just felt that you weren't equipped to determine the subtleties of it. And and that in turn then shifts the burden onto secondary care resources. And I think as educationalists, we are in such a privileged position because we're able to actually identify those issues and actually put things in place to change those issues. So focusing on the importance of clinical reasoning when we're teaching undergraduates, postgraduate trainees, both in GP and in dermatology, about diagnosis is is really important. And I think that our educational practice should also reflect how we're delivering patient care. So the fact that yes, dermatology is a very visual specialty. And actually given the pandemic, we're moving even more towards that given how much teledermatology we're doing these days and how um consultants of secondary care and registrars are giving advice and guidance to GPs based on pictures and a short history. So I think, you know, conducting research in those areas, identifying the best ways in which we can train undergraduates and postgraduates to be equipped to deliver those services is a is an up and coming area.
SPEAKER_03Absolutely. I mean teledermatology is its own subspecialty that's completely emergent and has got loads of uh important questions behind it. Even considering the human factors behind telederm and as we've said how we teach it and how we teach it at that interface between primary care and secondary care. There's so much to consider. We may explore this in a future podcast. But with that, we've just given everyone a blueprint for the uh next generation of medical educators so no one listening to this has any excuse. You've all got plenty of plenty of work to be getting along with and we will draw the episode to a close. Thank you both so much um for joining. We've discussed the key principles of medical education um research what inspires us and some things that make us hopeful for the next few years and the next generation of dermatology medical education. So thank you many and thank you Laksha for joining um it's been really great and a really interesting um conversation. I suspect this podcast could have been two hours long rather than one. And for our listeners uh I will share some of the papers that we've mentioned as usual uh on the BJD website and on social media and you can find more episodes of BJD talks on the BJD website uh more discussion regarding medical education and our papers from the BJD at BRJ dermatol on Twitter and at BRJ dermatology on Instagram or by using the hashtag hashtag BJD talks bye for now