|Year : 2011 | Volume
| Issue : 3 | Page : 750
Commentary on "Teaching Fearlessness: A Manifesto"
University of Colorado, Denver, USA
|Date of Submission||22-Nov-2011|
|Date of Web Publication||16-Dec-2011|
University of Colorado, Denver
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jason H. Commentary on "Teaching Fearlessness: A Manifesto". Educ Health 2011;24:750
Is this research? On first encounter, Wear and colleagues’1 contribution does not appear to be a research paper. Even the authors chose to call their paper a manifesto, invoking the sense of a public appeal or exhortation, which it certainly is, and which many of us would regard as the obverse of dispassionate research. Yet, some 'findings' are presented, partly from one student’s observations, partly from other authors.
Does such a paper belong in a research journal? Please indulge me while I seek to make the case that this and other research journals badly need even more papers of this type than are usually published.
Observations made by just one student from one program hardly fit with our usual expectation that authors will provide data from which generalizable conclusions can be derived, and from which others can gain new understandings and insights. Although this journal and a growing number of others are being hospitable to 'qualitative research,' not all of those journals would consider this paper to even fit into that category.
Yet, perhaps paradoxically, I suggest that this is every bit a research paper as is one filled with carefully gathered numbers from a large cohort of subjects.
What is research? Research is a sequential set of processes, embracing many stages. Often, the most important part of research is the initial phase, the one represented by this paper: it is the perceiving of circumstances or conditions that until then have been insufficiently recognized, understood or acted upon. Although this phase is implied in many research reports, it is overlooked in others, sometimes leading to the conduct of studies that produce statistically significant findings about unimportant, even trivial, topics.
What can a paper such as this one contribute? Well-thought-through 'position papers,' such as I consider this one to be, can serve as springboards for reflection, exploration, recommendations and subsequently conducted, more conventional, systematic research. The authors of this paper have summarized a condition that some prior authors, and many of us who teach in the clinical environment, recognize as familiar, perhaps even all too common. Might this paper have enriched your thinking, perhaps even helped provoke you to action? If so, it offers even more of a contribution than is typically achieved by many more conventional research papers.
In my view, we need more papers like this one; papers that cannot be sufficiently understood by simply scanning the abstract or reading the conclusions; papers that deserve to be read in their entirety, even more than once; papers that give us pause, that lead to sustained reflection and deeper thought on the paper’s subject than we may have previously devoted to its topic. I hope that you will consider making this paper, and the questions it introduces, both directly and by implication, the subject of your own continuing reflections and discussions with your colleagues, perhaps in committee meetings and journal clubs in which you participate.
A particular request: If you choose to take some action based on whatever thoughts may have been sparked by this paper, I encourage you to give special attention to the role of residents (registrars) in your teaching program. In many programs, residents provide a large, sometimes the largest, proportion of clinical role modeling to which medical students are exposed. Yet, few residents have been helped to prepare for being teachers. Many residents feel that they are under the continuous pressures of having insufficient time and of being placed in clinical situations that stretch them to and beyond their limits. For some, being under this unrelenting stress can manifest as nastiness, impatience, even cruelty toward others, especially toward students who tend to be perceived as underlings and therefore as safe targets of the residents’ discontent.
Some suggestions: If you feel inclined to take the Wear and colleagues’ paper seriously, let me presume to offer some questions for further reflection by you and your colleagues, in case you have not already thought of, and taken action on, these:
- In your program, is there an awareness of the risks of negative role-modeling and demeaning behavior by those who teach and supervise students?
- Are the potential consequences of negative role-modeling and demeaning behavior being explored?
- Does your program routinely offer students a situation in which they feel totally safe when sharing critical observations about their teachers, and about the educational program?
- How would teachers and administrators in your program react to the discovery that one or more of your students was as perceptive and articulate, as well as critical, as was the student whose observations are quoted in this article? Would such students be encouraged to elaborate and be thanked, or might they be ignored, or even face some negative consequences for their having displayed 'fearless speech'?
- The student quotations cited in this paper emerged during the authors’ 'Reflections on Doctoring' course, which spans all the years in their pre-doctoral medical curriculum. Does your program offer anything like that course? If not, should it? What will it take to help others in your program realize the fundamental importance of providing such a set of experiences during the process of helping young people become physicians?
Inescapably, most research involves drilling down to quite small elements within one or more large systems. Gradually, we amalgamate the findings of many related, small studies and begin to gain a fuller understanding of processes that are larger than any of their component parts. Occasionally, a report helps us focus with greater precision on a large and important sub-system that is more encompassing than can be contributed by our typical, relatively narrowly-focused studies. This is one such report.
We do not need more research to decide that it is important for students to be encouraged to be thoughtful observers of the ways they are treated and of the examples of clinical behavior to which they are consistently exposed. Nor do we need more research to persuade us that students need genuinely safe opportunities for sharing their observations, whatever they may be. I hope this paper and its implications will be given the follow-up thought and action they deserve.
Hilliard Jason, MD, EdD
Member, Editorial Board and former Editor, Education for Health
Clinical Professor, Family Medicine, University of Colorado Denver, USA
1. Wear D, Zarconi J, Dhillon N. Teaching Fearlessness: A Manifesto. Education for Health: Change in Learning and Practice. 2011; 24(3):668. Available from: http://www.educationforhealth.net/articles/authorsnew.asp?ArticleID=668