The five ‘Es’ of anexcellent teacherJeremy Gibson, Directorate of Rehabilitation Medicine, Derby City General Hospital,Derby, UK

The Royal College of Physi-cians’ website (http://www.rcplondon.ac.uk/

college/committee/tc/personal_02_interview.htm) lists215 potential questions at con-sultant interview. One of these is‘What makes a good teacher?’.When this same question was‘googled’, I got 1 440 000 hits.Consider the following five ‘E’qualities that I suggest make ateacher excellent:

1. Education

2. Experience

3. Enthusiasm

4. Easy

5. Eccentricity

Education and experienceare the two ‘Es’ that underpingood teaching. It is vital thatteachers themselves, through aneducational process and a wealthof experience, have a good graspof the material presented to thestudents. Experience alone doesnot equate to being a good clini-cian, nor does it necessarily makea good teacher. A recent article inthe British Medical Journal lookedat the subject of whether certifi-cation improves medicalstandards.1 It quoted a systematicreview of studies publishedbetween 1966 and 1999, whichfound that over half (16 of 29analyses reported in 11 articles)showed positive and statisticallysignificant associations betweencertification and superior out-comes. Many years of clinicalexperience are helpful, but they

need to be balanced withdiligently keeping clinical andteaching practices current. One ofthe joys of teaching students isthe effort required to prepare up-to-date and good quality material,which acts as an impetus for one’sown development. Having saidthis, a teacher’s knowledge baseshould not be restricted simply tohis or her own subject, butalso include an understandingof learning theories, e.g. adultlearning theory, self-directedlearning and self-efficacy, andhow to incorporate these intopractice.2 There is an increasingappreciation that clinical teachersbenefit from learning how toteach, this being reflected in agrowing number of courses. Oneof these is ‘Teach the teachercourse’, which aims to give par-ticipants the practical techniques,

Experiencealone does notequate to beinga good clinician,neither does itnecessarilymake a goodteacher

The viewfrom here

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knowledge, skills and confidenceto design and deliver one-to-oneand group teaching sessions.3

No number of the most elab-orately constructed PowerPointslides can substitute the third ‘E’– genuine, palpable enthusiasm.Enthusiasm is infectious. Truepassion holds the students’attention and makes a lastingimpression on them. The mostgripping teachers burst with anenthusiasm for their subject thatcannot be contained within theclassroom, but extends into theclinical environment, providinginspirational examples for theirstudents to follow. Strong rolemodels have a part to play even inchoice of specialty among medicalstudents. An online survey ofmedical students at Manchester

University, assessing factorsimportant in making a careerchoice, ranked the influence of arole model eighth out of 25. It isworth noting that the influence ofrole models in this study wassignificantly more important toclinical than to pre-clinicalstudents.4 Another study used aquestionnaire, scoring factorsaccording to their importance incareer choice, with third-yearmedical students at NinewellsHospital and Medical SchoolDundee on the first day of their1-week attachment to otolaryn-gology. Of the factors to beranked, teacher as a role modelcame third, after career progres-sion and on-call commitment.5 Apostal questionnaire of 236 final-year medical students from theJohns Hopkins University School

of Medicine found that strong rolemodels, regardless of specialty orgender, were one of a number offactors considered to encouragechoice of specialty.6 A small(n = 76) telephone survey ofthird- and fourth-year students atNortheastern Ohio University’sCollege of Medicine, looking atwhat influenced their choice ofsurgical careers, found that stu-dents interested in or attracted tosurgery were significantly morelikely to have been encouraged intheir career choice on the basis ofa role model than students in noway interested in or attracted tosurgery.7 Role models are clearlyimportant, but their impact oncareer choice may vary betweenspecialties and whether studentsare clinical or pre-clinical.

Make it easy is the fourth ‘E’.Albert Einstein said ‘make every-thing as simple as possible, butnot simpler’.8 Nowhere is thistruer than in teaching. The greatteacher will take the mostcomplex concepts, abstracttheories and bring them down toearth, making apparently deadobscurities live. The truly awfulteacher can make the simplestfacts weigh heavily on thestudents’ intellects, andcomplicate the most basic ideas.Never forget, it is always possibleto make the most exciting anddynamic facts dry, dull anduninteresting with convolutedexplanations. Keep it simple.

A healthy and measureddegree of eccentricity, the fifth‘E’, can be effective in transmit-ting unforgettable facts. I stillremember as an undergraduatemy ophthalmology professorjumping on top of the frontdesk and imploring us never toforget about retinoblastoma. This,he said, is all that you willremember about my lecture.He was quite right; years later,the importance of detectingretinoblastoma is the only thingthat I still recollect about thatparticular lecture!

True passionholds thestudents’

attention andmakes a lasting

impression onthem

The greatteacher will

take the mostcomplex

concepts,abstract

theories andbring them

down to earth

4 � Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 3–8

A closing word of caution: thereis an inherited predisposition tobeing a good teacher. Perhaps themaxim ‘those who can’t, teach’would be better rendered, ‘thosewho can teach teach’. CertainlyHarold Ellis, a surgical superstarwith almost six decades of experi-ence at clinical teaching, agreedwith this at a recent interview. Hesaid: ‘teaching … is somethingthat can’t be taught. You can passon tips and make a good teacherbrilliant but you can’t make some-one teach who hasn’t got it.’9 Justas some people are born faster orstronger, some are born naturalteachers. There is a geneticcomponent.

REFERENCES

1. Sutherland K, Leatherman S.

Does certification improve medical

standards? BMJ 2006;333:439–

441.

2. Kaufman DM. Applying educational

theory in practice. BMJ

2003;326:213–216.

3. Mansour D. Teach the teacher course.

BMJ Careers 2008;8 March:84.

4. Al-Nuaimi Y, McGrouther G, Bayat A.

Modernising medical careers and

factors influencing career choices of

medical students. Br J Hosp Med

2008;69:163–166.

5. Ranta M, Hussain SSM, Gardiner Q.

Factors that inform the career choice

of medical students: implications for

otolaryngology. J Laryngol Otol

2002;116:839–841.

6. Lillemoe KD, Ahrendt GM, Yeo CJ.

Surgery – Still an ‘old boys’ club’?

Surgery 1994;116:255–261.

7. Erzurum VZ, Obermeyer RJ, Fecher A,

et al. What influences medical

students’ choice of surgical careers.

Surgery 2000;128:253–256.

8. http://www.quotedb.com/quotes/1360

9. Cross P. The essence of Ellis. BMJ

Careers 2007;335:197–199.

How enthusiasm hasshaped my careerJane and Belfield, Final Year Specialist Registrar in Radiology, Sheffield TeachingHospitals, UK

As a second year medicalstudent, I found radiologya fascinating but difficult

subject. I had attended various X-ray meetings – sitting at the back,feeling I knew very little, anddreading getting asked a ques-tion. I decided that I would liketo learn more about the special-ity, and arranged to undertake ashort research project to see whatwent on within a departmentthat is supposedly ‘in the dark’all day.

I approached a radiologyconsultant who arranged for meto perform some research intohow ultrasound was taught toundergraduate students. I spent4 weeks in the departmenttrying to learn some ultrasound,which seemed very confusing.The pictures all looked likedifferent shades of grey, andI found it hard to believe

how anyone could interpretthem.

During that month I observedvarious investigations andprocedures, and felt that I wasvery privileged, as medicalstudents at that time didn’thave formal radiology training.The consultant I was primarilyattached to gave me lots ofindividual teaching, and passedon his enthusiasm for thespecialty. I soon realised thatradiologists didn’t sit in a darkroom all day staring at a lightbox, and became determined tobecome a radiologist myselfone day.

Following graduation Ispent a few years doing generalmedicine, and gained myMRCP(UK) (membership of theRoyal Colleges of Physicians ofthe United Kingdom) before

applying to become a radiologyregistrar. I had moved away fromthe university town in which Itrained, but applied to that radi-ology scheme, and was fortunateenough to be given the position.

Just as somepeople are bornfaster orstronger, someare born naturalteachers

I had attendedvarious X-raymeetings –sitting at theback, feeling Iknew very little

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