Portal de Periódicos da CAPES

Hitting the sweet spot

2013; Wiley; Volume: 10; Issue: 1 Linguagem: Inglês

10.1111/tct.12028

1743-498X

Steve Trumble,

Empathy and Medical Education

All health care disciplines are underpinned by principles and theories. Some theories are clear, logical and easily applied. Others are less so. As a discipline, clinical teaching draws its theoretical basis from the fields of adult learning, vocational training and clinical practice. Clinicians who choose to teach tend to do so intuitively, eschewing theoretical models in favour of ‘what just works for me’. Attempts by academics to introduce clinicians to educational theories often result in frustration for both. A sense of beatific calm blankets these frustrations when a clinical teacher stumbles upon a model that makes sense. No longer are learners ‘difficult’ or ‘challenging’, they are just presenting interesting opportunities to test out the model. Years of intuitive clinical teaching can be affirmed by the application of a simple and robust theory that makes sense in the workplace. The essence of clinical teaching – for me, anyway – is found in the very simple concept of ‘hitting the sweet spot’. Just last month here in Melbourne, the tennis stadium resonated with the rhythmic ‘thoks’ of nicely hit tennis balls as the world’s best players contested the Australian Open. Our cricket grounds echoed with the sound of red leather balls being cleanly struck on the ‘sweet spot’ of the bat, and being lofted over the boundary line for six. So much the sweeter if the ball was delivered by an Englishman. The skill of the athletes wielding these bats and rackets comes largely from the ability to assess the path of the ball in flight and intercept it at just the right point to deflect it off in the chosen direction. Missing the ‘sweet spot’ means a lumpen volley into the net or a snick that is caught behind. Readers in other countries will recognise the same phenomenon in golf, baseball or badminton. A ball that hits the sweet spot flies straight and true, and the athlete knows they’ve done well. The academic model that best describes this sweet spot of clinical teaching is well captured by Laurent Daloz in his book Mentor: Guiding the Journey.1 He describes the growth in the learner that occurs when their teacher strikes the perfect balance between challenging them to achieve their vision, while giving them adequate support to do so. Too much challenge and they retreat. Not enough and they have no reason to strive. Just as the sweet spot is the key point of balance in the racket, bat or club, so it is in the clinical teacher’s individualised approach to each learner. This issue of The Clinical Teacher contains several articles that explore where the sweet spot lies for different learners in different situations. Macdougall and colleagues from Northumbria in the UK look at the effect of a simulated ‘day from hell’ on the confidence of senior students, and find that rather than retreating from the massive challenges presented, the students appreciated the opportunity to test themselves in a supportive environment.2 One might expect the highly realistic, cognition-overloading simulations described by the authors to be enough to turn the students into gibbering wrecks, but instead their teachers hit the sweet spot and allowed them to grow professionally. In a very different paper, Burgugi Banin and colleagues from Brazil compare the approaches of medical students and their teachers to spirituality in medicine.3 If the stark reality of a well-simulated cardiac arrest is enough to terrify most students, then the piercing emotion of spirituality should put paid to the rest. The paper shows significant differences in the way junior students approach religion within medicine when compared with their teachers and even their senior peers. Encouraging a junior student to consider his or her patient’s spiritual needs surely requires the deftest of touches: too heavy-handed and the teachable moment is lost. But colluding with the student to ignore the patient’s spirituality (and their own) just endorses the behaviour. Snydman and colleagues from Boston, USA, show a shift in the attitudes of medical residents to being observed by, and receiving feedback from, their peers.4 Initially reluctant, the residents came to welcome the peer assessment, in no small part because of the balanced way in which the programme was introduced. Clinical teaching is all about finding the right balance between supporting the learner and challenging them: offering enough carrot, but also providing just the right amount of stick. The experienced clinical teacher knows intuitively when they’ve struck this sweet spot and sent their learner flying towards their target. Best wishes from all at The Clinical Teacher for a very successful 2013. May all of your teaching result in a satisfying ‘thok’.