Paper 15
Our Philosophy on Worthwhile Education and The
Moral Mode of Educational Practice
OurPhilosophyonWorthwhileEducationandTheMoralModeofEducationalPractice
DellaFishandLindadeCossartCBE
November2016
1.Startingpoints
WebelievethattheendproductofMedicalEducationismedical.
Theproductofundergraduatemedicaleducationisadoctornowreadytolearnfurtheralongside
engaginginanappropriatelevelofmedicalpracticewithrealpatients.
TheproductofPGMEisapractisingdoctorwhoislearningtheimportanceofandabilitytoprovide
thehighestpossiblequalityofwisepatientcare.Thisisanendless,open-endedcapacity.
However,weseebycontrastthattheprocessofMedicalEducationiseducational.
Thus,thepracticeofMedicalEducationisessentiallyaneducationalpractice.
Itisnotthepracticeofmedicineorofmanagement,norofpsychologyorofsociology.
ThishasprofoundimplicationsforallwhoengageinPostGraduateMedicalEducation(asattendedtobetween
supervisorandsupervisee)andintheeducationforalldoctors(asofferedthroughalltheactivitiesthatwe
engagein).
2.WorthwhileEducation
Clearlyanydefinitionofeducationisvaluesbased.ButunlikeProfWilfCarr,wedonotseethisasinimicaltothe
ideathattherearemanyprinciplesthat‘educators’ofallkindswouldespouseincommon.
Indeed,inthe‘conversationsofmankind’abouteducation(Oakeshott)thathavetakenplaceintheWest,overat
leastthelast2,500years,wefindmuchthatisheldincommonaboutwhatisinvolvedin‘good’education.
Particularlyweespousetwokeyideas:
thatworthwhileeducationcanbedefined
andthateducationshouldbeconductedwithinthemoralmodeofpractice.
Whatwemeanbyworthwhileeducation
Forus,endemicintheword‘education’isthenotionthatwhatisofferedisworthwhile.Itisinthatsensea
virtuousactivity.
Wewouldfurtherarguethatapracticecannotbeclaimedaseducationalunlessitisunderpinnedby(implicitor
explicit)understandingofwhatitis‘toacteducationally’.
Itisbroadlyagreedbyeducatorsthattoacteducationallyisto:
openminds,liberatethinking,encouragecritique,explorethefoundationsofgoodpracticeand
developcreativity....and:tonurtureandinvolvethelearnerinintrinsicmotivation…(carrotnot
stick!)
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(Seeaskeyauthorstheworkof:Oakeshott,M.,Carr,D.,Carr,W.,Dewey.J.,Freire,P.,Palmer,P.J.,VanManen,M.)
Wearepersuadedthatworthwhileeducationisseen:
Ø Wherevertheactivityengagedinopensminds,liberatesthinking,encouragescritique
Thus,wherelearnersareenabledtothinkinbroaderratherthannarrowerterms,havetheirconfidence
well-groundedandfuelledratherthandrained,andhavetheirengagementwiththeworlddeepened—
thentheirteachersmay,irrespectiveoftheireducational‘know-how’orskills,claimtopractiseinan
educationalway.(seeCarr,W.1995,p.160).
Ø BUTwherelearnersarenotsodeveloped,noamountoftechnicallywellperformedteachingskills
andcleverstrategieswillcompensate,andnotechnicalknow-howwillmaketheexperience
educationalforlearners.
Ø Andso,toengageinaneducationalpracticeismorethanabout‘knowinghowtodoeducational
things’(havingthe‘skills’ofteaching).
Theargumentisasfollows
Indeed,aneducationalmethod(likeinstructingdoctorsinagivenskill)canbeskillfullyperformedbutit
willnotbeaneducationalpracticeatall,ifithasbeenusedtoimposeaprocessuponlearnerswhohave
beenrequiredtoignoretheirpersonalperspectivesincludingtheirownvalues,attitudesandfeelings,
suspendtheirthinking,shutdowntheircriticalfaculties,abandontheirmoralawareness,andmerelyparrot
aperformance.
Thiswouldnotconformtoethicaleducationalprinciplesofprocedureconcernedwithcultivatingthe
understandingwhichenableslearnerstoexploreandcometoownaviewaboutwhy,how,whereand
whentousethatskill,whichinturncommitsthemtodeveloporchangetheirpractice.Indeed,itwould
betraining,noteducation.
Indeed,‘traininginaparticularskillmayormaynotbeeducational,dependingontheextenttowhichit
opensupthemindandcontributestothatgrowthasaperson’(Pring2000)
Thus,wesee:‘education’assignificantlydifferentfrom‘training’,‘conduct’assignificantlydifferentfrom
‘behaviour’,andthattheaimofproducingatechnicallyskillfuldoctor/healthcareworkerisnotthesame
asseekingtoproducearoundedprofessional.
Thus,webelievethatmanyareteachers,butfewareactuallyeducators!
Further,educationthatisproperlyconstruedandenactedasworthwhile,
isapracticewithimpact.
Wehavecollectedevaluationevidenceofourpostgraduateteaching(modulesatPGCert,Diplomaand
Dissertationlevel)inwhichnumbersofattendingseniordoctorshaveputonrecord,unequivocally,atthe
endoftheircoursethatworthwhileeducationofthekinddefinedbelowhascausedthemnotonlyto
changetheireducationalpracticesbutalsotorethinkandchangetheirclinicalpractice.
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3.Teachinginthemoralmodeofpractice
Weseeteachingasamoralandintellectualpracticewitharichtraditionthatgoesbacktothe
GreeksinthecenturiesBeforeChrist:theargumentWithacknowledgementtoHansen,D.(2001)
i.
Tofocusonlyonthemeansofteaching(the‘howto’)issterile.Itthenbecomes:ajobwithclear-cut
tasks;thetransmissionofknowledge;anoccupationwherethoseoutsideitsetthetermsandconditionsand
theactivitiescarriedout;aprofessionofferingspecializedactivities,butwherestillwecanbeeasilydiverted
bytechnicalmattersfromthinkingaboutthemoralandtheintellectualdimensions.
ii.
Tofocusinsteadonlyontheendscanleadto‘outcomes-focused’approaches,wheretheproductis:
socializing;acculturating;producingproductivemembersofsociety,successfulandcompliantworkers....
Thisisdangerousandequallyuneducational.
iii.
Teachingasapracticehasitsownintegrity,.....tothosewhoarethoughtfulaboutwhattheydoas
teachers.
iv.
Teachersshouldfirstdeterminewhattheycareabout[intermsofthequalitiesofpractisingdoctors]
andthencraftaconceptionofteachingthatcohereswiththatdetermination.’(Hansen,p.4)
v.
Teacherswhogivetheirplanningandtheirpracticeintellectualandmoralsubstancearealsoechoing
thecomponentsofteachingthathavedevelopedovertime.
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Further,theygivesustainedintellectualandmoralattentiontotheirlearners.Thatis,theyare
intellectuallyattentivetolearnersbyfocusingonwhatlearnersknow,cando,feelandthink,withaneyeto
buildingknowledgeoftheworldandhowtocontinuetolearnwithinit.
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Teachersaremorallyattentivetolearnersbybeingalerttolearners’responsestoopportunitiesto
growaspersons(tobecomemoreratherthanlessthoughtfulaboutideas,andmoreratherthanlesssensitive
toothers’viewsandconcerns).Theyaremindfulthateverylearnerisunique,withadistinctivesetof
dispositions,capabilities,understandingsandoutlooks.
Thusthebondsbetweenteacherandlearnerareintellectualandmoral,pertainingtotheiremerging
knowledge,understandingandgrowthaspersons.
Theconcept‘person’iscentraltothepracticeofteaching.
PERSON:Whoyouarehasagreatbearingonhowyouinteractwithlearners.
CONDUCT:Theideaof‘conduct’helpstocapturetheintellectualandmoralpresenceateacherdevelops.
Learnerslearnasmuchfromateacher’sconductasfromthesubjects/heteachers.
MORALSENSIBILITY:Thisisabouttheoverallattitudeandsensitivitiesateacherbringstobearinteaching.
Teachersconductthemselveslikethisnotasameanstoanend,butbecausethatiswhattheyseeas‘beinga
teacher’.
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Beingateacherinthemoralmodeofeducationalpracticemeans
1. Makingexplicitforyourself:
v
v
v
thehumanandhumaneaswellasthetechnicalaspectsofpatients'needs;
thehumanandhumaneaswellasthetechnicaldemandsofmedicalpracticein
allitscomplexity;andtherefore
theeducationalimperativestobeworkingonwithlearningdoctors.
2. Seeingeducationalpracticeas:
v attending to learners' being and becoming as persons, and to their thinking and decision-making
processes,aswellastotheirlearningofknowledgeandskillsdefinedintheircurriculum;
v recognizingthat—inaddition,orevenopposition,towhatyousay—yourbeingasadoctoranda
teacherwillhaveaprofoundimpactonyourlearnerasanimportantmodelforthatlearner,whois
inevitablywatchingyouallthetimeasyouworkwithandforpatients;
v being an advocate for the kind of education necessary for developing a wise doctor (one who
practiseswiththebestinterestsofthewholepatientattheirheart,usingtheirexpertisewithsound
professionaljudgementtotailorthecaretheyoffertothepatient’sowncircumstances).
3. Having:
v clarifiedforoneselfwhatdoesanddoesnotconducetoengagingineducationandmedicineinthe
moralmodeofpractice;
v committedtoworktosupportworthwhilePGMEandwherenecessarytoresistthenarrownessof
thedemandsmadebythecurriculum,bythepressureofdailypractice,bytheexpectationsofthe
NHS,government,RoyalColleges,andthemedia);
v committedtoeducatingthewisedoctor-ifnecessaryinoppositiontoanyrequirementsofexternal
agentsthatareinimicaltothis.
4. Insummary
ThemoralmodeofpracticeinPGMEisaboutaspiringtounderstandandmakeexplicitforyourselfhow
you see your practice of medicine, what kinds of education will conduce to developing a wise doctor,
using this to critique what external agents require and where necessary seeing these as mere basic
requirementsandseekingtoenrichtheminwayswhichthoughnotrequiredarenotprecluded.
ToparaphrasePring,2000,p.16,weseeeducationasreferringto
thoseactivities,onthewholeformallyplannedandtaught,whichbringaboutlearning,thatis
worthwhilebecauseitcontributestopersonalwell-being,providingtheknowledge,understanding
andvalueswhichenablepeopletothinkinthewaythatisconsideredworthwhileandtolivetheir
livesmorefully.
And,crucially,weshouldrecognizetheprivilegethatcomeswiththeeducationofpostgraduatedoctors
beingbasedonthebestandmostpreciousformofteacher/learnerinteractions,namelyone-to-one
teaching.TodaysuchopportunitiesareonlyfoundinourtwomostprestigiousUKuniversities(Oxbridge).
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