TEACHING AND EDUCATION

Teaching, in a narrow sense, the way most of us think about it, is an activity by an individual aimed at causing another person to know some new fact or to know how to accomplish some new task. The focus appears to rest on the teacher and the activity of teaching. It does not take long to realize, however, that this way of looking at the teaching/learning activity has misplaced emphasis. If not with the teaching activity, where does the emphasis belong? The answer to this question lies in understanding the definition of education.

Education is an all-encompassing process (not merely a specific activity) resulting in a change in behavior on the part of the student/learner. The focus of education is the learner, not the teacher. It is the student who is educated by interacting with an environment that provides experiences. Education is a change in behavior based on experiences. The experiences most often include the student interacting with a teacher, but they are almost never limited to that alone. The entire milieu defines the total experience ( Fig. 85-1 ). When the milieu changes, so may the education; that is, the change in behavior exhibited by the student may vary dramatically if the milieu is varied.

Picture the educational setting in which an anesthesiology resident is learning how to use epinephrine when weaning a patient from cardiopulmonary bypass. The knowledge and skills that must be learned include application of the pharmacologic principles of catecholamines to the pathophysiology of cardiovascular disease by turning on a mechanical infusion pump to deliver the indicated dose of a medication while technically monitoring for dose response and toxicity. Learning these facts and the skills sufficient to use them is much different when done from a textbook or a preoperative conference with a staff preceptor than when done during the operating room interaction between the surgeon and anesthesiologist, where varied opinions may consider dopamine a more sound physiologic choice or intermittent boluses a better administration technique. The interposition of the concerned surgeon and real-time patient setting between the student and the knowledge and skills to be learned changes the learning environment and, hence, the educational experience for the resident. More is learned than the facts and psychomotor skills. As the attitudes of both the anesthesiologist and the surgeon are displayed during resolution of the question about the "best" drug to use and the "right" way to give it, the resident learns how these two types of practitioners are supposed to relate to one another.

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Figure 85-1 Diagrammatic representation of the educational experience. The two major components are the plan for teaching and the process of education that actually occurs. At the core is the content (cognitive, psychomotor, and/or affective) to be taught and learned. Growing out of the content are the planned goals of education, the methods and the program of instruction, and the environment in which the teaching and learning will occur. In the diagram, each building block of the plan is added to the previous one in an all-encompassing fashion. What is planned as education and what is experienced may or may not be the same. As represented by the diagram, the educational process that actually occurs includes all of the plan and layers on it, both the real environment and the teacher/student interactions that provide the education, that is, the experiences that provide the basis for the ultimate change in student behavior. (Modified from Atkins E: Curriculum Theorizing as a Scientific Pursuit: A Framework for Analysis [unpublished doctoral dissertation]. University of Pennsylvania, 1982.)

It seems obvious, therefore, that there is more to consider than just teaching. What more is there to the anesthesiologist's responsibility than just teaching those around him or her? The answer is provided by answering the component parts of the question posed at the beginning of this chapter.

Teach to whom?

Why teach?

Who teaches?

What to teach?

How to teach?