Excellence in clinical teaching: the core of the mission.

The core of clinical education is the dialogue between physician teachers and their students and residents. Several years ago the authors began to examine the nature of the "talk" in one-on-one ambulatory clinical teaching encounters. Discourse analysis, a qualitative method for examining communication, can identify patterns of interaction and can highlight the factors that impede useful teaching conversation and learning in the contexts of clinical education. Further, it can identify the microskills that physician-teachers need to teach effectively and humanistically. Having faculty members coach each other is an effective institutional approach to teaching these microskills, and it is especially valuable to have teachers examine the language they use in clinical teaching, so that they can understand the different impacts that different kinds of language can have on learners. Physicians are responsible for cultivating humanistic attitudes in their students. When a physician is humanistic in helping a student learn, the student can, in turn, use the same attributes with the patient. The humanistic behaviors that are valuable parts of the physician-patient relationship are the same ones that must also characterize the relationship between physicians and their students. Excellent one-on-one teaching in clinical settings requires two major things: first, medical educators must understand the special communication skills that create effective and humanistic teaching; and second, administrators must re-recognize that teaching is the true heart of our medical schools and teaching hospitals, and therefore support the faculty professional development needed to foster excellent teaching.