Key Points

The 2009 Thelma Shobe Lectureship

Lee S. Shulman

"The Pedagogical Imperative in the Health Sciences:
The Challenges of Professional Formation"

Dr. Lee Shulman, immediate past president of the Carnegie Foundation for the Advancement of Teaching and renowned scholar of professional and general education summarizes his focus for the upcoming Thelma Shobe Distinguished Lecture on Ethics and Spirituality in Health Care, April 29th, 2009, 12:00, presented by UCSF School of Nursing.

Under Dr. Shulman's direction, The Carnegie Foundation for the Advancement of Teaching has completed a ten year program of research on professional education. This research, undertaken on the 100th anniversary of the original Carnegie Flexner Report on Medical Education, is already having a significant influence on professional education. Dr. Shulman will present cross-professional educational comparisons between Clergy, Engineering, Law, Medicine, Nursing and Teaching emphasizing themes in the scholarship of teaching and the formation of professionals. He will address the question: What does it mean to "profess" as health care professional educators?

Dr. Shulman highlights key points in his lecture below:

The Pedagogical Imperative in the Health Professions:
The Challenges of Professional Formation

The professional preparation and sustenance of teaching in the health professions requires its own rounds and rotations, its own case conferences, its own routinized practices of public performance and repair. What would teaching look like if we took it as seriously as we take clinical care and clinical research?

Ideas, knowledge, understanding and hence scholarship matter, matter so much that they cannot be hoarded and preserved solely for the cognoscenti. Teaching is that form of scholarship-based knowledge that needs to become community property. Teaching is that professional role which can improve and flourish if those engaged in it do not hoard what they have learned, much less the errors they have undertaken and the mistakes they have made.

In one focus group of nurses a student defined a nurse as "the patient's last line of defense." I shall argue that, in parallel, in the health sciences (and everywhere else in the Academy), we must expand that view and declare that "The teacher is the student's last line of defense." Alas, in an academic community where teaching is constantly subordinated both to research and publication on the one hand and on clinical care on the other, the pedagogical imperative has been tragically overlooked.

From our work on the education of ministers, priests, and rabbis, came the metaphor of pastoral imagination as a reflection of the essential tension between sacred text and worldly action, between vision and vocation, between conception and comportment, between theory and practice. All professional education must address three essential apprenticeships:Knowledge of relevant science, technology, literature and theory, skilled know-how and judgment in clinical practice and ethical comportment and formation. How, in the education of health professionals, which attempts to do justice to all three apprenticeships, can one faithfully discharge one's pedagogical obligations to all three while attempting to support the development of the healing equivalent of pastoral imagination? In spite of an atmosphere of educational program acceleration, for example, the press to complete nursing doctorates in 3-4 years, doctoral education must include a heavy emphasis on the pedagogical and moral imperatives of the scholar, and not solely the obligations of research.

In our studies of the education of lawyers, we observed the tension between the competing roles of lawyer as "zealous advocate" and as "officer of the court." How do teachers in the health professions address the parallel dilemmas of health care? How do they engage in the pedagogical work of enacting learning that wrestles with such challenges, embodying those values and commitments needed to confront such situations thoughtfully and ethically, and do so in a regular, continuing and persistent way so that it contributes to the formation of the health professional? Engineers note: "We mess with the world, and then are responsible for the messes we make." Teachers mess with the minds and hearts of students by teaching them and engaging with them, and too are responsible for the consequences.

Health care professionals have the moral obligation to resist the hegemony of research and publication when it becomes a barrier to the pedagogical imperative, and the need for a courageous stand against research as ritual rather than as a social and communal contribution to the common good. Health care professionals have the moral obligation to profess what one knows, to confess what one does not, to act in the absence of full knowledge on the promise that we will "forgive and remember," and, when necessary, to act in spite of the consequences when commitment must take precedence over certainty.