Brit. 3. mad. Educ., 1968~2, 274-277

The Role of Research in the Development of a Professional FERNANDO TAPIA University of Missouri School of Medicine

There is a vague, but universally accepted genera- lization that research involvement and excellence in medical pedagogy go hand in hand. It is such an unquestionable thought that, besides not being challenged, it isn’t even analysed for the details of the ‘how’ or ‘why’ research is good for the medical educator. Perhaps the time has come to give this truism a closer scrutiny.

Research in medical schools has been looked upon as cornucopia of blessings, beginning with the reputed wisdom of the government of the United States to extend research grants through regularly organized departments rather than creating re- search institutes where the only ‘students’ to be found would be advanced post-doctoral fellows. In relation to this isolation of the research institute, the Sub-committee on Research of the President’s Commission on Heart Disease, Cancer and Stroke (1965) said in part ‘. . . [instead of locking resear- chers in institutes] . . . How much more could be contributed by these giants if bright young minds could be exposed to their incisive and imaginative thinking’.

By transposition the thought emerges that the faculty member who does research exposes his student to his ‘incisive and imaginative mind‘. I quote Turner (1967) of Johns Hopkins School of Medicine from his presidential address to the ASSO- ciation of American Medical Colleges at San Francisco in 1966:

‘The Commission Report puts its fmger on a consideration of overriding importance to medi- cine, that of the favorable impact of research on medical students, both predoctoral and post- doctoral, and on junior faculty. Not only are the brightest of these recruited into research ranks, but there is reuson to believe [italics are mine] that young physicians become better clinicians if their minds are sharpened by contact with the critical attitudes essential to research.’

Although Turner states that ‘there is reason to believe’ in benefits accruing to students who asso- ciate with critical attitudes essential to research,

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no one will pull that ‘old rock’ and ask for his data. This is one of the accepted generalizations. How- ever, it serves to begin impaling the teacher on the need to do research since the researcher-teacher or teacher-researcher has an apparent teaching advantage.

Research, but more precisely National Institutes of Health research moneys, has been responsible, through financing of the faculty, for such things as the 25% increase in the annual medical graduates from 1951 to 1966. To quote Turner further in a statement about research money, ‘. . . in most medical schools, preclinical departments have been transformed in their pedagogical effectiveness as well as in their research potential, and much the same can be said of clinical departments’. Even if we accept these statements as valid, we must still keep clear that what research did to teaching was, at least in part, through increased faculty members (because research moneys were available to hire them) and perhaps because students associated with researchers. That research is essential to a teacher, however, is not to be garnered from this, even though the connection between academic promo- tion and research productivity (publications) lends further credence to the supposition.

At this juncture it is imperative that we be clear that what is usually said is that in education, and specifically in medical education, there are certain advantages to be derived from research and researchers but that these are related to the pro- pinquity between the researchers and the students. Some feel that this propinquity provides a mutual fertilization, since, to the researcher, the stimulus of teaching and the association with eager young learners, to quote William Bean of Iowa, ‘makes up for the let and trammels of undergraduate and graduate teaching’ (Bean, 1968).

By having researchers, it would seem the medical school or university derives many benefits which are easily translated into the substance of its teaching thrust - more staff, keen and critical minds, etc. There is, however, a specific question: Does the

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academic person or teacher gain intrapsychically (intracranially, if you will) from doing research? And if so, does research provide the exclusive sustenance for his professional growth?

Although never proven in so many figures, the endorsement of research rings like a prattle of platitudes - for example, if the research has merit, according to Russell Cooper (1946)~ head of the Department of General Studies of the University of Minnesota, it will ‘. . . challenge the imagination and resource- fulness of the professor and force him to be careful, systematic and precise. Such experience will almost certainly make him a stronger scholar in all aspects of his work, . . and we expect the student to develop scholarly interests and a capacity for original work, then the faculty must point the way through productivity on their own account. In scholarship like in morals, practice speaks louder than precept.’ Perhaps then, the educator of medical pro-

fessionals not necessarily going into research must be of a slightly different ‘ilk and hue’. In his harsh but insightful article, West (1966) makes a case against the investigator-teacher-clinician whom he calls the scholarly clinician. This person West considers to have his clinical interest confined to a narrow spectrum and to use his patients to teach. A desirable faculty member, according to West, is the clinical scholar, one who uses his patients to learn. Accordingly, the advantage to the student lies ‘more from watching us learn than watching US teach’. This, if true, must be especially valuable if the physician leaving medical school is really being cast into the role of the constant learner and up-dater of his skills and knowledge.

The Gundy Report The Gundy Report (1966), an analysis of medical research in Canada, in referring to the ‘teacher scientist’, did not refer to bim exclusively as an exotic, laboratory-bound figure surrounded by scintillation counters and similar gadgetry. The concept of the teacher scientist includes any physician who embraces the critical attitude to his daily work, strives continually to draw meaningful conclusions from his experience, and conveys the fruits of his experience to others. These fellows are ‘studying all the time’. This, however, is not merely book study but must include, published or not, critical analysis of his experiences as a human biologist. Thus West and the Gundy report seem to lend support to the image of the ideal professional school educator being something different than a researcher who teaches.

A study done at Northwestern by Men and Haring (1966) showed that medical students, in-

terns, and residents rated their clinical instructor’s effectiveness in reverse relation to their seniority. The longer they had been out of medical school the less impressive they were as teachers. This decline started at the age of 35. On the other hand, Pelz and Andrews (1966) noted that research performance has its peak at mid-career - the late 30s and early 40s. It is probably an easily explained paradox, but an implication remains that the pro- fessional is likely to be an effective teacher before he is a productive researcher, and that, after his days as a productive researcher, he is not likely to be an effective teacher. It would have been most useful if the Metz and Haring study could have gone one step further and analysed the extra- teaching activities of the more highIy rated ‘oldies’ to see if they were the active researchers, or what.

The above bit of legerdemain certainly does not imply, however, that the better teacher may not also be one who publishes and obtains government awards. In fact, Bresler (1968) noted that students tended to rate more highly the same members of the Tufts’s faculty who were obtaining most govern- ment awards and publishing more frequently. Unequivocally one may surmise from such a study that research and teaching are not incompatible. However, the question is still whether the teacher needs to do research to be a better teacher and if, in truth, research is the one scholarly pursuit which ‘supports good teaching, since it keeps the dissemination of obsolete knowledge to a minimum, encourages the introduction of new teaching meth- ods, prevents professional astigmatism, and en- courages respect and enthusiasm for scholarship among the students’ (Bresler, 1968).

Grow or Die Russell Cooper voiced another provocative thought regarding faculty members (Cooper, 1946): ‘They are subject to the biological law that an organism must either grow or die. The large number of faculty members who are slowly withering away on the campuses of America testifies to this lugubrious fact. They constitute, perhaps, the greatest single challenge to the thoughtful administrator.’

How can a faculty member grow? He has, apparently, several courses - teaching per se, counselling, research, extra-departmental activities within a school or university, and even extra academic involvements. Apparently, when kept within h i t s , practical contacts with the world of affairs may add to the maturity of the professor. Thus research is one of the avenues for professional growth. Fortunately, it usually enjoys great support through facilitating processes - sabbaticals, labora- tory space, library facilities, reasonable financial aid, assistance with publication, data manipulation,

276 Fernando Tapia

research assistants, etc. What is more, research enjoys such recognition in promotion that it has led Cotsonas, professor of medicine at Illinois (Cotsonas and Kaiser, 1963) to state ‘the estimate of the teacher’s research is important in the eyes of the administrator; it constitutes a significant “halo effect” in that it appears to override any attempt to view the teacher in any other way’.

Now, how do researchers grow? For those who wish to cultivate them, the Survey Research Center of the University of Michigan in studying Scientirts in Organization (Pelz and Andrews, 1966) noted several factors about research scientists. Among these was the recognition that their professional growth is faster when they are intrinsically re- warded - opportunity to use their skills, to gain new knowledge, to deal with challenging problems, and freedom to follow up one’s own ideas. Of course, this whole process was further boosted when extrinsic rewards followed achievement - salary, authority, and association with top executives.

But can you, to fracture a proverb, make a silk sow out of a purser’s ear ? Can you turn a faculty into researchers when, for instance, a review committee points its fmger at a medical school and says - ‘Not enough research coming from there’? An interesting study on research ability done by Strauss (1966) makes one wonder. Among 162 professors involved in research and in teiching research there was an impressive agreement that research ability was a vital and complex trait consisting, mnemonically speaking, of seven Is - Interest, Intelligence, Industry, Initiative, In- formation, Imagination, and Integrity. They agreed that high intelligence was necessary but not sufficient, nor was moderate intelligence a limitation. Imaginations (creativity), they felt, was the most significant attribute.

Thus injudicious pressures by the administrators on the academic professional who is not a genuine researcher may lead him away from his best professional model and drive him to such ploys as the entrepreneurial model - that is, the operator. Or he may give up the ghost, for if there were ever opportunities for sinecures, it’s in academics, where tenure is the sword that cuts both ways - protecting the meek and lazy as well as providing a secure base for those who wish to take risks and extend themselves. But it comes to everyone, the conspic- uous task of growth beyond the level at which one is recruited. It is a very striking possibility that the medical school faculty member who sees many patients but analyses his work, scrutinizes his results, updates his techniques, and broadens his art, thereby becomes eminently more capable of teach- ing by precept the practice and art of medicine.

‘Search for truth is the essence of all scholarship.

Research is only one aspect of this all-encom- passing search. Not all teachers, however, need be engaged in the creation of new knowledge. Equally needed are those who are concerned with study of the creative utilization of knowledge and the integration of available bodies of knowledge in meaningful ways.’ (Stratemeyer, 1965).

Reading about some of the great educators - Mark Hopkins, Charles W. Elliot, William James - one is often impressed by the stature of the man as a worldly, unselfish, and involved person. Conviction, courage, and determination to improve things was the essence of them. It seems that when the goals of instruction are broadened, the non-technical aspects of the professional art rise to dominating importance. Of course, these persons and the legends around them, like good wine, have im- proved with age. But, then, only the better wines improve with age.

Avenue for Professional Growth In summary, research is one of the avenues for professional growth - in fact, one of the best and most appreciated by administrators. I t would seem that the researcher has his own special traits and he flourishes best under special intrinsic rewards as well as the usual extrinsic inducements. Certainly research does not subvert good teaching, but that research activity develops a better teacher is questionable, although proximity to researchers gives the student some benefits, especially if the student is to be a researcher himself. The researcher who teaches and teaches well is certainly the golden apple of a dean’s eye. Such a professional may well be confined by the limits of the research interests on which he has focused. However, this is probably more than made up for by the ease and clarity with which subject matter bordering on the limits of scientific knowledge is hopefully handled.

The subject of research and professional growth opens up the question of professional growth in and of itself. That professional stature is found through other avenues should not be overlooked. However, the thoughtful dean or administrator must also find ways of accountability while legend and history reserve their verdict.

References Bean, W. B. (1968). Institutes versus depamnents. Curr.

med. Dig., 35, 277. Bresler, J. B. (1968). Teaching effectiveness and govern-

ment awards. Science, 160, 164-167. Cooper, R. M. (1946). The Promotion of Professional

Growth in Faculty Members. Proceedittip, Institute for Administrative Officers of Higher fnstinrtionr. Vol. IS, pp. 113-123. University of Chicago Press, Chicago.

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Cotsonas, N. J. Jr., and Kaiser, H. F. (1963). Student evaluation of clinical teaching. J . med. Educ., 38, 743-745.

Metz, R., and Haring, 0. (1966). An apparent relation- ship between the seniority of faculty members and their ratings as bedside teachers. J . med. Educ., 41, 1057-1062.

Pelz, D. C., and Andrews, F. M. (1966). Scientists in Organizations: Productive Climate for Research and Development. Wiley and Sons, New York.

Stratemeyer, F. B. (1965). Perspective on college teaching and research. Amer. Ass. Coll. Teach. Educat. York, 18, 37-41.

Strauss, S. (1966). Research Ability. Science, 50, 418- 437.

Subcommittee on Research of the President’s Commis- sion on Heart Disease, Cancer and Stroke (1965). Report, pp. 137-223 in A National Program to Conquer Heart Disease, Cancer and Stroke. Vol. 11. U.S. Government Printing OAice, Washington, D.C.

The Gundy Report. (1966). Medical research in Canada, an analysis of immediate and future needs. Canad. med. Ass. J., 9 4 806-808.

Turner, Thomas B. (1967). The medical schools twenty years afterwards: impact of the extramural research support programs of the National Institute of H4th.J. med. Educ., 42, 109-118.

West, K. M. (1966). The Case Against Teaching. J. med. Edue., 41, 766-771.