Publication on Ambulatory Clinics: Unsatisfying Lack of Limitations

I have been reading the publications by Dr. Irby on the topic of teaching in Ambulatory Medicine. In “What Clinical Teachers in Medicine Need to Know”, he interviewed 6 teachers with “excellent ratings” from the Department of Medicine at the University of Washington School of Medicine in Seattle. He concluded that there are several “domains” of knowledge important to being an effective teacher, including knowledge of medical content, the learners, the clinic patients, the context of the practice, general teaching principles, and teaching script. While Dr. Irby’s publication is well-referenced, I found the lack of a “Limitation” section or an explicit discussion of the study’s limitations unsatisfying. Even though small sample size is common in qualitative studies, I would still have appreciated acknowledgement be given to this, followed perhaps by an explanation of why this study remains valid despite this. All the teachers in the study belonged to the same school, which could impact the generalizability of conclusions. For example, are these domains consistent between these teachers because these concepts are truths or simply because the same teachers have had the opportunity to exchange teaching methods with each other over coffee?

I also found the term “teaching script” interesting. This concept is recurrent across Dr. Irby’s two publications and draws parallel with the language used to describe medical learning (illness script). This linguistic homology almost suggest a similarity in how we structure our own knowledge and how we reformat it in teaching. Or, at the very least, a similarity in the way we think about the way we think.  

-Jenny