Feature, Soapbox

Training is evolving with the times

When asked to write this piece on training I had to reflect on the moments in my career that led to training being such an integral part of what I do. Small things that add up over a lifetime and mould you. Partly it was luck and opportunity, having great leaders and mentors, and having a partner who was also passionate about teaching.

I also reflect on what I have learned by teaching and about teaching. I now realise what I thought was an effective style of training in the past looks very different today. I wonder what else needs to change in the coming decades of my career to ensure the training of the next generation of eyecare professionals is even better than before.

Teaching and learning styles are rapidly changing, and – for the most part – for the better. I recall my first degree was taught in a typical didactic fashion. So, when I started medical school some years later, I was excited to experience a totally new style of learning, which was group-based problem solving. We, the students, were encouraged to determine what we needed to know and seek those answers. What I realised at that time was that if learning is exciting and selfdriven it becomes passionate learning and thereby deep learning. I took this forward with the motto that everything I taught should be relevant and rousing.

But we now know that passionate teaching alone may not be enough. Whereas when I first graduated, medical education was somewhere between didactic learning and an informal apprenticeship, now it is becoming a true science, with a large body of literature to guide it. Gone are the days of “eminence-based teaching” and to replace it is evidence-based teaching.

The example that comes to mind is that of “pimping”[1]. This is the common practice of asking students increasingly difficult questions, on the spot, until they fail. A kind of trial by fire or a form of hazing disguised as educating. The weight of pedagogical evidence shows that this style of teaching is both ineffective and actually leads to harm to those being “pimped”.

When I was made aware of the body of literature around this, I was forced to change my teaching style and now I actively avoid this in favour of a more guided learning style.

My other great influence has been my mentors and these great men and women taught me many things. The summary of what they passed on to me was to always give of your time and energy wholeheartedly because those who do are more than compensated for their effort.

In my years working at Sydney Eye Hospital, I saw this in the culture of teaching. Every day one or more consultants gave dedicated teaching, often out of their own time. This generosity was not lost on the students, who as a result, put real effort into their learning. I also think of my own mentors who made themselves available with their time and sage advice. This has had a great influence on my willingness to devote time and effort to my trainees.

Lastly, when I am choosing topics to teach, I try to give thought to the curriculum I am creating. I am aware that selecting topics I think are important is a trap and that it is more important to cover topics that will actually be of use to the student in front of me, not a generic syllabus.

This can be achieved by not only finding out where a particular trainee’s understanding is at, but also where they want to take it.

Teaching for me is a joy. The variety is the spice that keeps my week interesting: optometry students, therapeutics candidates, medical students and ophthalmology registrars. We are privileged in medicine to have the opportunity to teach. We are also living through a time of meaningful change in health education. By combining care for our trainees, passion for teaching and evidencebased education I derive great pleasure and I hope my experience inspires others too.


Name: Dr Nick Toalster
Qualifications: BAppSci Optom (Hons), MBBS (Hons), FRANZCO
Business: Okko Eye Specialists and Royal Brisbane & Women’s Hospital Consultant
Position: Ophthalmologist
Location: Brisbane
Years in profession: 15


  1. Chen, D.R. and K.C. Priest, Pimping: a tradition of gendered disempowerment. BMC Med Educ, 2019. 19(1): p. 345.

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