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I teach public health across its span, from undergraduate medical students meeting health systems, health information systems and research methodology for the first time, to experienced professionals who already carry clinical and managerial responsibility. They are, without exception, people I enjoy being in a room with, and my aim for each of them is the same: to help them move from receiving knowledge to using it, so that they leave able to act on evidence in a real setting. I have come to describe how I try to do this through a metaphor I built and refined over two years of study in health professions education, the Theatre of Reflective Design. In plain terms, I treat a learning space as a rehearsal room. Learners step onto the stage as performers rather than sitting quietly in the audience; feedback works like the mirrors that line a rehearsal room, letting people see their work from angles they could not manage alone; and my teaching is itself a piece of design that I keep revising, in the way a prototype is tried, tested and improved. The idea rests on Donald Schön's picture of the reflective practitioner, the professional who thinks while doing and learns by looking closely at what they have done (Schön, 1983).

What I believe about teaching and learning

The people in front of me already know a great deal. Whether they are second-year medical students or clinicians who have led services for years, they arrive with experience worth taking seriously, and I teach with that in mind rather than treating anyone as an empty vessel to be filled. Learning, in my experience, is rarely a straight line. Understanding grows by being tried out, bumped against kind but honest feedback, and reshaped. A few values keep me steady while that happens. Excellence, and the habit of always refining one's work. Competence, teaching that rests on more than instinct. Integrity, including being open about what I do not yet know. Innovation, and the freedom to experiment with design and digital tools. And accountability, owning the choices I make and the room I create, and hoping to pass that ownership on. I did not always teach this way. I came to it assuming it was in my blood, since both my parents were teachers, and two years of study gently corrected me. The lesson that stayed with me is simple: I used to assume everyone shared my frame of reference, and I now take care to explain my terms and check that I have been understood before pressing on. This statement, which explains itself as it goes, is written in that spirit.

The theories that inform my practice

Good teaching deserves more than good intentions, so I lean on ideas that put words to what I try to do. Adult learning theory reminds me that grown-ups learn best when the work is relevant and speaks to problems they recognise (Taylor & Hamdy, 2013). Experiential and reflective learning tell me that people make meaning by working through what they have done, not by being told (Boud, Keogh & Walker, 2013). Transformative learning, Jack Mezirow's phrase for the learning that stays with us, happens when we examine and loosen assumptions we did not know we were holding (Mezirow, 1991). When I set assessments I follow constructive alignment, John Biggs's sensible principle that what we hope students will learn, how we teach it, and how we test it should all pull in the same direction (Biggs, 1996). And I am fond of blended learning, the mix of face-to-face and digital, while never forgetting that access to technology is uneven and can quietly leave people behind.

From belief to practice

This shows up in what I actually teach. In the Postgraduate Diploma in Health Care Management I take a group of health managers through a five-day strand on evidence and information, carrying them from routine health data all the way to Design Science Research, an approach that builds and tests practical tools, models and processes to solve real problems, and the very approach that carried my own doctorate. I design and mark that work too, so I see where it lands. With MBChB students I teach artificial intelligence in health by opening the province's live electronic medical record in front of them, so that something abstract becomes a system they will meet on the wards. I have also had the pleasure of running Design Science Research workshops across the PRIMAFAMED primary care network in East, Southern and West Africa, and by invitation at the University of Benin. With a colleague I designed a virtual learning environment for community-oriented primary care, teaching students out in the community rather than the hospital, weaving together mapping, virtual home visits and predictive modelling.

Assessment and how I judge my effectiveness

I use assessment to help people learn, not only to sort them. I wrote the Division's framework for assessing Design Science Research in public health, and as a national examiner for the College of Public Health Medicine I write questions and design stations that reward thinking rather than memory. As for whether I am doing well, I watch several mirrors: what my learners make and say, what trusted colleagues tell me, and my own frank notes on what worked and what fell flat. I pay close attention to who managed to take part, because a session that delights the well-resourced and loses everyone else has not really worked.

The educator I am becoming

More and more I see teaching as something larger than my own classes. I am responsible, in part, for the education of those who come after me, and that is a responsibility I am growing into. I have supervised master's students through to completion, including one dissertation passed cum laude, and I am now stepping up to doctoral co-supervision. Nationally I help write the entrustable professional activities for public health medicine, the pieces of real professional work we can trust a trainee to carry out unsupervised (ten Cate, 2005), where I lead the health measurement and informatics part, following a path already laid in public health elsewhere (Moloughney et al., 2017). I would love to see Design Science Research and digital health woven through the programmes I teach on, from specialist training to postgraduate coursework and a stronger offering in digital health. Yet these are levers to move us forward rather than the point of the work. What lasts in a health system is built on relationships and on reliable systems that let people trust one another, and if I have one strength it is connectedness: I am at home, and well networked, across the three spheres of government, in academia and in civil society, and I try to teach in a way that opens those doors for my students and colleagues too. I treat teaching as scholarship in Ernest Boyer's sense, work that is planned, shared and open to peer review (Glassick, 2000), and I hold my own growth as a teacher lightly, as a journey still underway (van Schalkwyk, 2013; Van Lankveld et al., 2021). That, in the end, is the kind of educator I hope to become: someone working behind the scenes so that colleagues and students can do the best work of their lives.

References

Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education, 32(3), 347-364.

Boud, D., Keogh, R., & Walker, D. (2013). Reflection: Turning experience into learning. London: Routledge.

Glassick, C. E. (2000). Boyer's expanded definitions of scholarship, the standards for assessing scholarship, and the elusiveness of the scholarship of teaching. Academic Medicine, 75(9), 877-880.

Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.

Moloughney, B., Moore, K., Dagnone, D., & Strong, D. (2017). The development of national entrustable professional activities to inform the training and assessment of public health and preventive medicine residents. Canadian Medical Education Journal, 8(3), e71-e80.

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books.

Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-e1572.

ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176-1177.

Van Lankveld, T., et al. (2021). Supporting a teacher identity in health professions education: AMEE Guide No. 132. Medical Teacher, 43(2), 124-136.

van Schalkwyk, S. (2013). Journeys of growth towards the professional learning of academics: Understanding the role of educational development. International Journal for Academic Development, 18(2), 139-151.