Pocket Guide to Teaching for Medical Instructors

Pocket Guide to Teaching for Medical Instructors, 3rd Edition

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Found at these bookshops Searching - please wait We were unable to find this edition in any bookshop we are able to search. These online bookshops told us they have this item: Preface to the Second Edition. Preface to the First Edition. Chapter 1 Adult learning. Chapter 2 A structured approach to teaching.

Chapter 3 Lecturing effectively. Chapter 4 Teaching skills. Chapter 5 Managing role-play and scenarios. Chapter 6 Facilitating discussions and workshops. Chapter 7 Getting assessment right. Chapter 8 Giving feedback. Chapter 10 The role of the instructor. Chapter 11 Annotated bibliography.

Book ratings by Goodreads. Goodreads is the world's largest site for readers with over 50 million reviews. Even experienced members of the audience can sometimes be under considerable pressure and may forget things that they would rea- sonably be expected to know. Questions along a row: Asking 10 people to name ten known facts has a number of negative effects: By the time you get to the eighth person, there are only three left and pres- sure along the row will almost certainly guarantee that students will not be able to contribute. In the meantime, students in the first few positions can take a break and possibly lose concentration and a sense of engagement.

This is not an uncommon strategy and it has the merit in encouraging all the audience to think of a possible answer before someone who may look as if they know is invited to respond. Whatever the strategy, there are a number of things you need to do in response to an answer, assuming for the moment that it is correct. Say 'thank you', rather than 'excellent' or any other over-enthusiastic superlative. A reason for this is that answers to particularly low level questions are rarely anything other than successfully recalling something from memory - often from another session.

Repeat or paraphrase the answer: Expand on the response, particularly if it is partial. Ask supplementary question s. Relate it to other parts of your lecture, if relevant. Because lectures are rarely introducing new material, and very rarely, complex or abstract material, the likelihood is that respond- ents will answer correctly. However, you do need to be prepared for two phenomena: It is important that you allow both, but the strategies are some- what different. Lecturing effectively 23 and!

ATP is the Obviously, there should be variations on these, but you should look for the supportive, rather than hypercritical or sarcastic. Idiot, you think the first shock should be 50 J? I might need to talk to your clinical director'. Whatever the strategies you adopt in the dialogue, you should be aiming for a conversation that ena- bles the audience to share with you and everyone else, a more cer- tain understanding of the issues.

Closure Closure has three stages: Asking for questions and waiting for 10 seconds to get any , gives an audience the opportunity to check any uncertainties they may have. In general, it is safe to treat these as genuine requests for information and you answer them briefly and succinctly.

You may, however, come across the occasional individual who will ask something like: T read in a recent edition of the Annals of Emergency Medicine that However, it is vital that you do not undermine the student however you might feel as the question may mask uncertainty and a lack of confidence. The summary is your opportunity to give the students a 'take- home message' and it should relate directly to the learning out- comes you spelled out in the set.

Once more, it should be succinct 24 Chapter 3 and not revisit the whole content of what you have had to say. The summary should always follow questions - this ensures that the lecture does not run over time T can accept one more ques- tion before I summarise' and also ensures that the audience leaves with your take-home message fresh in their mind rather than an awkward question.

Termination is important because it avoids the situation in which the audience are not sure what is going to happen next. Something like 'Right, wait here as Professor Angstrom is going to talk to you about a new way of thinking about the control of Type 1 diabetes' or 'Thanks for your attention, and now it's time for coffee. Be back by Summary and learning A lecture is an opportunity to remind people of what they may have come across in other contexts and a chance to share issues and concerns within a safe environment.

While lectures are not good at delivering complex knowledge or practical skills, they have a distinct place in learning. Using techniques, such as questioning, to engage learners improves the experience. Taxonomy of Educational Objectives: The Classification of Educational Goals. Longmans, Green, New York, Toronto, Once a skill has been learnt, regular practice and correct performance are key factors in developing mastery of the skill. Learners arriving on courses often come from varied backgrounds with varied experience, and this is often most apparent by their varied ability to perform the range of key skills.

Acquiring a practical skill is influenced by the retention of fac- tual knowledge, the psychomotor performance and the attitude of the candidate as a learner. The interaction between the candidate and the teaching environment is important in achieving a behav- ioural change in their practice and mastery of a skill. The whole process is about promoting independent practice of the skill. The process of changing behaviour is situation dependent in other words, linked to the candidates' experiences.

The key to success here is the instructor's ability to help candidates identify how they can apply new information, skills and attitudes to their everyday clinical practice. Once this has been established, the skills themselves are best taught in stages. Acquisition of the skill by the candidate reflects their ability to become increasingly organised as a result of the learning experience. Researchers have demonstrated that retention of both knowledge and psychomotor skills decline sharply after months if they are not practiced.

The retention of skills that are regularly used by clin- icians is more encouraging. Thus over the last decade, we have seen a significant shift from trying to teach all healthcare professionals all domain skills to a more focused approach on skills that they will use in their normal work. This leads to an increased motivation and desire to learn, with candidates realising the value of new skills, which enable them to function in everyday work situations. Important principles when teaching practical skills are to: Poor retention of resuscitation skills by learners is attributed in many studies to ineffective teaching.

The goal of teaching or the learning outcome should be change in the behaviour of the learner; repeated practice will greatly enhance achievement and performance. The four- stage approach is the teaching methodology adopted on provider courses, and is centred on the way informa- tion is processed by the candidate, and not just the factual infor- mation provided Bullock, Structure Skills" teaching is based on a universal structure for teaching. As discussed in Chapter 2, this consists of set, dialogue where a four- stage approach is used and closure.

Set including environment Preparation of the environment in which the skills are taught is essential if the session is to be successful. Often, several groups Teaching skills 27 are taught in the same room and therefore care must be taken to avoid distractions between groups, either by adequate separation or by the use of screens. Candidates must also have enough room to observe the skill as it is demonstrated. Remember, bodies gener- ate heat and a room containing several groups will soon become hot and stuffy.

As the instructor, it is your responsibility to ensure that you have all the equipment needed to teach the skill. You should ensure that it functions and you know how it works. Arrange the equipment in a realistic manner, removing anything that is not essential. When the candidates arrive for the session, they must be given clear, realistic learning outcomes. Motivate them by explaining the skill's importance and put it into context within the rest of the course. Finally, identify how the candidates are expected to partici- pate in the session.

This is vitally important in skills teaching because the initial approach used may be very different to what they have experienced previously. You are responsible for setting the mood, for motivating the candidates through the learning outcomes for the session and for clarifying the roles, that each will play. Dialogue This is the main part of the session where the skill is actually taught using the four-stage approach. Although all methods of education are ultimately about the processing of information, the four-stage approach is orientated specifically towards developing the learner's ability to acquire and operate on information received.

This is sum- marised in Box 4. Stage 4 Repeal dem. Demonstration of the skill, performed at real speed with or without speech. In this first stage, the instructor demonstrates the skill as they would normally practice it. In order to create realism, the demon- stration is performed in real time, allowing the learner a unique 'fly on the wall' insight into the performance of the skill. No com- mentary or explanation is given, but any verbalisation that accom- panies the skill should be included, for example shouting for help.

The demonstration provides the candidate with strong visual imagery which shapes new learning. Stage 2 Reinforcing components of clinical expertise. Repeat demo nst ration with, dialogue, providing the rationale for During this stage there is an exchange of facts and ideas between teacher and learner. In stage 2, the instructor is able to slow down the whole performance of the skill, providing the basis for actions and indicating the evidence base for the skill where appropriate.

Involving learners by engaging them in dialogue underpins theor- ies of adult learning. Involving the candidate and acknowledging what they bring to the learning environment serves to increase their motivation and desire to learn. This potentially allows the instructor to lead them from what they already know to what they need to know. Provision of meaningful feedback is important to facilitate acquisition of the skill. A period of time for questions within stage 2 can enable the candidates to gain clarity and the instructor to assess understanding prior to stage 3. Teaching skills 29 Stage 3 Part transition of responsibility for the skill from instructor to candidate.

Repeal demonstration guided by one o! During this third stage the learner talks the instructor through the skill while the instructor performs it. This allows the candidate to 'gather and organise information from the environment in order to form useful patterns, which form the basis of their own future behaviour' Eggen and Kauchek, Strong visual reminders will help the candidate recall the skill under the stressful condi- tions of actual practice. At this stage the responsibility for the performed skill is moved firmly away from the instructor towards the learner.

The emphasis here is on cognitive understanding knowledge that will guide the psychomotor activity performance of the skill in stage 4. It is also important at this and the following stage to correct error or misapprehension. Opportunity for further questions and reflection on the skill adds to the importance of this stage.

Positive reinforcement of good practice will enhance the future practice of each individual learner. Stage 4 Independent candidate practice. Repeal demonstration by the learner, and practice of ;he skid by all learners. This stage completes the teaching and learning process. It completes the transference of ability from the expert instructor to the nov- ice candidate , and helps establish the abilities of learners in the particular skill.

For virtually all newly learnt skills, a single practice may be insufficient, and all candidates must be encouraged to con- tinue to practice in order to gain further confidence and competence. Once candidates have demonstrated com- petency in a particular skill, they should be encouraged to maintain this level of performance throughout the rest of the course, reinforc- ing skilled practice.

The strength of using an information processing approach is that it is concerned predominantly with meaningful, pur- poseful learning as opposed to learning by rote. Closure Hopefully, most of the questions generated during the skills teach- ing session will have been raised and answered during stages 3 and 4.

It is essential that at the end an opportunity be given for final questions to be aired. A summary should affirm achievement of the objectives for the session, linking the skill to the rest of the course and reinforcing its importance and usefulness. Summary and learning The theories of skill acquisition described in this chapter provide the instructor with a firm basis for teaching. This well structured and systematic approach allows repeat practice in a safe environ- ment. The opportunity to gain 'protected' practice and experience is an essential ingredient in psychomotor learning Quinn, The four- stage approach to skills teaching on the provider courses represents the dialogue component in this model.

The main focus of using this methodology is to effectively transfer skill from the expert instructor to the novice candidate , as the first step towards gain- ing skill mastery. Holt, Rinehart and Winston, New York, Skill acquisition in resuscitation. Teaching Content and Thinking Skills. Prentice Hall, Englewood Cliffs, The Principles and Practice of Nurse Education , 3rd edn. Chapman and Hall, London, There are five common types of role-play: Learners use their own responses and actions in a given situation; in other words, they behave as themselves but in a novel to them context.

Learners are given a role to play with clear instructions on how this should be performed. For example, 'You are a nervous junior doctor confronted with a febrile child and her mother. As with improvisation but following a discussion as to the nature of the roles, and possible outcomes. When learners play a role other than their normal one to gain insight into the thoughts, attitudes and behaviours of Pocket Guide to Teaching for Medical Instructors, Second Edition.

Over-developing the features of a character to make a particular point, for example, an aggressive relative receiving bad news. Role-play can also be used to teach specific interpersonal skills which may then later be included in more complex simulations. For example, telephone discussions with a senior clinician about a referral may be conducted by seating two learners back-to-back. As with all teaching modalities, attention has to be paid to plan- ning and facilitation, with attention to environment and set being central to the success of the subsequent dialogue.

There are differ- ences between the two, largely arising from the fact that role-plays tend to be free of equipment while scenarios rely on equipment. Scenarios sometimes called moulages are focussed role-play often used in healthcare teaching. Jones defines a scenario as: Presented in these terms, scenario teaching can overcome some of the traditional reservations about this form of teaching by empha- sising emotional security see Maslow in Chapter 1. Scenarios have the capacity to allow learners to integrate their learning from other contexts: In something approaching real time, learners can inter- act within a context, including other health professionals and rele- vant equipment ECG, tubes, collars, etc.

At the heart of scenario teaching is role-play in which learners act out how they imagine how they may behave in another role in given circumstances. Structure of a role-play session Set including environment For most role-play you won't need much more than chairs, pos- sibly supplemented by some equipment to add to the illusion. Managing role-play and scenarios 33 Mainly, you need to consider where to place your chairs for the role-players and any observers.

Things to consider include: Being overlooked by people external to the immediate group. How close do you want people to be to one another? Do you want the audience or a critiquer to be in direct eye line with the main role-player? Would a role -player need a desk or other surface to make notes? The first three of these relate more to the emotional, rather than the physical environment and because of the nature of the roles that are being explored, this needs thought. Even though role-play is not real, it does need to be realistic and this also needs careful planning. Much of that, however, will be built into the design of the role-play and that is beyond the scope of this chapter.

Where you can ensure some feasibility, however, is by ensuring that individuals are given roles they could reason- ably be expected to play: The role description and the context should be enough to enable the role -players to explore the issues experientially within a constrained period of time followed by shared reflection about what took place.

It is vital that role-play is properly explored in order for every- one role -players, critiquer and audience to learn from it. Time management is something that you need to emphasise, so that the role -players know how long they have got and that you will let them know when they need to move towards closure. Dialogue During the role-play episode itself, the facilitator is there to listen, and to manage time boundaries.

It might be helpful to make notes to assist the discussion that follows, which is also part of the dia- logue. While feedback and critiquing is part of this process, the post- episode discussion is where additional learning can take place. During this time, participants should be encouraged to explore thoughts and feelings and to identify problematic and challenging moments. As far as is possible from memory of what is, after all, an ephemeral event, comments and discussion should be based on evidence - what peo- ple said, and how they said it.

A shared exploration of this can be a powerful learning experience for role-players and observers. Equipment will depend entirely on the nature of the scenario being offered: The best way to determine what you need is to 'walk through' the scenario. This will allow you also to make a number of decisions about what is missing and consider questions like what to use if there is nothing to suction with.

This process can also alert you to any other uncer- tainties or ambiguities that are present in the scenario story. Some issues may arise because of the way in which the mani- kin functions. While modern, increasingly complex manikins are becoming available much teaching still involves older, less realistic dolls. The detail of the more interactive manikin is beyond the scope of this chapter except to say that instructors must learn how to use them before teaching with them.

The use of live patients actors or real patients can provide some considerable advantages, but also some disadvantages. These are summarised in Box 5. Thus they need to be carefully briefed and must practice the scenario so that difficulties can be resolved. If they are made up so that they look as if they have the illness or Managing role-play and scenarios 35 trauma that they are supposed to have, this may add to the learn- er's experience.

Dialogue Whether it is a manikin or a real patient, the responsibility for pro- viding accurate patient feedback belongs to the instructor running the scenario. Learners quickly recognise this and look for feedback. It is better, therefore, to be proactive, rather than reactive, thus: The role of the instructor in a scenario is to provide this clinical infor- mation and offer the occasional prompt in order to help the learner keep within the protocols.

These should be subtle, for example: Some learners may be incredibly slow and they need to be prompted 36 Chapter 5 by adding in new, and possibly urgent, clinical signs e. Others may move rapidly, usually by tell- ing the instructor what they would do, rather than actually doing it. These can be controlled by simple requests, for example: Remember, the scenario is an integration of skills and knowledge acquired elsewhere and learners should be encouraged to demon- strate their psychomotor ability as well as their knowledge.

Sessions should be terminated immediately in the event of safety being compromised. Closure As discussed earlier in this chapter, role-play and scenario teaching have a strong emotional component and participants need to be allowed to return to normal, particularly if they have been dealing with issues which could resonate powerfully with their own exper- ience. This can be achieved very easily by asking them to relate personal details of a trivial nature e.

This serves to remind Alison who she really is.

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As with all teaching modalities, role-play and scenarios need to close properly, by: Summary and learning Role-play and scenario teaching differ from other teaching methods in the way in which, if successful, they relate directly to Managing role-play and scenarios 37 practice. They utilise skills, knowledge and affect in order to enable learners to explore a simulation of their real world.

As an instructor, you should aspire to make the simulations as real as necessary to maximise the learning experience for all participants. A Handbook for Teachers and Trainers, 2nd edn. Kogan Page, London, The outcomes of well-organised group activity are almost invariably better than those achieved by even the best individual member working alone. It is also recognised that group activity can be extremely useful in assessing adults' ability to apply the- oretical knowledge to practice.

To achieve these goals this teaching method requires the teacher to be a facilitator of learning rather than a definitive source of knowledge. The challenge therefore is to create a setting where learners benefit from a more student- centred experience. As with all educational activities, good planning, organ- isation and facilitation are required. The ideal group size is less than 12 for discussions and less than 8 for workshops.

Participants tend to become inactive and contribute less if the group is larger. This chapter explores the different approaches to group discus- sions and workshops, providing some ideas for their planning whilst highlighting the skills required in facilitating them. Though the skills used in running workshops and discussions are those of a facilitator, the term 'Instructor' will be used throughout, encom- passing the roles of teacher and facilitator.

Pocket Guide to Teaching for Medical Instructors

Effective planning is crucial. The first stage is to clearly define the desired outcomes of the session, as this will determine which type of group session you will run. Starting and finishing, subtly role direction encouraging participation Examples of topics for each type of session include: They can also include elements of skills and may use equipment.

Open discus- sions do not appear on the timetable of some courses - there are, however, frequent informal opportunities for open discussion dur- ing breaks and mentor meetings. In addition, for instructors, the more formal open discussions that are the basis for elements of the faculty meetings occur on a daily basis. Common aides used to focus the discussion are the flip chart, whiteboard or overhead projector. The usual rules apply when using these, but the instructor should be clear about what con- tent will be written, or what pre -prepared content will be revealed and when.

Facilitating discussions and workshops 41 Figure 6. The instructor sets the mood by saying what is expected of candidate participa- tion before stating clear learning outcomes and commencing the dialogue. Dialogue The most common pitfall for the instructor in closed discussions is the temptation to deliver a lecture to a small group. The key, therefore, is to ensure candidate participation by engaging them in a non-threatening way and allowing all candidates equal oppor- tunity to contribute, acknowledging that contribution and how it meets the outcomes for the session.

The simplest way to engage candidates is to use questions to elicit a response. There are several strategies to consider when asking questions to a group, but a few simple techniques will help get the right result. Start off by asking a question to the group as a whole before asking one of the candidates who appears to know the answer 42 Chapter 6 for their response. If it is the right response, acknowledge that fact and write it up if appropriate. When given an incorrect answer re-pose it or refine it and offer it again either to the whole group or the same individual depending on circumstances.

This approach to questioning is commonly referred to as the 'pose, pause, pounce' technique. You pose the question, wait for a response then choose an individual to answer, remembering to reflect the answer back to the group. Eye contact is useful if you want to elicit a response from an individual, as it is a powerful way of non-verbally involv- ing the entire group.

If a group or individual is reticent, using can- didates' names can also be a powerful tool to ensure contribution, for example 'Name one of the 4 H's Ask if there are any questions before summarising. It is particularly useful if you refer back to the candi- date contributions during your summary, thereby acknowledging their input and reinforcing the learning outcomes.

A clear termin- ation is essential here as discussion may continue. Structure of an open discussion session Set including environment Again, seating is the main initial consideration. Communication is easier in this arrangement and it also serves to convey a sense of equal- ity. The inclusion of a gap within the seating allows individuals to leave the group with minimal disruption, should that prove neces- sary.

Once the group is assembled, the instructor clarifies the pur- pose of the discussion and identifies the learning outcomes.

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These will be exploratory in nature and will describe the group's process Facilitating discussions and workshops 43 Figure 6. Occasionally, in open discussions there may be a need to establish ground rules, which can include: Dialogue In contrast to a closed discussion, the instructor does not lead the dialogue, it is driven from within the group. The instructor will need to facilitate the group to keep it on track but should keep contributions to a minimum.

The instructor must ensure that everyone is invited to contribute without forcing them to do so. Controlling techniques for verbose or reticent candidates become vital to maintaining control and these are explored later in this chapter. Good non-verbal communication skills may be required to facilitate an open discussion effectively. Closure In this instance it may not be appropriate to ask if anyone has any questions, but the instructor should ensure that the session is 44 Chapter 6 satisfactorily terminated.

If the discussion was particularly heated or if there appear to be some unresolved issues, these should be dealt with before terminating the session. Summary may not be required as there may have been no clear outcomes. However, the instructor should close the session by thanking the group for their contributions. Workshops The workshop is an extension of the closed discussion format. Set, dialogue and closure as discussed above remain central to the organisation of workshops.

The aim of any workshop is to engage a group of people in study. Many workshops encourage the learner to take part both mentally and physically. Workshops can be organised as a group discussion around a manikin or other audio visual aids see Figure 6. One of the keys to success is to allow the candidates to think through the information supplied for the workshop and confer with their colleagues before reaching a consensus of opinion on Figure 6.

Facilitating discussions and workshops 45 how to proceed. At best, the workshop can be a really dynamic process with elements of discovery learning fostering a real sense of achievement for the candidates. At worst, the workshop can turn into a lecture around a set of charts. The good instructor will set clear learning outcomes, give clear guidance on required outcomes and allow the group time and space to reach their conclusions, interjecting where necessary to keep the candidates focused.

For example, when using case-based scenarios additional information can be introduced when a particular stage has been reached or to help out when a problem is encountered. Ideally, a workshop is an opportunity to develop practical skills in a simulated situation and link theory with practice. During the workshop there is the temptation to interject or stand over a group that is working through the task.

Sometimes this is neces- sary if the group lacks direction or is unclear about the task. Some groups, if they require it, will allow a space for the instructor to facilitate causing minimal disruption. Generally it is better if, once the task is set, the groups are allowed to get on with it. Praise can be given during the feedback if a group has worked particularly well together.

The important thing to remember is that the work- shop is designed to increase the confidence of candidates in apply- ing theoretical principles and developing clinical competence. It also offers the instructor an opportunity to evaluate the impact of the structured learning experience across the range of abilities within the group.

One way of facilitating a workshop is to take an approach which has problem-based learning PBL as the central theme. This works particularly well in case -study based work- shops where the skilled instructor can use the existing knowledge within group to reach sometimes quite complex clinical decisions. This acknowledgement of existing knowledge is a central tenet of adult learning and if used effectively serves to give some owner- ship of the workshop to the candidates making them work more cohesively and efficiently as a group. The key to this approach is to set a scenario, give relevant clinical information and ask 'What actions should you, as the medical team, take, based on the infor- mation so far?

The instructor's role is to pose the problem and allow students to explore their understanding. They should have read the manual and the purpose is to check their understanding through discussion amongst themselves. The role of the instruc- tor is more of a facilitator during these sessions. This means that you will probably listen much more than you will talk. After your initial statement, you should, through subtle use of body lan- guage and a particular approach to asking questions see below , allow the conversation to develop among the candidates, having them speaking to one another, rather than directing everything to you.

This saves you from occupying a judicial role, which is some- thing that can be observed in adult education settings where ses- sions become: Brookfield, This is the socio-emotional component of the learning environ- ment and unless it is well handled, can interfere with effective learning for many group members.

More significantly, however, it is the nature of the interactions that is expected among the group. The question we should consider is: What is the nature of the intellectual activity that candidates are engaging in? In lec- tures, this is relatively straightforward: In discussion, however, it is not simply a matter of rehearsing what has been previously read. As Candy puts it: If cognitive process are indeed processes of reconstruction rather than replicating or depicting an a priori existing reality , then the focus of any explanatory effort must shift from what there is or may be to how we arrive at the conceptual constructs we actually have.

Candy, The strategy to develop this is, as stated above, asking appropriate questions. Mackway-Jones and Walker help us out here. Facilitating discussions and workshops 47 As was explored in Chapter 3, appropriate questions are there to reflect the levels of knowledge that candidates might reasonably expect to have: Discussions and workshops should focus more on understanding and the other higher levels. Body language As explored in Chapter 3, some experts in communication argue that body language communicates more than words.

Certainly some unconscious behaviours can communicate very effectively and par- ticular attention needs to be paid to these to avoid negative impact on the group. Some helpful strategies include: This might sound hostile or aggressive but it makes people speak to the group rather than to you. Again this may feel uncomfortable but it does encourage the group to continue to explore the issues. Potential issues The issue that is of most concern to facilitators of interactive ses- sions is that of control: Destroyers are extremely rare, the other two more common.

It takes a determined talker to continue over the top of those cues. Non-talkers can be encouraged by: Small groups lay bare some of the complex socio-psychological issues of teaching and learning, mainly arising from instructors' concerns about power and authority. However, much of the research sug- gests that among fairly well motivated communities, group cohe- sion and a sense of responsibility almost guarantee the status quo: Summary and learning Closed discussions, open discussions and workshops are all essen- tially learner- orientated activities.

Each requires slightly different behaviours from the instructor and their learner. The instructor should therefore be attuned to the dynamics within the learning group, exercising control or discretion as necessary. Similarly, problems with individuals who become dis- ruptive or non -engaging within the group may best be dealt with by the group itself if they are empowered to do so.

Individual feed- back, may also afford opportunities for candidates to reflect on their contribution to group work and dynamics. Through the lens of learning: Using Experience for Learning.

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