ABC of Learning and Teaching in Medicine E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: ABC Series
- Sprache: Englisch
ABC of Learning and Teaching in Medicine is an invaluable resource for both novice and experienced medical teachers. It emphasises the teacher’s role as a facilitator of learning rather than a transmitter of knowledge, and is designed to be practical and accessible not only to those new to the profession, but also to those who wish to keep abreast of developments in medical education.
Fully updated and revised, this new edition continues to provide an accessible account of the most important domains of medical education including educational design, assessment, feedback and evaluation. The succinct chapters contained in this ABC are designed to help new teachers learn to teach and for experienced teachers to become even better than they are. Four new chapters have been added covering topics such as social media; quality assurance of assessments; mindfulness and learner supervision.
Written by an expert editorial team with an international selection of authoritative contributors, this edition of ABC of Learning and Teaching in Medicine is an excellent introductory text for doctors and other health professionals starting out in their careers, as well as being an important reference for experienced educators.
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Seitenzahl: 359
Veröffentlichungsjahr: 2017
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Table of Contents
Cover
Title Page
List of Contributors
Preface
Acknowledgements
CHAPTER 1: Becoming a Better Teacher
Becoming a better teacher
What every medical educator needs to know
Understanding yourself
Understanding learning and learning environments
Understanding learners
Conclusion
References
CHAPTER 2: Educational Theory
Introduction
What is a theory?
What types of theory exist?
Why do I need theories?
Conclusion
Further reading
CHAPTER 3: Inquiry‐based Learning
Making IBL work: using small groups
Methods of inquiry‐based learning
Information technology and IBL
Conclusion
Further reading
CHAPTER 4: Course Design
What is a course?
Three key issues to consider when designing a course
Approaches to course design
Assessment, course evaluation and course review
The dynamic curriculum
Further reading
CHAPTER 5: Creating Educational Materials
Introduction
Aims – Be specific about your learning objectives
Appropriateness – Ensure that your teaching materials are appropriate and varied
Analysis – Break complex tasks into manageable steps
Application – Encourage the application of new skills and knowledge
Approach – Encourage a deep approach to learning
Atmosphere – Ensure a supportive, motivating educational environment
Summary
References
CHAPTER 6: Creating a Safe and Effective Learning Environment
Introduction
Maslow’s hierarchy of needs
Learning environments in healthcare settings
Learning in clinical environments
Learning away from the clinical environment
Virtual learning environments (VLEs)
Conclusion
Summary
References
CHAPTER 7: Feedback in Medical Education
Introduction
Challenges in feedback: the gap between giving and receiving
Rationale: Why make the effort to engage the learner and provide constructive feedback?
What to do about it?
Tips to improve feedback effectiveness: bridging the gaps between giving, receiving and using feedback
Summary
References
CHAPTER 8: Small‐Group Learning
Introduction
Principles for small‐group learning
Domains of learning
Areas of focus for facilitating small groups
Small‐group learning in classroom based activities
Small‐group learning in skills workshops
Small‐group learning in clinical settings
Conclusion
Further reading
CHAPTER 9: Lectures, Lecturing and Learning
How students learn in lectures
Preparing to lecture
Performing a lecture
Evaluation
Conclusion
CHAPTER 10: Simulation in Healthcare Education
Introduction
What is simulation?
Why use simulation?
What is simulation used for?
What are the advantages of simulation?
How do you use simulation effectively?
How do you run a simulation learning event?
Conclusion
References
CHAPTER 11: Workplace Learning
Workplaces: context, trigger and variability
Workplace learning in perspective
Practice‐based learning
Understanding development at the workplace – three intertwined levels
Supporting development at the workplace – a continuous challenge
Conclusion
References
CHAPTER 12: Learner Supervision
Introduction
Why do learners need supervision?
Who are the learners and who are the supervisors?
What is involved in the supervision of learners?
Problem avoidance and problem management
Conclusions
References
CHAPTER 13: Formative Assessment
What is formative assessment?
Feedback in formative assessment
Formative assessment in curriculum design
Formative assessment for institutional transformation
Formative assessment in medical education
Summary
References
CHAPTER 14: Written Assessment
Different question formats
True/false questions
‘Single, best option’ multiple choice questions
Multiple true/false questions
‘Short answer’ open‐ended questions
Essays
‘Key feature’ questions
Extended matching questions
Script concordance test
Conclusion
Further reading
CHAPTER 15: Skill‐based Assessment
Background
Applying basic assessment principles to SBA
Agreeing the content
Designing the circuit
Marking schemes
Evaluation
Advantages and disadvantages of SBAs
Further reading
CHAPTER 16: Work‐based Assessment
Methods for work‐based assessment
Basis for judgement
Method of data collection
Portfolios
Summary
Further reading
CHAPTER 17: Quality Assurance of Assessments
What is QA and why is it necessary?
Designing a process of QA
The three levels of QA
The three stages of QA
QA activities
QA standards
Reporting and acting on the results of QA
Pulling all of the decisions together and undertaking QA
Summary
Acknowledgment
Further reading
CHAPTER 18: Students in Difficulty
Introduction
How do students in difficulty present?
Why do students struggle?
Educational assessment interview – making an ‘educational diagnosis’
Interventions
Outcomes
Prevention and early intervention
Issues
References
CHAPTER 19: Teaching and Learning Professionalism
Introduction
What is professionalism?
Professionalism curricula: what should be included?
Learning professionalism in clinical practice
Reflective practice
Workshops
Challenges for professionalism curricula
Assessing professionalism
Conclusion
References
CHAPTER 20: Social Media and Learning
The practice
Digital professionalism
SoMe and the open learning culture
How SoMe can support personal learning
Thinking about your learners
Conclusion
CHAPTER 21: The Mindful Clinician‐Teacher
What is mindfulness?
Where might mindfulness be helpful in clinical practice?
What learning to be mindful means: progressing from not knowing → knowing → realising → actualising
Further reading
CHAPTER 22: Evaluation
Evaluation
Planning an evaluation
What are the goals of the evaluation?
Who are the stakeholders in the evaluation?
What should be evaluated and what information should be collected?
What methods will be used to collect the information?
From whom will the information be collected?
Who will collect and analyse the information?
How will information be fed back to the stakeholders?
What decisions can be made as a result of the evaluation?
When will the evaluation be repeated?
Completing the evaluation cycle
References
Index
End User License Agreement
List of Tables
Chapter 01
Table 1.1 Explicit faculty development opportunities
Chapter 04
Table 4.1 Contemporary approaches to course design and delivery
Chapter 10
Table 10.1 Levels of simulation
Table 10.2 Effective and ineffective debriefing
Chapter 11
Table 11.1 Advantages and disadvantages of workplace learning
Chapter 13
Table 13.1 Examples of formative assessment formats used in medical education
Chapter 15
Table 15.1 The assessment of clinical skills: key issues when planning
Table 15.2 Measures for improving reliability
Chapter 17
Table 17.1 Example of quality assurance (QA) activities and example standards for two specific types of summative assessment
Chapter 20
Table 20.1 Social media (SoMe) tools and their use
List of Illustrations
Chapter 01
Figure 1.1 Various domains of knowledge contribute to the idiosyncratic teaching strategies (‘teaching scripts’) that tutors use in clinical settings.
Chapter 02
Figure 2.1 The development of laws from theories.
Figure 2.2 Ranges of theory.
Figure 2.3 Miller’s pyramid.
Chapter 04
Figure 4.1 Three key issues to consider when designing a course.
Figure 4.2 Continuous quality improvement.
Figure 4.3 Learning outcomes.
Chapter 05
Figure 5.1 The 6A Approach to creating educational materials.
Chapter 06
Figure 6.1 Maslow’s hierarchy of needs – applied to teaching in medical settings.
Figure 6.2 The learning environment – defining roles of the faculty (NACT, 2007). The requirements in the workplace for a good learning environment can be broken down into four main headings. These should apply to all members of the clinical team whenever possible. The summary in the figure was developed specifically to support doctors in training but they can be equally applied to undergraduates.
Chapter 07
Figure 7.1 Culture, context and the process of providing feedback for improvement.
Figure 7.2 A feedback framework: three critical components.
Chapter 08
Figure 8.1 Small‐group discussion.
Figure 8.2 Small‐group skills teaching.
Chapter 09
Figure 9.1 Example of a 1‐minute paper.
Chapter 10
Figure 10.1 Procedural skills development using specialist and improvised kit.
Figure 10.2 Mid‐fidelity manikin for complex scenario‐based learning.
Figure 10.3 Example of a scenario template.
Figure 10.4 Scottish mobile skills unit.
Figure 10.5 Linked components of simulation‐based learning activities.
Chapter 11
Figure 11.1 Diagrammatic representation of hierarchy in curriculum building.
Figure 11.2 Visual representation of experiences, trajectories and reifications (ETR) framework.
Chapter 12
Figure 12.1 A historical perspective: ‘In his master’s steps he trod…’
Figure 12.2 The tasks of supervision. The particular concern of educational supervision is ‘formation’ – helping the learner to develop. It should be apparent, however, that this supervisory function cannot happen without the other two. Normative supervision refers to the quality control element of relating learners’ performance to that of others – trying to help them to become responsible for monitoring and self‐audit. Restorative supervision is all about support and debriefing.
Figure 12.3 Support and challenge helping learners to grow.
Figure 12.4 Lifelong learning.
Figure 12.5 Learner/supervisor styles.
Figure 12.6 Responsibilities.
Chapter 13
Figure 13.1 Effective formative assessment links the students and teaching staff with curriculum planning and institutional aims.
Chapter 15
Figure 15.1 Miller’s triangle (adapted) as a model for competency testing.
Figure 15.2 A blueprint of a skill‐based assessment mapping 14 ten‐minute doctor–patient interactions. Numbers in grey represent individual stations.
Figure 15.3 Fourteen‐station undergraduate OSCE which fails to address context specificity.
Figure 15.4 Statistics demonstrating how reliability (generalisability coefficient) improves as station number is increased and the number of raters on each station is increased.
Figure 15.5 Designing a circuit.
Figure 15.6 An international family medicine OSCE.
Figure 15.7 Using a simulator.
Figure 15.8 An example of a global marking schedule from a postgraduate family medicine skill assessment. It is essential that word descriptors are provided to support the judgments and that examiners are trained to use these.
Figure 15.9 Summary: setting up a skill‐based assessment (SBA).
Chapter 16
Figure 16.1 Cambridge Model for Assessing Clinical Competence. In this model, the external forces of the healthcare system and factors related to the individual doctor (e.g. health, state of mind) play a role in performance.
Figure 16.2 Classification scheme for work‐based assessment methods.
Figure 16.3 Portfolios.
Chapter 17
Figure 17.1 Decisions in the quality assurance (QA) design process.
Chapter 18
Figure 18.1 Students struggle for a wide range of complex, interacting reasons.
Figure 18.2 Four overlapping areas that may lead to trainees falling into difficulty.
Chapter 19
Figure 19.1 Tutors need to balance support and challenge effectively.
Figure 19.2 Learning professionalism through role‐modelling in clinical practice.
Chapter 20
Figure 20.1 Open learning cycle.
Figure 20.2 Personal learning environment. VLE, virtual learning environment.
Chapter 21
Figure 21.1 S.T.O.P. – awareness practice.
Chapter 22
Figure 22.1 Evaluation cycle.
Figure 22.2 Participation by teachers in evaluation.
Figure 22.3 Examples of methods of evaluation.
Guide
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Table of Contents
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Learning and Teaching in Medicine
Third Edition
EDITED BY
Peter Cantillon
Discipline of General PracticeSchool of MedicineNational University of IrelandGalwayIreland
Diana Wood
School of Clinical MedicineUniversity of CambridgeCambridge, UK
Sarah Yardley
Central & North West London NHS Foundation TrustMarie Curie Palliative Care Research DepartmentUniversity College LondonLondon, UK
This edition first published 2017 © 2017 by John Wiley & Sons Ltd
Edition HistoryJohn Wiley & Sons Ltd (2e, 2010)
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The right of Peter Cantillon, Diana Wood and Sarah Yardley to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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Library of Congress Cataloging‐in‐Publication Data
Names: Cantillon, Peter, editor. | Wood, Diana, editor. | Yardley, Sarah, editor.Title: ABC of learning and teaching in medicine / [edited by] Peter Cantillon, Diana Wood, Sarah Yardley.Description: Third edition. | Hoboken, NJ : Wiley, 2017. | Series: ABC series | Includes bibliographical references and index. | Identifiers: LCCN 2017017748 (print) | LCCN 2017018824 (ebook) | ISBN 9781118892152 (pdf) | ISBN 9781118892169 (epub) | ISBN 9781118892176 (paper)Subjects: | MESH: Education, Medical | Teaching | Learning | Educational MeasurementClassification: LCC R834.5 (ebook) | LCC R834.5 (print) | NLM W 18 | DDC 610.76–dc23LC record available at https://lccn.loc.gov/2017017748
Cover Design: WileyCover Image: © Phil Fisk/Gettyimages
List of Contributors
Jo BrownNational Teaching FellowHead of Quality in Teaching and LearningCentre for Medical EducationBarts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Peter CantillonProfessor of Primary CareDiscipline of General PracticeSchool of MedicineNational University of IrelandGalway, Ireland
Alan DellowMedical Education UnitFaculty of MedicineRamathibodi HospitalMahidol UniversityBangkok, Thailand
Tim DornanProfessor of Medical EducationQueen's University BelfastNorthern Ireland, UK;Emeritus ProfessorMaastricht UniversityMaastricht, The Netherlands
Walter EppichAssociate Professor of Paediatrics and Medical EducationNorthwestern University Feinberg School of MedicinePaediatric Emergency PhysicianAnn & Robert H. Lurie Children’s Hospital of ChicagoChicago, Illinois, USA
Dason EvansSenior Lecturer in Medical Education, Head of Clinical SkillsBarts and the London School of Medicine and Dentistry Queen Mary University of London, London, UK
Deborah GillProfessor of Medical Education and DirectorUCL Medical SchoolLondon, UK
Gerard J. GormleyCentre for Medical EducationSchool of MedicineDentistry and Biomedical SciencesQueen's University BelfastBelfast, UK
Inam HaqProfessor and Co‐Director Sydney Medical ProgrammeSydney Medical SchoolUniversity of SydneySydney, Australia
Karen Mann†Professor Emeritus, Division of Medical EducationFaculty of MedicineDalhousie UniversityHalifax, Nova Scotia, Canada
Peter M. HamiltonLecturer, School of Medicine Griffith UniversityQueensland, AustraliaEric HolmboeAccreditation Council for GraduateMedical Education Chicago, Illinois, USA
Jean KerNational Lead for Clinical skills and SimulationNHS Education for Scotland;Emeritus Professor of Medical EducationSchool of Medicine Dentistry and Nursing, University of DundeeDundee, UK
Natalie T. LaffertyHead Centre for Technology & Innovation in LearningUniversity of DundeeDundee, UK
Stephen LibenDirector, Pediatric Palliative Care Program and Attending Physician Professor of PediatricsMontreal Children’s HospitalMcGill University Health CentreMontreal, Canada
Annalisa MancaCentre for Medical Education Queens University Belfast Belfast, UK
Rachel MorrisInstitute for Continuing EducationUniversity of CambridgeCambridge, UK
Jill MorrisonProfessor of General Practice and Dean for Learning and TeachingCollege of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgow, UK
Hilary NeveProfessor of Medical EducationPlymouth University Peninsula Schools of Medicine and DentistryPlymouth, UK
John NorciniPresident and CEOFoundation for Advancement of International Medical Education and Research (FAIMER)Philadelphia, Pennsylvania, USA
Vimmi PassiDivision of Medical EducationFaculty of Life Sciences and Medicine King’s College London, London, UK
Ed PeileProfessor Emeritus (Medical Education)University of Warwick;Lead for Training DevelopmentsThe Collaborating Centre for Values‐based Practice in Health and Social CareSt Catherine's CollegeOxford, UK
Gary D. RogersProfessor of Medical Education Deputy Head of School (Learning & Teaching)School of MedicineProgram Lead for Interprofessional and Simulation‐Based LearningHealth Institute for the Development of Education and ScholarshipGriffith UniversityQueensland, Australia
Joan SargeantProfessor, Division of Medical Education, Faculty of MedicineDalhousie UniversityHalifax, Nova Scotia, Canada
Lambert W.T. SchuwirthFlinders University, Adelaide, Australia;University of Maastricht, Maastricht, The Netherlands
Ben ShippeyDirector of Institute of Health Skills and EducationSchool of Medicine Dentistry and NursingUniversity of DundeeDundee, UK
Celia TaylorAssociate ProfessorWarwick Medical SchoolUniversity of WarwickCoventry, UK
Pim W. TeunissenProfessor of Workplace Learning in HealthcareMaastricht UniversityMaastricht;Gynaecologist at the Department of Obstetrics & GynaecologyVU University Medical CenterAmsterdam, the Netherlands
Cees P.M. van der VleutenProfessor and ChairFlinders University, Adelaide, Australia;University of Maastricht, Maastricht, The Netherlands
Val WassEmeritus Professor of Medical EducationFaculty of HealthKeele University, Keele, UK
Jeremy WebbInstitute of Continuing EducationUniversity of CambridgeCambridge, UK
Diana WoodDirector of Medical Education andClinical DeanSchool of Clinical Medicine, University of CambridgeCambridge, UK
Sarah YardleyConsultant in Palliative MedicineCentral & North West London NHS Foundation Trust;Honorary Lecturer Marie Curie Palliative Care Research Department, University College LondonLondon, UK
Note
†
Deceased
Preface
The ABC of Learning and Teaching began its life as a series of articles in the British Medical Journal. The articles proved so popular that they were subsequently assembled into an ABC series book, first published in 2003. The objective of the original articles and the subsequent book was to make theories of learning and insights from educational research accessible and practicable for medical educators. We commissioned international experts to author each chapter to ensure that the content was both authoritative and up‐to‐date. The second edition was published in 2010 with an expanded chapter list of 16. We are proud now to offer the third edition, which extends the range of topics, and therefore chapters, to 22. New chapter topics include social media in medical education; learning and clinical workplaces; and a chapter dedicated to helping readers to develop themselves as teachers. We have also completely revised each of our more established chapters, such as teaching in small groups or dealing with students in difficulty. Each chapter provides a selection of insights and ideas from the literature in approximately 1500 words. Liberal use is made of illustrations, figures and boxes to communicate concepts, summarise ideas and provide educational approaches for immediate use in practice. In this third edition therefore we have stayed true to our original intention, i.e. we attempt to make current ideas, theories and approaches in education available to medical educators in short accessible chapters. We do hope that the current edition provides you with a wealth of ideas and strategies for use in your work as a medical educator.
Acknowledgements
We would first of all like to thank all of our expert authors who have contributed so generously to this third edition. We would also like to thank the commissioning, series and copy editors at Wiley for their excellent support and forbearance in the preparation and assembly of this ABC.
CHAPTER 1Becoming a Better Teacher
Peter Cantillon
Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland,
OVERVIEW
This chapter outlines teacher development strategies for teachers who find it difficult to attend formal faculty development
Teaching scripts (i.e. teachers’ knowledge of the subject matter, the learners, the context and teaching techniques) provide excellent organisational frameworks for thinking about teaching
Developing a critical self‐awareness of teaching beliefs and practices is essential if teachers are to develop themselves. Critical self‐awareness can be developed by:
developing a habit of teaching evaluation
arranging peer observation of teaching
completing a teaching orientation inventory
learning how to get the most out of teaching and learning experiences through reflective practice
Becoming a better teacher
For centuries medicine has been learned through an apprenticeship of observation and participation. Medical teachers acted as apprentice masters who provided their apprentices with access to patients and shared their expertise. It was unusual for clinicians to undergo any form of teacher training, because the only qualification required for teaching was clinical proficiency. The expert clinician/amateur teacher model persists to this day, but it has come under increasing pressure with the advent of limited hours working time directives, competency‐based curricular designs, enhanced supervisory roles, external accreditation of medical education and increasingly complex assessment strategies. As a result, it is becoming ever more difficult for medical educators to rely solely on their subject matter knowledge as being sufficient for their teaching roles. In many countries there is now an expectation that doctors who have formal educational roles should undertake some form of faculty development in order to fulfil those roles. It is important to bear in mind, however, that many medical teachers are full‐time clinicians or may have significant research responsibilities, thus making it difficult for them to engage with faculty development opportunities. Given the very real pressures of service delivery and research productivity, how can we support clinicians in their endeavours to become better informed educators? This chapter will set out to address this question.
What every medical educator needs to know
If you are thinking about developing yourself as a medical educator, it is important to have a sense of direction. You need to have some idea about what aspects of your teaching role you might want to enhance. Since the early 1990s, several reviews have been published exploring the attributes of excellent medical teachers and the key findings from these reviews are summarised in Box 1.1. When structuring the attributes of excellent teachers in Box 1.1. I used features of the so‐called teaching script model described by David Irby (1992). Irby interviewed medical teachers who had been identified as excellent educators by other teachers. He found that expert teachers use mental shortcuts, which he called teaching scripts, to structure their teaching. When asked to teach about something familiar, expert teachers call on particular forms of knowledge, including:
knowledge about the subject matter;
knowledge about the learners;
knowledge about the patient;
knowledge about teaching.
Box 1.1 Attributes of excellent medical educators
Understand learners
Knows what learners should be able to do, say or perform at a particular stage of development
Knows how to use observation and questioning techniques to diagnose the state of learners’ knowledge and competence
Is aware that learners differ in terms of prior knowledge and ability even within groups at the same chronological stage of development
Is aware that he/she cannot re‐inhabit themselves at an earlier stage of development and must therefore endeavour to look at problems and challenges through the learner's eyes.
Understand learning
Is aware of behaviourist, cognitive and constructivist perspectives on learning
Is aware of the benefits of active learning techniques
Understands what motivates learners and how to capture attention
Understands how his/her own enthusiasm and role model behaviour influence learning
Understand self
Aware of personal teaching values, beliefs and biases
Critically reflects on teaching experiences
Routinely seeks evaluation of teaching from learners and peers
Uses evaluation findings to develop as a teacher
Understands how to use effective teaching strategies
Uses questions to explore thinking and direct learning
Knows how to structure explanations around core concepts
Provides focused and timely feedback for learners and seeks feedback on his/her own clinical teaching activity
Is self‐aware as a role model
Knows how to use time effectively for maximum educational benefit
Knows how to ensure learner safety in busy educational and clinical learning environments
Teaching scripts represent automated ways of thinking and teaching (see Figure 1.1). Whilst it is unlikely that you will consciously construct teaching scripts (they tend to come into being implicitly), the teaching script model does provide a useful way of thinking about what you need to know when you teach, (e.g. ‘knowledge of the learners’ implies that you need to know who these learners are, their names, where they are in the course, what they are likely to know – you can use this knowledge to pitch your teaching appropriately).
Figure 1.1 Various domains of knowledge contribute to the idiosyncratic teaching strategies (‘teaching scripts’) that tutors use in clinical settings.
Using the teaching script model we can conceptualise that becoming a teacher is essentially about understanding yourself, your learners and learning. This chapter will, for the most part, focus on understanding yourself as a vital part of developing yourself as a teacher. The chapter will also offer some suggestions about how we might come to understand learners. Understanding learning is core business for faculty development and we offer a table that summarises many of the formal faculty development opportunities available.
Understanding yourself
Most descriptions of teacher development talk about what teachers should be able to do, what they should know, etc. However, it is important to bear in mind that medical teachers become the teachers that they are as a result of their experiences as learners and practitioners as they transit a multitude of clinical, professional and educational contexts. Over time, doctors develop strong implicit beliefs and assumptions about learning and teaching that inform their teaching practices. We know from cognitive descriptions of teacher development that educators’ ‘prior knowledge’ about teaching, (i.e. their beliefs, their rules of thumb, their teaching habits) exert a strong influence over what they are capable of subsequently learning about teaching. Prior knowledge is very powerful in shaping what people pay attention to: the sense that they make and what they learn. In practice this means that teachers are likely to tacitly reject new ideas that do not fit with their strongly held beliefs or that threaten to disrupt well‐established teaching habits. Thus, developing and encouraging self‐knowledge and critical self‐awareness (curiosity about your own thinking and practices) are essential attributes to nourish if you want to become a better teacher.
How to develop self‐knowledge as a teacher
Perhaps the simplest way to become aware of yourself as a teacher is to develop a strong and consistent habit of evaluating your teaching. Evaluation in this context means placing a value or worth on your teaching. You can look for evaluation information from two common sources – your learners and your professional peers:
Learners can tell you about what it was like to listen to you or to be observed by you, etc. They can tell you about things like clarity, speed, diction and how safe they felt in your company. Learner safety, like patient safety, is an essential consideration for the excellent teacher.
Learner safety means that learners feel secure to share their doubts, their misconceptions and their scepticism with you, without fear of ridicule or disrespect.
This is a lot easier if you begin to regard yourself as a coach who is trying support students in achieving something rather than as a demonstrator.
Professional peers can tell you about the currency and comprehensiveness of the content that you might wish to explain. They can also tell you about whether you are carrying out important teaching functions, such as exploring learners’ thinking, giving them opportunities to perform and providing feedback.
There are many forms of evaluation and, indeed, there are many evaluation forms! The commonest format is the post hoc questionnaire distributed to students during or after an event. Used diligently (i.e. if you customise the questionnaire items in relation to what you want to evaluate), evaluation questionnaires can yield useful data for reflection. On the downside, questionnaire evaluation strategies often lead to survey fatigue. Furthermore, if questions are not refreshed and developed, there is a gradual drop‐off in response rates. Most importantly, learners will cease to engage in evaluation if they get the impression that you will not respond to their criticisms and observations. Thus the most important message about using evaluation questionnaires to evaluate your teaching is that you should ensure you take learners’ suggestions seriously and that you publicise the changes made to your learners.
There are other more stimulating ways of finding out how learners value and experience your teaching. These include:
Asking students to complete a 1‐minute paper (see an example of a 1‐minute paper in
Chapter 9
).
Electing student monitors who take it upon themselves to talk to colleagues about teaching events or teachers with a view to providing feedback to the teachers or directors – student monitors provide more detailed descriptions of the student experience, what they are learning and also how they experience you as a teacher.
Looking through a small sample of student notes after a tutorial, small or large group session to see what they are learning and paying attention to.
Looking at the quality of student performance in summative assessments in relation to content or topics that you have taught. Their performance under exam pressure can reveal a lot about what they learned and therefore about the value/effectiveness of your teaching.
Peer evaluation
Peer evaluation involves asking a colleague to sit in when you are teaching or, alternatively, to watch a video of your teaching. The professional peer can provide an unstructured observation of what you are doing or use a structured observation tool (see Box 1.2) to provide feedback to you after the event. Unstructured peer observation can lead to some quite organic and creative observations and will depend on your peer observer’s prior knowledge of teaching, learning and the subject matter. Using standardised teaching observation tools, on the other hand, can help to structure peer feedback and provide a useful focus for what you want your peer to observe. Examples of what you might like your peers to look at as well as teaching observation tools that they can use are listed in Box 1.2.
Box 1.2 Peer observation tools and features of good teaching
Attributes of good teaching for peers to observe
Quality of feedback conversations with learners
Ability to diagnose/discern the state of learners’ knowledge and skills
Ability to provide explanations that build conceptual knowledge and that support understanding
Use of questions that explore thinking and motivate
Ability to establish a safe learning environment
Ability to make effective use of limited time for teaching
Peer teaching evaluation tools
These are all freely available online and can be downloaded for use. It is very important that any publications that use these tools, including reports, should acknowledge the source.
The Maastricht Clinical Teaching Questionnaire (MCTQ)
The Peer Observation Form (POF), Imperial College London
The Peer Observation Scale, Ronald Berk, Johns Hopkins School of Nursing
The Stanford Faculty Development Program evaluation tool (SFDP 26)
The Professionalism Mini‐evaluation Exercise (P‐MEX)
Knowing your teaching orientation
Whilst I hope that you will always attempt to evaluate your teaching, you can also develop your self‐knowledge by taking one of the many teaching orientation assessments. In the 1980s it became clear that teachers could be categorised along a continuum between being ‘teacher‐centred and learner‐centred’. Teacher‐centred teachers were more likely to use didactic lecturing techniques in their teaching and were likely to conceptualise teaching in terms of transmitting knowledge to learners. From a teacher‐centred perspective learning is about receiving and categorising information. A teacher‐centred approach places the control very much in the hands of the teacher; however, there are serious problems with teacher‐centredness. Cognitive research has revealed that learners do not hear what teachers say; rather they hear what they are capable of hearing and their attention is directed largely by their prior knowledge, their attitudes, interests and so on. This led to a recognition that learner‐centred teachers who focus more on what and how learners are learning (as opposed to their own performance as teachers) are better able to facilitate deeper and more effective learning amongst their students. This observation led to the development of many instruments for measuring the orientation of teachers. One of the better established instruments is the Teaching Perspectives Inventory, or TPI. This allows you to conceptualise your own implicit views and perceptions about teaching as well as providing some guidance about how you might develop better and more learner‐centred orientations. You can take the TPI online at http://www.teachingperspectives.com/tpi/. The author, Dan Pratt, has provided some very useful guidance on the different perspectives as well as a means of interpreting the results on the website.
Learning from experience: becoming a reflective teacher
So far we have discussed the use of external sources of evidence, e.g. learners, peers, standardised self‐assessment instruments, to come to understand ourselves. There are many techniques that also allow you to learn from your own experiences –the most established of these is so‐called ‘reflective practice’.
Reflection is a term that has many potential meanings. At its simplest, reflection means ‘to look back and consider something’. While such thoughtfulness can result in insight and learning, it does not automatically lead to genuine transformations in thinking or practice. Yet, looking back on experience is what many people think reflection means. In education, reflective practice means looking back with a view to transforming routinised ways of thinking and doing things. Mezirow (1990) described a more critical perspective on reflection in terms of being a
… process of becoming critically aware of how and why our presuppositions have come to constrain the way we perceive, understand, and feel about our world; of reformulating these assumptions to permit a more inclusive, discriminating, permeable and integrative perspective; and of making decisions or otherwise acting on these new understandings.
– Mezirow (1990)
The key purpose of reflective practice as a teacher is to ensure that your experiences allow you to question the assumptions; the habitual ways of thinking and acting that underpin how you learn and how you teach. There are many techniques associated with reflective practice, including, for example, keeping a journal or writing a blog. Such techniques allow you to record experiences and at the same time to demonstrate to yourself (and, if you like, to others) what meanings you are deriving from that experience.
Understanding learning and learning environments
Developing yourself as a teacher is not only about beginning to understand yourself as an educator, a coach and a mentor, but it is also about understanding how learning occurs and about coming to appreciate the enormous influence of the context in which learning occurs (i.e. the learning environment) on what is learned and how it is learned. Whilst a large portion of this chapter has been devoted to the importance of self‐awareness in becoming a teacher, the issue of understanding learning has been addressed in several other chapters, including Chapters 1 and 3–6. The influence of learning environments on learning is also well covered in Chapter 9. Formal approaches to developing as a teacher are summarised in Table 1.1. The remainder of this chapter will therefore be devoted to the final part of Irby’s teaching script model, i.e. understanding learners.
Table 1.1 Explicit faculty development opportunities
Faculty development opportunity
Benefits
Challenges
Certificate/diploma/master’s in medical/health professions education You can find a reasonably up‐to‐date list of master’s in medical education available worldwide at:
http://www.faimer.org/resources/mastersmeded.html
Provide a comprehensive teacher development programme
Opportunity to meet like‐minded teaching enthusiasts
Provide an important qualification for formal teaching appointments in many countries
Difficult to integrate academic workload with clinical and personal life responsibilities
On‐site courses require a major personal time commitment
Online courses can leave learners feeling quite isolated
Difficult to translate academic and abstract educational concepts to the realities of clinical workplaces
Teaching fellowships
These are 1‐ or 2‐year medical teacher training posts that are available in many countries
Usually involve dedicated time for teaching, teacher development as well as clinical work
Sometimes include funding/support for higher degree or doctorate in medical education
Teaching fellowships do not always fit well with established postgraduate residency programs
Some teaching fellowships are used to advance clinical research rather than teacher development
Teaching fellowships require significant funding to make them viable
Faculty development workshops
These are the commonest and most accessible form of teacher development available in developed countries
They have been shown to be effective in changing thinking and teaching practice
Faculty development workshops often provide knowledge and skills that are not easily translatable into the actual job of teaching in workplaces
Establishing a peer group of teachers
Provides an important support system as well as stimulus for developing teachers
Provides ready sources of peer observation and feedback
Difficult to establish and sustain, particularly amongst doctors in training grades
Require constant work in order to maintain motivation to participate and contribute
Web 2.0 opportunities, including educational blogs, wikis, Twitter feeds, YouTube channels, webinars and TED talks
There are a multitude of health professions education blogs, wikis, etc.
They are largely asynchronous and can therefore be accessed at any time
Most are free and therefore available to everyone in developing and developed countries
It is important to be selective about what wikis, Twitter feeds, blogs etc. you subscribe to, as they can fill up the inbox very quickly
Understanding learners
There are some critical things that you need to know about learners in order to get better at teaching:
You cannot see the world as your learners see it, even if you occupied their role or social position in the recent past. This is because all of your subsequent experiences, your training and reflections have caused much of your knowledge to be automated and condensed. (For example, think back to the first time you had to present a case during a ward round and think about how you might carry out that same task now. Much of what was very effortful and fear‐inducing at that time is now seamless and requires very little cognitive effort.) As we learn to perform as doctors, much of our knowledge becomes automated and we employ a lot of mental shortcuts, such as pattern recognition. You need to be aware of the need to unpack your knowledge for learners, i.e. step by step, so that they can travel with you along your line of thinking.
Learners are engaged in a continuous game of impression management (as are you). Goffman(1959) described in his seminal text,
The Presentation of Self in Everyday Life
