As a junior medical officer or registrar in university teaching hospitals, you will often be expected to teach medical students and interns – sometimes at the last minute. The clinical setting plays a crucial role in developing not only students’ knowledge and clinical skills, but also their communication skills and professionalism. Here are a few key tips to help you to 1) structure a teaching session, 2) provide effective feedback, and 3) increase student engagement.
Although the wards may be busy, you can still plan to teach common, often recurring topics and follow a set structure. I suggest the ‘Outcomes-Activities-Summary’ (OAS) method (see Figure 1) to plan a teaching session, whether you’re teaching in a tutorial room or in the clinical setting, where unexpected teaching and learning opportunities are more likely to arise (1).
Decide on 2-4 focussed outcomes that are achievable within the time you have for the teaching session, and convey these to the students. For example: “by the end of this bedside tutorial, students will be able to recognise the difference between wheeze and stridor”. Consider what activity the student will be involved in, and how you will involve them. Although the adult attention span is short (10-20 minutes), active learning styles help to engage learners and increase knowledge recall (2).
Your dialogue should be brief, succinct and relevant. Be adaptable, for example, if patients are unavailable, or uncomfortable, consider using role play for your student group. End the session by giving a brief summary of what has been covered and ask students to identify the most important point/knowledge/skill they learnt during the session. Give one or two short take-home messages and advice on a relevant self-directed learning task (i.e. provide an ‘educational prescription’). Always finish on time!
Figure 1: The OAS method for lesson planning and teaching (1).
Provision of feedback forms an integral part of the learning process and is one of the most important interactions between the ‘teacher’ and the ‘learner’. However, there are two common barriers to the feedback process: lack of direct observation of tasks and the desire to avoid upsetting students with honest and critical feedback. Feedback has the greatest impact on learning when it is immediate – be sure to leave enough time for this during your teaching session.
Specific feedback helps to close the gap between the student’s current performance and the level of performance required. Your feedback should reinforce good practice, and promote self-reflection so that students are motivated to engage in relevant activities to further their learning and practice skills. Although giving feedback can be uncomfortable, use of a structured method, such as Pendleton’s model (3) offers the learner the opportunity to evaluate their own performance first, which you can then build upon (see Figure 2).
Figure 2: Feedback model (data from Pendleton et al, 1984)
As a tutor, your role is to ‘facilitate’ the learning: lead the discussion, ask open-ended questions to guide the learning process and ensure active participation from students. Initially, establish an appropriate culture and a positive learning environment for your group. Ensure the room is set up appropriately and facilitate effective introductions. Learn and use students’ names, outline any expectations or ‘ground rules’ (e.g. patient confidentiality) and determine the learning needs of individuals. Remember to be learner focussed and encourage students’ active involvement (4).
Ensure that you:
The use of frequent questions helps to create a learner-centred approach to teaching. This will allow you to gain an understanding of the learning needs of individual students and enable you to pitch your response and interactions at an appropriate level (5).
By using questions, you can promote clinical reasoning, encourage reflection, and monitor the learners’ progress. Building the complexity of questions can also engage students (see Figure 3). For example, a closed question requires only a single answer, while the use of open questions requires the learner to combine pieces of information and formulate an answer (6). By using different questioning strategies, you can promote different responses, stimulating deeper thinking, reflection and discussion (7).
Here are some examples of questioning strategies:
Figure 3. The use of open questions promotes synthesis of information (1).
In some circumstances, you might employ the technique of “Pose; Pause; Pounce” (Figure 4) (6). After you pose a question, pause to allow the learner to register what you are asking, and think about their response. Allow silence and refrain from jumping in immediately to rephrase the question or answering the question yourself.
Figure 4: The 3 Ps of Questioning (adapted from Lake, Vickery, Ryan, 2005).
At the end of your teaching session, think about the facilitation strategies you used, how well they worked, if lesson goals were met, and how the teaching session could be improved in future. You can also ask the students for verbal feedback. Be open to the feedback being given as it is intended to be helpful.
Teaching can be very rewarding. By planning your teaching activities and following a recognisable structure, student learning and engagement will be optimised. Key issues for good preparation include: determining learning outcomes, designing the learning activity and providing a clear summary or take home-message. Facilitation methods should encourage active student participation, with opportunities for feedback.