Doctors as instructors: Introduction
The association between physicians and instruction is good established. The really word ‘doctor ‘ means ‘teacher ‘ , arising from the Latin verb “ docre ” , to learn. The duty of the physician to educate and portion learned cognition with patients, equals and pupils has been evident from an early phase of my medical grade.
The General Medical Council ( GMC ) , who regulate medical instruction and preparation in the United Kingdom, recognises the importance of competence within this professional country, stating ;
‘You must maintain your cognition and skills up to day of the month throughout your working life ‘ and ‘aˆ¦work with co-workers and patients to keep and better the quality of your work and advance patient safety ‘ .
While this competency within your field is an of import portion of being a good physician, the utility of your cognition, accomplishments and experience are finite if limited to yourself. If nevertheless, your experience can be efficaciously transferred to others, its usage of can literally go infinite. For this really ground, medical schools and the GMC recognise ;
‘Teaching, preparation, measuring and measuring physicians and pupils are of import for the attention of patients now and in the hereafter ‘ .
While each of us had experienced instructors who we judged peculiarly good or peculiarly bad, few of us spend clip to reflect on what elements of the brush made us come to our decisions. It is of import to recognize that the ability to be an ‘effective instructor ‘ and a ‘good scholar ‘ is complex, made harder in medical specialty due to the assortment in scholars encountered ( patients, general populace, pupils, other professionals ) and the huge comprehensiveness, deepness and of all time spread outing field on medical cognition and understanding..
The GMC stipulates ;
‘If you are involved in learning you must develop the accomplishments, attitudes and patterns of a competent instructor ‘ .
To assist accomplish this end, portion of this SSU will research the theory behind acquisition and instruction and after contemplation, the major constituents and countries I need to develop, to go a competent instructor during my medical calling.
Good Medical Practice: Teaching and preparation, measuring and measuring. GMC, 2006.
Tomorrow ‘s Doctors: Standards for the bringing of instruction, larning and appraisal. GMC, 2009.
Teaching is a more demanding and complex undertaking than might foremost look. This becomes evident when we reflect on our ain experience of ‘good ‘ and ‘bad ‘ instructors, and seek to penetrate what qualities, wonts and patterns they incorporated to merit our given appraisal. The inquiry therefore arises, what makes a good instructor? From my ain experience qualities include: assurance, enthusiasm, ability to flip material degree to audience aptitude and cognition and the flexibleness to integrate the scholar ‘s demands into their session.
This subdivision of my portfolio aims to summarize my acquisition, understanding and contemplations gained following a literary reappraisal on learning theory and pattern. This demand stems from my initial acquisition demands appraisal, which highlighted the demand to understand the theory behind successful instruction.
As I explain theories and best pattern, I reflect on some of my anterior successes and ruins while learning. Actions that I identify as necessary to better, are highlighted in ruddy and given an alphabetical superior ( e.g. addition written feedback degree Celsius ) . The superior links straight with the action/s in my development program ( subdivision 2 ) e.g. J ( PDP 5 ) .
The scientific discipline of larning
The existent ‘art and scientific discipline of assisting grownups to larn ‘ , was termed Andragogy by Malcolm Knowles in 1950. He was the first individual to suggest grownups larn in a different manner to kids and created a theory based upon his premises. These later developed into seven rules on how to learn grownup scholars ( figure 1 )
A Establish an effectual acquisition clime, where scholars feel safe and comfy showing themselves
Involve scholars in common planning of relevant methods and curricular content
A Involve scholars in naming their ain needs-this will assist to trip internal motive.
A Encourage scholars to explicate their ain larning objectives-this gives them more control of their acquisition
A Encourage scholars to place resources and invent schemes for utilizing the resources to accomplish their aims
A Support scholars in transporting out their acquisition programs
A Involve scholars in measuring their ain larning -this can develop their accomplishments of critical contemplation.
Figure 1. The seven rules on how to learn grownup scholars
Many of these rules make certain premises about the scholar e.g. that they are motivated to larn. It is besides of import to retrieve that as a medical instructor, non all my scholars have the same demands. For case, some patients will non desire this construction and may necessitate a more didactic attack to ease their apprehension.
While this was a good start sing the methodological analysis to adult acquisition, it was a twosome of decennaries before models of believing about what and how grownups learn became popular.
Knowles M. Informal Adult Education. Guide for pedagogues based on the author ‘s experience as a programme organiser in the YMCA, New York: Association Press 1950.
Keston C. Independent Learning: A Common Essential Learning: Saskatchewan Department of Education Core Curriculum Investigation Project 1997.
Extensive literature is available speculating how different persons learn. In 1984 David Kolb published his acquisition manners theoretical account. The thought was that we learn during life foremost through making, so by reflecting on the result. This gives us the option to change future pattern through better understanding our experience. The really act of contemplation allows the support of thoughts, generalizations and the formation of new thoughts or constructs to happen ( figure 2 )
Figure 2. The four cardinal elements of the Kolb rhythm of experimental acquisition.
Concrete experience* . Doing/ sing.
Brooding observation* . Reviewing and analyzing the experience and your opinions of event/s. This phase includes the treatment about acquisition and instruction and can be to a great extent influenced by feedback from others.
Abstract conceptualisation* . This is the clip where we convey our theories and the analysis of past action together, leting us to reflect, conclude and learn.
Active experimentation* . If alteration was theorised from the old phase, so at this phase we can be after and experiment with our erudite cognition, therefore finishing the circle by taking us back to present a new concrete experience.
**** Where I use illustration of the three phases of experimental acquisition within my undertaking, I use the four coloured footings above.
This procedure happens at a bomber witting degree most of the clip and can merely be described as test and mistake. This ability, nevertheless, to inquiry, investigation and learn from our experiences is valued within medical specialty and brooding pattern is encouraged during medical preparation.
Kolb expanded his rhythm by reasoning that where an single starts on the rhythm depends on their learning manner or attack to larning state of affairss ( diverging, absorbing, meeting or suiting ) and made larning suggestions associating to their group ;
Divergent: Sensitive people who prefer to watch instead than make, are interested in people, tend to be inventive and emotional, be given to be strong in the humanistic disciplines, and like to work in groups.
Assimilative: Prefer a concise, logical attack ; necessitate good clear account instead than practical chance. Prefer readings, talks, researching analytical theoretical accounts, and holding clip to believe things through.
Convergent: Quite analytical in nature, can work out jobs, prefer proficient undertakings, and are less concerned with people and interpersonal issues.
Accommodating: ‘hands-on ‘ , and relies on intuition instead than logic. These people use other people ‘s analysis, and prefer to take a practical, experiential attack. This learning manner is prevailing and utile in functions necessitating action and enterprise. Peoples with an suiting acquisition manner prefer to work in squads to finish undertakings.
What I find most interesting, is non where you start on the rhythm, it was Kolb ‘s thought that persons have really different acquisition manners, penchants and later larning demands. While many of these ‘style ‘ descriptions read a small similar horoscopes to me, I have had troubles working in squads with certain squad members in the yesteryear. On contemplation, it seems likely these persons had a different penchant to larning to me, which generated struggle. This thought of grouping persons and proposing advice to learner was farther explored by Honey and Mumford.
Kolb, D. Experiential Learning experience as a beginning of larning and development. New Jersey: Prentice Hall, 1984. Cantillion P, Hutchinson L and Wood D. ABC of acquisition and learning medical specialty. BMJ publication 2004.
Hillier Y. Reflective instruction in farther and big instruction. Continuum 2005.
Contemporary theoretical account of grownup acquisition
The thought that many people exhibit strong penchants for a given manner of acquisition was expanded by the well known modern-day theoretical account of grownup acquisition manners by Honey and Mumford. They used a questionnaire to research acquisition and penchants, to categorize people into the undermentioned groups ;
Militant. Besides called drivers, respond to working on undertakings which include originative thought, reflecting and be aftering. May demand to better ability to listen and work with others.
Reflector. Prefer structured acquisition activities where they are provided with clip to detect reflect and are so allowed to work in a elaborate mode. Might need to develop abilities to put precedences and do determinations.
Theorist. Respond good to logical, rational construction with clear purposes, where they are given clip for methodical geographic expedition and chances to oppugn their mind. May demand to work on their originative and sidelong thought.
Pragmatist. Respond best to practically based, instantly relevant acquisition activities, which allow range for pattern and antecedently learned theory. May demand to work on their analytical and critical thought.
As with all behavioral theoretical accounts, this is a usher non a rigorous set of regulations. While it is of import non to ‘label ‘ yourself or other scholars, many people will recognize some of their inclinations, and significantly, practical applications are suggested to ease acquisition.
This is something which I can straight associate to my manner of larning. I decided that it might be utile to better the cognition of my ain acquisition penchants by taking their questionnaire a ( PDP 4 ) . The web site from which I answered the inquiries, suggested that I preponderantly fell into the matter-of-fact group. Their suggestions included that ;
‘I addition satisfaction from rehearsing accomplishments instead than speculating ‘
‘I need clear aims and guidelines in my caput before I attempt a undertaking ‘
‘I find larning ‘ theory ‘ hard without gestating its practical application ‘
Understanding your ain traits is of import as a scholar and interesting these suggestions do suit traits and penchants I have observed in myself. I had, nevertheless, ne’er given thought to how as a instructor and squad member, understanding your scholar ‘s likes and disfavors can assist. I can see that some of the most hard groups I have worked in contain members with different manners from me ( brooding observation ) , frequently reflectors/ theoreticians. From looking at the suggestions for pragmatists ( abstract conceptualization ) , in future learning sessions/ presentations, I need to decelerate the gait of bringing and be patient while reflectors/ theoreticians think abstractly b ( PDP 6 ) . I besides need to see the groups single acquisition manners and orient my talk/ future negotiations if necessary degree Celsius ( PDP 6 ) . This clip to believe will besides let learner the chance to reexamine and reflect on what I have said, the brooding observation phase of the rhythm of acquisition.
EOP: I identified my larning demand ( missing consciousness of personal acquisition penchants ) , taken the trial ( concrete experience ) , thought about group jobs experienced in the yesteryear ( brooding observation ) and decided how my learning manner affected this ( abstract conceptualization ) . By puting an action ( B, degree Celsius ) to better group kineticss in the hereafter ( active experimentation ) , I hope to reflect on the consequence, therefore finishing the rhythm.
Fewing J. Rough and ready acquisition manners. Brainboxx 2005. hypertext transfer protocol: //www.brainboxx.co.uk/a2_learnstyles/pages/roughandready.htm Last accessed 10/10/10
Honey P & A ; Mumford A. The Manual of Learning Styles. Peter Honey Publications 1982.
Harden R and Crosby J. The good instructor is more than a lector: The 12 functions of the instructor. Amee instruction usher 2000. 4 ( 22 ) : 334-347.
Fleming ‘s VARK theoretical account
Other proposals make extra suggestions to congratulate single acquisition. Neil Fleming proposed the popular thought that we each have single sensory penchants to how we learn. The Fleming ‘s VARK ( ocular, audile, reading/writing and kinaesthetic ) theoretical account can let instructors to fix Sessionss which appeal to an person ‘s favoured manner or mode of acquisition or seek to include different centripetal modes to appeal to a wider audience of scholars. This theoretical account is particularly utile because it is easy to gestate and offers advice to ease acquisition. As a ocular scholar, I find it difficult to work at place with the kids around ( ocular and audile perturbation ) and prefer to work in the soundless survey room of the library. I normally employ multi-media and head maps to help my perusal, frequently adding notes to plot instead than bring forthing text notes. To help the acquisition of others, I will seek to integrate different modes to accommodate all scholars. I frequently use white board mindmaps in group Sessionss, I will seek to rehearse utilizing more reading/writing and kinaesthetic modes d ( PDP 6 ) . The latter might include ward-based larning where we are ‘hands-on ‘ with the patient.
Wood D.A ABC of acquisition and instruction in medical specialty. BMJ 2003 ; 326: 95-97.
One to one instruction
One to one instruction is at the opposite pole to the traditional talk. In footings of cognition transportation, its efficiency is really low, but when measured in footings of active acquisition, rating, feedback chances and the ability to pattern behavior, it scored really extremely. In the one to one scenario, understanding the scholar ‘s demands, aims and integrating their favoured acquisition manners within the brush, become the most effectual. Good one to one Sessionss need to be good prepared, interesting and contain constructive advice.
A strong relationship can besides be fostered within such a personal scene. This can let the personal and professional positions of the scholar to be openly discussed, and offers the strongest platform for influence and alteration in a trustful teacher/student relationship. This is of import to let the unfastened treatment of serious issues or to given constructive feedback, discussed subsequently.
What I find most utile from one to one coach Sessionss is the personal, individualized feedback and the chance to reflect on thoughts and understanding. Identified lacks either can be remedied or a strong clinical ground to seek the right reply can be given, which promotes active, independent acquisition.
Gordon J. ABC of acquisition and instruction in medical specialty: One to one instruction and feedback. BMJ 2003 ; 326: 543-545.
Small group learning
There are several advantages to learning smaller groups compared to larger 1s. A grip of anterior cognition, outlooks and personal aims can be obtained. By turn toing these issues, motive and engagement can be increased during the session. This relies to a great extent upon the accomplishment of the supplier to change stuff, be flexible and use ‘ad hoc ‘ learning methods/ stuffs to run into suited aims and outlooks.
Smaller Numberss besides allows for group treatment. This can offer a wealth of larning chance for both student/s and supplier. Understanding and significances can be verbalized, interpersonal accomplishments ( listening, dialogue, communicating, carrying, presentation, teamwork ) can be practised and single rating can be made.
Personally, I find deficient instruction, specifically hapless facilitation, most noticeable within the smaller group puting. Common mistakes include suppliers merely showing information without ask foring or promoting learner engagement, or as discussed subsequently, giving replies to inquiries instead than promoting any deepness of thought. While these Sessionss still provide information, they miss the chances which group treatment and group interaction offers. During the most memorable and effectual little group Sessionss I have attended, the instructor acts as a group leader, merely easing the treatment of the subject instead than presenting it.
Troubles for the supplier include pupils being unprepared/ uncooperative or laterality of a individual pupil. By puting land regulations ( e.g. non speaking at the same clip as another group member ) or promoting single engagement through direct inquiring, these obstructions can be managed. It is, nevertheless, of import to acquire the balance of construction and intercession correct. This can be achieved by merely step ining where necessary e.g. to clear up unknown, wrong thoughts or to travel subjects frontward or associate to related constructs.
Inadequate intercession, nevertheless, can let groups to go side tracked or lose their flow. To assist keep involvement and energy, dividing pupils into braces or little groups with specific undertakings, or giving them prearranged engagement ( e.g. short presentations ) can assist cut down your internal engagement within the group and promote their ain liberty.
Within the little group puting I am strong at easing engagement from all members ; I do non, nevertheless, set session aims or assess anterior cognition vitamin E ( PDP 7 ) . I have besides ne’er conducted a formal lesson program e or done a anterior scholar ‘s needs appraisal vitamin E ( brooding observation ) , these will besides travel into my development program ( abstract conceptualization ) . These actions can be found in PDP subdivision 7.
Jaques D.A ABC of acquisition and instruction in medical specialty: learning little groups. BMJ 2003 ; 326: 492-494.
Lectures are an efficient manner of go throughing on cognition and experience to big groups of scholars. Done good they can offer current thought, aid excite involvement, explain constructs, supply nucleus cognition, and direct ego direct acquisition ( SDL ) . They are less effectual at altering attitudes, promoting higher order thought, and by and large create inactive acquisition.
When mentioning to the Kolb rhythm of acquisition, lectures allow really limited clip for scholars to reflect on the given information, critically measure it or do decisions ( abstract conceptualization, figure 2 ) . To forestall your talk going drilling or bury within hours, there are a figure of ways to maximize its consequence.
In readying consider:
Where, and how it fits into the scholar ‘s course of study.
The degree of item to include.
What will they be assessed on ( hence of import to advert and include ) .
What learning methods the leaners are used to or familiar with.
What engineering and other media are available and look into in progress your competency utilizing them.
To ease acquisition ;
Use concrete illustrations to exemplify abstract rules.
Give press releases or supply electronic entree in progress.
Allow for intermissions in the bringing to give pupils clip to compose notes.
Check for understanding by inquiring inquiries or by running a mini quiz.
Encourage pupils to inquire inquiries.
Be clear and humourous ( if you can! ) .
As a pupil with appraisals and clinical duty looming, I find my motive to pay attending is maximised by the phrase ‘this ever comes up in tests ‘ or ‘you will necessitate to cognize this as a junior physician ‘ . I will utilize similar phrases in my instruction to assist present, and thereby prosecute, or to put aims, thereby actuating pupils f ( PDP 7 ) .
There are a figure of facets that are strikingly different from when I attended university for my first degree a decennary ago. There are ever clear aims stated at the start and reminded at the terminal, a clear drumhead page and inside informations of farther larning material/ sites. As a instructor of my equals, now I can see how these help scholars concentrate on the subject and assist the callback and keeping of cognition. Finally, retrieving to measure your ain public presentation and inquiring for scholar feedback g helps ease the rhythm of larning and finally better your instruction. I have ne’er proactively sought rating and ne’er actively changed the few negotiations I have delivered twice. To better my instruction accomplishments and quality of my Sessionss, this is something I will seek to make g ( PDP 7 ) .
Cantillon P. Clinical reappraisal ABC of acquisition and instruction in medical specialty: Teaching big groups. BMJ 2003 326:437
Adapted from Winston Churchill, a favorite military expression is ‘Fail to be after, program to neglect ‘ . For the huge bulk of us, this holds true when it comes to successful instruction. Much of this has been discussed within other countries of my learning theory subdivision, nevertheless, this is the general program I will follow when preparing and running my instruction Sessionss ;
See the subject ; why choose it and content. Keep it relevant and avoid information overload
Audience ; Expectations, larning manners and mode penchants, Numberss, inquiries, interruptions.
Aims ; based on scholar ‘s demands
Engagement ; inquiries and activities for scholars and instructor.
Location ; Materials available and engineering to include ( e.g. entree to X raies or ache board ) .
Facilitate SDL ; include extra resources and/or prep.
Practice, pattern, pattern.
Evaluation ; self and peer directed
I have non put superscripted action points on all of these so as non to perplex my undertaking any more than is necessary! I will, nevertheless, refer to them when planning and fixing my presentations.
Keston C. Independent Learning: A Common Essential Learning: Saskatchewan Department of Education Core Curriculum Investigation Project 1997.
The procedure of rating is indispensable to the teaching/ larning procedure and is the footing for clinical audit. It allows the presentation of cognition, exposes a deficiency of it, and helps facilitates knowledge callback, which aids long term memory keeping. Information gained from the assessor can besides be used to develop the course of study or expose any insufficiencies / spreads in certain course of study subjects.
As a pupil, the most obvious illustration of this is through direct inquiring. Questioning is a powerful tool, used less often to mortify the scholar today, nevertheless, frequently still used inadequately. Far excessively frequently the inquirer is excessively speedy to reply their inquiry without promoting deeper thought and callback.
On the busy ward, it is normally the pupil ‘s inquiries which are handled ill by the clinical instructor. Often an immediate reply is given or excessively much information is given without treatment. When times allows, a better method is to try to let the pupil to reply their ain inquiries. This can be done by inquiring the pupil to clear up, inquire them what they think or by and large probe their apprehension of the subject by inquiring them related inquiries ( rehearse good oppugning techniques ) H ( PDP 6 ) . This method encourages callback and links to develop between subjects, both aid the storage of long term memory.
Questioning besides helps to measure scholar apprehension of something explained, merely taught or witnessed. Using a closed inquiry like ‘Did you understand that ‘ , tempts pupils to state ‘yes ‘ . Asking if they can summarize it, nevertheless, requires a presentation of apprehension ( inquire the scholar to summarize understanding ) H ( PDP 6 and 10 ) .
Morrison J. ABC of acquisition and instruction in medical specialty: Evaluation. BMJ 2003 ; 326: 385-387.
Gordon J. ABC of acquisition and instruction in medical specialty: One to one instruction and feedback. BMJ 2003 ; 326: 543-545
Bing able to give and have feedback are accomplishments good established within the medical course of study and of import within the instruction procedure. This allows the development of an person ‘s ascertained public presentation and the procedure of pull offing hapless or potentially dangerous/ unprofessional behavior with minimum struggle.
A system common at the Peninsula Medical School is Pendleton ‘s regulations of feedback ;
Clarify any points of information/facts.
Ask the scholar what went good -identify the public presentation strengths.
Discuss what went good, adding your own/group observations.
Ask the scholar what went less good and how they might better following clip.
Discuss what went less good, adding your own/group observations and recommendations.
In the context of bettering my instruction accomplishments, I will promote feedback on my ain instruction Sessionss to seek and integrate recommendations into future negotiations i ( PDP subdivision 7 ) . Through making this otherwise in pattern I come into the active experimentation phase.
Pendleton D, Scofield T, Tate P and Havelock P. The audience: an attack to acquisition and instruction. Oxford University Press 1984.
Gordon J. ABC of acquisition and instruction in medical specialty: One to one instruction and feedback. BMJ 2003 ; 326: 543-545
Leadership: instruction by illustration
Leading by illustration was an activity emphasised within my military experience and some of my most memorable clinical experiences come from watching good pattern. For these grounds, I think leading and specifically ‘teaching by illustration ‘ is an of import subject. To be a good instructor and to let others to pattern good behavior, I believe you should endeavor to be ; honest, dependable, respectful, and enthusiastic, reflect critically on your ain learning process/ public presentation.
Learning in the clinical environment
In readying for my future function as a junior physician, clip spent on the ward and in outpatient clinics is increasing. The clinical scene offers ‘real ‘ patients with ‘real ‘ jobs, peculiarly powerful and relevant acquisition stimulation. This environment besides allows the scholar to be straight involved in patient attention and even taking ownership for some facets of their direction. These experiences are frequently the most memorable and assist animate SDL to make full exposed spreads in cognition. They besides allow the practical application of clinical accomplishments ( scrutiny of pathology ) and softer accomplishments ( empathy, professionalism ) which can be hard to imitate in the schoolroom.
There are, nevertheless, a figure of jobs and obstructions posed to both scholar and instructor within this environment. On many occasions my instruction has been sub-standard, cut short or cancelled due to staff deficits, exigencies or staff timetabling. Clinical instructors are after all, clinicians first and instructors second. Other less obvious booby traps relate to patient attention. It is of import to look into how confident / competent scholars are at executing undertakings ( e.g. canullation ) before inquiring them. It is besides of import to detect how under the ‘pressure of observation ‘ , the scholar obtains consent, maintains privateness and self-respect.
In the schoolroom, the instructor normally has a clearly formulated lesson or objective/s in head. With the distractions of the working environment, nevertheless, it is easy for the instructor to miss way or become distrait, leting the scholar to go a inactive perceiver instead than active participant. In my experience the ‘best ‘ instructors are really flexible on the ward. They make the most of any available chances in fortunes less than ideal, encourage scholars to acquire involved and to dispute both their apprehension and clinical pattern.
Hay R. Teaching and larning in the clinical scene. Radcliff Printing 2006.
Spencer J.A ABC of acquisition and instruction in medical specialty: acquisition and instruction in the clinical environment. BMJ 2003 ; 326: 591-594.
Jacobs J. Teaching in the clinical environment: Guide Supplement. Medical Teacher 2009 ; 31: ( 5 ) 454-456
Technology & A ; learning stuffs
The most common errors I observe within the instruction environment is mutual exclusiveness with multimedia equipment ( frequently memory sticks ) . This can be avoided by merely look intoing equipment compatibility good before your talk and have a program B ( e.g. ability to e-mail the talk person ) . Other errors include ; overcrowding of talk slides, text which is excessively little and material non associating to the verbal content/ subject rubric.
Experience and anterior preparation has taught me that minimalistic slides are normally better and slides are merely an assistance, you need to hold learned the subject good to present a good talk. These are non action points, nevertheless, because they have become wonts of mine. To corroborate or deny the premise that this is good instruction pattern, I will specifically inquire my little group to measure the slides for one of my negotiations i ( PDP subdivision 7 ) .