How to Teach in Clinical Settings (eBook)

Mary Seabrook (Autor)

eBook Download: PDF | EPUB

2013
John Wiley & Sons (Verlag)
978-1-118-62092-2 (ISBN)

Infos

How to Teach in Clinical Settings is a practical guide to support all doctors wishing to develop their skills in clinical teaching and supervision.
It provides hands on strategies to address common problems such as giving critical feedback effectively and teaching mixed-level groups. It gives guidance on the particular challenges of teaching in clinical settings including the need to manage teaching with service provision, to engage patients, motivate students, and to judge the balance of support and independence appropriate for each trainee.
How to Teach in Clinical Settings is invaluable for all doctors involved in teaching and training at any stage of their career. It is also useful and accessible to medical students who increasingly need to consider and develop their own teaching skills as part of their career progression.

Mary Seabrook, Medical Education Consultant, London, UK

Inhalt

Acknowledgements ix

Introduction xi

Chapter 1 Creating an effective learning environment 1

Practical ways to create an environment conducive to learning
4

Design of clinical placements 6

Continuity between learners teachers and patients 8

Teaching and learning resources 9

The teaching climate 9

What makes a good clinical teacher? 10

Involving patients in teaching 11

Involving other disciplines in teaching 13

Some principles of effective clinical teaching 15

Useful strategies for clinical teaching 15

Five tips for clinical teaching which do not take time or money
17

References 17

Chapter 2 Teaching in clinical contexts 19

Teaching on ward rounds 19

General principles 19

Useful strategies 21

What you teach unwittingly 23

The psychiatric ward round 25

Handover meetings board rounds and bench rounds 26

Bedside teaching 29

Preparation 29

Structure for bedside teaching 30

Feedback at the bedside 34

Examination practice at the bedside 36

Teaching in clinics 38

General principles 38

Supervising trainees in parallel clinics 40

Effective questioning on presented cases 41

Seeing the patient together 42

Supervising students or trainees who are supernumerary 43

Teaching in the Accident and Emergency department 46

Teaching the interpretation of images/specimens 47

Teaching in theatre 49

General principles 50

Useful strategies 50

Teaching practical skills 56

On-call/remote teaching 60

Teaching patients 62

Teaching other disciplines 64

Further reading on clinical teaching 65

References 66

Chapter 3 Workplace-based assessment and feedback 67

The workplace-based assessments/supervised learning events
67

Using the tools effectively 69

Case-based discussion 71

The mini-clinical evaluation exercise (Mini-ACE in psychiatry)
73

Directly observed procedural skills 75

Multi-source feedback (MSF) 77

Teaching observation tools 79

Giving feedback 81

Giving negative feedback 81

General principles of feedback 82

Useful strategies for giving feedback 82

Feedback models and structures 85

Further reading on assessment and feedback 89

References 90

Chapter 4 Common problems in clinical teaching 91

Balancing teaching and service demands 91

Pitching teaching at the right level 94

Dealing with complaints and clinical incidents 96

Ad hoc teaching 100

Teaching people at different levels together 101

Teaching older or more experienced colleagues 103

Engaging the quiet or reluctant learner 104

The difficult consultation 106

Teaching multiple students 107

Teaching trainees with no interest in your speciality 108

References 109

Chapter 5 Next steps 110

Developing as a teacher 110

Evaluating your teaching 111

Useful resources 115

Appendix Glossary of assessment tools 118

Index 119

Textauszug

Chapter 1

Creating an effective learning environment

The clinical environment can be an exciting and, at the same time, daunting place in which to learn. Students entering clinical placements have to adjust to learning in a work environment, where, unlike at school or college, their learning is not the organisation's primary goal. They are usually enthused by the prospect of clinical work but feel that they lack a genuine role or place in the team. They may need help to learn how to gain access to patients and find learning opportunities.

So what determines how much people learn in workplace settings such as hospitals and general practices?

A study of learning at work found three main factors (Table 1.1).

Table 1.1 Main factors affecting learning at work [1]

Factor

Examples

1. Characteristics of the learner

Confidence, motivation, capability, prior knowledge (This is probably the most important factor, accounting for about 50% of variance in learning.) [2]

2. The immediate work culture

Level of challenge and responsibility, quality of supervision/management, emotional support, learning climate, pressures and priorities

3. The broader context

The career structure, appraisal systems, working hours, training policies

Depending on your role, you may be able to impact on different areas. Most people find it quite easy to teach a motivated, competent and appropriately confident student or trainee. However, what if a trainee appears uninterested or lacking basic clinical skills? Someone in a pastoral role such as an educational supervisor or a personal tutor could address areas such as a learner's confidence and motivation. They might also help learners to set goals for developing their clinical skills, with teachers at all levels providing opportunities for practice and feedback.

Someone with a more strategic role such as a course organiser or training programme director may have some influence on the broader context, for example, ensuring that learners have adequate time for private study in their timetable.

Those supervising learners on a daily basis (often students or trainees at the next level up) will probably have most influence on their immediate conditions of work, such as the climate for learning and the type of work in which they are engaged. These aspects (which are addressed in the next two sections) are important, and sometimes underestimated, although not by Albert Einstein, who is reported to have said

I never teach my pupils; I only attempt to provide the conditions in which they can learn [3].

Thinking point

Can you remember your early clinical placements as a student or newly qualified doctor? What were your first impressions? What messages did you receive about how easy or difficult learning would be? What, if anything, would have made you feel more ready and able to learn? What do you think is the optimum climate for learning?

Discussion

Most doctors will have had mixed experiences. Learners report positive aspects such as supportive teams, effective, approachable teachers and constructive feedback, and difficulties such as unstable or incomplete teams, lack of patient continuity and teaching by humiliation [4–6]. Views on the ideal learning climate also vary, both individually and between specialties. Some favour a supportive environment. Others believe that exposing learners' deficiencies publicly is necessary to protect patients, maintain standards and prepare doctors for the demands of their working lives [7]. Evidence from relevant research studies follows.

Factors identified by medical students as influencing the effectiveness of placements at a large teaching hospital are shown in Table 1.2. Trainees mention similar helpful characteristics: a study of resident medical officers in Australia identified eight elements of a placement contributing to professional development (Table 1.3).

Table 1.2 Medical students' experiences of clinical placements [6]

What students found helpful

What students found difficult

Feeling valued within the team

Feeling in the way

Being made to feel useful

Being ignored

Having a forum to discuss their ideas where they will not be laughed at

Being talked over and not having things explained to them

Friendly, accessible and approachable staff

Not being able to contribute to patient care

Staff who want to teach

A pattern of teachers being late or cancelling planned teaching

Lots of practical experience and exposure

Hanging around waiting for opportunities

Doctors being interested in what they are doing

Lack of induction—learning by getting things wrong

Expectations being made explicit

Table 1.3 Elements of the clinical environment perceived by trainees as contributing to learning

Element

Description

Autonomy

Responsibility for patient care

Supervision

Guidance and direction from senior medical colleagues

Social support

Being accepted, recognised and valued within the team

Workload

Balance between service and professional development

Role clarity

Clarity of expectations about what should be done and achieved

Variety

Diversification of the work

Orientation to learning and teaching

Emphasis on learning and development and availability of learning activities

Orientation to general practice

Attention given to learning requirements relevant to general practice

Adapted from [8] with permission from Taylor & Francis Ltd.

Both studies highlight the importance of clear expectations, opportunities for practical experience and the exercise of responsibility. They also agree on the need for a social climate in which learners feel accepted and valued. These findings are supported by a major review of educational research which found that expert teachers respect students, both as learners and as people, showing care and commitment for them [2]. The optimal educational climate is described as one ‘where error is welcomed, where student questioning is high, where engagement is the norm’ [2].

In a clinical context, error would not be welcomed, but it is safer for patients if the climate is sufficiently open that learners are not afraid to ask questions or admit mistakes or weaknesses [9, 10]. It is easy for senior doctors to forget how scary they can seem to those lower down the hierarchy! At the same time, a culture of high expectations is important, with teachers demonstrating high standards themselves and expecting the same of their learners [11].

Practical ways to create an environment conducive to learning

Aim for a combination of challenge (setting goals and tasks which are demanding but achievable) and support (providing advice, encouragement and feedback to enable goals to be met). Practical things you can do include the following.

Before students/trainees arrive

• Send a welcome letter/e-mail to let them know where and when to come and what to bring.
• You may want to suggest how they could prepare for their placement, for example, relevant reading.

On arrival

Make them feel welcome/part of the team:

• remember and use their name;
• show a personal interest, for example, finding out more about their previous jobs, travel to work, spare time activities;
• find somewhere that they can meet, put things, access resources.

Orientate them (Box 1.1):

• introduce them to key colleagues;
• provide a proper induction, including written information;
• show them where to find and how to use relevant equipment or protocols;
• advise them how to learn—for example, what questions to ask themselves about patients, what to do when clinicians are late or do not arrive for teaching, how to focus their reading;
• direct them to relevant Intranet pages—ask current/past students to develop a list of useful resources which can be continuously modified by new trainees;
• tell them good times to contact you and how to do so (Box 1.2).

Clarify expectations:

• explain what they can expect from the rotation, and perhaps what they cannot;
• explain the behaviour and standards you expect from them (e.g. dress code, punctuality, when/how to report back on patients);
• negotiate specific learning objectives;
• ask trainees/students from a previous rotation to advise them on working in the team—they will tend to tap into the things that newcomers want to know.

Box 1.1 Planning for new trainees

Mr. Jones, a colorectal surgeon, always takes a week's holiday in the first...

Produkt-Details

• Erscheint lt. Verlag: 14.11.2013
• Reihe/Serie: HOW - How To
• Reihe/Serie: HOW - How To
• Reihe/Serie: How To
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Themenwelt: Medizin / Pharmazie ► Studium
• Themenwelt: Sozialwissenschaften ► Pädagogik
• Schlagworte: Allgemeine u. Innere Medizin • appropriate • Balance • Clinical • Common • Critical • doctors • Feedback • General & Internal Medicine • Giving • Guide • hands • Independence • invaluable • Medical Professional Development • Medical Science • Medizin • mixedlevel • particular challenges • patients • Perspektiven in medizinischen Berufen • Practical • Problems • Settings • Skills • Strategies • Teach • Trainee
• ISBN-10: 1-118-62092-5 / 1118620925
• ISBN-13: 978-1-118-62092-2 / 9781118620922