QA Medical Education:Teaching Clinical Skills

Faculty of Medicine9 September 2008

Common Pitfalls with Clinical Teaching

• Lack of clear objectives and expectations• Focus on factual recall rather than on

development of problem solving skills and attitudes

• Teaching pitched at the wrong level• Passive observation rather than active

participation of learners• Inadequate supervision and feedback

Common Problems with Clinical Teaching

• Little opportunities for reflection and discussion

• More teaching in in-patient and tertiary-care setting

• Over-expectation on student competencies• Teaching by humiliation• Large number of students• Lack of preparation

Common Problems with Clinical Teaching

• Inadequate role models• Informed consent not sought from patients• Lack of respect for privacy and dignity of

patients• Patient safety• Incentives to patients

Outcomes of Clinical Education

1. Clinical knowledge2. Clinical skill3. Communication skill4. Clinical reasoning5. Practical procedures6. Patient investigation7. Data interpretation and retrieval

Outcomes of Clinical Education

8. Patient management 9. Health promotion and disease

prevention10. Professional skill11. Self-directed learning 12. Attitude and ethics

Common teaching methods in the hospital settings

1. Bedside teaching2. Logbook and Portfolio3. Task-based learning4. Problem-based learning5. Study guides6. Grand rounds7. Business ward round

8. Teaching ward round 9. Clinical conference10. Apprenticeship model11. Patients-centered model12. Shadowing a junior doctor13. Medical record writing14. Workshop

Common teaching methods in the hospital settings

Learning Environment in Clinical Settings

• Autonomy• Supervision• Social support• Workload• Role clarity• Variety• Orientation to learning and teaching• Orientation to general practice

Clinical Learning Cycle

Preparatory

Explanatory-Reflection-Feedback-Working knowledge

Experiential-Briefing-Clinical practice-Debriefing

Improvement of Clinical Teaching - PSU

• Improvement of bedside teaching – faculty development

• More movement to ambulatory settings• Extension of affiliated hospital• Patients bank• Clinical skill training center• Logbook vs portfolio• How to link PBL to clinical education

Improvement of Clinical Teaching - PSU

• QA – subject audit, not department ?Narrative report Quality improvement – what,

how ?Link O-L-E PDCA

Standard, indicators TQA, WFME model

P D

CA

“The Best is an Enemy of Quality”