Teaching and Teaching and learning methodslearning methods

Presented byPresented by::Prof. Namir Al-TawilProf. Namir Al-Tawil

M.B.Ch.B, FICMS/CMM.B.Ch.B, FICMS/CMHawler Medical UniversityHawler Medical Universitynamiraltawil@gmail.comnamiraltawil@gmail.com

ContentsContents

Lectures.Lectures. Learning in small groups.Learning in small groups. Teaching in the clinical skills center.Teaching in the clinical skills center. Bedside teaching.Bedside teaching. Ambulatory care teaching.Ambulatory care teaching. In the community.In the community. Distance education.Distance education. Peer-assisted learning.Peer-assisted learning.

ObjectivesObjectives

At the end of this lecture the At the end of this lecture the audience must:audience must: Know the main methods of teaching and Know the main methods of teaching and

learninglearning Know the advantages and Know the advantages and

disadvantages of each.disadvantages of each.

I. LecturesI. Lectures

II. Learning in II. Learning in small groupssmall groups

Learning in small groupsLearning in small groups

An educational method to promote An educational method to promote studentstudent’’s learning.s learning.

There is movement from a teacher-There is movement from a teacher-centered approach of education to a centered approach of education to a more student centered approach.more student centered approach.

Characterized by student Characterized by student participation and interaction.participation and interaction.

Small number of students doesnSmall number of students doesn’’t t always mean student participation.always mean student participation.

AdvantagesAdvantages

Familiarizes students with an adult Familiarizes students with an adult approach to learning.approach to learning.

Encourages students to take Encourages students to take responsibility for their own learning.responsibility for their own learning.

Promotes deeper understanding of Promotes deeper understanding of material.material.

Encourages problem solving skills.Encourages problem solving skills. Encourages participation. So it is Encourages participation. So it is

more enjoyable. more enjoyable.

Advantages, contAdvantages, cont..

Develops:Develops:

Interpersonal skillsInterpersonal skills

Communication skillsCommunication skills

Social team-working skillsSocial team-working skills

Presentation skillsPresentation skills

DisadvantagesDisadvantages

Needs:Needs:

More teachersMore teachers

More roomsMore rooms

More resourcesMore resources

Examples of small groups Examples of small groups sessionssessions

Seminars.Seminars. Workshops.Workshops. Clinical skills session.Clinical skills session. Communication skills sessions.Communication skills sessions. Problem based learning tutorials.Problem based learning tutorials. Clinical teaching sessions Clinical teaching sessions ward-basedward-based ambulatory careambulatory care community-basedcommunity-based

Requirements of a tutorRequirements of a tutor

Tutor guide must be provided to the Tutor guide must be provided to the tutor, so that the objective would be tutor, so that the objective would be clear for him.clear for him.

New tutors have to enter special New tutors have to enter special training courses.training courses.

Tutors should be the first to appear Tutors should be the first to appear at the appointed hour, not the last. at the appointed hour, not the last. They have to check the venue, the They have to check the venue, the seating, and the resources.seating, and the resources.

The role of the studentThe role of the student The positive commitment of the The positive commitment of the

student is the key to success.student is the key to success. Learners must realize that what they Learners must realize that what they

get out of the process directly reflect get out of the process directly reflect what they put into it.what they put into it.

The input: prior reading and active The input: prior reading and active participation.participation.

Student groups may function Student groups may function satisfactorily in the absence of a tutor.satisfactorily in the absence of a tutor.

FinallyFinally::

A mixed approach to the A mixed approach to the learning situation is often learning situation is often appropriate and may be appropriate and may be positively encouraged. positively encouraged.

The use of both lectures and The use of both lectures and small groups may be small groups may be complementary to the learning complementary to the learning process.process.

III. Teaching in III. Teaching in the clinical the clinical skills centerskills center

ObjectiveObjective

The clinical skill center (CSC) The clinical skill center (CSC) seeks to provide an environment seeks to provide an environment for learning clinical skills in for learning clinical skills in which students can practice which students can practice without jeopardizing patient without jeopardizing patient care or provoking adverse care or provoking adverse effects. effects.

Current trendsCurrent trendsI. Developing simulated I. Developing simulated

clinical environmentclinical environment Requirements:Requirements: Space for creation of simulated Space for creation of simulated

environments.environments. Simulators of varying degrees of Simulators of varying degrees of

sophistication.sophistication. Simulated and standardized Simulated and standardized

patients and patient-instructors.patients and patient-instructors.

SpaceSpace

The clinical skills center should The clinical skills center should provide more space than the ordinary provide more space than the ordinary (real) hospital rooms.(real) hospital rooms.

RequirementsRequirements:: Separate restroom facilities for Separate restroom facilities for

simulated patients (SP).simulated patients (SP). A briefing room where SP can relax, A briefing room where SP can relax,

eat, and store their belongings and be eat, and store their belongings and be briefed as a group by SP trainer.briefed as a group by SP trainer.

Space, contSpace, cont..

A seminar room.A seminar room. Office space.Office space. A monitoring station.A monitoring station. Room temperature.Room temperature. Lighting.Lighting. Air-conditioning, fire alarm, Air-conditioning, fire alarm,

soundproofing, and emergency lighting.soundproofing, and emergency lighting. A photocopier, and fax.A photocopier, and fax. An audio-visual presentation room, with An audio-visual presentation room, with

teleconferencing capacity.teleconferencing capacity. Storage space for models and simulators. Storage space for models and simulators.

II. SimulatorsII. Simulators

Simple models are used to simulate Simple models are used to simulate intimate or invasive procedures such intimate or invasive procedures such bladder catheterization, rectal, and bladder catheterization, rectal, and breast examination.breast examination.

More complex simulators allow students More complex simulators allow students to perform intravenous cannulation and to perform intravenous cannulation and intra-articular injections.intra-articular injections.

The latest generation combine the model The latest generation combine the model and a computer generated performance and a computer generated performance indicator. e.g. simulators for pelvic indicator. e.g. simulators for pelvic examinations, and cardiology simulators.examinations, and cardiology simulators.

III. Simulated and III. Simulated and standardized patientsstandardized patients

Individuals of all ages can be trained Individuals of all ages can be trained to reproduce a clinical history and to to reproduce a clinical history and to respond to physical examination in a respond to physical examination in a consistent manner.consistent manner.

They can also assess the care They can also assess the care providerprovider’’s performance.s performance.

Patients with appropriate educational Patients with appropriate educational backgrounds and extensive training backgrounds and extensive training have been used as patient instructors.have been used as patient instructors.

IV. Bed side IV. Bed side teachingteaching

Bedside teachingBedside teaching

““To study the phenomenon of disease To study the phenomenon of disease without books is to sail an uncharted without books is to sail an uncharted sea whilst to study books without sea whilst to study books without patients is not to go to sea at allpatients is not to go to sea at all””

Sir William Sir William OslerOsler

1849-1849-19191919

The learning triadThe learning triad

PatientsPatients

Doctors Doctors StudentsStudents

PatientsPatients

Direct contact with patients is important Direct contact with patients is important for the development of clinical reasoning, for the development of clinical reasoning, communication skills, professional communication skills, professional attitudes, and empathy.attitudes, and empathy.

It is valuable to It is valuable to startstart with simulated with simulated patients (patients (normal anatomy and physiologynormal anatomy and physiology). ).

Patients should not be obliged to Patients should not be obliged to participate in the teaching sessions.participate in the teaching sessions.

Patients should be briefed, so that they Patients should be briefed, so that they know what will be expected of them.know what will be expected of them.

StudentsStudents

The optimum No. of bedside teaching The optimum No. of bedside teaching is 2-5 students.is 2-5 students.

They must be dressed with white They must be dressed with white coats (or a special uniform) and name coats (or a special uniform) and name badges.badges.

They are expected to behave They are expected to behave professionally in the ward.professionally in the ward.

They should be briefed in the They should be briefed in the beginning about the purpose of the beginning about the purpose of the session and goals to be achieved.session and goals to be achieved.

Students, contStudents, cont..

Students have found ward based Students have found ward based teaching the most valuable way of teaching the most valuable way of developing clinical skills.developing clinical skills.

In the beginning, students may feel a In the beginning, students may feel a state of fear and embarrassment of an state of fear and embarrassment of an unfamiliar environment. unfamiliar environment.

They may feel anxious if unsure of their They may feel anxious if unsure of their knowledge base or clinical abilities.knowledge base or clinical abilities.

The tutor must help to relieve anxiety The tutor must help to relieve anxiety and let and let ““allall”” students participate in the students participate in the session.session.

TutorsTutors

Tutors may be consultant staff, junior Tutors may be consultant staff, junior hospital doctors, nurses, trained hospital doctors, nurses, trained patients, or student peers.patients, or student peers.

Tutors are powerful role models for the Tutors are powerful role models for the students especially in the early years.students especially in the early years.

It is important that they demonstrate It is important that they demonstrate appropriate knowledge, skills, and appropriate knowledge, skills, and attitudes.attitudes.

The wardThe ward

Ward teaching should not take Ward teaching should not take place when meal, cleaners, or place when meal, cleaners, or visitors are expected.visitors are expected.

The use of side room for pre- or The use of side room for pre- or post-ward round discussion post-ward round discussion provides a useful alternative provides a useful alternative venue for discussion once the venue for discussion once the patients have been seen. patients have been seen.

Educational objectivesEducational objectives

Clinical skills.Clinical skills. Communication skills.Communication skills. Clinical reasoning.Clinical reasoning. Practical procedures (venepuncture, Practical procedures (venepuncture,

bladder catheterization, cannulation).bladder catheterization, cannulation). Patient investigation and management.Patient investigation and management. Professional skills (the observation of Professional skills (the observation of

doctors and how do they deal with each doctors and how do they deal with each other and with other health care workers).other and with other health care workers).

Attitude and ethics.Attitude and ethics.

V. Ambulatory V. Ambulatory care teachingcare teaching

Why teach in ambulatory Why teach in ambulatory carecare

The ambulatory care setting The ambulatory care setting offers a offers a varietyvariety of clinical of clinical situations and a range of situations and a range of commoncommon clinical conditions clinical conditions not seen in inpatient care. not seen in inpatient care.

Where can teaching take Where can teaching take placeplace

General OP clinics.General OP clinics. Specialist or tertiary referral clinics.Specialist or tertiary referral clinics. Multi-professional clinics (staff from Multi-professional clinics (staff from

variety of disciplines see patients variety of disciplines see patients together e.g. hand clinics)together e.g. hand clinics)

Clinics for specific diseases like diabetes Clinics for specific diseases like diabetes clinic and foot clinics.clinic and foot clinics.

Accident and emergency department.Accident and emergency department. Radiology and imaging suites.Radiology and imaging suites.

Where can teaching take Where can teaching take placeplace

Clinical investigation unit e.g. Clinical investigation unit e.g. endoscopy unit.endoscopy unit.

Day surgery unit.Day surgery unit. Physiotherapy and departments of Physiotherapy and departments of

other professions allied to medicine .other professions allied to medicine . Social services department.Social services department. Ambulatory care teaching center.Ambulatory care teaching center.

How to facilitate learning How to facilitate learning in ambulatory carein ambulatory care

LogbooksLogbooks: used to list the core clinical : used to list the core clinical problems to be seen during the problems to be seen during the attachment and to document the attachment and to document the student activity and learning achieved student activity and learning achieved with each patient contact.with each patient contact.

Task-based-learningTask-based-learning: A list of tasks are : A list of tasks are given to the students: participate in given to the students: participate in consultation with the attending staff, consultation with the attending staff, interview and examine patients, review interview and examine patients, review a number of new radiographs with the a number of new radiographs with the radiologist. radiologist.

Advantages of teaching in Advantages of teaching in the ambulatory care settingthe ambulatory care setting A wide range of clinical conditions may be A wide range of clinical conditions may be

seen.seen. There are large numbers of new and return There are large numbers of new and return

patients.patients. Students have the opportunity to experience Students have the opportunity to experience

a multi-professional approach to patient care.a multi-professional approach to patient care. Unlike ward teaching, increased numbers of Unlike ward teaching, increased numbers of

students can be accommodated without students can be accommodated without exhausting the limited No. of suitable exhausting the limited No. of suitable patients. patients.

Advantages of teaching in Advantages of teaching in the ambulatory care settingthe ambulatory care setting Students enjoy this teaching Students enjoy this teaching

situation and probably prefer it to situation and probably prefer it to ward-based teaching.ward-based teaching.

Medical schools should recognize Medical schools should recognize the role ambulatory care teaching the role ambulatory care teaching has in relieving pressure on ward-has in relieving pressure on ward-base teaching and provide base teaching and provide appropriate resource for its appropriate resource for its implementation and development. implementation and development.

VI. Community VI. Community Based Medical Based Medical

EducationEducation((CBMECBME))

DefinitionDefinition

CBME refers to medical education CBME refers to medical education that is based outside a tertiary or that is based outside a tertiary or large secondary level hospital. large secondary level hospital.

Community oriented medical Community oriented medical education describes curricula that education describes curricula that are based on addressing the health are based on addressing the health needs of the local community and needs of the local community and preparing graduates to work in that preparing graduates to work in that community.community.

SettingSetting

Most CBME curricula are based on a Most CBME curricula are based on a PHC philosophyPHC philosophy and are conducted and are conducted in a primary care setting. in a primary care setting.

Uses for CBMEUses for CBME

Preclinical aimsPreclinical aims:: Learning in the fields of Learning in the fields of epidemiologyepidemiology, ,

preventive healthpreventive health, , public health public health principlesprinciples, , community developmentcommunity development, , the the social impactsocial impact of illness and of illness and understanding how patients interact understanding how patients interact with the health care system. with the health care system.

Also used for learning basic clinical Also used for learning basic clinical skills, especially skills, especially communication skills.communication skills.

Uses for CBME, contUses for CBME, cont..

Clinical aims.Clinical aims.

1.To learn about general practice.1.To learn about general practice.

A general practice rotation is the A general practice rotation is the most common clinical CBME most common clinical CBME attachment and appear in most attachment and appear in most modern medical curricula.modern medical curricula.

Clinical aims, contClinical aims, cont..

2.To learn multiple disciplines 2.To learn multiple disciplines concurrently.concurrently.

- This concept takes advantage of the - This concept takes advantage of the broad patient base in primary care, broad patient base in primary care, and has been situated in rural and has been situated in rural communities.communities.

- Clinicians are more likely to have - Clinicians are more likely to have significant roles in primary care, significant roles in primary care, emergency medicine, obstetrics, and emergency medicine, obstetrics, and inpatient care. inpatient care.

VII. Distance VII. Distance educationeducation

DefinitionDefinition

The term The term ‘‘distance educationdistance education’’ covers the covers the various forms of study at all levels which various forms of study at all levels which are not under the continuous, immediate are not under the continuous, immediate supervision of tutors present with their supervision of tutors present with their students in lecture rooms, or in the same students in lecture rooms, or in the same premises, but which nevertheless, premises, but which nevertheless, benefit from the planning, guidance, and benefit from the planning, guidance, and tuition of tutorial organization.tuition of tutorial organization.

Holmberg Holmberg 19971997

Why distance educationWhy distance education??

It is an excellent alternative to It is an excellent alternative to continuing medical education continuing medical education courses when there are certain courses when there are certain constraints like time, funding, and constraints like time, funding, and geography.geography.

Distance education can allow Distance education can allow learners to study a topic to the learners to study a topic to the depth they desire and at a pace that depth they desire and at a pace that suits them. suits them.

VIII. Peer-VIII. Peer-assisted learning assisted learning

(PAL)(PAL)

Definition of Peer Assisted Definition of Peer Assisted LearningLearning

Any situation where people learn from, Any situation where people learn from, or with, others of a similar level of or with, others of a similar level of training, background or other shared training, background or other shared characteristic.characteristic.

In the undergraduate curriculum this In the undergraduate curriculum this could include any small group work (e.g. could include any small group work (e.g. problem based learning). In problem based learning). In postgraduate medicine, e.g. peer review postgraduate medicine, e.g. peer review of journal articles, clinical team meeting of journal articles, clinical team meeting and appraisal. and appraisal.

AdvantagesAdvantages

Advantages for tutors:Advantages for tutors: Provides opportunities to reinforce and revise Provides opportunities to reinforce and revise

their learning.their learning. Encourages responsibility and increased self-Encourages responsibility and increased self-

confidence.confidence. Develops teaching and verbalization skills.Develops teaching and verbalization skills. Enhances communication skills, and empathy.Enhances communication skills, and empathy. Develops appraisal skills (of self and others) Develops appraisal skills (of self and others)

including the ability to give and receive including the ability to give and receive appropriate feedback.appropriate feedback.

Enhance organizational and team-working Enhance organizational and team-working skills.skills.

Advantages, contAdvantages, cont..

Advantages for tuteesAdvantages for tutees Feel more relaxed, and more supported.Feel more relaxed, and more supported. Can ask questions, even the silly ones.Can ask questions, even the silly ones. Provides opportunity to obtain detailed Provides opportunity to obtain detailed

feedback on their knowledge and skills.feedback on their knowledge and skills. Associated with social benefits, role Associated with social benefits, role

modeling, and increased motivation to modeling, and increased motivation to learn.learn.

It is efficacious: peer tutors seem to be It is efficacious: peer tutors seem to be as good as staff in certain areas.as good as staff in certain areas.

““The peer tutors were great The peer tutors were great

teachers. They are students as well, teachers. They are students as well,

so they know what and how we so they know what and how we

think, the mistakes we tend to makethink, the mistakes we tend to make””

Tutee (Howman et al 2003)Tutee (Howman et al 2003)

Advantages, contAdvantages, cont..

Advantages for medical schoolAdvantages for medical school Cost and resource-effective.Cost and resource-effective. Students feel more involvement in the Students feel more involvement in the

course and ownership.course and ownership. It is easier to standardize tutoring from It is easier to standardize tutoring from

peers than from professional teachers.peers than from professional teachers. Meets obligation to train medical students Meets obligation to train medical students

in teaching skills.in teaching skills. Encourage a culture of collaborative Encourage a culture of collaborative

learning instead of competitiveness. learning instead of competitiveness.

Disadvantages of PALDisadvantages of PAL

Student tutors may have inadequate Student tutors may have inadequate depth of knowledge.depth of knowledge.

Student tutors may teach Student tutors may teach ‘‘the wrong the wrong thingthing’’ or give incorrect information. or give incorrect information.

Tutors lack experience and may Tutors lack experience and may transfer knowledge and skills poorly.transfer knowledge and skills poorly.

TutorsTutors’’ ego and personality issues ego and personality issues may cause groups to be dysfunctional.may cause groups to be dysfunctional.

Disadvantages of PAL, Disadvantages of PAL, contcont..

Students may be encouraged to examine Students may be encouraged to examine each other, with potential peer pressure, each other, with potential peer pressure, embarrassment, and inappropriate embarrassment, and inappropriate behavior.behavior.

Time and effort are required to organize Time and effort are required to organize PAL programs, train tutors, and monitor PAL programs, train tutors, and monitor outcomes.outcomes.

Student tutors may be used as Student tutors may be used as ‘‘cheap cheap laborlabor’’, teaching on established courses, , teaching on established courses, where there is no real benefit for the where there is no real benefit for the tutor, because there are insufficient tutor, because there are insufficient faculty staff.faculty staff.

SummarySummary

More than one teaching method is More than one teaching method is needed.needed.

There is movement from a teacher-There is movement from a teacher-centered approach of education to a centered approach of education to a more student centered approach.more student centered approach.

Questions and commentsQuestions and comments

?? ?? ??

Thanks for Thanks for listeninglistening