Teaching and learning methods

Teaching and learning methods Presented by: Prof. Namir Al-Tawil M.B.Ch.B, FICMS/CM Hawler Medical University namiraltawil@gmail.com

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

Objectives • At the end of this lecture the audience must: • Know the main methods of teaching and learning • Know the advantages and disadvantages of each.

I. Lectures

Lecture A process by which the notes of a teacher become the notes of a student without passing through the minds of either. O’Donnel 1997

Role • An opening lecture of a course will stimulate interests and curiosity. • A lecture should have a stated aims; e.g. at the end of the lecture, the audience should be able to list, to know, to…..

Types of lecture sessions • Didactic lecture: Spoon feeding the students with predigested facts. • Overview. • Core: series of lectures presenting the core content of the course. • Non-core: A lecture presenting materials beyond the core. E.g. recent research developments. • Assessment material. The style of examinations can be introduced.

Types of lecture sessions, cont. • Interactive lecture (lecturer-student-patient) • Shared lecture: two or more lecturers may share the session to present multi-professional approaches or opinions on a topic. • Mini-symposium: several participants can take part to demonstrate multi-professional approaches to management of a clinical problem.

Components • Selection. -Materials chosen as key points should lead to the stated objectives. -Generally, 5 key points are suitable for a lecture of one hour. • Sequencing. - Between key points the lecture should proceed in a logical progression.

Components, cont. -Within key points the use of a variety of examples, illustrations, and elaborations will increase the chance of new information being retained. • Linking A summary should be made at the end of the presentation of each key point before progressing to the next.

Duration • Students’ attention decrease after 45 minutes. • There must be time for answering questions. • Lectures delivered by more than one person may last longer, but better to give a break in between the two sessions.

Format • Introduction. • Body. • Conclusion. Note: Students are more receptive in the first and last few minutes of the lecture. So these are the times to emphasize the key points of the lecture.

Introduction • Last around 5 minutes. • The lecturer must attract attention, establish rapport, and provide motivation to the audience to concentrate for the main body of the lecture. • The key points of the lecture must be indicated. The lecturer can provides a statement of the objectives of the lecture (e.g. at the end of this lecture you should be able to……….) so students can arrange their thoughts. • The students’ preexisting knowledge base should be identified.

Body • The classical method: This divides the lecture into sections and sub-sections. Easy to plan and take notes from, but can be boring soon. • The problem centered method: Begins by stating a problem and then argues for and against various solutions. • The sequential method: Consists of a series of linked statements which lead to a conclusion as one part logically leads to the next. E.g: definition of problem, Signs and symptoms, prognosis, investigation, management, and lastly monitoring.

Conclusion • Finish the lecture with a review of the objectives and key points which were stated in the introduction. • You can indicate avenues of self-directed learning which the students might wish to follow. • Some lecturers ask for feed back for their performance.

A, E, I, O, U • Attract attention. • Establish rapport. • Identify knowledge base. • Provide advance organizer-Objectives and key points. • Indicate Usefulness.

Presentation • Where to stand? • How to speak? • Eye contact. • Lights (beware of dimming lights). • When to change style?

Highlights • An important question for any lecturer to consider when planning a teaching session is, “How can I help my students to learn during my lecture?” Cantillon, 2003 • Say what you are going to say, say it and say what you have said. • Ensure that you have arrived at the correct lecture theatre to avoid beginning your lecture with the wrong audience.

Highlights, cont. • If you are unsure of the answer to a question raised, ask the student to meet you later to discuss it. • Always end your lecture with a summary of the content rather than a discussion of some obscure points raised as question.

II. Learning in small groups

Learning in small groups • An educational method to promote student’s learning. • There is movement from a teacher-centered approach of education to a more student centered approach. • Characterized by student participation and interaction. • Small number of students doesn’t always mean student participation.

Advantages • Familiarizes students with an adult approach to learning. • Encourages students to take responsibility for their own learning. • Promotes deeper understanding of material. • Encourages problem solving skills. • Encourages participation. So it is more enjoyable.

Advantages, cont. • Develops: Interpersonal skills Communication skills Social team-working skills Presentation skills

Disadvantages • Needs: More teachers More rooms More resources

Examples of small groups sessions • Seminars. • Workshops. • Clinical skills session. • Communication skills sessions. • Problem based learning tutorials. • Clinical teaching sessions ward-based ambulatory care community-based

Requirements of a tutor • Tutor guide must be provided to the tutor, so that the objective would be clear for him. • New tutors have to enter special training courses. • Tutors should be the first to appear at the appointed hour, not the last. They have to check the venue, the seating, and the resources.

Issues of importance during group work • Participation of all group members. • Critical thinking (interpretation and synthesis of information). • Articulation of thoughts/views. • Learner interaction. • Review of objectives. • Intermittent summary of achievements. • Observation of agreed time constraints (development of time management skills).

The role of the student • The positive commitment of the student is the key to success. • Learners must realize that what they get out of the process directly reflect what they put into it. • The input: prior reading and active participation. • Student groups may function satisfactorily in the absence of a tutor.

Finally: • A mixed approach to the learning situation is often appropriate and may be positively encouraged. • The use of both lectures and small groups may be complementary to the learning process.

III. Teaching in the clinical skills center

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

Current trendsI. Developing simulated clinical environment Requirements: • Space for creation of simulated environments. • Simulators of varying degrees of sophistication. • Simulated and standardized patients and patient-instructors.

Space • The clinical skills center should provide more space than the ordinary (real) hospital rooms. Requirements: • Separate restroom facilities for simulated patients (SP). • A briefing room where SP can relax, eat, and store their belongings and be briefed as a group by SP trainer.

Space, cont. • A seminar room. • Office space. • A monitoring station. • Room temperature. • Lighting. • Air-conditioning, fire alarm, soundproofing, and emergency lighting. • A photocopier, and fax. • An audio-visual presentation room, with teleconferencing capacity. • Storage space for models and simulators.

II. Simulators • Simple models are used to simulate intimate or invasive procedures such bladder catheterization, rectal, and breast examination. • More complex simulators allow students to perform intravenous cannulation and intra-articular injections. • The latest generation combine the model and a computer generated performance indicator. e.g. simulators for pelvic examinations, and cardiology simulators.

III. Simulated and standardized patients • Individuals of all ages can be trained to reproduce a clinical history and to respond to physical examination in a consistent manner. • They can also assess the care provider’s performance. • Patients with appropriate educational backgrounds and extensive training have been used as patient instructors.

IV. Bed side teaching

Bedside teaching “To study the phenomenon of disease without books is to sail an uncharted sea whilst to study books without patients is not to go to sea at all” Sir William Osler 1849-1919

The learning triad Patients Doctors Students

Patients • Direct contact with patients is important for the development of clinical reasoning, communication skills, professional attitudes, and empathy. • It is valuable to start with simulated patients (normal anatomy and physiology). • Patients should not be obliged to participate in the teaching sessions. • Patients should be briefed, so that they know what will be expected of them.

Students • The optimum No. of bedside teaching is 2-5 students. • They must be dressed with white coats and name badges. • They are expected to behave professionally in the ward. • They should be briefed in the beginning about the purpose of the session and goals to be achieved.

Students, cont. • Students have found ward based teaching the most valuable way of developing clinical skills. • In the beginning, students may feel a state of fear and embarrassment of an unfamiliar environment. • They may feel anxious if unsure of their knowledge base or clinical abilities. • The tutor must help to relieve anxiety and let “all” students participate in the session.

Tutors • Tutors may be consultant staff, junior hospital doctors, nurses, trained patients, or student peers. • Tutors are powerful role models for the students especially in the early years. • It is important that they demonstrate appropriate knowledge, skills, and attitudes.

The ward • Ward teaching should not take place when meal, cleaners, or visitors are expected. • The use of side room for pre- or post-ward round discussion provides a useful alternative venue for discussion once the patients have been seen.

Educational objectives • Clinical skills. • Communication skills. • Clinical reasoning. • Practical procedures (venepuncture, bladder catheterization, cannulation). • Patient investigation and management. • Professional skills (the observation of doctors and how do they deal with each other and with other health care workers). • Attitude and ethics.

V. Ambulatory care teaching

Why teach in ambulatory care • The ambulatory care setting offers a variety of clinical situations and a range of common clinical conditions not seen in inpatient care.

Where can teaching take place • General OP clinics. • Specialist or tertiary referral clinics. • Multi-professional clinics (staff from variety of disciplines see patients together e.g. hand clinics) • Clinics for specific diseases like diabetes clinic and foot clinics. • Accident and emergency department. • Radiology and imaging suites.

Where can teaching take place • Clinical investigation unit e.g. endoscopy unit. • Day surgery unit. • Physiotherapy and departments of other professions allied to medicine . • Social services department. • Ambulatory care teaching center.

How to facilitate learning in ambulatory care • Logbooks: used to list the core clinical problems to be seen during the attachment and to document the student activity and learning achieved with each patient contact. • Task-based-learning: A list of tasks are given to the students: participate in consultation with the attending staff, interview and examine patients, review a number of new radiographs with the radiologist.

Teaching and learning methods