Teaching and learning methods

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Teaching and learning methods

• Presented by
• Prof. Namir Al-Tawil
• M.B.Ch.B, FICMS/CM
• Hawler Medical University
• namiraltawil_at_gmail.com

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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.

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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.

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I. Lectures
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Lecture

• A process by which the notes of a teacher become
  the notes of a student without passing through
  the minds of either.
• ODonnel
  1997

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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..

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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A, E, I, O, U

• Attract attention.
• Establish rapport.
• Identify knowledge base.
• Provide advance organizer-Objectives and key
  points.
• Indicate Usefulness.

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Presentation

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

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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.

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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.

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II. Learning in small groups
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Learning in small groups

• An educational method to promote students
  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 doesnt always mean
  student participation.

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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.

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Advantages, cont.

• Develops
• Interpersonal skills
• Communication skills
• Social team-working skills
• Presentation skills

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Disadvantages

• Needs
• More teachers
• More rooms
• More resources

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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

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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.

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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).

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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.

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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.

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III. Teaching in the clinical skills center
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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.

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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.

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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.

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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.

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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.

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

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IV. Bed side teaching
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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

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The learning triad

• Patients
• Doctors
  Students

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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.

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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.

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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.

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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.

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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.

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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.

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V. Ambulatory care teaching
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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.

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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.

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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.

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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.

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Advantages of teaching in the ambulatory care
setting

• A wide range of clinical conditions may be seen.
• There are large numbers of new and return
  patients.
• Students have the opportunity to experience a
  multi-professional approach to patient care.
• Unlike ward teaching, increased numbers of
  students can be accommodated without exhausting
  the limited No. of suitable patients.

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Advantages of teaching in the ambulatory care
setting

• Students enjoy this teaching situation and
  probably prefer it to ward-based teaching.
• Medical schools should recognize the role
  ambulatory care teaching has in relieving
  pressure on ward-base teaching and provide
  appropriate resource for its implementation and
  development.

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VI. Community Based Medical Education

• (CBME)

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Definition

• CBME refers to medical education that is based
  outside a tertiary or large secondary level
  hospital.
• Community oriented medical education describes
  curricula that are based on addressing the health
  needs of the local community and preparing
  graduates to work in that community.

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Setting

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

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Uses for CBME

• Preclinical aims
• Learning in the fields of epidemiology,
  preventive health, public health principles,
  community development, the social impact of
  illness and understanding how patients interact
  with the health care system.
• Also used for learning basic clinical skills,
  especially communication skills.

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Uses for CBME, cont.

• Clinical aims.
• 1.To learn about general practice.
• A general practice rotation is the most
  common clinical CBME attachment and appear in
  most modern medical curricula.

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Clinical aims, cont.

• 2.To learn multiple disciplines concurrently.
• - This concept takes advantage of the broad
  patient base in primary care, and has been
  situated in rural communities.
• - Clinicians are more likely to have significant
  roles in primary care, emergency medicine,
  obstetrics, and inpatient care.

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VII. Distance education
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Definition

• The term distance education covers the
  various forms of study at all levels which are
  not under the continuous, immediate supervision
  of tutors present with their students in lecture
  rooms, or in the same premises, but which
  nevertheless, benefit from the planning,
  guidance, and tuition of tutorial organization.
• 
  Holmberg 1997

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Why distance education?

• It is an excellent alternative to continuing
  medical education courses when there are certain
  constraints like time, funding, and geography.
• Distance education can allow learners to study a
  topic to the depth they desire and at a pace that
  suits them.

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VIII. Peer-assisted learning (PAL)
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Definition of Peer Assisted Learning

• Any situation where people learn from, or with,
  others of a similar level of training, background
  or other shared characteristic.
• In the undergraduate curriculum this could
  include any small group work (e.g. problem based
  learning). In postgraduate medicine, e.g. peer
  review of journal articles, clinical team meeting
  and appraisal.

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Advantages

• Advantages for tutors
• Provides opportunities to reinforce and revise
  their learning.
• Encourages responsibility and increased
  self-confidence.
• Develops teaching and verbalization skills.
• Enhances communication skills, and empathy.
• Develops appraisal skills (of self and others)
  including the ability to give and receive
  appropriate feedback.
• Enhance organizational and team-working skills.

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Advantages, cont.

• Advantages for tutees
• Feel more relaxed, and more supported.
• Can ask questions, even the silly ones.
• Provides opportunity to obtain detailed feedback
  on their knowledge and skills.
• Associated with social benefits, role modeling,
  and increased motivation to learn.
• It is efficacious peer tutors seem to be as good
  as staff in certain areas.

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• The peer tutors were great teachers. They are
  students as well, so they know what and how we
  think, the mistakes we tend to make
• Tutee (Howman et al 2003)

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Advantages, cont.

• Advantages for medical school
• Cost and resource-effective.
• Students feel more involvement in the course and
  ownership.
• It is easier to standardize tutoring from peers
  than from professional teachers.
• Meets obligation to train medical students in
  teaching skills.
• Encourage a culture of collaborative learning
  instead of competitiveness.

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Disadvantages of PAL

• Student tutors may have inadequate depth of
  knowledge.
• Student tutors may teach the wrong thing or
  give incorrect information.
• Tutors lack experience and may transfer knowledge
  and skills poorly.
• Tutors ego and personality issues may cause
  groups to be dysfunctional.

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Disadvantages of PAL, cont.

• Students may be encouraged to examine each other,
  with potential peer pressure, embarrassment, and
  inappropriate behavior.
• Time and effort are required to organize PAL
  programs, train tutors, and monitor outcomes.
• Student tutors may be used as cheap labor,
  teaching on established courses, where there is
  no real benefit for the tutor, because there are
  insufficient faculty staff.

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Summary

• More than one teaching method is needed.
• There is movement from a teacher-centered
  approach of education to a more student centered
  approach.

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Questions and comments

• ?
• ?
• ?

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Thanks for listening