Teaching the consultant teachers: identifying the core content

Design and implementation of a training programme on ultrasound-guided lower limb peripheral nerve blockade: An Advanced Clinical Practitioner's personal journey

Increased demand in services, workforce pressures and continued financial constraints has resulted in a significant expansion in advanced clinical practice roles in the United Kingdom. This article will describe the personal experience of a perioperative Advanced Clinical Practitioner in the design and implementation of a training programme to achieve competence in ultrasound-guided lower limb peripheral nerve blockade. Three specific lower limb peripheral nerve blockade were included in the training programme, namely sciatic nerve block at the popliteal fossa, saphenous nerve block, and femoral nerve block. Key service drivers underpinning development, rationale for Advanced Clinical Practitioner involvement in lower limb peripheral nerve blockade and governance will also be discussed.

Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative

OBJECTIVE

To describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation-SURfactant administration-Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress syndrome (RDS) receiving non-invasive ventilatory support.

SETTING

Two large neonatal intensive care units (NICUs) at Northwell Health (New Hyde Park, New York, USA).

STUDY POPULATION

Infants with RDS receiving continuous positive airway pressure in the NICU and eligible for surfactant administration.

RESULTS

LISA was initiated in our NICUs in January 2021, after extensive guideline development, education programmes, hands-on training and provider credentialing. Our Specific, Measurable, Achievable, Relevant and Timely aim was to deliver surfactant by LISA for 65% of total doses by 31 December 2021. This goal was achieved within 1 month of go-live. In total, 115 infants received at least one dose of surfactant during the year. Of those, 79 (69%) received it via LISA and 36 (31%) via INSURE. Two Plan-Do-Study-Act cycles contributed to improved adherence to guidelines on timely surfactant administration and both written and video documentation.

CONCLUSIONS

Safe and effective introduction of LISA with the use of video laryngoscopy is achievable with careful planning, clear clinical guidelines, adequate hands-on training and comprehensive safety and quality control.

[Survey on training in orthopedics/trauma surgery : Is Germany ready for a competence-based training?]

BACKGROUND AND OBJECTIVE

A high-quality advanced training is a key factor for good and safe patient treatment. Germany is currently revising the advanced training curricula and logbooks aiming to change the training into a competence-based training. The aim of this study was to analyze the day to day reality of orthopedic and trauma surgery advanced training in Germany based on the elements of the advanced training.

METHODS

In March 2020 an online survey on advanced training was carried out with 44 questions on the topics of advanced training curriculum, logbook, educational resources, evaluation, authorized trainer and distribution of working time .

RESULTS

A total of 237 persons completed the survey, of which 208 fulfilled the inclusion criteria. The respondents perceived a lack of clear standards in the advanced training curriculum and 25% did not receive structured learning resources in the form of simulations or courses. Mandatory annual process interviews were performed in only 58%. Most respondents valued the expertise of the trainers in orthopedic and trauma surgery, whereas they rated their competence in supervision and giving feedback as below average. Administrative work consumed 220 min of the daily working time and on average 60min remained per day for respondents to learn operative skills.

CONCLUSION

The survey revealed inconsistencies in the current advanced training curriculum and a lack of supervision and evaluation. The implementation of competence-based advanced training should therefore not only focus on a change of the curriculum but also on implementing competence-based training at all levels of training (learning resources, training, evaluation).

Improved Less Invasive Surfactant Administration Success in Preterm Infants after Procedure Standardization

Less invasive surfactant administration (LISA) has been introduced at our tertiary Level IV perinatal center since 2016 with an unsatisfactory success rate, which we attributed to an inconsistent, non-standardized approach and ambiguous patient inclusion criteria. This study aimed to improve the LISA success rate to at least 75% within 12 months by implementing a highly standardized LISA approach combined with team training. The Plan Do Study Act method of quality improvement was used for this initiative. Baseline assessment included a review of patient medical records 12 months before the intervention regarding patient characteristics, method success rate, respiratory, and adverse outcomes. A multi-professional team developed a standardized LISA approach and a training program including an educational film, checklists, pocket cards, and team briefings. Twenty-one preterm infants received LISA before and 24 after the intervention. The mean LISA success rate improved from 62% before the intervention to 92% (p = 0.029) after the intervention. Implementing a highly standardized LISA approach and multi-professional team training significantly improved the methods’ success rate.

Factors affecting consultant attitudes to undertaking undergraduate medical student teaching in the UK: a systematic review

OBJECTIVE

This systematic review aimed to explore consultant attitudes towards teaching undergraduate medical students in the UK.

DESIGN

Systematic review.

METHODOLOGY

Standard systematic review methodology was followed. MEDLINE, EMBASE and OpenGrey were searched from inception to August 2019 to identify studies exploring senior doctors' attitudes towards teaching undergraduate medical students. Two reviewers independently carried out key methodological steps including study screening/selection, quality assessment and data extraction. A narrative synthesis was undertaken.

RESULTS

Five studies were included in the review dating 2003-2015. Two studies used questionnaires, and three used focus groups/semistructured interviews. Key findings identified across all studies were consultants generally found teaching undergraduate medical students enjoyable, and consultants identified time constraints as a barrier to teaching. Other findings were consultants feeling there was a lack of recognition for time spent teaching, and a lack of training/guidance regarding teaching students.

CONCLUSIONS

This is the first systematic review to explore senior hospital doctors' attitudes towards teaching undergraduate medical students. Despite these five studies spanning 12 years, the same attitudes and issues regarding teaching are identified by all, suggesting lack of time particularly is a persistent problem regarding consultant-based teaching. An anecdotal impression is that consultants are no longer as enthusiastic about teaching as they once were, but it is evident over the 12 years of these studies that enjoyment levels, and presumably enthusiasm, have not changed significantly.

Tips for teaching procedural skills

The teaching of procedural skills required for clinical practice remains an ongoing challenge in healthcare education. Health professionals must be competent to perform a wide range of clinical skills, and are also regularly required to teach these clinical skills to their peers, junior staff, and students. Teaching of procedural skills through the use of frameworks, observation and provision of feedback, with opportunities for repeated practice assists in the learners' acquisition and retention of skills. With a focus on the teaching of non-complex skills, this paper explores how skills are learned; ways to improve skill performance; determining competency; and the provision of effective feedback.

‘Teaching the teachers' in psychiatry

The teaching of medical skills to medical students and to other doctors is a skill in itself. The traditional ‘apprenticeship’ system of learning within medicine is now known to be inefficient and flawed, in both the UK and in other countries where it has been scrutinised. This article sets out guiding principles to help doctors set up ‘teaching the teachers' courses, which teach the skills of teaching. Psychiatrists at all grades, from senior house officer up to consultant, need some teaching skills, and the authors outline how to plan a course, determine the needs of potential learners and set its objectives and content. Guidance is given on some of the opportunities that are available to obtain formal qualifications in medical education.

Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention

BACKGROUND

Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination.

METHODS

All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups.

CONTROL GROUP

lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated.

RESULTS

A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422.

CONCLUSIONS

The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

Core competencies in teaching and training for doctors in Scotland: a review of the literature and stakeholder survey

BACKGROUND

The UK General Medical Council requires all registered doctors to be competent in all areas of their work, including teaching and training.

AIMS

The current research sought consensus on core competencies for all consultants and GPs involved in teaching and training in Scotland.

METHOD

A draft list of 80 competencies was developed from the literature and made available as a survey to all consultants and GPs with teaching roles and all final year speciality trainees working in Scotland. Respondents rated the importance of each competency and provided free text comments.

RESULTS

There were 1026 responses. Eighteen competencies were rated as "high priority", and are recommended as a baseline for all doctors involved in teaching and training; 55 were rated as "medium priority", and are recommended in relation to specific teaching and training roles; and 7 were rated as "low priority". Free text responses suggested the topic was controversial and emotive, and emphasised the importance of further work to engage trainers.

CONCLUSIONS

The findings appeared to have face validity, and it was felt these could be used as the basis for developing a "Scottish Trainer Framework" for doctors and others involved in teaching and training in Scotland.

Teaching the surgical craft: surgery residents perception of the operating theater educational environment in a tertiary institution in Nigeria

Background:

The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees.

Materials and Methods:

Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17.

Results:

A total of 33 residents were participated in this study. Twenty nine (88%) males and 4 (12%) females. 30 (90%) were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident's perception of workload/supervision/support P < 0.05; however, there was no significant differences in junior registrar versus senior registrar's perception of the education environment in all the subscales P > 0.05.

Conclusion:

This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.

Emotional congruence in learning and health encounters in medicine: addressing an aspect of the hidden curriculum

This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more attention to be paid to the role of emotion within medical education and within health care provision. What is already known about the role of emotion in learner-teacher encounters and in patient-doctor encounters will be used to develop the concept of emotional congruence within these two types of encounter as a challenge to clinical teachers to examine their own practice. The reasons why emotional congruence is not always apparent in the learning environment of the teaching hospital will be discussed using the model of the 'hidden curriculum'. It will be suggested that explicit strategies to counteract the hidden curriculum in relation to emotion can bring about transformative change in individual practice and the health care environment that has the potential to improve both learning and health outcomes.

How we make good doctors into good teachers: a short course to support busy clinicians to improve their teaching skills

BACKGROUND

Doctors are expected to teach but many are reluctant through lack of training. Busy clinicians have little time to attend faculty development initiatives. We wanted to increase clinical teaching capacity locally. WHAT WE DID: In response to requests from doctors lacking confidence in their teaching skills, we developed a programme tailored to the needs of working clinical teachers. The emphasis is on teaching effectively in a busy clinical environment. There are five 90 min modules: bedside teaching, effective supervision and feedback, teaching physical examination and procedures, effective lectures and facilitating development of clinical reasoning skills. The course is practical, interactive and takes place in a supportive learning environment adjacent to the workplace. A total of 81 clinicians participated in the course.

EVALUATION

The main outcomes were increased confidence in bedside teaching, teaching more effectively on ward rounds and reduction in need for support with teaching. Participants reported a better understanding of basic educational theory and its relevance to clinical teaching. There is increased activity in clinical teaching among past participants.

CONCLUSIONS

All clinical teachers require guidance and encouragement in developing their teaching skills. An accessible, practical focused teaching course run locally by colleagues with education expertise can improve clinicians' skills and motivation to teach.

Sophistry, the Sophists and modern medical education

The term 'sophist' has become a term of intellectual abuse in both general discourse and that of educational theory. However the actual thought of the fifth century BC Athenian-based philosophers who were the original Sophists was very different from the caricature. In this essay, I draw parallels between trends in modern medical educational practice and the thought of the Sophists. Specific areas discussed are the professionalisation of medical education, the teaching of higher-order characterological attributes such as personal development skills, and evidence-based medical education. Using the specific example of the Sophist Protagoras, it is argued that the Sophists were precursors of philosophical approaches and practices of enquiry underlying modern medical education.

Development of a framework of medical undergraduate teaching activities

CONTEXT

The need for a comprehensive framework of teaching activities in undergraduate medical education was identified by colleagues involved in teacher training at the University of Edinburgh, UK and Karolinska Institutet, Sweden. Such a framework could be used to develop training programmes for medical teachers, to help experienced teachers to reflect upon and communicate with others about their practice, and as a focus for further research on medical teaching.

METHODS

A provisional framework of medical teaching activities and a model illustrating how these activities are situated within the wider context of learning and teaching were developed iteratively using the literature and pilot studies. The provisional framework and model were then methodically tested using journal analysis, brainstorming sessions and focus group sessions with medical teachers and teacher trainers in both institutions. Data gathered from this research were analysed and used to further develop the framework and model.

RESULTS

Many of the provisional teaching activities in the framework were further developed in response to the research data and some new activities were added. Teaching activities seemed to cluster into three domains: 'Facilitating', 'Managing', and 'Learning and Community Building'. Specific tasks were identified relating to planning, administering, resourcing, implementing and evaluating each teaching activity. Participants found the model of learning and teaching helpful and felt it adequately represented the place of teaching activities within the wider context of undergraduate medical education. The framework and model are now being used by the authors in faculty development, undergraduate teaching and further research.

What can we expect of clinical teachers? Establishing consensus on applicable skills, attitudes and practices

CONTEXT

Despite myriad advances in medical education, we have not yet established a universally accepted set of attributes we can reasonably expect from our teachers.

METHODS

A modified Delphi technique established the skills, attitudes and practices thought to be core for clinical teachers within our region. We identified relevant statements from the literature. Individuals with significant involvement in undergraduate teaching acted as Delphi panelists. Four statement categories emerged: Preparing to Teach, Delivery of Teaching, Teacher Conduct and Supporting Activities. Two iterations of the Delphi round then took place. In the first round, panelists were asked to accept, reject or develop the statements identified from the literature. In the second round, they were asked to accept or reject modified statements. Throughout the exercise panelists were expected to differentiate between what could be expected from both those involved in clinical undergraduate education and those with a specialist educational remit. Agreement of > or = 80% was used to assign statements to basic or advanced categories.

RESULTS

A total of 38 regional panelists participated in the Delphi process. After the 2 iterations, 27 statements were accepted at basic level, mostly in Teacher Conduct (11), and least in Supporting Activities (2). Overall, only 4 statements scored > 80% at advanced level. Many statements (25 of 56), were not clearly defined as either basic or advanced and failed to gain acceptance > 80% for either category.

DISCUSSION

A useful set of attributes has been developed that can be applied to a majority of clinical teachers. There was less agreement than expected around higher level attributes. Further debate is invited.

Educational CPD: an exploration of the attitudes of UK GP trainers using focus groups and an activity theory framework

BACKGROUND

There is a move to "professionalize" medical educators, but little has been published on the views of UK GP trainers to this change.

AIMS

To explore the attitudes of GP trainers to their own professional development as teachers.

METHODS

A focus group study was undertaken in a large UK Deanery. The emergent theory was developed using Activity Theory, which sees learning as a dynamic interaction between individuals and their cultural, social and historical setting.

RESULTS

There were a range of factors influencing GP trainer development. GP trainers were more motivated to develop themselves as teachers when their GP registrar was perceived to be of high quality. There was ambivalence amongst trainers regarding university qualifications in medical education. The biggest obstacles to professional development were the attitudes of the GP trainer's partners, and the challenge of finding protected time. Trainers looked to the Deanery for leadership and direction for their educational CPD, but expressed disappointment that this was not more regularly in evidence.

CONCLUSIONS

Incongruity exists between the professionalization of GP training and the feeling that trainers themselves have about the way they are regarded. GP trainer development can be understood more fully when viewed as a product of discourses between the trainer and their environment.

Managing change in postgraduate medical education: still unfreezing?

BACKGROUND

Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors.

AIMS

To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change.

METHODS

We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change.

RESULTS

12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'.

CONCLUSIONS

At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.

Long-term effect of a course on in-training assessment in postgraduate specialist education

BACKGROUND

In-training assessment has become an important part of clinical teachers' responsibilities. One way to ensure that clinical teachers are qualified for this role is setting up a course. A "Teach the teachers" course focusing on in-training assessment was designed for anaesthesiologists in Denmark.

AIMS

To evaluate short and longer term effects of a course on in-training assessment for clinical teachers in Anaesthesiology.

METHOD

Fifty-one anaesthesiologists attended a 2-day interactive course about in-training assessment. Effects of the course on knowledge were assessed using identical pre- and post- tests. Longer- term effects were measured six months after the course using the same test. Self-reported use of in-training assessment methods was evaluated using supplemental questions in the follow-up test.

RESULTS

There were significant increases in knowledge about in-training assessment immediately following the course (effect size, Cohens d = 1, 5). The knowledge was retained six months later. Knowledge about assessment by clinical structured observation and by written assignments showed further increases in the follow-up period. Participants used the various assessment methods in their daily practice during the six-month study period.

CONCLUSION

A focused "Teach the teachers" course during the implementation phase of a new assessment programme increased participants' knowledge about in-training assessment.

Quality of clinical supervision as perceived by attending doctors in university and district teaching hospitals

CONTEXT

Attending doctors (ADs) play important roles in the supervision of specialist registrars. Little is known, however, about how they perceive the quality of their supervision in different teaching settings. We decided to investigate whether there is any difference in how ADs perceive the quality of their supervision in university teaching hospital (UTH) and district teaching hospital (DTH) settings.

METHODS

We used a standardised questionnaire to investigate the quality of supervision as perceived by ADs. Fifteen items reflecting good teaching ability were measured on a 5-point Likert scale (1-5: never-always). We investigated for factors that influenced the perceived quality of supervision using Likert scale items (1-5: totally disagree-totally agree) and open-ended questionnaires.

RESULTS

A total of 83 ADs (UTH: 51; DTH: 32) were eligible to participate in the survey. Of these, 43 (52%) returned the questionnaire (UTH: 25; DTH: 18). There was no difference in the overall mean of the 15 items between the UTH (3.67, standard deviation [SD] 0.35) and DTH (3.73, SD 0.31) ADs. Attending doctors in the DTH group rated themselves better at 'teaching technical skills' (mean 3.50, SD 0.70), compared with their UTH counterparts (mean 3.0, SD 0.76) (P = 0.03). Analysis of variance of the overall means revealed no significant difference between the different hospital settings.

CONCLUSIONS

The results suggest that teaching hospital environments do not influence how ADs perceive the quality of their supervision. Lack of time for teaching was perceived as responsible for poor supervision. Other factors found to influence AD perceptions of good supervision included effective teaching skills, communication skills and provision of feedback.

Educational CPD: how UK GP trainers develop themselves as teachers

BACKGROUND

There is little in the literature giving the perspective of UK General Practice (GP) trainers on their development as teachers.

AIMS

What motivates GP trainers develop themselves as teachers? What obstacles to their professional development do GP trainers perceive?

METHOD

A questionnaire to all GP trainers in the West Midlands Deanery in 2004.

RESULTS

360/444 (81%) questionnaires were returned. 56.6% of GP trainers had another educational role in addition to training GP Registrars in the practice. 15.8% of trainers possessed an educational qualification. 13 had completed a Certificate in Medical Education and 28 were engaged in study towards that qualification. Trainers wanted more time to spend on their development as teachers than they presently have, and would then be interested in a wider variety of learning methods. However, 56.6% of trainers would still not choose to undertake a university-accredited course. Female GP trainers perceived more difficulty in obtaining protected time for their development as teachers (Educational CPD) (p = 0.021), were significantly less sure of their partners' support for this development (p = 0.033), and were more likely to agree with trainers undertaking a Certificate in Medical Education (p = 0.003). Having an additional educational role did not affect trainers' ability to take protected time, but significantly increased the amount of time aspired to (p = 0.005). Nothing made more difference to trainers' perception of their ability to undertake Educational CPD than did the perceived attitude of their partners.

CONCLUSIONS

Educational CPD was very important to GP trainers, but getting protected time was difficult. Consideration of the needs and opinions of partners was a very strong barrier to trainers taking sufficient protected time. Given more available time, GP trainers would be more likely to consider gaining academic qualifications in education. However, this was not be something that all trainers wanted.

A Description of a Validated Effective Teacher-Training Workshop for Medical Residents

A teacher-training program for residents was designed and piloted in the St. Elisabeth Hospital in Curaçao, Netherlands Antilles. The program comprised of six modules namely: effective teaching, self-knowledge and teaching ability, feedback, assessing prior knowledge, trouble shooting and time management.

METHOD

Instruction was provided during a two-day workshop with eight hours instruction time per day. Residents in the first three years of training participated, and the instructors were experienced clinicians. Lectures, group discussions, case simulations, video presentations and role-plays were the forms of instruction.

RESULTS

Using standardized questionnaires, the participants rated the quality of the workshop highly. They considered it to be a feasible and appropriate educational intervention and that it had a positive impact on their teaching skills.

CONCLUSION

This workshop was developed based on careful analysis of medical residents' perceived educational needs and systematically implemented and evaluated. The results show that it is a suitable and effective educational intervention.

Clinical supervision in the emergency department: a critical incident study

OBJECTIVES

To identify the key features of effective clinical supervision in the emergency department (ED) from the perspectives of enthusiastic consultants and specialist registrars. To highlight the importance of clinical supervision within emergency medicine, and identify obstructions to its occurrence in everyday practice.

METHODS

A critical incident study was undertaken consisting of structured interviews, conducted by telephone or in person, with 18 consultants and higher level trainees selected for their interest in supervision.

RESULTS

Direct clinical supervision of key practical skills and patient management steps was considered to be of paramount importance in providing quality patient care and significantly enhancing professional confidence. The adequacy of supervision varied depending upon patient presentation. Trainees were concerned with the competence and skills of their supervisor; consultants were concerned with wider systemic constraints upon the provision of adequate supervision to juniors.

CONCLUSIONS

The value of supervision extends to all patient presentations in the ED. The study raised questions concerning the appropriate attitudes and qualifications for supervisors. Protected supervisory time for those with trainees is mandatory, and must be incorporated within ED consultant job planning.

Partner, Learn, Progress: a conceptual model for continuous clinical education

In practice disciplines, such as nursing, learning can be maximised through experience located in the clinical setting. However, placement in the clinical setting does not automatically mean that the learner's professional practice will improve. Experiences in 'real-life' settings need to be effectively facilitated to obtain the desired outcomes. This paper through the discussion of 'Partner, Learn, Progress' details a conceptual model for promoting learning in the clinical context. 'Partner' refers to the positive association between the learner and the experienced clinician that engenders trust. It occurs on a personal level in the context of a broader social and political environment. 'Learn' refers to the process whereby the experienced clinician is able to assist the learner make sense of theoretical knowledge or knowledge that has previously been 'distal' to their practice to be integrated into their immediate practice. The clinician requires to be cognisant of the learner's existing knowledge level so that the activities and accompanying discussion assist in making connections between theory and practice. Learning incorporates mutual collaboration whereby the learner is able to practise the application of knowledge in a safe context and make their own connections. The further exploration of meanings through experiences, feelings, attitudes leads the learner to 'progress': the development of knowledge. Such a conceptual model provides a framework for educators and supervisors of clinical learning to educate and learn from the next generation of nurses that will lead the nursing profession into the future.

How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting

INTRODUCTION

The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the professional development of medical residents.

OBJECTIVE

To examine how medical residents perceive the supervisory roles of attending doctors, in terms of what they perceive as poor supervision and what they characterise as good supervisory practice.

METHOD

We carried out a questionnaire survey of 38 medical residents at the Department of Paediatrics at the teaching hospital of the University of Amsterdam, the Netherlands. Attending doctors directly involved with the supervision of medical residents participated in the study. The clinical settings where supervision occurred included the neonatal and paediatric intensive care units and the general paediatric wards.

RESULTS

Medical residents rated the quality of supervision they received in all departments positively. A majority of the attending doctors were rated highly in 'overall supervision'. Creating pleasant learning environments and being stimulated to learn and function independently were aspects of supervision characterised positively. Coaching in clinical skills and procedures, effective communication skills and clinical decision making using principles of cost-appropriate care were aspects of supervision found to be deficient.

DISCUSSION

This study shows that medical residents enjoy supervision from collaborative, understanding and patient attending doctors. Medical residents prefer to be treated as adult learners and enjoy feedback that is constructive, measured and adapted to their professional needs.

Training the trainers: do teaching courses develop teaching skills?

OBJECTIVE

This paper reports on consultants' self-assessed changes in their teaching and training practices over an 8-10-month period. It compares the changes between a group undergoing a 3-day teaching course (participants) and a sample group taken from the course waiting list (controls).

METHOD

A questionnaire listing 18 teaching skills was given to the participants immediately prior to the course and 8-10 months later, and to the controls at the same time intervals. Respondents were asked to rate their ability, frequency of use of each skill, as well as their teaching confidence and effectiveness. Additionally, the second questionnaire asked respondents to identify changes they had made to their teaching. A total of 63% (54) of participants and 51% (23) of controls completed both questionnaires. Changes of 2 + on the rating scales were seen as genuine. The number of such changes was calculated for each individual and on each skill for the 2 groups. Data were analysed using a Mann-Whitney U-test.

RESULTS

The majority of course participants reported positive changes in teaching ability on a significantly greater number of skills than did the control group. As a group, changes in ability in 16 of the teaching skills were significantly greater for the participants than for the controls. Increased ability resulted in participants' increased frequency of use of only 4 of the teaching skills. The majority in the participant group reported changes to their teaching. Only a minority in the control group reported such changes. These changes were consistent with course topics and the teaching skills needed to meet General Medical Council recommendations for the education of new doctors.

CONCLUSIONS

The teaching course is an effective vehicle for increasing consultants' teaching skills.

The challenges of residents teaching neurology

BACKGROUND

Teaching is integrated into the daily practice of residents, and it is a skill necessary for practice as well as academics. The settings in which teaching and learning take place are ubiquitous but include classrooms, small groups, bedside rounds, and grand rounds. Given the learning environment of residency, neurology residents should have working knowledge of basic principles of effective teaching to make learning successful. Teaching also reinforces knowledge, and residents will likely be better practitioners if some basic skills of teaching are practiced.

REVIEW SUMMARY

Neurology teaching techniques for residents are rarely addressed in the medical literature. Although information regarding teaching principles in medicine exists, there is little information regarding how residents teach. We examine and review some of the more effective methods and appreciated qualities in teachers, with a particular emphasis for the neurology resident. We also review whom neurologists need to teach and the various settings in which teaching may take place.

CONCLUSIONS

Neurology residents encounter a variety of audiences in a variety of settings that require diverse teaching skills to effectively convey information to other providers as well as patients. The majority of these skills should be learned in residency to establish a foundation for teaching, regardless of future practice settings.

A faculty development program evaluation: from needs assessment to long-term effects, of the teaching skills improvement program

BACKGROUND

We evaluated whether the faculty development program, the Teaching Skills Improvement Program, met medical educators' needs at Hacettepe University Faculty of Medicine, Turkey. In a 1997 needs assessment survey, large proportions of 178 medical educators assessed their knowledge of educational issues and teaching skills as good or excellent. Nonetheless, 86% of the respondents stated they would like to participate in a future training program focused on the content indicated in the survey.

DESCRIPTION AND EVALUATION

In 1998, 83 faculty members took part in the program and expressed a high degree of satisfaction with its content and organization, as well as the course trainers' teaching. Most of the participants got high scores on a test of knowledge related to the course content and performed proficiently in a microteaching session.

CONCLUSION

Six months to a year later, large proportions of the participants reported using many of the training techniques in their teaching program.

Factors influencing teaching and learning in the preregistration year

Preregistration training is a transitional period in the career of new medical graduates as they complete their final year of basic medical education in practice settings. This study gathered the views of both preregistration house officers and their educational supervisors on preregistration training in the Mersey Deanery between August 2000 and August 2001.

What can clinical teachers learn from Harry Potter and the Philosopher's Stone?

Many clinical teachers acquire a working knowledge of the principles of teaching and learning through observation, by adopting positive and rejecting negative examples of clinical instruction. Well selected vignettes of teaching behaviours taken from contemporary film and literature may provide rich substrate by which to engage clinical teachers in discourse about instructional technique. This paper draws on J K Rowling's novel and its companion film, Harry Potter and the Philosopher's Stone, and critically analyses the teaching styles of the staff at Hogwarts School of Wizardry and Witchcraft in the context of contemporary generic and medical education literature. Specifically, it argues that effective teachers demonstrate not only an in-depth knowledge of their discipline but possess a keen appreciation of the cognitive changes that occur in their students during the learning process. They are, furthermore, proficient in core instructional skills such as small group facilitation, feedback and questioning. Most importantly, effective teachers model appropriate attitudes in their professional setting and possess highly developed personal qualities such as creativity, flexibility and enthusiasm.

The relationship between pre-registration house officers and their consultants

CONTEXT

Previous studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn.

OBJECTIVES

To study the relationship between pre-registration house officers and their consultants through exploring an interpersonal exchange and the emotional context in which the exchange took place. To consider any association between the type of relationship implied and the trainee's attitude to their career.

DESIGN

Postal questionnaire covering a wide range of issues. This study focused on an open question about a significant or interesting exchange, followed by supplementary questions exploring the emotional context of the exchange.

SETTING

336 hospitals throughout the United Kingdom.

SUBJECTS

A cohort of doctors were followed from the time of their application to medical school, and studied towards the end of their pre-registration year (n=2456).

RESULTS

The response rate to the questionnaire was 58.4%. Responses were categorised as Support and supervision; Unreasonable behaviour; Consultant fallibility; Fair criticism and No exchange. Over half the responses described an interaction that made them feel positive. Trainees particularly appreciated positive feedback, clinical support, teaching, career advice, patronage, or social interaction. The importance of formal appraisal or review sessions in providing the setting for a positive exchange was confirmed. Positive interactions were associated with a positive view of medicine as a career. A minority described an interaction that was negative, involving unreasonable demands, criticism (whether perceived as fair or unfair), humiliation, or sexism. These were associated with a more negative view of medicine as a career, and of themselves as doctors.

A framework for developing excellence as a clinical educator

The current emphasis on providing quality undergraduate and postgraduate medical education has focused attention on the educational responsibilities of all doctors. There is a greater awareness of the need to train doctors as educators and courses have been set up to satisfy this need. Some courses, such as those on how to conduct appraisal, are specific to one task facing a medical educator. Other courses take a broader view and relate educational theory to practice. In this paper we describe an outcome-based approach in which competence in teaching is defined in terms of 12 learning outcomes. The framework provides a holistic approach to the roles of the teacher and supports the professionalism of teaching. Such a framework provides the basis for the development of a curriculum for teaching excellence. It helps to define important competences for different categories of teachers, communicate the areas to be addressed in a course, identify gaps in course provision, evaluate courses, assist in staff planning and allow individuals to assess their personal learning needs. The framework is presented to encourage wider debate.

AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education - a unifying perspective

This paper looks at five focal terms in education - curriculum, environment, climate, quality and change - and the interrelationships and dynamics bemeen and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifetation of the curriculum and the other three concepts. Ideas pertaining w the theory of climate and its measurement can provide a greater understanding of the medical cumadurn. The environment is an impoltant detemzinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related w behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students' experiences of the climate of their medical education environment are related w their achievements, sangaction and success. Measures of educational climate are reviewed and the possibilities of new climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it inw dzfferent components giving, for example, separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, w report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. The climate is important for staff as well as for students. The organizational climate that teaching staff experience in the work environment that they inhabit is important for their well-being, and that of their students. The medical school is a learning organization evolving and changing in the illuminative evaluation it makes of its environment and its curriculum through the action research studies of its climate. Consderations of climate in the medical school along the lines of continuous quality improvement and innovation are likely to further the medical school as a learning organization with the attendant benefits. Unless medical schools become such learning organizations their quality of health and their longevity may be threatened.