Students' perception of the characteristics of effective bedside teachers

Structure and quality of bedside teaching: A videographic analysis

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience.

Anesthesiology resident preferences regarding learning to perform epidural anesthesia procedures in obstetrics: a qualitative phenomenological study

BACKGROUND

Learning to perform neuraxial techniques in obstetrics is considered one of the most difficult skills for anesthesiology trainees to acquire and no consensus exists regarding the best practices for teaching these procedures. Utilizing a qualitative, phenomenological approach, we aimed to explore what trainees perceive as the best approaches to teaching epidural anesthesia techniques; identify how these perceptions align or differ from those of faculty anesthesiologists; and examine how these approaches fit into the cognitive apprenticeship framework, which describes a process of reflection on how learning occurs in the authentic environment.

METHODS

Semi-scripted interviews were conducted with 10 residents and three faculty members from the division of obstetric anesthesiology at an academic center. Interviews were transcribed, de-identified, fragmented, and coded. A thematic analysis was conducted, and codes re-organized into the cognitive apprenticeship framework of (1) content, (2) method (including subcategories modeling, coaching, scaffolding, articulation, reflection, and exploration), (3) sequence, and (4) sociology (including situated learning and culture of expert practice).

RESULTS

Trainees valued a staged approach to learning epidural techniques, independent trouble-shooting, graded independence, focused feedback, and a calm instructor. The challenges of learning and teaching epidural techniques identified by trainees and instructors included the tactile nature of the procedure, teaching on awake, non-sedated patients, limited teaching time, and creating an environment of psychological safety.

CONCLUSION

Trainee and instructor preferences for teaching epidural procedures in obstetrics aligned with the cognitive apprenticeship framework. These concepts may be applied to curriculum design, evaluation, feedback, self-assessment and faculty development.

Lecturer Competence from the Perspective of Undergraduate Psychology Students: A Qualitative Pilot Study

Understanding what students mean by lecturer competence can be crucial in order to recognise indicators with which to assess these competences, improve the quality of university teaching and support lecturers in undertaking their role appropriately. This qualitative pilot study aimed to explore the meaning of competence in a convenience sample of Italian undergraduate psychology students (N = 122). We collected free-associations about what “lecturer competence” actually means for the students. The data corpus underwent a lexical Correspondence Analysis (CA) using the ASPAR procedure of SPAD-T. Two factors were extracted: “socio-emotional dimension” and “task specialist.” Students associated the competent lecturer with those who was involved with the achievement of the task goals, on the one hand or those who was engaged in the group’s maintenance, on the other. Furthermore, Cluster Analysis identified four clusters: (1) the captivating lecturer; (2) the lecturer oriented to both task and socio-emotional aspects; (3) the rigorous lecturer; and (4) the benevolent lecturer. The preliminary results of this pilot study showed an articulated and multi-dimensional representation of the meanings of lecturer competence from the students’ point of view and lay the foundations for a broader quantitative study on the conceptions concerning lecturer competence.

Midwifery Education Institutions in Italy Creation and Validation of Clinical Preceptors’ Assessment Tool: Students’ and Expert Midwives’ Views

Background: The aim of the study is to create and validate a midwifery preceptor’s evaluation form to be used by midwifery students. The International Confederation of Midwives recommends that clinical placements need to be supervised by a preceptor in order to be efficient for students who, in this way, gain competence and proper practice within the midwifery practical area. Methods: This is an observational multi-center transversal study and leads to the validation of an evaluation questionnaire. Methodically, the following steps were followed: literature review, focus group with midwifery students, meeting between expert midwives, creation of the preceptor’s assessment form, filling in of the forms by midwifery students and expert midwives, and validation of the form. The study was carried out in eight Italian universities and included eighty-eight midwifery students and eight midwives. Results and Conclusion: A midwifery preceptor’s assessment questionnaire was created made up of four attribute areas which, as a total, included 33 items. Cronbach’s alpha score was calculated after examining the forms filled in by students and expert midwives. An alpha score of 0.97–0.85 was obtained. The result was Pearson Correlation Coefficient r = 0.78.

Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.

Characteristics of Effective Teachers of Invasive Bedside Procedures: A Multi-institutional Qualitative Study

BACKGROUND

Faculty supervision of invasive bedside procedures (IBPs) in the ICU may enhance procedural education and ensure patient safety. However, there is limited research on teaching effectiveness in the ICU, and there are no best teaching practices regarding the supervision of IBPs.

RESEARCH QUESTION

We conducted a multi-institutional qualitative study of pulmonary and critical care medicine faculty and fellows to better understand characteristics of effective IBP teachers.

STUDY DESIGN AND METHODS

Separate focus groups (FGs) were conducted with fellows and faculty at four large academic institutions that were geographically distributed across the United States. FGs were facilitated by a trained investigator, audio-recorded, and transcribed verbatim for analysis. Themes were identified inductively and compared with constructs from social and situated learning theories. Data were analyzed between and across professional groups. Qualitative research software (NVivo; QSR International) was used to facilitate data organization and create an audit trail of the analysis. A multidisciplinary research team was engaged to minimize interpretive bias.

RESULTS

Thirty-three faculty and 30 fellows participated. Inductive analysis revealed three categories of themes among successful IBP teachers: traits, behaviors, and context. Traits included calm demeanor, trust, procedural competence, and effective communication. Behaviors included leading preprocedure huddles to assess learners' experiences and define expectations; debriefing to provide feedback; and allowing appropriate autonomy. Context included learning climate, levels of distraction, patient acuity, and institutional culture.

INTERPRETATION

We identified specific traits and behaviors of effective IBP teachers that intersect with the practice environment, which highlights the challenge of teaching IBPs. Notably, FG participants emphasized interpersonal, more than technical, aspects of successful IBP teachers. These findings should inform future curricula on teaching IBPs in the ICU, standardize IBP teaching for pulmonary and critical care medicine fellows, and reduce patient injury from procedural complications.

The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran

BACKGROUND

An essential characteristics of clinical education is the need to learn a large number of practical and communication skills along with theoretical knowledge. It is challenging to design learning opportunities (LOs) for clinical setting. We aimed to determine optimal learning opportunities from the viewpoint of Medical curriculum planners, to determine the gap between the current condition and the optimal condition in medical schools, and to present feasible tactic for clinical learning opportunities.

METHODS

This study comprised of three sub-studies and was conducted using triangulation. The first sub-study was performed using the Modified Delphi method with a view to identifying optimal learning opportunities. Data was collected by online focus group discussion and a questionnaire. The second sub-study was conducted with the aim of comparing the current condition and the optimal condition. Data was collected from nine medical schools across Iran using a checklist, available documents, observation, and interview. The third sub-study was conducted using an expert panel comprising of seven curriculum planners of the M.D.

PROGRAM

The goal of this phase was to provide feasible tactic to improve clinical education in medical schools.

RESULTS

In the first sub-study, the participants determined all items, including student-centered learning, non-threatening learning environment, and record and management system of clinical learning opportunities as implementable learning opportunities with over 70% consensus. However, in the second sub-study, student-centered teaching methods were practiced in 33% of medical schools and the non-threatening learning environment in 67% of the schools, while the record and management system of learning opportunities was not launched in any of the schools. From the viewpoint of the expert panel members, learning opportunities adapted to clinical contents, specification of content-based learning opportunities, and continuous supervision on learners to achieve the expected learning outcomes were among clinical learning opportunities with over 70% consensus.

CONCLUSIONS

Student-centered clinical learning practices, together with virtual learning methods, can lead to clinical enhancement. Opportunities such as interactive and participatory practices should gain further consideration. Also assigning responsibility to learners and monitoring them are strategies for enhancement.

Medical students' perceptions of bedside teaching

BACKGROUND

Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students' satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants. We aimed to identify how students perceived bedside teaching delivered by junior doctors compared with consultants METHODS: A questionnaire was distributed to all third-year medical students at Keele University via e-mail. Responses were submitted anonymously.

RESULTS

Forty-six students responded (37.4%), 73.3 per cent of whom said that they felt more comfortable having bedside teaching delivered by junior doctors than by consultants. Consultants were perceived as more challenging by 60 per cent of respondents. Students appeared to value feedback on their performance, trust the validity of taught information, and to value the overall educational experience equally, regardless of the clinical grade of the teacher.

DISCUSSION

Student preference does not equate to the value that they place on their bedside teaching. Junior doctors are perceived as being more in touch with students and the curriculum, whereas consultants are perceived as having higher expectations and as being both stricter and more knowledgeable. The clinical teacher's approachable manner and enthusiasm for teaching are more important than clinical grade, as is the ability to deliver well-structured constructive feedback.

What constitutes a good clinical teacher?

BACKGROUND

The practical part of medical studies occurs in clinical settings. The characteristics of a good clinical teacher have been reflected in a large number of medical educational studies, mainly within the western context.

OBJECTIVES

To explore the views of medical students and staff with regard to the characteristics of a good clinical teacher, and to determine whether sex and type of department have any significant effect on this issue within the Saudi context.

MATERIALS AND METHODS

A questionnaire was developed. It consists of 25 characteristics with four domains: professional, teaching skills, personal, and social. The study population included 85 fourth-year students and 36 faculty staff in the following three departments: respiratory technology, physical therapy, and medical laboratory technology, at the University of Dammam, Kingdom of Saudi Arabia.

RESULTS

The questionnaire had high reliability and satisfactory content validity. There were statistically significant sex differences regarding the importance of one domain (professional, P<0.001) and seven individual characteristics. Female participants accorded higher mean ranks compared with men (25.3 vs. 32.5 in social domain). Faculty significantly accorded higher mean ranks in all domains compared with students. No statistically significant differences among students' views based on the type of department were observed.

CONCLUSIONS AND RECOMMENDATIONS

There was a general agreement on the importance of all characteristics, but the degree of importance significantly varies. Faculty in general and female participants in particular viewed such attributes as more important than their counterparts. These characteristics should be incorporated in the teacher evaluation format/questionnaire currently used by the college, which will ultimately have a positive impact on teaching and learning in Saudi Arabia.

A systematic review on critical thinking in medical education

BACKGROUND

Critical thinking is the ability to raise discriminating questions in an attempt to search for better ideas, a deeper understanding and better solutions relating to a given issue.

OBJECTIVE

This systematic review provides a summary of efforts that have been made to enhance and assess critical thinking in medical education.

DESIGN

Nine databases [Ovid MEDLINE(R), AMED, Academic Search Premier, ERIC, CINAHL, Web of Science, JSTOR, SCOPUS and PsycINFO] were searched to identify journal articles published from the start of each database to October 2012.

RESULTS

A total of 41 articles published from 1981 to 2012 were categorised into two main themes: (i) evaluation of current education on critical thinking and (ii) development of new strategies about critical thinking. Under each theme, the teaching strategies, assessment tools, uses of multimedia and stakeholders were analysed.

DISCUSSION

While a majority of studies developed teaching strategies and multimedia tools, a further examination of their quality and variety could yield some insights. The articles on assessment placed a greater focus on learning outcomes than on learning processes. It is expected that more research will be conducted on teacher development and students' voices.

An interprofessional Web-based resource for health professions preceptors

OBJECTIVE

To develop a Web-based preceptor education resource for healthcare professionals and evaluate its usefulness.

METHODS

Using an open source platform, 8 online modules called "E-tips for Practice Education" (E-tips) were developed that focused on topics identified relevant across healthcare disciplines. A cross-sectional survey design was used to evaluate the online resource. Ninety preceptors from 10 health disciplines affiliated with the University of British Columbia evaluated the E-tips.

RESULTS

The modules were well received by preceptors, with all participants indicating that they would recommend these modules to their colleagues, over 80% indicating the modules were very to extremely applicable, and over 60% indicating that E-tips had increased their confidence in their ability to teach.

CONCLUSION

Participants reported E-tips to be highly applicable to their teaching role as preceptors. Given their multidisciplinary focus, these modules address a shared language and ideas about clinical teaching among those working in multi-disciplinary settings.

Students' educational needs for clinical reasoning in first clerkships

Developing clinical reasoning skills early in medical education is important. However, research to uncover students' educational needs for learning clinical reasoning during clerkships is limited. The aim of our study was to investigate these needs. Focus group discussions with an independent moderator were conducted. Students were included directly after 10 weeks of clerkships. The (verbatim) transcripts were coded manually and discussed by the authors until consensus was reached. Saturation was reached after three focus groups, including 18 students in total. Statistical analysis indicated our sample matched the approached group of 61 students. After a consistency and redundancy check in ATLAS.ti, 79 codes could be identified. These could be grouped into seven key themes: (1) transition to the clinical phase, (2) teaching methods, (3) learning climate, (4) students' motivation, (5) teacher, (6) patient and (7) strategies in clinical reasoning. Students can adequately describe their needs; of the seven key themes relevant to clinical reasoning five are in line with literature. The remaining two (patient factors and the need for strategy for clinical reasoning) have not been identified before.

Junior doctors and undergraduate teaching: the influence of gender on the provision of medical education

BACKGROUND

International experience has demonstrated that the medical profession is becoming less dominated by men. This "feminization of medicine" has been a topic of much debate in the medical literature. As the gender ratio in the profession changes, it is likely that a greater proportion of undergraduate education will be provided by women. Whether this shift away from the male-dominated provision of medical education will have an effect on undergraduate education is unknown.

PURPOSE

The aim of this research was to clarify whether there are differences between the attitudes and practices of male and female junior doctors regarding the practice of undergraduate teaching.

METHOD

A survey methodology among a cohort of nonconsultant hospital doctors in a major Irish teaching hospital was utilized. The overall response rate was 93%. The cohort held a positive attitude toward teaching undergraduates, and the majority were actively engaged in this activity. Doctors of both genders expressed a willingness to undertake teacher training.

RESULTS

There were no significant differences between the genders regarding the self-reported quantity of teaching provided to undergraduates. Male doctors perceived themselves as more confident educators when compared to female doctors, but this is likely to reflect cohort demographics in which a greater proportion of male doctors were more senior.

CONCLUSIONS

This study demonstrates that male and female doctors have similar attitudes toward, and practices in, voluntary undergraduate teaching. As a result, any gender shift in medicine is unlikely to result in a significant change in junior doctors' attitudes toward undergraduate medical education.

Effects of "minimally invasive curricular surgery" - a pilot intervention study to improve the quality of bedside teaching in medical education

BACKGROUND

Bedside teaching is an important element of undergraduate medical education. However, the impact of curricular course structure on student outcome needs to be determined.

AIMS

This study assessed changes in fourth-year medical students' evaluations of clinical teaching sessions before and after the introduction of a new course format.

METHOD

The curricular structure of bedside teaching sessions in cardiology was modified without changing the amount of teaching time. Clinical teachers were instructed about the new teaching format and learning objectives. The new format implemented for adult but not paediatric cardiology sessions was piloted with 143 students in winter 2007/08. By computing effect sizes, evaluation results were compared to data obtained from 185 students before the intervention.

RESULTS

Significant rating increases were observed for adult cardiology teaching sessions (Cohen's d = 0.66) but not paediatric cardiology sessions (d = 0.22). In addition to improving the structure and organization of the course, the intervention significantly impacted on students' perceptions of their learning outcome regarding practical skills (d = 0.69).

CONCLUSIONS

Minimal curricular changes combined with basic faculty development measures significantly increase students' perception of learning outcome. Curricular structure needs to be considered when planning bedside teaching sessions in medical undergraduate training.

Domains of effective teaching process students perspectives in two medical schools

BACKGROUND

There has been little systematic investigation of student belief about the characteristics of the optimum process for clinical bedside teaching.

AIMS

The intent was to identify the most important characteristics of the bedside teaching experience from the perspective of two groups of students, one from Oman and the other from Canada.

METHOD

Students were asked to complete a questionnaire about their concept of the ideal process of bedside teaching. Their answers were analyzed using factor analysis.

RESULTS

Answers provided by the students was consistent with the presence of six domains. These corresponded to Preparation, Introduction, Experience, Summary, Explanation, and Conclusion. 'Preparation' involves consideration of the patient and the knowledge level of the learners, 'Introduction' involves effective communication, and 'Experience' means the need for the students to be actively involved in the history and physical examination. The remaining three domains deal with the need to provide a summary and elaboration as well as advice and feedback. These 6 factors explained 60% of the total variance.

CONCLUSIONS

While these areas still need to be defined more closely, the application of these six domains to the structure of the bedside teaching experience is likely to result in improved student learning.