This Changed My Teaching

In preparation for teaching a Clinical Skills session, we diligently reviewed the tutor guide and video ahead of time.  However, we sometimes wondered how other teachers were translating the advice from the guide into their teaching.

I used to feel crushed when looking up from notes during a presentation to a packed lecture hall of colleagues intensely concentrating ….on their smartphones. It is hard not to feel discouraged. If only I had the insights of Osler, the wit of Churchill and the stage presence of Obama, my audience would forever be on the edge of those squeaky swivel seats, drinking in every minutia. Alas, the reality pales and those late hours in front of the computer all those weeks before never seem enough to capture the ever shrinking attention span of the adult learner.

Like many teachers, I begin to plan my course by creating course-level learning objectives and after that design the course to meet these. In winter 2015, I participated in the Course Design Intensive (CDI), a workshop offered by the Centre of Teaching and Learning (CTLT), for those who want to design or re-design a course. My goal was to re-design my psychosocial rehabilitation course in the Master of Occupational Therapy program. I wanted to make it more relevant to students’ future practice and augment their interest to work with people living with severe mental illness.

I wondered why new learners just transitioning to new clinical experiences sometimes seemed hesitant to participate and thus appeared less engaged in clinics and journal clubs. I found that some learners would jump in and take part in conversations, discussions, and even engaging with patients.

I was frustrated at times that the students and residents did not always follow the instructions I gave. Their work was sometimes incomplete, off topic, or plainly wrong. While this was not true for most students, it was consistently true for a few each year. Teaching about empathy for example, I would invite residents to practice doing an interview with each other using empathic reflections and they would do it incorrectly.

One of the topics examined in my initial “professionalism” course are the bylaws and Standards of Practice of the licensing body. Bearing in mind that the end goal is that students should be able to apply these standards to practice, not just memorise them, the multiple choice question (MCQ) exam format I have used contained a typical practice scenario with a variety of possible options for action, with instructions for the student to select the “best” option.

Dr. Deborah Altow (biography and disclosures) What I did before Like many teachers, I was seduced by the imperative to make sure my students gained the benefit of my experience, and thus I talked too much. I had always told my students that the two 4-letter words they needed most were KIND and WAIT.

One could never be too kind to a patient in distress, and one could learn how to fill in the gaps by WAITING for the patient to clarify, enlarge, or focus on, the issue. I was convinced that more talking meant better understanding, and that was clearly not the case!

Telling our students that “it will be on the exam”, may give us a sense that the students will learn it. This line tends to get used when there is an important topic that the teacher suspects students might otherwise not sufficiently attend to. Yet the strategy is unlikely to inspire deep and long-term learning, the kind of learning that students will later be able to retrieve and apply to patient care.

In the past I followed a tried and tested format for classroom lecturing ‘Tell them what you are going to tell them’ (a set of well-written educational objectives), ‘tell them what you want to tell them’ (no shortage of instructional papers on how to develop a good PowerPoint presentation) and finally ‘tell them what you have told them’ (a concise summary).

Before this incident in the emergency room, I had no established teaching practice that focused consciously on checking the veracity of a trainees’ use and understanding of medical terminology. This challenged my assumption that the medical student comprehended such composite terms accurately.

An ongoing problem with student supervision in the clinical setting is managing the expectations of Clinical supervisors. Frequently, clinical supervisors are clinicians with many years of experience in their specialty, who have not been practicing at “entry level” for some time.