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PubMed1990

Teaching physicians about teaching: an experiential workshop.

Teaching improvement workshops are most effective when they engage teachers actively in practice teaching, particularly when the teaching situation is similar to the actual one to which the teachers will return. Teachers, however, often find such involvement threatening. In this paper we describe a 3 h workshop which succeeds in overcoming teachers' reluctance to participate in situations that are relevant to their real teaching problems, students, and subject matter. The most exciting outcome, in our view, was teachers' increased sensitivity to the limitations of their teaching approach and their increased awareness of the role of their concept of teaching in shaping their teaching strategies. Weaknesses of the workshop include its dependence on the skills of a group director, the tendency of the group to seek a single right answer instead of exploring alternatives and the usual danger of role rigidity which troubles all role enactment procedures.

Ontario↗
PubMed2004

Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals.

OBJECTIVE: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. DESIGN: Mailed survey. PARTICIPANTS: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. MEASUREMENTS: Prevalence and characteristics of ongoing FD. RESULTS: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than non-university hospitals. For non-university hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered > or =1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had "advanced" programs, defined as offering > or =10 topics, lasting >2 days, and using > or =3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faculty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. CONCLUSIONS: A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

Data Collection↗
PubMed2000

Teaching in practice: a qualitative factor analysis of community-based teaching.

INTRODUCTION: In response to Tomorrow's Doctors, the use of primary care as a teaching base has been extended in many medical curricula. Previous reports have largely been speculative, looking at the theoretical possibilities and concerns of general practitioner teachers; in order to validate such studies, it is now important to evaluate the experience of those actually engaged in new teaching opportunities. In addition, curriculum developers need to go beyond descriptive studies to weight the factors which may help or hinder new teaching. AIM: The aim of this qualitative study was to use the context of a substantive increase in community-based teaching to evaluate the perspective of key general practice tutors on factors related to recruitment and retention, impact and outcomes, curriculum delivery, training and support, and quality assurance of the course. METHODS: Data were collected by written questionnaires to a sample of 45 general practitioners, plus semi-structured interviews with 15 general practitioners (33% of total sample). The data were purposively analysed to seek key factors, which were weighted by 'force field' analysis to show the balance of positive and negative factors. RESULTS: The data demonstrate important factors which may facilitate or impair community-based teaching at the levels of tutor, student, practice, and academic context. DISCUSSION: A 'cycle of satisfaction' is described, where personal motivation, shared team responsibility for teaching, and an enhanced professional self-image may all be crucial interdependent contributors. Suggestions are drawn from the data on key elements of effective academic support and possible practical quality indicators.

Attitude of Health Personnel↗
PubMed1999

Registered nurses' perceptions of teaching: constraints to the teaching moment.

Nursing literature indicates that patient teaching is an integral role function of the nurse. While some authors suggest that patient teaching is an essential part of nursing care, others argue that nurses are not adequately prepared to assume the role of teacher. This study explores the context within which nurses engage in patient teaching, revealing tensions experienced on a day to day basis within the practice setting. The principles of teaching and learning are also explored, raising questions about the extent to which nurses utilize these principles to guide the teaching moment. It is asserted that nurses find it difficult to engage in activities which are pivotal to the provision of quality patient education. Whether this is because they have little awareness or understanding of the principles of education, or whether this is related to the milieu in which teaching takes place, is explored.

Attitude of Health Personnel↗
PubMed1988

Study of teaching residents how to teach.

In the study reported here, the authors evaluated the effectiveness of a teaching skills program for residents. Twenty-two residents in obstetrics and gynecology, medicine, and family medicine were randomly assigned to control and experimental groups. The experimental groups received instruction and feedback about teaching skills during their first and second postgraduate years. Both groups were evaluated at three times: in the first year before the instructional program, in the second year during the instructional program, and in the third year six months after instruction. During each study phase, videotapes were made of each resident teaching a student in the context of a case presentation. Trained raters evaluated eight teaching skills exhibited in the videotapes. In general, there was greater increase and less decline in the scores of the experimental than the control groups. These data suggest that teaching skills can be improved by instruction and that without support residents' teaching skills do not improve in relation to their clinical competence.

Evaluation Studies as Topic↗
PubMed2006

Clinical teaching and clinical outcomes: teaching capability and its association with patient outcomes.

BACKGROUND: There is little research on the impact of medical education on patient outcome. We studied whether teaching capability is associated with altered short-term patient outcomes. METHODS: We performed a multicentre retrospective cross-sectional study involving 40 clinician teachers who had attended on the general internal medicine services in hospitals affiliated with the University of Toronto along with the clinical outcomes of consecutive patients treated for community-acquired pneumonia, congestive heart failure, chronic obstructive pulmonary disease and gastrointestinal bleeding (n = 4377) between 1999 and 2001. Doctors were characterised by teaching effectiveness scores (n = 677) as high-rated or low-rated according to house staff ratings. RESULTS: There was no correlation between the teaching effectiveness scores and the mean length of stay for those patients treated for community-acquired pneumonia (high-rated = 10.3 versus low-rated = 8.1 days, P = 0.058), congestive heart failure (high-rated = 10.1 versus low-rated = 9.9 days, P = 0.978), chronic obstructive pulmonary disease (high-rated = 9.4 versus low-rated = 9.9 days, P = 0.419) and gastrointestinal bleeding (high-rated = 6.3 versus low-rated = 6.8 days, P = 0.741). In addition, we observed no significant correlation between teaching effectiveness scores and 7-day, 28-day and 1-year readmission rates for all pre-specified diagnoses. CONCLUSION: There is no large correlation between teaching effectiveness scores and short-term patient outcomes, suggesting that doctor teaching capabilities, as perceived by house staff, does not generally impact clinical care.

Community-Acquired Infections↗
PubMed2003

Teaching as therapy: cross sectional and qualitative evaluation of patients' experiences of undergraduate psychiatry teaching in the community.

OBJECTIVE: To explore the impact of participating in undergraduate teaching in general practice for patients with common mental disorders. DESIGN: Questionnaire survey and qualitative in-depth interviews. SETTING: Community based undergraduate teaching programme for fourth year students at a London medical school doing a psychiatry attachment. PARTICIPANTS: Questionnaire survey: all patients involved in the teaching programme over one academic year. In-depth interviews: 20 patients, 14 students, and 12 general practitioner tutors participating in the programme. RESULTS: The questionnaire showed high levels of satisfaction with teaching encounters for participating patients, which were corroborated in the interviews. Many patients and general practitioners reported specific therapeutic benefits for patients from contact with students, including raised self esteem and empowerment; the development of a coherent "illness narrative"; new insights into their problems; and a deeper, more balanced, and understanding doctor-patient relationship. For a few patients the teaching caused some distress, which may relate to a lack of insight into their condition or deficits in students' interviewing skills. CONCLUSIONS: Participation in teaching can have additional positive therapeutic outcomes for selected patients with common mental disorders, although a small minority report negative effects. Testing in a larger sample is needed to determine the characteristics of patients in these two subgroups and establish whether these effects persist.

Adult↗
PubMed1995

Diffusion of innovation II: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a drug development perspective.

Diffusion theory was used to examine differences in adoption rates of new drugs by British Columbia teaching and non-teaching hospitals. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), requesting hospital pharmacy directors to provide formulary inclusion dates of 29 study drugs marketed between July 1987 and March 1990. Of the 36 initial responses, 31 were suitable for further analysis and these were surveyed again in April 1993 (response rate = 100%) as to the formulary status of drugs not initially approved. The second survey ensured that all study drugs would have at least 36 months on the Canadian market when determining formulary acceptance times. Of the 29 study drugs, six were not approved for use in any of the 31 study hospitals. The six teaching hospitals had a median formulary approval time of 8.0 months compared to 12.8 months in the 25 non-teaching hospitals for the 23 study drugs. Although 21 of 23 study drugs were approved for use earlier in teaching hospitals than non-teaching hospitals, only alfentanil was found to be adopted significantly earlier (U = 11, n1 = 5, n2 = 19, alpha = 0.05). Variations in formulary approval times for new drugs have a bearing on patient care, Pharmacy and Therapeutics Committees, hospital budgets, and pharmaceutical firm revenues.

British Columbia↗
PubMed2001

[Problem based learning in the teaching of physics to medical students. Comparison with traditional teaching].

BACKGROUND: Problem based learning, integrating basic science with clinical problems, is one of the most recommended forms of teaching for medical schools. AIM: To compare a problem based learning program for physics with traditional teaching methods. MATERIAL AND METHODS: In the physics course, first year medical students were separated in groups with traditional learning and problem based teaching. Both groups were subjected to the same knowledge and qualitative evaluations. RESULTS: At the end of the course, cognitive performance in both groups was similar (60.8 and 61.3% among traditional teaching and problem based learning groups respectively). However, students assigned to the problem based learning group evaluated significantly better the teaching methodology and process. CONCLUSIONS: Physics education, using problem based learning, obtains the same cognitive results but a higher degree of satisfaction than traditional teaching among students.

Curriculum↗
PubMed2002

Teaching first-year medical students physiology: does the human patient simulator allow for more effective teaching?

BACKGROUND: Although the Human Patient Simulator (HPS) is an effective teaching tool in many medical fields, literature supporting its use in the teaching of physiology to medical students is lacking. This study investigated the effectiveness of HPS-based teaching of cardiovascular physiology to first-year medical students. METHODS: Two hundred and ten first-year medical students were scheduled to our HPS laboratory with the purpose of demonstrating "physiology in action". Students were divided into groups of 19-25 each, and attended a lecture followed by a HPS session. Using a theatre-type simulator complete with mannequin, anaesthesia machine and monitors (METI, Sarasota FL), the scenarios of hypovolaemia, sepsis, and cardiac failure were run to demonstrate the physiological changes that occur with changes in preload, afterload, and cardiac contractility. Each student was given a true/false test before, and again after the HPS session, followed by a survey of their learning experience. RESULTS: There was marked improvement in test scores after the HPS session (82.1% vs. 64.6%, P < 0.001). Most of the students felt that HPS was a better teaching tool (94.5%) and raised more questions (76.5%) than lectures. They wanted more topics to be taught this way (96%), as they could apply and re-enforce textbook knowledge, and visualise real-time changes. However, they felt that their experience could have been enhanced with more time and smaller groups. DISCUSSION: HPS is an excellent teaching tool as it stimulates student curiosity and makes knowledge acquisition and understanding easier. It is highly desirable to be incorporated into the teaching of physiology.

Anesthesiology↗
PubMed2001

The process of developing a research questionnaire to measure attitudes to shared learning.

This article discusses the process by which a questionnaire was developed specifically to measure attitude to shared learning. Over a three-year period the attitude questionnaire was developed and tested using pre-registration students who were engaged in a shared learning programme. These pre-registration students were from three professional groups, namely occupational therapy (OT), diagnostic radiography (DR), and therapeutic radiography (TR). While the study hypothesis was that shared learning would improve attitudes over the three-year period, the focus of this article is to discuss the process by which the research instrument was developed. The rationale for focusing on the process is a simple one. After a diligent literature search it was clear that there were no attitude questionnaires specific to attitude measurement in relation to shared learning. Thus without an already validated attitude to a shared learning questionnaire, it became imperative to create systematically a credible attitude measure of shared learning. The process centred on understanding how monadic scales are constructed and used to measure attitudes and perceptions of participants. Amongst a number of processes to be followed was the need also to check the reliability of the developed questionnaire. This was done using the Cronbach alpha coefficient. A Cronbach alpha coefficient of 0.7 was set as a minimum reliability requirement, which was duly satisfied. The outcome of this process was that it very useful to learn how to produce a suitable instrument to measure attitude to shared learning and to add in a small way to the range of attitude questionnaires available.

Journal Article↗
PubMed1991

Analog language teaching versus natural language teaching: generalization and retention of language learning for adults with autism and mental retardation.

Examined the effects of two instructional methods on language generalization and long-term retention in 23 adults with autism and severe to profound mental retardation. Analog language teaching employed discrete trials in a controlled setting concentrating on discrimination and identification of materials. Natural language teaching emphasized instruction through interactions that occurred incidentally to training students in the use of materials to perform functional tasks. Assessments were conducted under conditions favoring analog teaching to assure against partiality toward natural language teaching. Under such disadvantageous conditions, the methods of natural language teaching would be supported by results showing either no difference or an advantage in their favor. Both techniques increased initial and long-term generalization though the results suggest no relative superiority for either method under these assessment conditions. A significant interaction was found between prior functioning level and sequence of instruction. Because natural language teaching has many strengths, few drawbacks, and produces equal generalization and retention under disadvantageous conditions, it is strongly supported as preferable for people with autism and mental retardation.

Adolescent↗
PubMed2004

Teaching residents how to teach improves quality of clerkship.

OBJECTIVE: To evaluate the impact of a resident's teaching skills workshop on the ratings of the obstetrics and gynecology clerkship by third-year medical students. STUDY DESIGN: The 6-week obstetrics and gynecology clerkship at the University of Michigan is provided at 4 different sites including the University of Michigan Hospital. At the end of each rotation, medical students complete an evaluation form assessing various aspects of their learning experience, including the overall quality of clerkship. A workshop, "Teaching Residents How to Teach," was conducted at the University of Michigan Hospital, whereas the other 3 sites served as the control. Clerkship evaluations were compared before and after the workshop using Student t test. RESULTS: Students at the University of Michigan Hospital rated all items on the evaluation form higher after the teaching workshop. The overall quality of the clerkship at the University of Michigan Hospital improved ( P = .05), whereas the other sites remained stable. CONCLUSIONS: A "Teaching the Residents How to Teach" workshop improves the overall quality of the clerkship.

Clinical Clerkship↗
PubMedDate not supplied

Evaluating clinical teaching in the medicine clerkship: relationship of instructor experience and training setting to ratings of teaching effectiveness.

A clinical teaching assessment form was used to evaluate the teaching by faculty and residents in the required third-year medicine clerkship over a two-year period. Data from 1,627 forms were analyzed for differences between groups of teachers at different experience levels and for comparison of teaching programs at different training sites. The level of involvement of instructor with student correlated with ratings by the students. Among groups of instructors, chief medical residents received the highest overall ratings. Faculty were rated higher than first-, second-, and third-year residents when degree of involvement of instructor with student was high. Ratings among faculty of different academic ranks were not significantly different. Analysis of data from different clinical settings showed that the teaching efforts by clinical faculty members in the ambulatory setting received the highest ratings from students. Although increased involvement of instructors with students or other factors may have led to the higher ratings in the ambulatory setting, the results are encouraging for the use of ambulatory teaching sites for the basic medicine clerkship.

Clinical Clerkship↗
PubMedDate not supplied

Cultural teaching: the development of teaching skills in Maya sibling interactions.

Psychology has considered the development of learning, but the development of teaching in childhood has not been considered. The data presented in this article demonstrate that children develop teaching skills over the course of middle childhood. Seventy-two Maya children (25 boys, 47 girls) ranging in age from 3 to 11 years (M = 6.8 years) were videotaped in sibling caretaking interactions with their 2-year-old brothers and sisters (18 boys, 18 girls). In the context of play, older siblings taught their younger siblings how to do everyday tasks such as washing and cooking. Ethnographic observations, discourse analyses, and quantification of discourse findings showed that children's teaching skills increased over the course of middle childhood. By the age of 4 years, children took responsibility for initiating teaching situations with their toddler siblings. By the age of 8 years, children were highly skilled in using talk combined with manual demonstrations, verbal feedback, explanations, and guiding the body of younger learners. Children's developing competence in teaching helped their younger siblings increase their participation in culturally important tasks.

Child, Preschool↗
PubMed1991

Complementary value of traditional bedside teaching and structured clinical teaching in introductory surgical studies.

A prospective randomized trial was conducted to see if student performance in a combined multiple choice and objective structured clinical examination was better following a period of structured clinical teaching compared with traditional bedside teaching. Student groups were crossed over in a second phase of the experiment to allow the two teaching techniques to be compared sequentially in the same group. There was no significant difference between the two teaching techniques as measured by performance in a criterion-referenced examination. The results of the study led to modification of the curriculum for third-year introductory surgical studies to incorporate both teaching strategies, which are regarded as complementary in value.

Australia↗