Essential skills for a medical teacher : an introduction to teaching and learning in medicine

Front Cover
Essential Skills for a Medical Teacher
Copyright Page
Table Of Contents
Foreword
Preface
About the Authors
Acknowledgements
1 The ‘Good Teacher’
	Section 1 text
	1 The teacher is important
		The curriculum, the student and the teacher
		The teacher matters
		The necessary attributes can be learned
		Motivation for teaching
	2 The different faces of a good teacher
		What is required of a good teacher
		The good teacher embodies a range of abilities
		The technical competencies of a good teacher
		How a good teacher approaches their work
		The good teacher as a professional
	3 Understanding basic educational principles
		Be FAIR to your students
		Feedback
		Activity
		Individualisation
		Relevance
	4 Being an enthusiastic and passionate teacher
		What is a passionate teacher?
		Does it matter?
		Every teacher can be a passionate teacher
		Teacher stress and burn out
	5 Knowing what works best
		A ‘PHOG’ approach
		Evidence-informed teaching
		What is evidence?
		Searching for evidence
		Evaluating evidence
		Best evidence medical education
		Judgement, intuition and teaching
	6 Collaborating and working as a team
		Collaboration is important
		Collaboration between teachers within a medical school
		Collaboration with others within your institution
		Collaboration between the different phases of medical education
		Collaboration with other healthcare professionals
		Collaboration with other stakeholders
		Collaboration between teachers with the responsibility for a similar programme locally, nationally or internationally
		Collaboration in practice
	7 Checking your performance as a teacher and keeping up to date
		Teaching as a professional activity
		Enquiring into your own competence
		Keeping up to date
		Scholarship in teaching
2 What the Student Should Learn
	Section 2 text
	8 The move to an outcome/competency-based approach
		An important trend in medical education
		What is outcome/competency-based education?
		Why an outcome/competency-based approach?
		Myths and concerns about OBE
			Myth One: OBE is concerned with detail and the big picture may be missed
			Myth Two: OBE is a threat to the autonomy of the teacher and removes their freedom and independence
			Myth Three: OBE is contrary to trends in medical education
			Myth Four: OBE is about minimum competence and excellence is ignored
			Myth Five: OBE is labour-intensive and the time required cannot be justified
		Entrustable Professional Activities (EPAs)
			What is an EPA?
			Granularity and EPAs
			Relationship between an EPA and learner outcomes and competencies
			EPAs and specification of the level of supervision
			EPAs and the curriculum
	9 Specifying the learning outcomes and competencies
		Who is responsible?
		Involvement of stakeholders
		Approaches that can be adopted
			Focus group and nominal group technique
			The Delphi technique
			A critical incident survey
			Studies of errors in practice
			Task analysis
			Interviews with recent graduates
			Study of existing curricula and publications
			A mixed economy
	10 Describing and communicating the learning outcomes and competencies
		Learning frameworks
		Criteria for a learning outcome framework
		The Dundee three-circle outcome model and the ‘Scottish Doctor’ framework
		The CanMEDS Physician Competency Framework
		The Accreditation Council for Graduate Medical Education (ACGME)
		The Brown Abilities
		Global Minimum Essential Requirements (GMER)
		General Medical Council UK
	11 Implementing an outcome-based approach in practice
		The ostriches, the peacocks and the beavers
		Implementing an OBE programme
		Student progression in an OBE curriculum
		Implementation guidelines
		An OBE implementation inventory
3 Curriculum Development
	Section 3 text
	12 The ‘authentic’ curriculum
		The concept of a curriculum
		The ‘authentic’ curriculum – from university to the real world
			The planned, the delivered and the learned curriculum
	13 Ten questions to ask when planning a curriculum
		The ten questions
		What is the medical school or training programme’s vision or mission?
		What are the expected learning outcomes?
		What content should be included?
		How should the content be organised?
		What educational strategies should be adopted?
			Student-centred/teacher-centred
			Presentation-based/information-orientated
			Integrated/discipline-based
			Community-based/hospital-based
			Elective/uniform
			Systematic (planned)/apprenticeship (opportunistic)
		What teaching methods should be used?
			The teacher’s toolkit
		How should assessment be carried out?
		How should details of the curriculum be communicated?
		What educational environment or climate should be fostered?
		How should the process be managed?
	14 Sequencing curriculum content and the spiral curriculum
		The importance of sequencing
		Guidelines for sequencing
		Basic and clinical sciences
		A spiral curriculum
		Progression
		Transition between courses
	15 Student engagement and a student-centred approach
		The move from teacher-centred to student-centred learning
		Reasons for the move
		What is student-centred learning?
			Students take responsibility for their own learning
				Study guides
			Learning is personalised to the needs of the individual student
			A shift of power relationship from the teacher to the student
	16 Building learning around clinical problems and presentations
		The importance of the clinical problem in student learning
		Problem-based learning (PBL)
			What is PBL?
			The PBL continuum
			The context for PBL
		Task-based learning (TkBL)
			What is task-based learning?
			TkBL in a clinical setting
			Implementation of TkBL
			Clinical presentations
			A curriculum cube
	17 Using an integrated approach
		A move to an integrated curriculum
		Advantages of integration
		Focus for integration
		The integration continuum
			Step 1 – Isolation
			Step 2 – Awareness
			Step 3 – Harmonisation
			Step 4 – Nesting
			Step 5 – Temporal coordination
			Step 6 – Sharing
			Step 7 – Correlation
			Step 8 – Complementary
			Step 9 – Multi-disciplinary
			Step 10 – Inter-disciplinary
			Step 11 – Trans-disciplinary
	18 Interprofessional education (IPE)
		A move to IPE
		Principles of interprofessional learning
		Continuum of interprofessional education
		Implementation in practice
			A vision for IPE
			An implementation strategy
			Tackling a negative mindset
	19 The apprenticeship, community-based education, longitudinal clinical clerkships and work-based learning
		The apprenticeship model
		Trends in curriculum planning
		Community-based education
			What is community-based education?
			Rationale for community-based education
			Urban and rural settings
			Implementation of community-based learning
		Longitudinal integrated clerkships (LICs)
			The problem with the traditional clinical clerkships
			Features of a LIC
			Implementation of LICs
		Work-based learning
			What is work-based learning?
			Principles of work-based learning
			Advantages of WBL
			Implementation of WBL
			Problems and pitfalls of WBL
	20 Responding to information overload and building options into a core curriculum with threshold concepts
		The problem of information overload
		Responding to the problem
		A core curriculum with options or student-selected components
		Advantages of a core curriculum with SSCs
		Specification of a core curriculum
		Threshold concepts
			Key characteristics
			The importance of threshold concepts
		Electives/SSCs
		Choice of SSC topics
		Assessment of SSCs
		Integration of SSCs with the core
	21 Recognising the importance of the education environment
		What is the learning environment
		The education climate is important
		Aspects of the education environment
			Collaborative or competitive orientation
			Student or teacher orientation
			Supportive or punitive orientation
			Community or hospital orientation
			Research or teaching orientation
		The effects of the environment
		Assessment of the education environment
		The use of environment measures
	22 Mapping the curriculum
		The need for a curriculum map
		What is a curriculum map?
		Curriculum mapping is on today’s agenda
		Potential users of the curriculum map
		Preparing a curriculum map
4 Styles of Teaching
	Section 4 text
	23 The lecture and teaching with large groups
		The use of lectures
		Problems with lectures
		When to use lectures
		Delivering a good lecture
			Get some facts in advance
			Think about the content and structure
			The introduction to the lecture
			Visual aids
			Engaging the audience
			The close of the lecture
			Handouts
		Students’ presence and behaviour at lectures
		The ‘flipped classroom’
			What is a ‘flipped classroom’?
			Application in medical education
			Advantages and disadvantages of the flipped classroom
			Implementation in practice
	24 Learning in small groups
		What is small group teaching
		Role of small group teaching
		Advantages of small group teaching
		Problems with small group teaching
		Techniques used in small group work
		Implementing small group work
			Before a small group activity
			During a small group activity
			After the small group activity
		Team-based learning (TBL)
			What is TBL?
			Implementation of TBL
	25 Independent learning
		The importance of independent learning
		Benefits for the student
		Independent learning in the curriculum
			Time allocated for independent learning and scheduling in the curriculum
			Directed self-learning and the role of the teacher
			Study guides
		Learning resources
	26 Teaching and learning in the clinical context
		Changing perceptions of clinical teaching
		The student
		The teacher
		The patient
		Teaching procedural skills
			Student progression
		Planning and implementing
		Clinical supervision
	27 Simulation of the clinical experience
		Reasons for simulation
		Simulating ‘real’ patients
		Simulated patients
			Recruiting and training simulated patients
		Simulators (manikins and models)
		Virtual patients
			Uses of virtual patients
			Advantages of using virtual patients
		Choice of simulation
		Clinical skills centres
	28 E-learning
		A move to e-learning
		E-learning activities
		Reasons for adopting e-learning
		Educational features
		Distributed and distance learning
		Blended learning
		E-learning – the educational strategies
	29 Peer and collaborative learning
		Recognition of peer-to-peer (P2P) learning
		P2P learning
		Collaborative learning
		Examples of P2P and collaborative learning
		Benefits to be gained by P2P and collaborative learning
		Implementation in practice
			P2P learning
			Collaborative learning
5 Assessment
	Section 5 text
	30 Six questions to ask about assessment
		The importance of assessment
		Why assess the student?
		Who should assess the student?
		What should be assessed?
			Competency-based assessment
		How should the student be assessed?
			Standard setting
			Programmatic assessment
		When should the student be assessed?
			The progress test
		Where should the student be assessed?
	31 Written and computer-based assessment
		Written assessment has a role to play
		The elements in a written assessment
			The stimulus
			The student’s response
			The assessment of a student’s response
		Standard setting
		Types of written assessment
			Essay questions
			Short essay questions (SEQs)
			Short answer questions (SAQs)
			Multiple choice questions (MCQs)
			Extended matching questions (EMQs)
			Modified essay questions (MEQs)
			Script concordance test (SCT)
			Situational judgement tests (SJTs)
		The technology
	32 Clinical and performance-based assessment
		The importance of clinical assessment
		The patient
			‘Real’ patients
			Simulated patients
			Simulators and models
			Computer-based simulations
		Approaches to clinical and performance assessment
			The objective structured long examination record (OSLER)
			The objective structured clinical examination (OSCE)
			Mini clinical evaluation exercise (Mini-CEX)
			Direct observation of procedural skills (DOPS)
			Case-based discussion (CbD)
			Multi-source feedback (MSF) or 360 degrees evaluation
			A portfolio
		Implementing a clinical assessment
			A blueprint
			Selection of methods
			The examiner
			A student’s profile
			Feedback
	33 Portfolio assessment
		What is a portfolio?
		Why portfolios?
		Advantages
		Implementing portfolio assessment in practice
	34 Assessment for admission to medicine and postgraduate training
		The importance of selection
		Graduate or direct from school entry
		Aims of selection
		Criteria for selection methods
		Choice of method
			Academic record and performance at school
			Autobiographical narrative
			References
			Interviews
			The multiple mini-interview (MMI)
			General mental ability and aptitude tests
			Situational judgement tests (SJTs)
			Personality inventories
			Selection for admission to specialty training
	35 Evaluating the curriculum
		Why evaluate the curriculum?
		Focus for the evaluation
			The CIPP approach
			Value-added assessment
		The ‘ten questions’ framework for curriculum evaluation
		Kirkpatrick’s four levels of evaluation
		Undertaking a curriculum evaluation
Appendices
	Appendices
	Appendix 1 Entrustable Professional Activities (Epas) for Undergraduate Medical Education as Specified by the Association of American Medical Colleges (AAMC) (Greenberg, R., 2014. Core Entrustable Professional Activities for entering residency. https://www.aamc.org/cepaer)
	Appendix 2 The Learning Outcomes for A Competent Practitioner Based on the Three-Circle Model (reproduced with permission from Harden et al., 1999. AMEE Guide No. 14: Outcome-based education Part 5)
	Appendix 3 Four Dimensions of Student Progression (reproduced with permission from Harden, R.M., 2007. Learning outcomes as a tool to assess progression. Med. Teach. 29, 678-682)
	Appendix 4 A Page from a Study Guide, ‘Learning Paediatrics: A Training Guide for Senior House Officers’ (reproduced with permission from Harden, R.M., Laidlaw, J.M., Hesketh, E.A., 1999. Study guides – their use and preparation. AMEE Medical Education Guide No. 16. Med. Teach. 21, 248-265)
	Appendix 5 Summary of Various Points in the Continuum Between a Problem-Based Approach and an Information-Oriented Approach ‘Rul’ is the rules or principles to be learned. ‘Eg’ is the problem or clinical example addressed by the student. (Reproduced with permission. First published in Harden, R.M., Davis, M.H., 1998. The continuum of problem-based learning. Med. Teach. 20, 317-322)
	Appendix 6 The Clinical Presentations That Provide A Framework for the Curriculum in Task-Based Learning (reproduced with permission from Harden, R.M., Crosby, J.R., Davis, M.H., et al., 2000. Task-based learning: the answer to integration and problem-based learning in the clinical years. Med. Educ. 34, 391-397)
	Appendix 7 First Two Sections of The Learning Outcome/Tasks Mastery Grid for Vocational Training in Dentistry (reproduced from Mitchell, H.E., Harden, R.M., Laidlaw, I.M., 1999. Med. Teach. 20, 91–98)
	Appenidx 8 Dundee Ready Education Environment Measure (DREEM) (reproduced with permission from McAleer, S., Roff, S., 2001. Curriculum, Climate, Quality and Change in Medical Education: A Unifying Perspective. AMEE Guide No. 23. Part 3 Appendix 1)
	Appendix 9 Examples of OSCE Stations
Index
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