How to teach in everyday clinical practice The Reverend Dr David Taylor Senior Tutor And Deputy Director School of Medical Education University of Liverpool

Clinical assessment in Medicine David Taylor School of Medical Education University of Liverpool

Clinicians are busy So any contact with students has to be as effective as possible So any contact with students has to be as effective as possible But what does effective mean? But what does effective mean?

Just for a moment Reflect upon what you want the students to get out of your teaching Reflect upon what you want the students to get out of your teaching

Answers Show thought process Show thought process How you’ve got there How you’ve got there Take away the information Take away the information Inspire curiosity Inspire curiosity Empathy Empathy Role model Role model Enjoy experience Enjoy experience Improvising Improvising Use of appropriate technology Use of appropriate technology Pt. dr. colleague relationships Pt. dr. colleague relationships OK to say sorry OK to say sorry How to access information How to access information Management of context Management of context Cut through/duck red tape Cut through/duck red tape Be non-judgemental Be non-judgemental How to reflect How to reflect Teach skills Teach skills Contextual relevance Contextual relevance Acknowledge limitations Acknowledge limitations Modulate behaviour depending upon patient Modulate behaviour depending upon patient Integration findings and… Integration findings and… holistic approach holistic approach Highlight important points Highlight important points Professional ethics Professional ethics Legal things Legal things How to be a LLL How to be a LLL communication communication

Situated learning When all of the “facts” are forgotten When all of the “facts” are forgotten When evidence based medicine has superseded the familiar approaches When evidence based medicine has superseded the familiar approaches When technology has advanced When technology has advanced Or when technology is unusable Or when technology is unusable Your approach to a problem/patient will be remembered Your approach to a problem/patient will be remembered

Task 2 What are the criteria for a good clinical teacher? What are the criteria for a good clinical teacher? What are the criteria for a bad clinical teacher? What are the criteria for a bad clinical teacher?

Answer Good Good Good communicator Good communicator Conscientious Conscientious Approachable Approachable Non-judgemental Non-judgemental Integrates t&P Integrates t&P Positive disposition Positive disposition Competent Competent Professional Professional Be prepared Be prepared Accepting criticism Accepting criticism Bad Bad Arrogant judgemental Rigid Inflexible Incompetent Abuse of power Master/servant Unprofessional/unethical Inarticulate mumbler Lack of commitment to teaching Victimisation

What makes a good clinical teacher? A series of criteria have been developed in the UK for use in the compulsory annual appraisal of senior clinical staff A series of criteria have been developed in the UK for use in the compulsory annual appraisal of senior clinical staff These examples come from the Royal College of General Practitioners These examples come from the Royal College of General Practitioners

The excellent GP teacher…. Is willing to develop himself and others through education, audit and peer review Is willing to develop himself and others through education, audit and peer review Ensures patients are not put at risk when seeing students or doctors in training Ensures patients are not put at risk when seeing students or doctors in training Understands educational theory and uses teaching methods linked to educational aims Understands educational theory and uses teaching methods linked to educational aims Uses formative assessment and constructs educational plans Uses formative assessment and constructs educational plans Assists in making honest assessments of learners Assists in making honest assessments of learners

And also… Provides high quality, patient focussed care and hence leads and teaches by example Provides high quality, patient focussed care and hence leads and teaches by example Encourages the practice to develop as a “learning team” in both clinical and administrative areas Encourages the practice to develop as a “learning team” in both clinical and administrative areas Provides an environment that encourages learning Provides an environment that encourages learning Library, IT, video, adequate space and protected time for teaching Library, IT, video, adequate space and protected time for teaching Informs patients about teaching in practice, but allows them to “opt out” without embarrassment Informs patients about teaching in practice, but allows them to “opt out” without embarrassment

The unacceptable GP teacher… Puts patients at risk by lack of learner supervision Puts patients at risk by lack of learner supervision Does not take teaching seriously Does not take teaching seriously Offers no personal/educational support to learners Offers no personal/educational support to learners Does not assess learners’ needs Does not assess learners’ needs

The unacceptable GP teacher… Does not have appropriate teaching skills Does not have appropriate teaching skills Uses inappropriate methods Uses inappropriate methods Makes biased judgements when assessing learners Makes biased judgements when assessing learners Fails to respond if learner performance is poor Fails to respond if learner performance is poor

A competent teacher should… Stimulate, interest and involve the learner Stimulate, interest and involve the learner Understand the learner’s needs and use teaching methods that suit them Understand the learner’s needs and use teaching methods that suit them Prepare well using a teaching plan Prepare well using a teaching plan Encourage the learner and provide regular feedback Encourage the learner and provide regular feedback Evaluate their teaching and change practice as appropriate Evaluate their teaching and change practice as appropriate Be a life-long learner themselves Be a life-long learner themselves

Three supports Staff development Staff development Peer review Peer review Peer mentoring Peer mentoring

It need not take much time And the emphasis should be on making the most of the time shared between clinician and student And the emphasis should be on making the most of the time shared between clinician and student In the UK we emphasise appraisal In the UK we emphasise appraisal

For all aspects of appraisal We need to demonstrate We need to demonstrate A realistic awareness about our own performance A realistic awareness about our own performance The data which supports that awareness The data which supports that awareness And our ability to reflect upon our performance And our ability to reflect upon our performance

The outcome of appraisal Should be an action plan which will Should be an action plan which will Identify and capitalise on strengths Identify and capitalise on strengths Identify and attempt to rectify weaker areas Identify and attempt to rectify weaker areas Mutually agreed between appraiser and appraisee Mutually agreed between appraiser and appraisee