Facilitating learning: Teaching and learning methods PDF

Preview

Summary

Facilitating learning: Teaching and learning methods Authors: Judy McKimm MBA, MA (Ed), BA (Hons), Cert Ed, FHEA Visiting Professor of Healthcare Education and Leadership, Bedfordshire & Hertfordshire Postgraduate Medical School, University of Bedfordshire Carol Jollie MBA, BA (Hons) Project Man...

Description

Fa cilit a t in g le a r n in g: Te a ch ing a n d le a r n in g m e t h ods Au t h or s: Ju dy M cKim m MBA, MA ( Ed) , BA ( Hons) , Cert Ed, FHEA Visit ing Professor of Healt hcare Educat ion and Leadership, Bedfordshire & Hert fordshire Post graduat e Medical School, Universit y of Bedfordshire

Ca r ol Jollie MBA, BA ( Hons) Proj ect Manager, Tanaka Business School, I m perial College London This paper was first writ t en in 2003 as part of a proj ect led by t he London Deanery t o provide a web- based learning resource t o support t he educat ional developm ent of clinical t eachers. I t was revised by Judy McKim m in 2007 wit h t he int roduct ion of t he Deanery’s new web- based learning package for clinical t eachers. Each of t he papers provides a sum m ary and background reading on a core t opic in clinical educat ion. Aim s The aim s of t his paper are t o: • Provide ideas of how t o m ake t he m ost of clinical sit uat ions when t eaching st udent s or t rainees • Raise awareness of t he advant ages and disadvant ages of a range of t eaching and learning m et hods in clinical t eaching • Enable you t o ident ify aspect s of your everyday work which can be used as evidence for CPD Le a r n in g ou t com e s Aft er st udying t his paper, you will be able t o: • I dent ify opport unit ies for t eaching and enabling learning in everyday clinical pract ice • Apply som e of t he m aj or t heories of learning and t eaching from Higher Educat ion and healt hcare cont ext s t o your own t eaching pract ice • Ut ilise a wider range of t eaching m et hods wit h st udent s and t rainees • Develop a reflect ive approach t o t eaching and learning which you can ut ilise in your own cont inuing professional developm ent Con t e n t s • Acknowledgem ent s • I nt roduct ion • The changing NHS: what does t his m ean for t eachers and learners? • The learning environm ent – ‘learner cent redness’ • The learning environm ent – t he physical environm ent • Lifelong learning • The adult learner • Managing learning in a clinical and vocat ional cont ext : o t he educat ion vs t raining debat e o ‘learning by doing’ – becom ing a professional o com pet ency based learning o rehearsal, feedback and reflect ive pract ice

•

•

Teaching o o o o o o o o o o o

and learning m et hods: preparing for t eaching facilit at ing t he int egrat ion of knowledge, skills and at t it udes t eaching and learning in groups facilit at ing learning and set t ing ground rules explaining group dynam ics m anaging t he group lect ures sm all group t eaching m et hods and discussion t echniques sem inars and t ut orials com put er based t eaching and learning – inform at ion t echnology and t he World Wide Web o int roducing problem based learning o case based learning and clinical scenarios References, furt her reading and useful links

Please not e t hat t he references, furt her reading and useful links for each of t he sect ions are all in t his sect ion, grouped under subheadings Ack n ow le dge m en t s Thanks m ust go t o colleagues who have cont ribut ed t owards t he developm ent of t his paper, in part icular Clare Morris, Undergraduat e Medicine Training Coordinat or at I m perial College London and Dr Frank Harrison, Senior Lect urer in Medical Educat ion, I m perial College London. I n t r odu ct ion This paper has been developed alongside Teaching and Learning in t he clinical cont ext : Theory and pract ice and I nt egrat ing t eaching and learning int o clinical pract ice. Bet ween t hem , t he t hree papers provide a com prehensive overview of t eaching and learning in t he clinical cont ext . Theory and pract ice provides an overview of som e educat ional t heories, explains how t hese have im pact ed on t eaching pract ice and offers ideas for put t ing t heory int o pract ice in t he clinical cont ext wit h a view t o creat ing good sit uat ions for learning. Facilit at ing learning: Teaching and learning m et hods focuses on t he ‘t ools of t he t rade’: looking at som e of t he m ain t eaching and learning m et hods t hat clinical t eachers m ight use. I nt egrat ing t eaching and learning int o clinical pract ice has been writ t en t o follow and ext end t he t heoret ical learning in t he ot her t wo papers. I t considers t he challenges of t eaching in opport unist ic set t ings and looks at ways t o int egrat e t eaching com m it m ent s and learning act ivit ies int o t ypical day- t o- day clinical scenarios.

Th e ch a n gin g N H S: w h a t doe s t h is m e an for t e a ch e r s a n d le a r n e r s? I n t he Theory and Pract ice paper you looked at som e of key learning t heories and how t hese m ight be used in clinical t eaching. There have been som e huge shift s in recent years in t he NHS and Higher Educat ion which have changed t he cult ures of bot h. Wit hout going int o long sociological explanat ions, it is useful j ust t o t hink of som e of t he key changes and look at how t hese have im pact ed on t he role of and expect at ions from clinical t eachers. Since t he lat e 1990s, when nat ional init iat ives t o reform undergraduat e and post graduat e m edical educat ion were int roduced, m edical educat ion ( which includes clinical t raining) has gradually placed great er expect at ions and m ore responsibilit ies on clinical t eachers. The Depart m ent of Healt h init iat ive UMCI SS ( Undergraduat e Medical Curriculum I m plem ent at ion Support Schem e) which support ed t he reform of all undergraduat e curricula in response t o Tom orrow’s Doct ors ( GMC, 1993) had a huge im pact on undergraduat e m edical educat ion. New t eaching and learning m et hods were int roduced int o courses such as problem based learning, video t eaching and web based learning and t he courses t hem selves becam e less inform al and m ore st ruct ured in t erm s of design, delivery and evaluat ion. Courses were expect ed t o clearly define aim s and learning out com es, m odes of delivery and assessm ent and t he nat ional agencies responsible for m onit oring educat ional qualit y, t he Qualit y Assurance Agency ( QAA) and for m edicine, t he GMC, were looking in det ail at how educat ion was being provided. See Evaluat ing t eaching and learning for m ore inform at ion about educat ional qualit y and course evaluat ion. The drive for change and im provem ent was not only lim it ed t o undergraduat e courses, st ruct ured specialist t raining was int roduced int o t he UK in 1996 and alongside t his cam e som e fundam ent al changes in post graduat e m edical educat ion. The durat ion of specialist courses were defined and curricula were set for each specialt y which aim ed t o ensure t hat t he st andards recom m ended by t he Royal Colleges were recognised by t he STA ( Specialist Training Aut horit y) . The ‘Calm an’ changes were concerned wit h: C urriculum A ppraisal L engt h of t raining M anagem ent of t raining A ssessm ent N at ional st andards Such init iat ives were also paralleled wit h changes concerned wit h m odernisat ion of t he NHS as a whole, t he em phasis on pat ient - cent red care, ( The NHS Plan: A plan for invest m ent , A plan for reform, DoH, 2000) , at ht t p: / / www.doh.gov.uk/ nhsplan encouraging st aff t o work t oget her m ore closely and learn in m ult iprofessional set t ings ( eg. in Working Toget her – Learning Toget her: A Fram ework for Lifelong Learning for t he NHS. DoH, 2001) , looking at how professions m ight be

redefined in t erm s of t heir skills bases, areas of responsibilit y and com pet ence ( eg in A Healt h Service of all t he t alent s: Developing t he NHS Workforce. Consult at ion Docum ent on t he Review of Workforce Planning. DoH, 2001) . One of t he changes we are seeing in m edical pract ice is “ less reliance on a part icular individual’s knowledge base or skill but rat her on a t eam approach” ….which includes represent at ives of all healt h professions….. “ Doct ors m ust be prepared t o t each and learn, not only wit hin t heir own profession, but also across disciplines” ( Peyt on, 1998) . The paper Mult iprofessional learning: m aking t he m ost of opport unit ies looks specifically at how t o m ake t he m ost of opport unit ies t o int roduce m ult iprofessional learning. Som e European Union direct ives also im pact on educat ion and t raining such as t he recom m endat ions on vocat ional and post graduat e t raining and specialisat ion and t he European Working Tim e Direct ive. Ot her changes include t he im pact of int roducing t echnological innovat ions ( part icularly inform at ion t echnology, I T) int o t he workplace and t he educat ional environm ent . We will look at som e of t he ways you can use I T and videos in t eaching and learning sit uat ions lat er in t his paper. I n The Doct or as Teacher ( 1999) t he General Medical Council set out t heir “ expect at ions of t hose who provide a role m odel by act ing as clinical or educat ional supervisors t o j unior colleagues…..( and) ..t o t hose who supervise m edical st udent s, as t hey begin t o acquire t he professional at t it udes, skills and knowledge t hey will need as doct ors” ( p.1) . The GMC not ed t hat t eaching skills can be learned and t hat t hose who accept special responsibilit ies for t eaching should t ake st eps t o ensure t hat t hey develop and m aint ain t he skills of a com pet ent t eacher. The personal at t ribut es of t he doct or wit h responsibilit ies for clinical t raining and supervision are seen t o include: • • • • • • • • • • •

an ent husiasm for his/ her specialt y a personal com m it m ent t o t eaching and learning sensit ivit y and responsiveness t o t he educat ional needs of st udent s and j unior doct ors t he capacit y t o prom ot e developm ent of t he required professional at t it udes and values an underst anding of t he principles of educat ion as applied t o m edicine an underst anding of research m et hod pract ical t eaching skills a willingness t o develop bot h as a doct or and as a t eacher a com m it m ent t o audit and peer review of his/ her t eaching t he abilit y t o use form at ive assessm ent for t he benefit of t he st udent / t rainee t he abilit y t o carry out form al appraisal of m edical st udent progress/ t he perform ance of t he t rainee as a pract ising doct or.

p. 4, The Doct or as Teacher, GMC, 1999

at ht t p: / / www.gm c- uk.org

The im pact of all t hese changes on clinical t eachers is t o raise expect at ions from st udent s/ t rainees and m onit oring/ funding organisat ions, increase account abilit y and place addit ional dem ands on busy clinicians. Let us go on t o explore som e of t he t hem es and assum pt ions which underpin som e of t he report s and recom m endat ions described above and t hink about how t hese m ight im pact on clinical t eaching. Th e le a r n in g e n vir on m en t – ‘le a r n er cen t r e dn ess’ One of t he m ain t hem es running t hroughout t he recent changes in HE and t he NHS is t he shift from a t e a ch e r cen t r ed approach t o a m ore le a r n e r ce n t r e d approach. This is not j ust a sem ant ic shift , but involves act ually put t ing t he learner’s needs at t he cent re of act ivit ies, not always easy in a busy clinical environm ent wit h increasing service pressures. However, m aking a psychological shift t o a learner cent red approach which involves st udent s and j uniors you m ay have working wit h you, can act ually be helpful because whereas t here are opport unit ies for learning in virt ually every act ivit y clinicians carry out , t here are not always opport unit ies for form al t eaching event s. I f clinicians can m ake t he shift in t heir approach t o facilit at ing learning rat her t han delivering t eaching, t hen m any m ore opport unit ies are opened up eg. at t he bedside, in t he consult ing room , in a clinic or operat ing t heat re. For clinical t eachers t o be able t o seize t hese opport unit ies and opt im ise learning, t hey need t o have t he confidence and expert ise t o ensure t hat learners act ually do learn. Som e of t his is about underst anding t he principles of facilit at ing effect ive learning and t eaching, som e of t his is about having t he pract ical skills t o put t he principles int o pract ice and som e of t his involves put t ing your own experience int o pract ice. The paper I nt egrat ing t eaching and learning int o clinical pract ice gives m any ideas and specific exam ples about how learning can be int egrat ed int o rout ine clinical pract ice, and ot her papers look at t eaching and learning in different clinical set t ings. Th e le a r n in g e n vir on m en t – t h e ph ysica l e n vir on m en t I n clinical t eaching, t here are a wide variet y of physical environm ent s in which t eaching and learning can occur. Clinical t eachers m ay be required t o deliver form al t eaching in a lect ure t heat re or classroom , m uch of t he day- t o- day t eaching goes on ‘at t he bedside’, in clinics, consult ing room s or in operat ing t heat res and som e t eachers are involved in developing open learning resources such as e- learning resources which ut ilise a ‘virt ual’ environm ent . Being aware of t he resources available t o you and t o learners can help t o enhance t eaching and facilit at e learning. For m ore inform at ion about how t o use learning resources ( including t he physical learning environm ent , t he im pact of room placem ent , seat ing arrangem ent s and ot her fact ors

which can affect t he learning process) see t he paper Using learning resources t o enhance t eaching and learning. The learning environm ent is also st ruct ured by t he curriculum and t he approaches t hat have been t aken in designing and delivering it . The paper Curriculum design and developm ent includes a sect ion on Models of curriculum developm ent which looks at different approaches t o curriculum planning such as PBL and t he im pact t hat t hese approaches have on learning. Life lon g le a r n in g Anot her t hem e running t hrough t he developm ent of professional educat ion and t raining is t hat of life lon g le a r n in g. Learners should acquire and ut ilise skills and at t it udes such as st udy skills and selfm ot ivat ion t hroughout t heir working lives. The idea of lifelong learning im plicit ly incorporat es m any ot her educat ional philosophies which underpin t he changes we are seeing in healt hcare educat ion. Lifelong learning essent ially m eans t hat people should cont inue t o learn t hroughout t heir lives, not j ust t heir working lives but in all aspect s. I t also m eans t hat individuals should be encouraged and support ed in t aking responsibilit y for t heir own learning and t hat organisat ions and t eachers should fost er t he at t ribut es in learners of learning independent ly and m onit oring t heir own progress. This is a very different way of looking at t he t eacher- learner relat ionship t han t he t radit ional m ast er- apprent ice m odel which was t he norm in m edical educat ion in t he past . There is a shift from t he ‘t eacher as expert ’ role in which m ore didact ic t eaching m et hods were used, t o ‘t eacher as facilit at or of learning’ in which t eachers guide learners t owards resources and sources of knowledge j ust as m uch as being t he sources of knowledge t hem selves. This is not t o dem ean t he t eacher’s expert ise or clinical knowledge however or t o say t hat we do not need t o use didact ic m et hods when appropriat e, but it acknowledges t hat m edicine incorporat es a body of knowledge t hat is developing and changes rapidly and t hat it can be j ust as im port ant t o know where t o find out som et hing as t o know t he answer yourself. Th e a du lt le a r n e r The not ion of t he adult learner is one of t he assum pt ions which underpins m any aspect s of post graduat e educat ion and t raining in part icular, but which also influences undergraduat e educat ion. This shift reflect s work carried out by researchers such as Brookfield ( 1998) who ident ify specific differences bet ween t he way in which adult s and children learn. The m ain charact erist ics of a du lt le a r n in g are: • • • • • •

t he learning is purposeful part icipat ion is volunt ary part icipat ion should be act ive not passive clear goals and obj ect ives should be set feedback is required opport unit ies for reflect ion should be provided

There have been recent challenges t o t he assum pt ions t hat children should be t reat ed different ly from adult learners and if you t hink about school curricula, t hey em body m ost of t he charact erist ics list ed above. Ram sden ( 1992) ident ifies six key principles of effect ive t eaching in Higher Educat ion as follows: • • • • • •

t eachers should have an int erest in t he subj ect and be able t o explain it t o ot hers t here should be a concern and respect for st udent s and st udent learning appropriat e assessm ent and feedback should be provided t here should be clear goals and int ellect ual challenge learners should have independence, cont rol an act ive engagem ent t eachers should be prepared t o learn from st udent s

Clearly som e of t hese are at t ribut es which belong t o individual t eachers whereas ot hers also rely on ensuring t hat t he organisat ional cult ure, policies and procedures m eet t he needs of learners. See Curriculum design and developm ent , sect ion on Course design and planning – t he broad cont ext for a m ore det ailed discussion and act ivit ies relat ing t o m eet ing t he educat ional needs of learners. M a n a gin g le a r n in g in a clin ica l a n d voca t ion a l con t e x t Above, we have considered som e of t he general t hem es and current t rends in HE and in healt hcare t raining. Let us now go on t o t hink m ore specifically about clinical t eaching and learning. We t end t o assum e t hat m edical st udent s and t rainees are highly m ot ivat ed learners, we do not however always quest ion what act ually m ot ivat es t hem t o learn. Beat t y, Gibbs and Morgan ( 1997) ident ified a num ber of ‘orient at ions t o learning’, which are sum m arised in t he t able below. These orient at ions include t he aim s and int erest s of learners, considerat ion of t hese can help ident ify m ot ivat ing fact ors in learning and provide ideas for m aint aining learner’s int erest s and helping t hem progress as professionals. Or ie n t a t ion

I n t e r e st I nt rinsic

Aim Training

Con ce r n s Relevance of course t o fut ure career

Ext rinsic

Qualificat ion

I nt rinsic

I nt erest

Recognit ion of qualificat ion’s wort h Choosing st im ulat ing t eaching sessions

Ext rinsic

Progression

I nt rinsic

Self im provem ent

Grades and academ ic progress Challenging, int erest ing m at erial

Ext rinsic

Proof of

Feedback and passing

Voca t ion a l

Aca de m ic

Pe r son a l

I nt rinsic

capabilit y Help com m unit y

t he course Relevance of course t o helping com m unit y

Ext rinsic

Enj oym ent

Facilit ies, sport and social act ivit ies

Socia l

We have all experienced t he m edical st udent whose social orient at ion som et im es seem s like t heir m ain reason for being at m edical school, helping learners t o reorient at e t hem selves is oft en one of t he m ain funct ions of personal t ut ors. See Educat ional supervision, personal support and m ent oring for m ore about t he different roles of t he t eacher in learner support .

Th e e du ca t ion vs t r a in in g de ba t e We t end t o use t he words ‘educat ion’ and ‘t raining’ som ewhat int erchangeably, but it is useful t o t ry t o dist inguish bet ween t hem . St enhouse ( 1975) argued t hat t here were four fundam ent al processes of educat ion: • • • •

Training ( skills acquisit ion) I nst ruct ion ( inform at ion acquisit ion) I nit...