Training the trainers: do teaching courses develop teaching skills?

OBJECTIVE: This paper reports on consultants' self-assessed changes in their teaching and training practices over an 8-10-month period. It compares the changes between a group undergoing a 3-day teaching course (participants) and a sample group taken from the course waiting list (controls). METHOD: A questionnaire listing 18 teaching skills was given to the participants immediately prior to the course and 8-10 months later, and to the controls at the same time intervals. Respondents were asked to rate their ability, frequency of use of each skill, as well as their teaching confidence and effectiveness. Additionally, the second questionnaire asked respondents to identify changes they had made to their teaching. A total of 63% (54) of participants and 51% (23) of controls completed both questionnaires. Changes of 2 + on the rating scales were seen as genuine. The number of such changes was calculated for each individual and on each skill for the 2 groups. Data were analysed using a Mann-Whitney U-test. RESULTS: The majority of course participants reported positive changes in teaching ability on a significantly greater number of skills than did the control group. As a group, changes in ability in 16 of the teaching skills were significantly greater for the participants than for the controls. Increased ability resulted in participants' increased frequency of use of only 4 of the teaching skills. The majority in the participant group reported changes to their teaching. Only a minority in the control group reported such changes. These changes were consistent with course topics and the teaching skills needed to meet General Medical Council recommendations for the education of new doctors. CONCLUSIONS: The teaching course is an effective vehicle for increasing consultants' teaching skills.     

Has bedside teaching had its day?

Though a diverse array of teaching methods is now available, bedside teaching is arguably the most favoured. Students like it because it is patient-centred, and it includes a high proportion of relevant skills. It is on the decline, coinciding with declining clinical skills of junior doctors. Several factors might account for this: busier hospitals, broader roles of clinicians, competing teaching modalities, and the limited training of clinicians as medical educators. However, bedside teaching offers unique benefits. Students gain first-hand experience of the doctor patient relationship. They see the process of interacting with patients, investigative yet sensitive, demystified. Certain clinical skills, like the recognition of the tactile sensation of hepatosplenomegaly cannot be simulated elsewhere. We advocate the preservation of bedside learning experience. Teaching guidelines should be written to minimise disruption to ward work, and to ensure the preservation of patient autonomy. Greater emphasis should be placed on bedside skills in the undergraduate curriculum. For teachers, training in teaching methodology should begin at undergraduate level, with subsequent protected teaching time in job plans. This would increase not just the quantity, but also the quality of bedside teaching.     

What is happening to bedside clinical teaching?

BACKGROUND: Bedside clinical teaching, an essential component of clinical training, was widely practised during the 1960s and early 1970s but has since declined substantially. OBJECTIVE: To highlight the importance of bedside teaching, giving examples of its significance, and to discuss the factors that have led to its decline. DESIGN: Review style. MAIN FINDINGS: There is much that can be gained from teaching at the bedside. It allows trainees to learn professionalism and to grasp the principles of communication with real patients. Unfortunately, the medical profession, like other fields of endeavour, has been invaded by computer technology. This has led to a decline in the frequency of bedside teaching and thus inflicted serious damage on the attainment of clinical skills by young doctors, despite their continuing interest in bedside teaching. Moreover, the increasing clinical, administrative and research duties of senior doctors have further contributed to this decline. CONCLUSION: Every effort should be made to reinstate bedside teaching as a leading component of medical training.     

Metacognition and nursing teaching: a possible combination?

Teaching students to learn how to learn is a challenge for schools that intend to form autonomous people who are capable of taking decisions. These are essential aspects for health professionals who are permanently confronted with complex situations and a multiplicity of problems to be solved by professional actions. The desire for changes, which is explicit in educators' discourse, does not guarantee substantial changes in the form teaching is being developed. The question about how to promote these alterations still remains unanswered. Studies developed in the last two decades about cognition and metacognition seem to indicate a possible strategy to transform knowledge into relevant professional behavior, since it favors thinking about the thinking process as well as the development and control of mental abilities that are capable of maximizing the use of the individual potentialities necessary for a nurse to solve health problems.     

Do patients have an obligation to participate in student teaching?

Context  Patients may participate in teaching in many ways, in different settings and with different degrees of expert supervision. The majority of patients are generally very willing to participate in teaching. At times, however, patients may decline to see students because they are too sick, wish to maintain their privacy, prefer to have more expert care, or simply wish to have no involvement with students. This raises the question as to whether patients have any obligation to participate in education.
Methods  A number of arguments are advanced to justify the claim that patients have an obligation to participate in student teaching. These include: that patients should participate in training for the benefit of others if they wish to benefit from the care of those who have learnt from others; that, without patient participation in teaching, the entire health system would collapse; that participation in education provides a benefit over and above the provision of individual care; that, as we all benefit from the presence of a functioning health system, we should all be prepared to contribute to it, and that patients should 'pay' for free public health care by participating in teaching.
Conclusions  None of the arguments that patients have an obligation to participate in medical education are convincing. We believe that patients participate in training largely out of altruism rather than obligation. Where possible, sick patients should be substituted for by healthy patients or simulations.     

Role modelling: how does it influence teaching in Family Medicine?

OBJECTIVE: To undertake a qualitative study to explore the influence of role modelling on teaching by comparing faculty members recollections of their teachers' behaviours with residents perceptions of the same behaviours in a family medicine residency programme in Saudi Arabia. METHOD: Using semi-structured interviews of faculty and a questionnaire based on the issues arising from the interviews, faculty members' recollections of their medical teachers' behaviours were compared with residents' current perceptions of the same teaching behaviours. SETTING: Department of Family Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. SUBJECTS: Faculty and residents. RESULTS: The four best-remembered teacher behaviours were: positive behaviour towards patients, negative behaviour towards junior colleagues, effective presentation of subject content and encouragement to participate in patient care. The residents perceived positive behaviour towards patients, positive behaviour towards junior colleagues, suboptimal skills of subject content presentation, and insufficient encouragement for trainees to actively participate in patient management. Although faculty retained many unhappy memories of teacher behaviour, it was encouraging that there was no evidence of perpetuation of the negatively perceived behaviours which provoked them. CONCLUSIONS: Discernment of the value of technical teaching skills was not a predictor of later proficiency.     

Is there any correlation between psychiatric disease and the teaching profession?

BACKGROUND: Some professional categories are at risk for burnout due to job-related stressors. Burnout is characterized by physical and emotional exhaustion, apathy, cynical attitude, low personal accomplishment and reduced self-control. Several studies on occupational stress have demonstrated that burnout has a strong impact on certain professions and in particular on teachers. OBJECTIVES: The purpose of the study was to highlight and compare differences among clinical disorders diagnosed in four different classes of workers in the Public Administration sector, with particular focus on job-related and mental disorders. MATERIALS AND METHODS: Based on the data collected in 3,447 medical examinations, performed by the Milan Health District from January 1992 to December 2003, in order to assess work fitness, researchers compared four categories of state employees (teachers, clerks, health care professionals and blue collars). RESULTS: The findings revealed that the risk of teachers to develop psychiatric disorders is 2-, 2.5-, and 3-fold higher than that of clerks, health care professionals and blue collars, respectively. Age or sex did not represent a confounding factor for increased rate of psychiatric disorders. Interestingly, teachers also presented an approximately 1.5-2 fold higher risk of developing neoplasms, compared with clerks and blue collars. CONCLUSIONS: The increased prevalence of psychiatric disorders among teachers that was detected in this cohort of state employees applying for a disability pension is striking and warrants further investigation. This finding points to the need for job-related interventions aimed at preventing teachers' psychiatric disorders, a multidimensional issue which requires active debate among institutions, unions, school authorities, the scientific community, professional associations and, last but not least, students and their families.     

Does EBM offer the best opportunity yet for teaching medical statistics?

Trends in the teaching of statistics to medical undergraduates since the 1970s are traced. I conclude that the aim of enabling doctors to evaluate statistical information relevant to their practice preceded the arrival of evidence-based medicine (EBM). However this aim was not well realized before 1990. EBM has given an enormous opportunity for statisticians to teach critical appraisal and to orientate future doctors towards evidence-based practice. This advantage should outweigh any disadvantage of loss of our discipline's identity in modern curricula.     

Why does teaching research skills to family medicine trainees make sense?

There are only a few countries in Europe that have incorporated research skills training in specialty training programmes. In the eyes of most practising family physicians, research traditionally is a field reserved for colleagues with academic ambitions; an activity that often is not associated with the clinical practice of family medicine. However, residents became aware that research is essential to improving healthcare provision. Research in family medicine has a long tradition. Performing or taking part in research projects opens new horizons to present and future family physicians and provides support to increase their self-esteem. Consequently, this could foster future family medicine development. The authors urge the whole family physician community to raise the awareness every single family physician towards teaching and learning research skills in specialty training and basic medical education as a generic subject.