Learning and Teaching

last authored: Sept 2012, David LaPierre
last reviewed:

 

 

Introduction

Learning is the process of getting information - both cognitive and procedural - into storage. Learning may occur in various settings: clinical (skills and behaviours), education (teaching, supervision), administration (committees, leadership roles, etc), and research.

 

Learning may be formal (process is primarily controlled by tutors), informal (unplanned, opportunistic), or self-directed. Effective learning brings the student into a place of uncertainty, leaves them there for a while, and then leads them to closure and consolidation.

 

Knowing how to learn effectively is fundamental to success in becoming a health care professional, and likewise, knowing how to teach is critical in raising new generations of colleagues.

 

While teaching is a part of the culture of medical practice - Hippocrates wrote almost 2500 years ago that the duty of the physician is "to teach them the art if they want to learn it, without fee or indenture", we feel is extremely important to adequately prepare, and compensate, clinical teachers for their efforts. While compensation is not addressed here, this page has extensive information on practical advice for both learners and teachers. Resources are applicable for both learners and teachers, as we all play both roles during our training, practice, and lives.

 

An introductory learner will be dependent, requiring an authority role as teacher. As the learner becomes interested, the teacher shifts to motivating and facilitating. Finally, as the learner becomes self-difected, the teacher steps back and delegates tasks to the learner.

 

Effective Teaching can be extremely challenging. Particular difficulties can arise from inadequate training or preparation as a teacher, time constraints, low levels of interest, differing levels of ability of the learner, and insufficient knowledge. Common problems in teaching that arise from these difficulties include:

• lack of clear objectives and expectations
• focus on recall, rather than problem-solving skills and other higher level competencies
• teaching aimed too high
• passive observation on the part of the students
• inadequate supervision and feedback
• little opportunity to reflect and discuss
• teaching by humiliation
• informed consent not sought by patients
• lack of respect for patients' privacy and dignity
• lack of concordance with rest of curriculum

It can be challenging to provide educational experiences and quality patient care.

 

learning type	reading, lecture, podcast	case-based learning	simulation and role-play	clinical encounters
assessment tool(s)	MCQ, short answer	short answer, feedback	OSCE	SNAPPS field notes

 

 

 

Overview of Learning

main article: competence and expertise

 

In experiential learning, the learner adopts a key role in guiding the dialogue. Success therefore depends on both the learner and the teacher. The learner's approach to learning is a critical factor in determining the quality of educational outcomes (Panagro, 1999).

It is important to have concrete examples on which to hang abstract information.

Perhaps we should start with experience...

Give clinical scenarios up front, to "hook" students and provide opportunity for elaboration. It is also important to ensure students experience a sense of responsibility.

small group or case-based learning is one effective method

 

Adult learning must be fostered in a climate of safety and freedom to experiment (dlp: simulations). Early successes are important to build confidence.

Learners should also be actively involved in the planning and unfolding of curriculum, ideally suited for their specific needs. This frequently requires diagnosis.

Learners should be assisted to identify resources and strategies that work specifically for them.

Learners should also be supported in carrying out their learning plans, with collective evaluation culminating from ongoing feedback.

 

Adults are independent and self-directed. They have a great deal of experience from which to draw lessons and are reflective. Learning ideally integrates with the rest of a busy life, with context of specific problems. It can be helpful to explicitly define these.

Adults tend to be interested in immediate problem-centred approaches, though are motivated by internal drives, rather than external ones.

 

Adults need to be actively involved and usually learn by doing.

 

Three key things

• appropriate context: experience, role play, PBL
• abstract info should be easily available
• task should be made clear: relate the abstract info to the concrete examples

People also need to want to learn, or to change. The motivation question is very important.

 

Goals of Learning

Health care takes place within organizational contexts. Organizational goals predict behaviour of learners, and their motivation. Also, organizations may at times mandate learning. This obligation need not be onerous.

From a sociological perspective, change, including innovation, is taken up according to how well it fits organizational needs.

From a psychological perspective, learning is a means to an end, in order to survive.

Professional values of health providers drive learning, in terms of social accountability and peer influence. As well, inner motivation to be a competent health care provider encourages learning (Mazmanian and Mazmanian, 1999).

 

Self-directed learning relates one's perceived ability to learn, based on one's resources.

Cognitive dissonance occurs when perceived awareness of current conditions and desired conditions are sufficiently diverse. When this gap is great enough, motivation for change occurs (Mazmanian and Mazmanian, 1999). The higher the dissonance, the greater the commitment to change should be.

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Overview of Teaching

Clinical teaching rarely comes easily to untrained teachers, who usually give mini-lectures, provide poor feedback (if at all), and do not press the learner to effectively think (Neher et al, 1992). Practice with a small number of proven techniques can have a dramatic impact on clinical teaching performance.

Contrary to many people's beliefs, the evidence does not suggest clinical teaching decreases billing (Adams and Eisenberg, 1997). It appears to decrease the number of patients seen in a given day by a slight (eg 2) level (Kearl and Mainous, 1993).

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Resources and References

Adams M, Eisenberg J. 1997. What is the cost of ambulatory education? Journal of General Internal Medicine. 12: S104-110.

Coppus, 2007. New publications daily.

Practical Prof - clinicial preceptor advice from Alberta

Vark-Learn. com

R-Scope - Resources and Support for Community Preceptor Excellence

Active Reviewing Guide

Kearl G, Mainous A. 1993. Physicians' productivity and teaching responsibilities. Academic Medicine. 2:166-167

Panagro L. 1999. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 74:1203-7.

 

ten Cate O, Durning S. 2007. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 29(6):591-9.

 

Secomb J. 2008. A systematic review of peer teaching and learning in clinical education. J Clin Nurs. 17(6):703-16

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