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Essential Skills for a Medical Teacher

Essential Skills for a Medical Teacher

Ronald M Harden | Jennifer M Laidlaw


Additional Information

Book Details


Essential Skills for a Medical Teacher is a perfect introduction for new teachers to the exciting opportunities facing them, whether they are working in undergraduate, postgraduate or continuing education. It will also be of considerable use to more experienced teachers to review and assess their own practice and gain a new perspective on how best to facilitate their students' or trainees' learning. The contents are based on the authors’ extensive experience of what works in medical education, whether in teaching and curriculum planning or in the organisation of faculty development courses in medical education at basic and advanced levels.

  • The text provides hints drawn from practical experience to help teachers create powerful learning opportunities for their students, providing readable guidelines and introducing new techniques that potentially could be adopted for use in any teaching programme.
  • Throughout the book introduces some key basic principles that underpin the practical advice that is given and which will help to inform teaching practice.
  • This book will assist readers to reflect on and analyse with colleagues the different ways that their work as a teacher or trainer can be approached and how their student or trainee's learning can be made more effective.
  • Medical Education is changing rapidly and this new edition takes full account of a number of important recent developments.
  • The text is fully updated after a thorough review of the medical education literature.
  • Five new chapters are incorporated:
    • The teacher is important
    • Collaborations in the delivery of the education programme
    • The authentic curriculum
    • Student engagement
    • Inter-professional education

  • New concepts added to the book include:
    • Content specification as ‘threshold’ concepts
    • Entrustable professional activities as an approach to outcomes
    • Longitudinal integrated clinical clerkships as part of clinical teaching
    • Integration of basic and clinical sciences

  • Refinement and expansion of the FAIR principles
  • Additional references to further reading.

Table of Contents

Section Title Page Action Price
Front Cover cover
Essential Skills for a Medical Teacher i
Copyright Page iv
Table Of Contents v
Foreword ix
Preface xi
About the Authors xiii
Acknowledgements xv
1 The ‘Good Teacher’ 1
Section 1 text 1
1 The teacher is important 3
The curriculum, the student and the teacher 3
The teacher matters 4
The necessary attributes can be learned 4
Motivation for teaching 6
2 The different faces of a good teacher 9
What is required of a good teacher 9
The good teacher embodies a range of abilities 9
The technical competencies of a good teacher 11
How a good teacher approaches their work 11
The good teacher as a professional 12
3 Understanding basic educational principles 15
Be FAIR to your students 15
Feedback 16
Activity 18
Individualisation 20
Relevance 23
4 Being an enthusiastic and passionate teacher 27
What is a passionate teacher? 27
Does it matter? 28
Every teacher can be a passionate teacher 28
Teacher stress and burn out 30
5 Knowing what works best 33
A ‘PHOG’ approach 33
Evidence-informed teaching 34
What is evidence? 35
Searching for evidence 35
Evaluating evidence 36
Best evidence medical education 37
Judgement, intuition and teaching 38
6 Collaborating and working as a team 41
Collaboration is important 41
Collaboration between teachers within a medical school 42
Collaboration with others within your institution 42
Collaboration between the different phases of medical education 42
Collaboration with other healthcare professionals 44
Collaboration with other stakeholders 44
Collaboration between teachers with the responsibility for a similar programme locally, nationally or internationally 44
Collaboration in practice 45
7 Checking your performance as a teacher and keeping up to date 49
Teaching as a professional activity 49
Enquiring into your own competence 50
Keeping up to date 51
Scholarship in teaching 53
2 What the Student Should Learn 55
Section 2 text 55
8 The move to an outcome/competency-based approach 57
An important trend in medical education 57
What is outcome/competency-based education? 58
Why an outcome/competency-based approach? 59
Myths and concerns about OBE 61
Myth One: OBE is concerned with detail and the big picture may be missed 61
Myth Two: OBE is a threat to the autonomy of the teacher and removes their freedom and independence 61
Myth Three: OBE is contrary to trends in medical education 61
Myth Four: OBE is about minimum competence and excellence is ignored 62
Myth Five: OBE is labour-intensive and the time required cannot be justified 62
Entrustable Professional Activities (EPAs) 62
What is an EPA? 62
Granularity and EPAs 63
Relationship between an EPA and learner outcomes and competencies 63
EPAs and specification of the level of supervision 64
EPAs and the curriculum 64
9 Specifying the learning outcomes and competencies 67
Who is responsible? 67
Involvement of stakeholders 68
Approaches that can be adopted 69
Focus group and nominal group technique 69
The Delphi technique 69
A critical incident survey 69
Studies of errors in practice 70
Task analysis 70
Interviews with recent graduates 70
Study of existing curricula and publications 70
A mixed economy 70
10 Describing and communicating the learning outcomes and competencies 73
Learning frameworks 73
Criteria for a learning outcome framework 73
The Dundee three-circle outcome model and the ‘Scottish Doctor’ framework 74
The CanMEDS Physician Competency Framework 75
The Accreditation Council for Graduate Medical Education (ACGME) 75
The Brown Abilities 76
Global Minimum Essential Requirements (GMER) 77
General Medical Council UK 77
11 Implementing an outcome-based approach in practice 81
The ostriches, the peacocks and the beavers 81
Implementing an OBE programme 81
Student progression in an OBE curriculum 82
Implementation guidelines 82
An OBE implementation inventory 83
3 Curriculum Development 87
Section 3 text 87
12 The ‘authentic’ curriculum 89
The concept of a curriculum 89
The ‘authentic’ curriculum – from university to the real world 89
The planned, the delivered and the learned curriculum 92
13 Ten questions to ask when planning a curriculum 95
The ten questions 95
What is the medical school or training programme’s vision or mission? 95
What are the expected learning outcomes? 96
What content should be included? 96
How should the content be organised? 97
What educational strategies should be adopted? 97
Student-centred/teacher-centred 98
Presentation-based/information-orientated 98
Integrated/discipline-based 98
Community-based/hospital-based 98
Elective/uniform 98
Systematic (planned)/apprenticeship (opportunistic) 99
What teaching methods should be used? 99
The teacher’s toolkit 99
How should assessment be carried out? 99
How should details of the curriculum be communicated? 100
What educational environment or climate should be fostered? 100
How should the process be managed? 101
14 Sequencing curriculum content and the spiral curriculum 103
The importance of sequencing 103
Guidelines for sequencing 103
Basic and clinical sciences 104
A spiral curriculum 104
Progression 106
Transition between courses 106
15 Student engagement and a student-centred approach 109
The move from teacher-centred to student-centred learning 109
Reasons for the move 109
What is student-centred learning? 111
Students take responsibility for their own learning 111
Study guides 112
Learning is personalised to the needs of the individual student 112
A shift of power relationship from the teacher to the student 113
16 Building learning around clinical problems and presentations 117
The importance of the clinical problem in student learning 117
Problem-based learning (PBL) 118
What is PBL? 118
The PBL continuum 119
The context for PBL 119
Task-based learning (TkBL) 119
What is task-based learning? 119
TkBL in a clinical setting 120
Implementation of TkBL 120
Clinical presentations 121
A curriculum cube 121
17 Using an integrated approach 125
A move to an integrated curriculum 125
Advantages of integration 126
Focus for integration 127
The integration continuum 127
Step 1 – Isolation 127
Step 2 – Awareness 127
Step 3 – Harmonisation 128
Step 4 – Nesting 128
Step 5 – Temporal coordination 128
Step 6 – Sharing 128
Step 7 – Correlation 129
Step 8 – Complementary 129
Step 9 – Multi-disciplinary 129
Step 10 – Inter-disciplinary 129
Step 11 – Trans-disciplinary 129
18 Interprofessional education (IPE) 131
A move to IPE 131
Principles of interprofessional learning 131
Continuum of interprofessional education 132
Implementation in practice 132
A vision for IPE 132
An implementation strategy 133
Tackling a negative mindset 133
19 The apprenticeship, community-based education, longitudinal clinical clerkships and work-based learning 135
The apprenticeship model 135
Trends in curriculum planning 135
Community-based education 136
What is community-based education? 136
Rationale for community-based education 136
Urban and rural settings 136
Implementation of community-based learning 137
Longitudinal integrated clerkships (LICs) 137
The problem with the traditional clinical clerkships 137
Features of a LIC 138
Implementation of LICs 138
Work-based learning 138
What is work-based learning? 138
Principles of work-based learning 139
Advantages of WBL 139
Implementation of WBL 140
Problems and pitfalls of WBL 141
20 Responding to information overload and building options into a core curriculum with threshold concepts 145
The problem of information overload 145
Responding to the problem 146
A core curriculum with options or student-selected components 146
Advantages of a core curriculum with SSCs 146
Specification of a core curriculum 147
Threshold concepts 148
Key characteristics 148
The importance of threshold concepts 149
Electives/SSCs 149
Choice of SSC topics 149
Assessment of SSCs 150
Integration of SSCs with the core 150
21 Recognising the importance of the education environment 153
What is the learning environment 153
The education climate is important 153
Aspects of the education environment 155
Collaborative or competitive orientation 155
Student or teacher orientation 155
Supportive or punitive orientation 155
Community or hospital orientation 155
Research or teaching orientation 156
The effects of the environment 156
Assessment of the education environment 156
The use of environment measures 157
22 Mapping the curriculum 159
The need for a curriculum map 159
What is a curriculum map? 159
Curriculum mapping is on today’s agenda 159
Potential users of the curriculum map 160
Preparing a curriculum map 162
4 Styles of Teaching 165
Section 4 text 165
23 The lecture and teaching with large groups 167
The use of lectures 167
Problems with lectures 167
When to use lectures 168
Delivering a good lecture 168
Get some facts in advance 169
Think about the content and structure 169
The introduction to the lecture 169
Visual aids 170
Engaging the audience 170
The close of the lecture 170
Handouts 171
Students’ presence and behaviour at lectures 171
The ‘flipped classroom’ 171
What is a ‘flipped classroom’? 171
Application in medical education 172
Advantages and disadvantages of the flipped classroom 172
Implementation in practice 173
24 Learning in small groups 175
What is small group teaching 175
Role of small group teaching 175
Advantages of small group teaching 176
Problems with small group teaching 176
Techniques used in small group work 177
Implementing small group work 178
Before a small group activity 178
During a small group activity 179
After the small group activity 180
Team-based learning (TBL) 180
What is TBL? 180
Implementation of TBL 181
25 Independent learning 183
The importance of independent learning 183
Benefits for the student 184
Independent learning in the curriculum 184
Time allocated for independent learning and scheduling in the curriculum 184
Directed self-learning and the role of the teacher 185
Study guides 185
Learning resources 186
26 Teaching and learning in the clinical context 189
Changing perceptions of clinical teaching 189
The student 190
The teacher 190
The patient 191
Teaching procedural skills 192
Student progression 192
Planning and implementing 192
Clinical supervision 193
27 Simulation of the clinical experience 195
Reasons for simulation 195
Simulating ‘real’ patients 196
Simulated patients 196
Recruiting and training simulated patients 197
Simulators (manikins and models) 197
Virtual patients 199
Uses of virtual patients 199
Advantages of using virtual patients 199
Choice of simulation 200
Clinical skills centres 200
28 E-learning 203
A move to e-learning 203
E-learning activities 203
Reasons for adopting e-learning 204
Educational features 204
Distributed and distance learning 205
Blended learning 206
E-learning – the educational strategies 207
29 Peer and collaborative learning 211
Recognition of peer-to-peer (P2P) learning 211
P2P learning 211
Collaborative learning 211
Examples of P2P and collaborative learning 212
Benefits to be gained by P2P and collaborative learning 212
Implementation in practice 213
P2P learning 213
Collaborative learning 214
5 Assessment 217
Section 5 text 217
30 Six questions to ask about assessment 219
The importance of assessment 219
Why assess the student? 221
Who should assess the student? 222
What should be assessed? 223
Competency-based assessment 224
How should the student be assessed? 224
Standard setting 226
Programmatic assessment 226
When should the student be assessed? 227
The progress test 227
Where should the student be assessed? 228
31 Written and computer-based assessment 231
Written assessment has a role to play 231
The elements in a written assessment 231
The stimulus 231
The student’s response 232
The assessment of a student’s response 232
Standard setting 233
Types of written assessment 233
Essay questions 233
Short essay questions (SEQs) 233
Short answer questions (SAQs) 234
Multiple choice questions (MCQs) 234
Extended matching questions (EMQs) 234
Modified essay questions (MEQs) 235
Script concordance test (SCT) 235
Situational judgement tests (SJTs) 235
The technology 235
32 Clinical and performance-based assessment 237
The importance of clinical assessment 237
The patient 237
‘Real’ patients 238
Simulated patients 238
Simulators and models 238
Computer-based simulations 239
Approaches to clinical and performance assessment 239
The objective structured long examination record (OSLER) 239
The objective structured clinical examination (OSCE) 239
Mini clinical evaluation exercise (Mini-CEX) 240
Direct observation of procedural skills (DOPS) 241
Case-based discussion (CbD) 241
Multi-source feedback (MSF) or 360 degrees evaluation 241
A portfolio 242
Implementing a clinical assessment 242
A blueprint 242
Selection of methods 242
The examiner 242
A student’s profile 243
Feedback 243
33 Portfolio assessment 247
What is a portfolio? 247
Why portfolios? 247
Advantages 248
Implementing portfolio assessment in practice 249
34 Assessment for admission to medicine and postgraduate training 253
The importance of selection 253
Graduate or direct from school entry 254
Aims of selection 254
Criteria for selection methods 254
Choice of method 255
Academic record and performance at school 255
Autobiographical narrative 255
References 255
Interviews 256
The multiple mini-interview (MMI) 256
General mental ability and aptitude tests 256
Situational judgement tests (SJTs) 256
Personality inventories 257
Selection for admission to specialty training 257
35 Evaluating the curriculum 259
Why evaluate the curriculum? 259
Focus for the evaluation 260
The CIPP approach 260
Value-added assessment 261
The ‘ten questions’ framework for curriculum evaluation 261
Kirkpatrick’s four levels of evaluation 263
Undertaking a curriculum evaluation 264
Index 281
A 281
B 281
C 281
D 283
E 283
F 283
G 284
H 284
I 284
J 284
K 284
L 284
M 285
N 285
O 285
P 285
Q 286
R 286
S 286
T 287
U 288
V 288
W 288