Clinical Teaching. How hard can it be?

Dr Vicky Gunn

Learning and Teaching Centre

• How hard can it be?

• What attributes, attitudinal qualities make a good clinical teacher?

Simple answer: just about as hard as it gets:

• Attributes needed:

1. Practical expertise;

2. Concentration to perform clinical requirement;

3. Knowing what you want, in terms of learning, from a given clinical situation;

4. Motivational approaches;

5. Ability to explain difficult concepts;

6. Being interested in the subject;

7. Showing compassion and caring;

8. Recognizing serendipitous opportunities.

Required all at once

And need to be expressed in ways students can ‘receive’ them.

Then, of course, there’s the patient.

• Clinical teacher must also be clinical supervisor

Tension

Underneath these attributes:

• Personal conception of roles and responsibilities as a teacher:

• Continuum or opposites?

Research suggests:

• Those who focus on technical expertise alone as making a ‘good instructor’ receive lower evaluation ratings than those who conceived their roles as integrating technical expertise and interpersonal communication for learning.

Chambers, et al (2004)

Clinical teaching is an amalgam of:

Common concerns

• Accurately assessing level of students’ knowledge, skills, attitudes;

• Knowing how much students’ can actually take-in;

• Managing useful questioning (sometimes in stressful situations);

• Knowing the curriculum well-enough to link what happens in clinic to relevant learning outcomes.

• ?

Emotions, feedback, and learning

• Negative feedback - personality or ability related - may affect self-efficacy and motivation;

• Emotional tone of the feedback is critical.

Students:

“appreciate feedback which is accurate, comprehensive and systematic, and provided in a positive emotional environment.” Fugill (2005)

Professional congruence characterized by:

• Space for spontaneity • Remaining open or non-defensive – even

when feeling under pressure (difficulty in real-time clinical setting)

• Being consistent – avoiding differences between: - personal values and professional behaviour;

- personal thoughts and what is actually said to students, remaining respectful and reasonably tactful, whilst avoiding hidden messages.

Common underlying or hidden judgements:

• ‘I’m judging you as a person, not you as a potential professional colleague’;

• ‘I’m in charge and don’t you forget it’; • ‘I don’t give a damn about you’; • ‘I’m superior to you’; • ‘My mind is made up. Nothing you can say

will alter it’.• ‘You’re a [normally a word relating to

gender, age, ethnicity, sexual orientation, disability]…, you shouldn’t be here.’

Areas for your self-assessment…..

can help you when thinking of:

1. What the students need to learn;

2. Just how complex the situation is

3. How much more you know about a given situation than you realise (meta-knowledge)

What about the students?

• What attributes, attitudinal qualities make a good learner in a clinical situation?

Student interaction and behaviour?

• Confidence (lack of) in presence of a patient (self-regulating behaviour)

• Relationship with you, expectations of you?

• ?

References

• Chambers, D. W., Geissberger, M., Leknius, C. (2004) Association amongst factors thought to be important by instructors in dental education and perceived effectiveness of these instructors by students. European Journal of Dental Education. 8(4):147-15.

• Fugill, M. (2005) Teaching and learning in dental student practice. European Journal of Dental Education, 9: 131-136.