Post on 24-Jul-2020
Thank you for viewing this presentation.
We would like to remind you that this material is the property of the author.
It is provided to you by the ERS for your personal use only, as submitted by the
author.
2016 by the author
Principles of teaching and learning: a practical perspective
Dr. Walther N.K.A. van Mook Internist-intensivist,
Chair of Professional Behaviour Committee Faculty of Health, Medicine and Life Sciences
Maastricht University Medical Centre
Conflict of interest disclosure I have no real or perceived conflicts of interest that relate to this presentation.
This event is accredited for CME credits by EBAP and EACCME and speakers are required to disclose their potential conflict of interest. The intent of this disclosureis not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial productsor services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remainsfor audience members to determine whether the speaker’s interests, or relationships may influence the presentation. The ERS does not view the existence of theseinterests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation. Drug or device advertisement is forbidden.
Outline
societal changes and professonal role changes
curriculum changes and changes in concepts of medical education
the Three C’s of medical education, consequences medical school/workplace
learning styles, retention of what is learned
competency based training and importance of context
learning climate
take home messages
internal quality control (re)registration
higher demands patient(organisations)
‘shared care’, ‘care’ vs ‘cure’, teamwork
costs
healthcare management
philosophy patientcare patients/doctors
(r)evolution informationtechnology
knowledge skills, technology
complexity of care
private vs professional life part-time work
attitude
WBIG, WGBO hours restriction
external quality control legislation
feminisation
2005
cardiac surgery Nijmegen
errors, patient safety
Societal changes
Contemporary professional
Accountable to others
Partnership model, teamwork
Shared decision making
Evidence-based practice
Continuous professional development mandatory
External quality control
Knowledge and information overload
Care
Art
Traditional professional
Accountable to oneself
Solo, individual
Decision made by doctor
Experience-based practice
Attention to professional development lacking
Internal quality control
Very gradual increase in knowledge and information
Cure
Science
Present Past
Professional role changes
Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.
Or….
Lit. Chantler. Lancet 1996:353: 9159: 1178-81
Traditional to integrated curricula
Traditional curriculum
teacher-centred determined by disciplines, departments and deans no over-all design, no integration theory/practice few educational formats
Integrated curriculum
student-centred determined by societal needs and graduate profile thematic, modular structure variety of educational formats
Changes in concepts of ME
Teaching Transfer of knowledge skills professionalism context to context
Individual learning Isolated knowledge Theoretical knowledge
Learning Construction of knowledge
Collaborative learning Contextual learning Theory and practice + application in practice + problem solving
How?
More authentic problems
Increasing complexity
Real life projects
Authentic assessment C ontextual
C onstructive C ollaborative
Context influences learning
influence of social pressure
average pressure, average task: correlation 0.41 strong pressure, difficult task: correlation 0.31
9% of variance of person’s behaviour determined by individuals attitude!
akrasia
challenge not ‘hard’ cases
tempting to leave the clearly visible path, driven by day-to-day routine (fatigue, hunger, stress etc)
Lit.:Acad Med 2007 82(1): 46-50 Rees; BMJ 1995 311(6998): 182-4 Mays
Importance of context
Lit.: Rev Gen Psych 2005 9: 214-227 Wallace
Professional lapse
How?
Less direction
Increasing independent learning
More demand driven
Portfolio assessment; self/peer assessment C ontextual
C onstructive C ollaborative
How?
Smaller groups
Group assignments
More ICT support
Learning task = assesment; include group work in assessment C ontextual
C onstructive C ollaborative
Consequences medical school
skills labs small group sessions problem-orientated experience-based early introduction of patients student-centred teacher-guided
Consequences workplace?
ideal environment for learning motivating authentic directed towards practical application direct observation/feedback many different tasks variety of patients
Workplace based learning
learning by doing on the job training job-embedded learning
What the literature tells us…
limited observation
limited supervision
limited direct feedback many routine tasks depending on patient mix in the department learning by doing, see one, do one, teach one learning from near accidents role models not always ideal relative lack of attention for generic competency
domains
Other lessons….
Effective experiential learning requires deliberate practice feedback reflection workplace should be more structured role modeling/role of teacher domain independent skills, e.g. PB
Kolb cycle (1983)
Learning phases and styles
concrete experience starts by experiencing: activists
reflective observation reserved, tests the water: reflectors
abstract conceptualising explanatory models, concepts, constructs:
theoretisists active experimenting: test theory in practice: pragmatists
Four learning styles
Perception/processing continuum
And…
not always in the same order we learn differently we tend to enter the cycle at preferred points
not always in the same degree/intensity we learn best if we move thru the cycle
we all learn from our own experience origin of the typical styles distinction thinker, doer
Four typologies
Also specialty dependent?
The cone of learning
.
Participatory Teaching Methods
Passive Teaching Methods
National Training Laboratories, Bethel, Maine, USA Bales, E. 1996
An itterative process
Experiencing/acting
Reflection on action
Conceptualisation of essential aspects
Develop and choose alternatives
Apply to new contexts and situations
1 5
2
3
4
Korthagen, F.A.J. (2002)
Applicable the workplace
discipline-orientated curricula
theme-orientated curricula
problem-orientated curricula
competence-orientated (or outcome- directed)
Back to history….
Nowadays….
• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional
• American (ACGME) structure Patient care Medical knowledge Practice-based learning
& improvement Interpersonal and
communication skills Professionalism Systems-based
practice
Nowadays….
• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional
31
An overarching competence?
Classical CanMEDs flower Modifications van Mook/van Luijk
All professionals are experts, but not all experts are professional!
farmer sports public maintenance
doctor conductor businessman
Generic?
Paraguay Punjab Jordan
Malaysia United States Spain
Generic?
Most important….
• patient mix/exposure to practice • opportunities for supervised/independent examinations • supervision and feedback received • organisation quality • limited number of students at one time • educational sessions • positive attitude of staff towards students • student being part of a team
Measures to improve effectiveness….
student study guides/navigation plan ‘teach the teacher’ trainings/FDPs more direct observation and feedback include protected time for selfstudy integration of learning and assessing in the workplace by using mini-CEX, logbooks etc.
Hallmarks of a good teacher.
.
is critical provides and aks for feedback respects the trainee schedules time for educational issues contributes/creates a safe learning
environment is enthousiastic stimulates gradual independence modeling, coaching, fading
• stimulates reflection
Boendermaker, P.(2003)
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Cognitive apprenticeship Cognitive apprenticeship
Modelling Exploration
Reflection Articulation
Coaching Scaffolding
Modelling demonstreert, denkt hard op, gedraagt zich als rolmodel
Coaching Observeert, geeft feedback, biedt assistentie
Scaffolding Biedt ondersteuning, stelt het niveau van de student vast,
bouwt ondersteuning geleidelijk af
Articulatie Stelt vragen aan de student
en stimuleert de student om zelf vragen te stellen
Reflectie Stimuleert student te reflecteren op zijn sterktes/zwaktes
Exploratie Stimuleert student om leerdoelen te formuleren Learning climate
Collins, Brown & Newman, 1989 Stalmeijer, 2011
Learning climate
Learning and teaching climate
.
D-RECT: Dutch Education Climate Test: 11 factors, 50 questions
MCTQ: Maastricht Clinical Teaching
Questionnaire: 5 factors, 21 questions
Team Q
Plos One 2014 Slootweg et al: Team Q Med Teacher 2011 Boor et al: D-RECT Acad Med 2010 Stallmeijer et al: MCTQ
medical school
student
residency
resident
life long learning
specialist
cooperation/teamwork working climate non-compliance guidelines errors complaints
Evidence? (literature study)
Lit. Med Educ 2005 Stern; NEJM 2005 Papadakis; Ann Int Med 2008 Papadakis
Learning curve….
Communication problems
Knowledge/skilss problems
Maslow, A. H. (1954)
Take home messages
.
clear navigational plan for students/teachers faculty development programmes specific and generic skills informal, experience based learning,
complemented with formal sessions observe, feedback, reflect, discuss gradual independence complement with assessment safe learning climate
“It may not be a perfect wheel, but it’s a state-of-the-art wheel.”
End
Walther N.K.A. van Mook MD PhD Internist-intensivist Department of Intensive Care Maastricht University Medical Centre+ P. Debyelaan 25 PO Box 5800 6202 AZ Maastricht, Netherlands E-mail: w.van.mook@mumc.nl
Copyright