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The following are different types of techniques used in medical education:

The characteristics of the above types of teaching with reference to their efficiency, use of active learning, and the degree of feedback representing real life scenarios, are given below:

1-to-1 teaching

This provides the setting for close and behavioural observation between the teacher and the learner.  It gives the ability for the teacher to customise the needs of the learning exercise to those of the learner.  This close interaction enables an individualised learning plan to be formulated.  Learners value the feedback highly.  This type of teaching encourages reflection and honesty on the performance by the learner.

With multiple sittings, it is possible to monitor the progress of the learner and to continually identify deficiencies that they may have.  In summary, 1-to-1 teaching is highly inefficient; however it provides an excellent learning environment.

Problem-based learning is a technique used for small group adult learners.  An unsolved problem or clinical scenario is given to the students.  The students then use triggers from the scenario to define their own learning objectives.  The learning objectives then lead to independent self-directed study.  After a period away from the group, they return to discuss the acquired knowledge.  This technique facilitates knowledge acquisition between members of the group and also facilitates other core skills such as:

This technique ensures all students are exposed to the same problems.  The group usually contains eight to ten students with a tutor who facilitates and manages the group.  All students have a role to play.  During group discussions the students elect a chair of the group and various other group positions such as scribe in order to play out the problem-based learning session.  It is important that the learning objectives are appropriate to the stage of training for the students.

• Student-centred
  
  
• Produces generic competencies
  
  
• Deep active learning
  
  
• Utilises a constructive approach
  
  
• Develops other core skills

• More staff are required therefore the exercise can be inefficient
  
  
• Information overload
  
  
• Problems with the group dynamics
  
  
• Does not work if not facilitated properly by the tutor
  
  

There is no recognised evidence to suggest that problem-based learning delivers superior results when compared to other forms of teaching.

The roles of the teacher, the learner and the outcome from the learning exercise are described below.  This is also described as a learning cycle.  Essentially the teacher uses the curriculum as the backbone and sets the learning objectives for the group. He then selects the teaching method required and decides on the method of assessment to see that the learning objectives have been met.  This leads to a learning experience where the three core components are embedded.  These are:

Following the learning experience the students are assessed against the learning objectives.  Feedback is then gained on the whole learning cycle.  Any input from feedback is then passed back to the teacher so that the curriculum may be updated.

Different learning objectives may be selected in the future as well as an alternative teaching method used.  This process is analogous to the audit cycle so a constantly improved teaching session evolves.

This is defined as ‘the art and science of helping adults learn’ and forms the basis of the adult learning theory.

This is where the learner accepts personal responsibility for learning.  It is highly dependent on self-efficacy, being based on how the learners make judgment calls on their learning. 

The internet can be used to create a virtual learning environment.  Different methods used include:

·         Immediate feedback on performance

·         Self-assessments by MCQ are economically possible

·         Use  of remote sites means that study can be performed at home

·         Efficient use of staff time

·         Security. Passwords can be shared amongst students

·         Authentication of users’ work

·         Hardware for students. The students need computers and internet access

·         Cost in setting up can be substantial

Can you draw a graphical representation of the learning cycle?

Teaching small groups provides more structure to the learning exercise for the students but there are inherent problems.  Problems may occur when the teacher talks too much, students don’t prepare for the exercise and when one student blocks the discussion. 

There are various ways to approach teaching small groups which are mainly based around the organisational structure of the students and their sitting positions. It is likely as a consultant that you will be teaching adult learners (trainees) and as a result most of your work will involve setting the discussion topics and facilitating the learning sessions.

Facilitation is a skill that is gained with practice and enables stronger members of a group to pass (facilitate) information to weaker members of the group. The management of group dynamics is also a key feature.

When group numbers become too large for seminar-based teaching the teaching method is altered to deliver the material by the lecture format. 

Lectures are an efficient means of transferring knowledge.  They are not effective for teaching skills or changing attitudes.  The use of handouts is common. Sometimes these are partially filled and contain a summary at the beginning and at the end.  Usually at the end of the lecture, time is allocated to ask questions and promote discussion.

Bligh in 2000 published a study in a medical education journal that compared two types of lecturing techniques.  The first lecture was a typical lecture where the mass transfer of information occurred.  The second lecture was however interrupted at regular intervals when students were asked questions on the subject matter by the lecturer.  This had the effect of stimulating the students during the lecture and this study showed that the recall of facts was improved using this second approach.  The learning outcome was better when the students were periodically asked questions and stimulated.

As a result of this study I no longer deliver the standard lecture but ask questions to the audience at preset time intervals so that the degree of learning by the students is improved.

Clinical teaching is predominantly focused on patients.  However, this poses problems such as:

·         The consultant may be unfamiliar with the level of training of the student

·         The lack of a clearly identified curriculum in some instances

·         The lack of learning objectives

·         Poor learning by passive observation

·         Minimal feedback

·         No time for reflection

·         The opportunistic nature of teaching in the clinical environment - this is also compounded by patients’ consent and refusal

Learning is best when it is an active process.  This is when the student is actively involved in the teaching exercise and does not learn by passive observation. They need to be involved.

There are different formats in which information can be taught.  These include using:

Assessment is a process by which students are examined in order to see if they have acquired the learning objectives.  There are various types of assessment which include:

This is essentially the old written examination where candidates have a certain period of time to answer set questions on an examination paper.  The answers are collected and marked against a template of desired content.  The answer is then allocated a score.

There are however various problems with written assessments.  What is the reliability to the question?  This refers to the accuracy with which a score is determined. What is the validity of the question?  Does the question test what it was said to test?

There are various types of written assessment including multiple choice questions, short answer questions and essays.

This is a nightmare question for the unprepared candidate but a very slick and professional answer is shown below:

In order to judge competence, information from as many aspects of a clinician’s performance as possible are assessed. This information can be gathered from:

These form part of the learning portfolio where information on knowledge, clinical performance and attitude can be looked at to assess and award competence.

The Objective Structured Clinical Examination (OSCE) has been developed over the years and can reliably measure clinical skill.  It is based on a circuit of stations where various pieces of curriculum and skills can be assessed.  For example history taking, communication, resuscitation, data interpretation, clinical examination and clinical procedures can all be assessed.  It is a successful method to measure the knowledge, skills and judgment which are required to gain clinical competency.  This form of assessment fills the gap that written tests cannot assess.