NBMH4143 Teaching For Healthcare Personnel - Caug19

NBMH4143
Teaching for Healthcare Personnel

NBMH4143
TEACHING FOR
HEALTHCARE
PERSONNEL
Assoc Prof Dr Lim Pek Hong
Copyright © Open University Malaysia (OUM)

Project Directors: Prof Dr Widad Othman
Prof Dr Siti Aishah Hashim Ali
Open University Malaysia
Module Writer: Assoc Prof Dr Lim Pek Hong

International Medical University
Moderator: Prof Dr T K Mukherjee

Enhancer: Mispan Mangon

Developed by: Centre for Instructional Design and Technology

First Edition, August 2019 [NBBS1304, April 2018 (rs)]

Copyright © Open University Malaysia (OUM), August 2019, NBMH4143
All rights reserved. No part of this work may be reproduced in any form or by any means without
the written permission of the President, Open University Malaysia (OUM).

Table of Contents
Course Guide xiăxvii
Topic 1 Aspects of Education in Healthcare 1

1.1 Dimensions of Educational Process in Healthcare 2
1.2 Elements of Educational Process 3
1.3 Philosophy of Teaching in Healthcare Personnel 4
1.4 Teaching Role of the Healthcare Personnel 5
1.4.1 Teaching Patients and Their Family Members 6
1.4.2 Teaching Healthcare Staff and Learners 9
1.5 Characteristics of Learners 11
1.5.1 Every Learner is an Individual 12
1.5.2 Prerequisite Knowledge, Skills and Attitude 12
1.5.3 Sociocultural Background 12
1.5.4 Educational Level of the Learner 13
1.5.5 Age of the Learner 13
1.5.6 Additional Factors 13
1.6 Conditions or Environments for Learning 15
1.6.1 Learning in Clinical Setting versus Classroom 15
Setting
1.6.2 Conditions of Learning in the Clinical Area 16
Summary 18
Key Terms 19
Assessment 19
References 19
Topic 2 Curriculum Design and Development 20

2.1 Curriculum Development 21
2.2 Factors that Influence Curriculum Development 22
2.2.1 Societal Needs 22
2.2.2 Political Factors 23
2.2.3 Learner Needs 23
2.2.4 Resources and Facilities 24
2.2.5 Subject Specialists 24
2.2.6 Professional Standards 24
2.2.7 Philosophy of Education 25
2.2.8 Theories of Learning 25

iv  TABLE OF CONTENTS
2.3 Curricular Cycle 27

2.4 Stages in Curriculum Planning 29
2.4.1 Stage 1: Directive Stage 29
2.4.2 Stage 2: Formative Stage 29
2.4.3 Stage 3: Functional Stage 30
2.4.4 Stage 4: Evaluative Stage 30
2.5 Curriculum Design and Planning 30
2.5.1 Educational and Professional Context 31
2.5.2 Learning Outcomes 34
2.5.3 Learning Objectives 34
2.5.4 Classifying Objectives 35
2.6 Curriculum Development ăStrategies and Models 37
2.6.1 Strategies in Curriculum Development 37
2.6.2 Curriculum Development Models 40
2.7 Elements of the Curriculum 43
2.7.1 Aims and Learning Outcomes or Objectives 44
2.7.2 Content 46
2.7.3 Teaching and Learning Methods 47
2.7.4 Assessment Methods 48
2.8 Pre-testing or Pilot Testing the Curriculum 49
2.9 Monitoring and Evaluating the Curriculum 50
2.9.1 Methods of Monitoring Curriculum 50
Implementation
2.9.2 Evaluation 51
Summary 52
Key Terms 53
Assessment 53
References 54
Topic 3 Clinical Teaching 56

3.1 Clinical Tutoring or Teaching 57
3.1.1 Principles of Clinical Teaching 58
3.1.2 Percepting and Your Practice 58
3.1.3 Teaching and Learning Situations 59
3.2 Strengths of Clinical Teaching 60
3.2.1 Problem-centred Learning 60
3.2.2 Experiential Learning 61
3.2.3 Individual and Team Learning 61

TABLE OF CONTENTS  v
3.3 Roles of Clinical Teachers/ Preceptors 62

3.3.1 Teaching by Role Modelling 62
3.3.2 Role as a Coach 65
3.3.3 Role as a Supervisor 69
3.3.4 Role as a Facilitator 69
3.3.5 Role as a Counsellor 70
3.3.6 Role as a Mentor 71
3.4 Assessing Learning Needs in Clinical Setting 73
3.4.1 What to Achieve? 74
3.4.2 When to Assess? 76
3.4.3 Who to Assess? 77
3.4.4 Assessment Linked to the Course/Programme/ 78
Professional or Regulatory Body
3.4.5 Tools for Assessing Educational Needs 79
3.5 Preparation and Planning for Clinical Teaching 80
3.5.1 Preparing for the Day 80
3.5.2 Planning for Clinical Teaching: The Basics 81
3.6 Relationship with the Patient or Client 83
3.7 Feedback 84
3.7.1 Giving Feedback 84
3.7.2 Receiving Feedback 85
3.7.3 Benefits of Giving and Receiving Effective 86
Feedback
Summary 86
Key Terms 87
Assessment 87
References 88
Topic 4 Preparing for Clinical Teaching Sessions 90

4.1 Identifying Learning Needs of Patients 91
4.2 Educational Models 94
4.3 BloomÊs Taxonomy of Learning Domains 96
4.3.1 Domains of BloomÊs Taxonomy ă An Overview 96
4.3.2 Domains of BloomÊs Taxonomy ă Detailed 98
Structures
4.4 Preparing For Clinical Teaching Sessions 103
4.4.1 Overview of Instructional Objectives 104
4.4.2 Setting Learning Outcomes 107

vi  TABLE OF CONTENTS
4.5 Planning a Teaching Plan 110

4.5.1 Characteristics of a Good Lesson Plan 110
4.5.2 Stages of a Lesson Plan 111
Summary 116
Key Terms 117
Assessment 117
References 118
Topic 5 Preparing a Lesson Plan 119

5.1 What is a Lesson Plan? 120
5.2 Purpose of a Lesson Plan 120
5.3 Basic Lesson Plan Model 121
5.3.1 What are Instructional Methods? 124
5.3.2 What is Teacher-centred Approach? 124
5.3.3 What is Learner-centred Approach? 124
5.4 Components of a Lesson Plan 125
5.4.1 Preparing a Lesson Plan for Theory or Knowledge 127
Session
5.4.2 Preparing a Lesson Plan for Skills Teaching 128
5.4.3 Illustration of Tasks in Lesson Planning 129
Summary 141
Key Terms 141
Assessment 142
References 142
Topic 6 Conducting Teaching 144

6.1 Presentation Skills 145
6.2 Microteaching 147
6.2.1 Process of Microteaching 148
6.2.2 Benefits of Microteaching 149
6.2.3 Peer Observation and Evaluation 150
6.3 Micro-teaching Skills 151
6.3.1 Setting Induction 152
6.3.2 Probing Questions 153
6.3.3 Explaining 156
6.3.4 Illustrating with Examples 157
6.3.5 Reinforcement 158
6.3.6 Stimulus Variation 160
6.3.7 Classroom Management 164
6.3.8 Closure 166

TABLE OF CONTENTS  vii
6.4 Advantages of Microteaching 167

6.5 Audio-visual Teaching Aids 168
6.6 Qualities of a Teacher 170
6.6.1 Characteristics of a Good Teacher 170
6.6.2 Roles of a Teacher 171
Summary 173
Key Terms 174
Assessment 174
References 175
Topic 7 Evaluation in Healthcare Education 176

7.1 Definitions and the Meaning of Evaluation 177
7.2 Purpose of Evaluation in Healthcare Education 178
7.3 Characteristics, Components and Principles of Evaluation 179
7.3.1 Characteristics of Evaluation 179
7.3.2 Components of Evaluation 182
7.3.3 Principles of Evaluation 182
7.4 Types of Evaluation 182
7.4.1 Formative Evaluation 183
7.4.2 Summative Evaluation 183
7.5 Classification of Evaluation 184
7.6 Techniques of Clinical Evaluation 185
7.6.1 Checklists 185
7.6.2 Anecdotal Records 187
7.6.3 Rating Scales 189
7.7 Objective Structured Clinical Examination (OSCE) 191
7.7.1 How OSCE is Conducted to Evaluate the 191
Competency of Healthcare Personnel
7.7.2 Organisation of the OSCE 192
7.8 Running Assessment 195
7.8.1 Characteristics of Running Assessment 195
7.8.2 Planning for Running Assessments 196
Summary 197
Key Terms 198
Assessment 198
References 198
Answers 200

viii  TABLE OF CONTENTS

COURSE GUIDE  xi
COURSE GUIDE DESCRIPTION

You must read this Course Guide carefully from the beginning to the end. It tells
you briefly what the course is about and how you can work your way through the
course material. It also suggests the amount of time you are likely to spend in order
to complete the course successfully. Please keep on referring to the Course Guide
as you go through the course material as it will help you to clarify important study
components or points that you might miss or overlook.
INTRODUCTION
NBMH4143 Teaching for Healthcare Personnel is one of the courses offered at
Open University Malaysia (OUM). This course is worth 3 credit hours and should
be covered over 15 weeks.
COURSE AUDIENCE
This course is for learners who are enrolled in the Bachelor of Medical and Health
Sciences (Hons) programme.
As an open and distance learner, you should be acquainted with learning

independently and being able to optimise the learning modes and environment
available to you. Before you begin this course, please ensure that you have the right
course materials and understand the course requirements as well as how the
course is conducted.

xii  COURSE GUIDE
STUDY SCHEDULE
It is a standard OUM practice that learners accumulate 40 study hours for every
credit hour. As such, for a three-credit hour course, you are expected to spend
120 study hours. Table 1 gives an estimation of how the 120 study hours could be
accumulated.
Table 1: Estimation of Time Accumulation of Study Hours
Study
Study Activities
Hours
Briefly go through the course content and participate in initial discussions 10
Study the module 40
Attend 5 tutorial sessions 10
Online participation 14
Preparation for micro-teaching sessions 23
Assignment 23
TOTAL STUDY HOURS ACCUMULATED 120
COURSE LEARNING OUTCOMES

By the end of this course, you should be able to:
1. Discuss the teaching function of healthcare personnel;
2. Analyse the components in the curriculum and its relation to each other;
3. Identify factors that need to be considered when planning a teaching session;
4. Demonstrate a teaching session using the selected teaching approach;
5. Evaluate a teaching session based on expected outcomes; and
6. Analyse the teaching role of healthcare personnel.

COURSE GUIDE  xiii
COURSE SYNOPSIS
This course will provide learners with the knowledge, skills and attitudes
necessary to implement the teaching role of a healthcare personnel in the clinical
setting. The course covers subjects pertaining to healthcare education particularly
the emphasis on clinical teaching or precepting. Fundamental to the core issues of
this subject, curriculum design and development as well as BloomÊs taxonomy of
learning domains are precisely discussed to enhance learnersÊ understanding so
that they may undertake the significant role as teachers in the clinical setting.
Learners are provided with sufficient examples of lesson plans for teaching
knowledge and skill-based sessions. All aspects of microteaching are highlighted
to facilitate learners in their micro teaching sessions. The final section of this course
provides learners the opportunity to explore various evaluation methods that are
applicable for teaching and learning in healthcare education.
This course is divided into seven topics. The synopsis for each topic is summarised
as follows:
Topic 1 gives an introduction to the dimensions of educational process in a

healthcare setting. The teaching roles of an assistant medical officer, particularly
in the clinical setting, are discussed with additional input on the characteristics of
learners in the clinical area. The final part of this topic includes a description of the
conditions and environment for learning in the clinical area.
Topic 2 discusses the curriculum design and development in healthcare education.

The stages of curriculum design are discussed systematically so that learners will
be able to make future planning of a curriculum for an allied health sciences
programme.
Topic 3 focuses on the principles of clinical teaching that includes the preceding
assessment of learning needs of the learners ă patients and their family members,
learners and staff. Preparation and planning for a clinical teaching are also
highlighted. Prior to that, teaching by role modelling is also discussed. The topic
ends with the benefits of giving and receiving effective feedback after each clinical
session.

xiv  COURSE GUIDE
Topic 4 initiates the preparation of clinical teaching sessions by identifying the

learning needs of patients and their family members. Prior to setting learning
outcomes, the learners are provided with information on BloomÊs taxonomy of
learning domains.
Topic 5 provides learners with an example of a basic lesson plan model followed
by sufficient examples of lesson plans which are suitable for teaching theory/
knowledge and practical/skill-based subjects.
Topic 6 discusses all aspects of microteaching with major focus on different micro-
teaching skills which will help in facilitating learners during their compulsory
micro teaching session. This segment also incorporates the different types of
audio-visual aids that can be utilised for effective teaching. The final part of the
topic highlights the qualities of a good teacher.
Topic 7 is the final topic of the module. It stresses the importance of evaluation in
healthcare education. It explains the definition, purposes, characteristics,
components, principles, types and classification of evaluation. Finally, it describes
the different tools and methods used for evaluating teaching in the clinical area,
particularly on the concept, purpose and the implementation of the Objective
Structured Clinical Examination (OSCE) including a brief note on running
assessments.
TEXT ARRANGEMENT GUIDE

Before you go through this module, it is important that you note the text
arrangement. Understanding the text arrangement will help you to organise your
study of this course in a more objective and effective way. Generally, the text
arrangement for each topic is as follows:
Learning Outcomes: This section refers to what you should achieve after you have
completely covered a topic. As you go through each topic, you should frequently
refer to these learning outcomes. By doing this, you can continuously gauge your
understanding of the topic.

COURSE GUIDE  xv
Self-Check: This component of the module is inserted at strategic locations

throughout the module. It may be inserted after one sub-section or a few sub-
sections. It usually comes in the form of a question. When you come across this
component, try to reflect on what you have already learnt thus far. By attempting
to answer the question, you should be able to gauge how well you have
understood the sub-section(s). Most of the time, the answers to the questions can
be found directly from the module itself.
Activity: Like Self-Check, the Activity component is also placed at various

locations or junctures throughout the module. This component may require you to
solve questions, explore short case studies, or conduct an observation or research.
It may even require you to evaluate a given scenario. When you come across an
Activity, you should try to reflect on what you have gathered from the module
and apply it to real situations. You should, at the same time, engage yourself in
higher order thinking where you might be required to analyse, synthesise and
evaluate instead of only having to recall and define.
Summary: You will find this component at the end of each topic. This component
helps you to recap the whole topic. By going through the summary, you should be
able to gauge your knowledge retention level. Should you find points in the
summary that you do not fully understand, it would be a good idea for you to
revisit the details in the module.
Key Terms: This component can be found at the end of each topic. You should go
through this component to remind yourself of important terms or jargon used
throughout the module. Should you find terms here that you are not able to
explain, you should look for the terms in the module.
References: The References section is where a list of relevant and useful textbooks,
journals, articles, electronic contents or sources can be found. The list can appear
in a few locations such as in the Course Guide (at the References section), at the
end of every topic or at the back of the module. You are encouraged to read or
refer to the suggested sources to obtain the additional information needed and to
enhance your overall understanding of the course.

xvi  COURSE GUIDE
PRIOR KNOWLEDGE
There is no prerequisite requirement for learners prior to taking this subject.
ASSESSMENT METHOD
Please refer to myINSPIRE.
REFERENCES
Adema-Hannes, R., & Parzen, M. (2005). Concept mapping: Does it promote
meaningful learning in the clinical setting? College Quarterly, Vol 8(3) :1ă7.
Anderson, L. W., Krathwohl, D. R., Airasian, P. W., Cruishank, K. A., Mayer, R. E.,
Pintrich, P. R., ⁄ Wittrock, M. C. (2001). A Taxonomy for learning, teaching,
and assessing: A revision of BloomÊs taxonomy of educational objectives.
New York: Longman.
Jarjoura, J. (July, 2003). Mentorship ă A key part of nursing practice. Registered

Nurses Association of Ontario (RNAO) Practice. Vol 2(3) .
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and

development. New Jersey: Prentice-Hall.
Neeraja, K. P. (2006). Textbook of nursing education. New Delhi, India: Jaypee

Brothers Medical Publishers.
Schon, D. A. (1983). The reflective practitioner: How professionals think in action.

New York: Basic.

COURSE GUIDE  xvii
TAN SRI DR ABDULLAH SANUSI (TSDAS)

DIGITAL LIBRARY
The TSDAS Digital Library has a wide range of print and online resources for
the use of its learners. This comprehensive digital library, which is accessible
through the OUM portal, provides access to more than 30 online databases
comprising e-journals, e-theses, e-books and more. Examples of databases
available are EBSCOhost, ProQuest, SpringerLink, Books247, InfoSci Books,
Emerald Management Plus and Ebrary Electronic Books. As an OUM learner, you
are encouraged to make full use of the resources available through this library.

xviii  COURSE GUIDE

Topic  Aspects of
Education in
1 Healthcare
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Discuss the components of dimensions that constitute the process of
education in healthcare;
2. Identify the elements of educative process in clinical teaching;
3. Explain the teaching role of a healthcare personnel in the clinical
area; and
4. Examine the important characteristics of patients and family
members as learners that affect the effectiveness of teaching and
learning in the clinical area.
 INTRODUCTION
The word „education‰ is derived from the Latin words educere (to lead out or to
draw out) and educatio (the act of teaching). Thus, education implies the act of
drawing out, leading, teaching and training.
Education is a process of bringing out the best in learners. It aims to produce

individuals who are well balanced, culturally refined, emotionally stable, ethically
sound, mentally alert, morally upright, physically strong, socially efficient,
spiritually upright, vocationally self-sufficient and internationally liberal.
Education in healthcare profession is task-intensive and involves performance-

based learning whereby non-technical skills, decision making and clinical
reasoning are important alongside integrity, empathy and compassion. Most of
these attributes are difficult to teach and assess in traditional classrooms.
Enhanced patient safety, on the one hand, has to be the ultimate outcome of any

2  TOPIC 1 ASPECTS OF EDUCATION IN HEALTHCARE
medical curriculum while on the other hand, it can be potentially compromised in

an apprenticeship-based model of medical education. Studies by Homeyer,
Hoffmann, Hingst, Oppermann and Dreier-Wolfgramm (2018) state that the
interprofessional education (IPE) has a positive impact on team work in daily
health care profession. To ensure high quality patient care, an effective inter-
professional collaboration between healthcare professionals, IPE promotes inter-
professional cooperation between the medical and the healthcare profession.
1.1 DIMENSIONS OF EDUCATIONAL PROCESS

IN HEALTHCARE
Figure 1.1 show the four dimensions of the educational process in healthcare.
Figure 1.1: Four dimensions of the educational process in healthcare
Let us look closely at the following explanations for each of the dimensions:
(a) Substantive Dimension

This pertains to what is taught and learned according to the curriculum. The
curriculum refers to the content and learning activities planned and directed
by a faculty for a specific group of learners for a particular purpose. Allied
health sciences curriculum is concerned with providing opportunities for
acquiring essential knowledge, skills and attitudes that will prepare learners
to assume the roles, responsibilities and functions in patient care at the level
in which they are being prepared for.
(b) Procedural Dimension

This refers to the way lecturers help the medical and health science learners
to learn. It includes the learner, the group of learners (the class) and the
lecturers, as well as all the methods and procedures used by the learners and
the lecturers.

TOPIC 1 ASPECTS OF EDUCATION IN HEALTHCARE  3
(c) Environmental Dimension

This dimension is related to the capacity of teaching. It includes physical
conditions such as classroom, hospital, ward, unit, skills laboratory and
health agencies as well as the socio-psychological climate based on the type
of institution, administration and organisation of personnel.
(d) Human Relations Dimension

The human relations dimension includes all personnel such as learners,
lecturers, healthcare personnel, patients and others who may participate in
the education of the medical and health science learner. The interactions
(human relations) of these individuals, both in the college and in the
educational setting outside the college, exert an important influence on the
effectiveness of the educational process.
The interactions among all these components of dimensions constitute the process
of education in healthcare.
1.2 ELEMENTS OF EDUCATIONAL PROCESS

An educative process comprises the following:
(a) Why educate ă Includes the aims of education. The aims depend on a host of
factors, namely political, economic, social, geographical, religion and others.
In a nutshell, education must produce socially efficient individuals. Hence,
healthcare education seeks to produce good, efficient healthcare personnel
to serve society.
(b) Whom to educate ă Concerns different types of learners especially those who
need to be motivated to learn the theory and practice of healthcare personnel.
(c) Who will educate ă Emphasises the significant roles and responsibilities of
qualified healthcare lecturers.
(d) Where to educate ă Determines the location where the learners are to be
educated, either in the college (classroom) or in a clinical setting (health
institution or skills laboratory), according to the learning objectives.
(e) What to educate ă According to the content of the curriculum in relation to

knowledge, skills and attitude.
(f) How to educate ă Involves various and appropriate teaching methodologies

to make the teaching-learning process dynamic, effective and inspirational.

1.3 PHILOSOPHY OF TEACHING IN

HEALTHCARE PERSONNEL
The philosophy of teaching in healthcare personnel includes patient-centred
care, interdisciplinary team, evidence-based practice, quality improvement and
informatics. This health education improvement includes those related to
oversight processes, the training environment, research, public reporting and
leadership. Educators, administrators and health professionals need to achieve an
approach to education that better prepares clinicians to meet both the needs of
patients and the requirements of a changing healthcare system (Greiner & Knebel,
2011).
The healthcare personnel is a patient educator and consultant who assists with the
development, implementation and evaluation of a comprehensive programme of
education for patients and families in the healthcare system. The healthcare
personnel also creates a centralised learning environment for patients and their
families, which will enable them to learn about health, illnesses and healthcare
through independent and assisted research.
The function of the healthcare personnel as a teacher for the patients and their
families as well as for peers and colleagues is woven throughout the professional
standards. Healthcare personnel is client-centred and designed to assist the
individuals to achieve and maintain maximum functioning throughout their
lifespan. This is accomplished by utilising the healthcare process, assuming
designated nursing roles and applying theoretical knowledge to the practice
setting.
The practice setting is central to the learning process. Not only does it influence
what is learned but it is also a powerful force in determining the patterns of
providing care, in forming attitudes and perceptions, and in setting goals for
the outcome of care. The teaching environment has to allow for supervised
exploration. The most significant learning occurs in situations that are both
meaningful and realistic. Hence, to make sure learning occurs, the learner must be
given access to the environment where knowledge, attitude and skills will
eventually be adopted.
The keystone in the teaching of healthcare personnel philosophy is significantly

unique as healthcare setting and learning are evolving. Learning is a continuous
process that involves the development of new insights, resulting in behavioural
changes. In order to facilitate this process, the educational methods must enable
learners to learn not only the body of specific knowledge and skills in order to be
a competent professional assistant medical officer but also to think creatively and
become lifelong self-directed learners.

1.4 TEACHING ROLE OF THE HEALTHCARE

PERSONNEL
Healthcare personnel is a caring discipline. In carrying out the professional role as
registered assistant medical officer and in the provision of health care to the
patients, they have a significant role in teaching not only patients but also their
family members as well as their colleagues and learners whom they encounter in
their daily work. This subtopic will explore the role of healthcare personnel as
teachers to their patients, patientsÊ family members, their colleagues and learners
in the clinical area.
As professional healthcare personnel, they have many roles to play. They carry out
clinical, supervisory, administrative, educational, communication and research
activities. One primary role of the healthcare personnel is to care for and ensure
that patients receive the best care so that they can have a good state of health and
well-being. In maintaining this role, the healthcare personnel has to educate, teach
and train patients, their family members, staff and learners to ensure that patients
will be able to care for themselves and that fellow healthcare personnel give safe
competent care to the patients.
Let us go through the teaching role of the healthcare personnel (Figure 1.2) for two
specific groups of people in the clinical setting:
(a) Patients and their family members; and
(b) Professional healthcare staff and learners.
Figure 1.2: Teaching roles of the healthcare personnel

Source: http://www.utusan.com

1.4.1 Teaching Patients and Their Family Members

Teaching refers to activities in which specific objectives or desired behaviour
changes are achieved. It is an interactive process between the teacher and one or
more learners. Patient teaching is inherent in the role of the assistant medical
officer by virtue of the healthcare professional position at the patientÊs bedside.
Shorter hospital stays which require patients to manage the convalescence at home
as well as the emphasis on health promotion and health maintenance rather than
relying on treatment alone have increased the need for patient teaching by
healthcare personnel.
For this reason, healthcare personnel who is caring for a patient has to ensure that
the patient understands his state of health and is able to cope with the bodyÊs
response to his state of ill health. To the extent that the healthcare professional has
to involve himself in teaching the patient not only about his condition but also
about any medication that needs to be consumed by the patient or any procedure
that needs to be carried out by the patient or his relatives when he is discharged
from the hospital. The current trend is to keep a patientÊs stay in the hospital as
short as possible and to teach him to cope with the illness response at his own
home in the presence and support of his family members.
For example, a patient may be admitted with diabetes mellitus and needs to have
his blood sugar monitored using a glucometer. In addition, he will be administered
soluble insulin. The patient or one of his family members may have to learn how
to conduct the glucometer test and administer the soluble insulin using the right
skills and technique.
This is only one example. There are many instances where healthcare professionals
need to teach and prepare patients on how to cope with and adapt to a different
lifestyle after a certain episode in their life that has affected the status of their
health.
For instance, if a baby is born with a harelip, his mother must be taught how to
feed and care for him so that the baby is well fed and grows well before any
corrective surgical intervention is performed on him.
In teaching the patient and family, the healthcare professional indirectly

contributes to the maintenance and promotion of health not only for the individual
and family members but also to the society and community at large.

ACTIVITY 1.1
Clinical teaching is in competition with other teaching modalities that

are easier to plan, including rapidly developing clinical simulation
techniques, often as part of clinical skills centres. Discuss with your
coursemates and share your answer in myINSPIRE online forum.
(a) Facts Related to Patient Teaching
(i) Patient teaching is a function of healthcare personnel and a legal

requirement for healthcare personnel. In some states, teaching is
included in the legal definition of healthcare personnel, making it a
required function of healthcare personnel by law.
(ii) Patient teaching is defined as a system of activities that is intended to

produce learning. These activities should help the patient meet
individual learning objectives. If they do not, the patientÊs needs should
be reassessed and the activities should be replaced by others. For
example, explanation alone may not teach a diabetic patient how to
prepare a syringe for an injection. The act of preparing the syringe may
be more effective.
(iii) Patient teaching is a dynamic interaction between the healthcare

professional (teacher) and the patient (learner). Both the teacher and
the learner communicate information, emotions, perceptions and
attitudes to the other.
(iv) Before learning can occur, a relationship of trust and respect must exist
between the teacher and the learner. The learner trusts that the teacher
has the required knowledge and skills to teach and the teacher respects
the learnerÊs ability to reach the goals. This relationship is enhanced by
communication that is continuous and reciprocal once mutual trust and
respect have been established.
(v) The goal of patient teaching is the patientÊs active participation in

healthcare and his compliance with instructions. Once the healthcare
professional begins instructing a patient (or family/support persons),
the teaching process should continue until the participants reach the
goals, change the goals or decide that the goals will not help meet the
learning objectives.

(b) Common Patient Teaching Mistakes
(i) Ignoring the restrictions of the patientÊs environment ă For example,

the lack of family support, financial resources or cultural issues that
influence healthcare management.
(ii) Failing to accept that patients have the right to change their minds ă
For example, teaching an elderly woman how to check her blood sugar
at home. However, after the lesson she decides she cannot do it and
wants her daughter to learn the procedure.
(iii) Using medical jargon ă This promotes confusion and frustration.
(iv) Failing to negotiate goals ă For example, if a healthcare professionalÊs

goal is to include smoking cessation for the patient after his surgery but
the patient has no intention to stop smoking.
(v) Duplicating the teaching of other team members ă This not only wastes
time but frustrates the patients as well.
(vi) Overloading the patient with information ă This runs the risk of giving
patients more information than they can absorb. The teacher needs to
differentiate important topics from nice-to-know information.
(vii) Choosing the wrong time to teach ă for example, when the patient is in
pain, following a diagnostic examination or surgery.
(viii) Not evaluating what the patient has learned ă For example, when the
teaching is performed at such a rapid pace and the patient knows too
little, thus he is not able to formulate a question.
(ix) Not reviewing the educational media or relying exclusively on media

ă Relying totally on media makes it impossible to individualise patient
teaching or to allow the patient to ask questions or to get feedback from
the patient.
(c) Evaluating Patient Learning

Plan how you will evaluate learning. Evaluation, the last phase of the
teaching-learning process, is the ongoing appraisal of the patientÊs learning
progress. The goal of evaluation is to find out if the patient has learned what
you have taught.

The following are ways of evaluating patient learning:
(i) Observe return demonstrations to see if the patient has learned the
necessary psychomotor skills for a task.
(ii) Ask the patient questions to see whether there is information or skills
that need reinforcing or re-teaching.
(iii) Give simple written tests or questionnaires before, during and after
teaching to measure cognitive learning.
(iv) Talk with the patientÊs family and other team members to get their
opinions on how well the patient is performing the learned tasks.
(v) Assess physiological measurements such as weight and blood pressure

to see if the patient has been able to follow a modified diet plan,
participate in an exercise programme or consume anti-hypertensive
medication.
(vi) Review the patientÊs own record of self-monitored blood glucose levels,
blood pressure or daily weight.
1.4.2 Teaching Healthcare Staff and Learners

As mentioned earlier, the role of the healthcare professionals as a teacher is not
only to teach patients and their families but also to teach their peers and colleagues.
This is putting together the art of healthcare personnel, which significantly allows
assistant medical officers to practise what they have learnt in theory. It is in the
clinical area that assistant medical officers ă both qualified and those under
training ă get the opportunity to have practical experiences in order to be
competent in the healthcare setting. As a registered assistant medical officer
working in the clinical area, you are bound to work with new, inexperienced staff
as well as learners undergoing training in your area of practice.
At some point in time, you will be required to teach new, inexperienced assistant
medical officers and learners about specific ways of caring for certain patients.
Teaching of staff and learners can be related to specific ways of caring for patients,
for example, caring for a patient on a ventilator, dressing a complicated wound or
even performing simple procedures such as washing hands and taking a patientÊs
vital signs. Sometimes the protocol of care for a patient may change with current

trends in treatment. The assistant medical officer therefore needs to ensure that all
assistant medical officers and learners in the clinical area are familiar with the
protocol. The way to ensure that everyone is familiar with the protocol is by
teaching everyone in the ward. Examples include the dressing of a patient with
severe burns in the surgical ward or burns unit, the pre-operative preparation for
a patient who is going for a total hip operation or the protocol for chemotherapy
for a cancer patient.
Healthcare personnel has the obligation to teach all colleagues, staff and learners
who are working in the clinical unit to ensure that everyone is equipped with the
necessary knowledge, skills and attitude to render the best care to all the patients
in the unit.
ACTIVITY 1.2
Revisit your work to the time when you had some learners or new staff
in your ward. Identify an area where the learners or new staff needed to
be taught.
Discuss the situation and your teaching role as a nurse in that situation.
Share your answer in myINSPIRE online forum.
„Learning defined as actionable knowledge is focused on connecting

specialised information sets, and the connections that enable us to learn more
are more important than our current state of knowing.‰
(George Seimens, 2005)
Learning includes:
(a) Exploration;
(b) Discovery and application of meanings; and
(c) Development of skills and attitudes.
Learning is self-activated. The significance of the teaching-learning situation is

influenced by the:
(a) Intellectual ability of the learner in terms of background knowledge and

experience;

(b) Type of learning activities; and
(c) Degree in which the learner participates in the teaching-learning situation.
Learning takes place through the use of the five senses ă sight, hearing, smell, taste
and touch.
As a healthcare professional, it is crucial for you to know your learners well

when you are implementing your teaching role. You need to gather sufficient
information about your learners in order to be able to plan a meaningful teaching
session for your learners, patients, relatives of patients, staff or learners. What are
some of the characteristics that you need to consider in the learners? Let us find
out in the next subtopic.
1.5 CHARACTERISTICS OF LEARNERS

Learners in the clinical setting have been identified as patients, relatives,
colleagues or learners. What are the characteristics of all these people that we need
to consider in respect to teaching and learning? Patients, relatives, colleagues and
learners all come from various backgrounds and all possess differing levels of
education. Therefore, the healthcare professional in his teaching role must
consider relevant characteristics of each person whom he has to teach in a specific
teaching-learning session. Figure 1.3 shows the characteristics of learners in a
clinical setting.
Figure 1.3: Characteristics of learners
The characteristics of learners affect patient learning. In order to be able to utilise

appropriate teaching strategies, the characteristics need to be assessed accordingly.
The following subtopics will also discuss other features to be included in your
assessment in addition to the five characteristics featured in Figure 1.3.

1.5.1 Every Learner is an Individual

One very important characteristic that we have to bear in mind is that all of us
are unique individuals. Therefore, healthcare personnel must view each learner
regardless patient, relative, colleague or learner as individuals with their own
differences. No two persons are alike. Being clear about this special characteristic
will allow the healthcare personnel to accept learners as individuals and not be
biased in his view regarding each one of them. Consequently, he will be able to
motivate each learner according to his needs.
1.5.2 Prerequisite Knowledge, Skills and Attitude

Attitude towards future learning is influenced by past learning experiences. Every
learner comes with his own prerequisite knowledge, skills and attitude based on
his previous exposure and learning experience. Therefore, the assistant medical
officer needs to assess each learnerÊs prerequisite knowledge, skills and attitude
accurately in order to plan a beneficial learning experience and not waste time
teaching what learners had already known and can perform. Preceding that,
encourage the learner to express how he views about learning in order to improve
his health so that you can deal with his feelings before any teaching is attempted.
If the patient has a negative attitude about learning, establish a relationship that
will help in altering that attitude.
1.5.3 Sociocultural Background

Some cultures value education to improve their condition while others view
change or new practices as intimidating. Do not stereotype a person because of his
culture. Instead, recognise that each person has a unique family background with
certain cultural values that may have an effect on how teaching-learning is
perceived.
As such, the assistant medical officer must take into consideration the origin of the
learnerÊs sociocultural background so that he will be sensitive to the learnerÊs usual
practices and perception of things. Acquiring this knowledge about the learner
will help the assistant medical officer in his teaching when he needs to
communicate with the learner and also to use terms that the learner can
understand. Being sensitive of the cultural practices and norms observed by each
individual based on his race and ethnic group will make the assistant medical
officer more respectful of his behaviour and conduct towards particular healthcare
practices. This will help contribute towards a more practical approach in teaching
the learner, resulting in a higher chance of achieving the goals and objectives of
the teaching session, and obtaining positive feedback regarding his teaching.

1.5.4 Educational Level of the Learner

The assistant medical officer needs to find out the level of education of each learner
in order to be able to plan and teach at a level that can be understood by the learner.
You will effectively promote learning if you are aware of the learnerÊs intellectual
ability and avoid „talking down‰ to him or using an inappropriate teaching
strategy. For those who are illiterate, the healthcare personnel may have to resort
to relevant resources to help make the teaching session effective and useful to the
learner.
1.5.5 Age of the Learner

Right from the start, it is important to consider the age of the learner so that the
healthcare personnel can address the learner appropriately. It is crucial to consider
the physiological age before you select age-appropriate teaching methods.
Delayed development in any of the following areas should be considered:
(a) Children have limited past experiences. Adults learn more quickly than
children do because they are able to build upon previous knowledge; and
(b) Use chronological age to assess whether the developmental stage is as

expected.
1.5.6 Additional Factors

(a) Physical Condition
The patient will not be ready to learn until he is comfortable enough to pay
attention to the information you present.
(b) Sensory Abilities

Note any deficits in the learnerÊs sight, hearing and touch so that teaching
can be planned appropriately.
(c) Emotional Health

The emotional state of the learner should be conducive to learning before
teaching is conducted. A patient who is moderately anxious about his
condition will probably be attentive to presentation of information that will
help him manage the condition. If the patient is in a state of crisis with a high
level of anxiety, delay the teaching until the crisis is over.

(d) Communication Skills

The basic requirement for the teaching-learning process is communication.
Assess your communication skills as well as those of the learner. Assess
the learnerÊs reading skills before using printed materials as a teaching aid
and to what degree of common language (Malay/English) is spoken and
understood by the learner.
(e) Social and Economic Stability

Being hospitalised and absent from work can cause excessive stress in certain
patients. Help the patient deal with any social and economic problems before
imposing additional stress of having to learn new information or a new skill.
(f) Responsibility
In order to learn self-care or to take preventive measures against illness,
a patient must have a sense of responsibility. Encourage the patient to
participate in planning the learning activities to promote his feelings of
control.
(g) Self-perception
Self-perception has an effect on the ability to learn. If effective learning about
a health problem is to occur, any unrealistic self-image or body image should
be addressed. If necessary, help the patient improve his self-image before
focusing on learning needs.
(h) Motivation to Learn

The patient must want to learn for the teaching to be effective. If the patient
is not motivated to learn the materials needed to improve his health,
discussing his interest and concerns may lead to successful learning.
ACTIVITY 1.3
Think of other characteristics in the learner that you have to consider

should you plan to conduct a clinical teaching in your ward, clinic or
hospital environment.
Post your answer on the myINSPIRE forum and discuss with your
coursemates.

1.6 CONDITIONS OR ENVIRONMENTS FOR

LEARNING
In this subtopic, we will look at the conditions or environments that are conducive
for learning.
1.6.1 Learning in Clinical Setting versus Classroom

Setting
Learning in the clinical setting is very different from learning in the classroom. The
clinical setting is the area that involves direct patient care. It is a place where life
experiences take place in an uncontrolled, unpredictable and a very dynamic
environment. The clinical setting is the area for the application of theory to
practice in order to develop competencies for safe and effective nursing care.
Therefore, it is more complex than learning in a classroom setting where the
healthcare professional teacher has more control over the circumstances for
learning and teaching.
ACTIVITY 1.4
1. What does learning in the clinical setting mean to you? Can you
explain the concept of learning in the clinical setting?
2. (a) Can you visualise the ward in which you are working in now
and compare its environment to that of a classroom where
you attended lectures during your training days?
(b) List at least three factors in the two different settings to show
the difference between the two learning environments.
3. Explain how the factors that can affect learning from a learnerÊs
point of view. You can identify factors in the hospital, clinic or ward
in which you are working. These factors can relate to the setting,
the patient, teacher or student, or resources available in the clinical
area.

1.6.2 Conditions of Learning in the Clinical Area

Learning in the clinical area can be made more meaningful when guided by
principles of learning. These principles will determine the conditions for learning
in the clinical area. Let us look at the key principles in learning and relate them to
the conditions of learning, focussing on learning in the clinical area. The key
principles in learning as shown in Figure 1.4 are as follows:
Figure 1.4: Conditions of learning in the clinical area
Let us look at the steps in practice, incorporating the principles mentioned.
(a) Firstly, the learner should be able to conceptualise what he is learning. For
example, in providing care for patients in the healthcare setting, the
healthcare personnel must be able to conceptualise activities of daily living
(ADL) and understand how important it is for every individual to be able to
carry out all the ADLs in order to live in a healthy state. Having a clear
concept of the importance of ADLs to healthy living can then alert the
beginner healthcare personnel to assess a patientÊs ADLs at each encounter
with the patient and render whatever care required by the patient according
to his assessment.

(b) The second condition is related to the principle that learning occurs through
imitation. The learner needs to see how things are carried out so that he can
practise until he gains competence in the skill. The healthcare personnel, in
carrying out his teaching role, needs to show and give the learner sufficient
time to learn exactly how to carry out certain skills under guided supervision
and be able to perform them independently when he has gained a certain
level of performance.
(c) As the learner needs to practise in order to gain competence, the healthcare
personnel in his teaching role has to ensure that the learner has ample
opportunities to learn and practise until he is competent in the job.
(d) The healthcare personnel in his teaching role also has to be aware of learning
through trial and error. Learners may make mistakes and can learn from
their mistakes. But in the healthcare setting, as we are dealing with patientsÊ
lives, the healthcare personnel has to ensure that the learner is closely
supervised so that no harm or injury may happen to the patient.
(e) A learner can acquire a skill only by actually performing it. Therefore, the
healthcare personnel has to allow the learner to practise and not take over a
procedure. Patience and perseverance are required to ensure that learners
carry out the practice at their own pace and pick up speed and accuracy as
they progress in their learning.
(f) The healthcare personnel who teaches in the clinical area has to ensure that
learning experiences for the learner are planned based on learnersÊ previous
learning experience. This will facilitate learners learning from the known to
the unknown. Thus, learners will be able to proceed from a simpler level to
a more complex level in their learning process.
(g) Learners need to be motivated to learn. Therefore, reinforcement at the

appropriate time, even for small achievements, may provide support and
motivate learners to go through the process of learning in an uncontrolled
environment in the clinical area. As they receive the motivation from their
teachers, they will be more prepared for learning emotionally and
psychologically.
(h) The healthcare personnel in his teaching role needs to establish that the
learner is psychologically ready to learn. If the learner is worried or upset
about certain personal problems, his mind will not be able to focus on what
he has to learn and learning will not take place.

(i) The healthcare personnel must instil in the learners that „practice makes
perfect.‰ Therefore, the healthcare personnel must remember to provide
reinforcement and feedback to learners and get them to repeatedly practise
the skills as long as opportunities and activities are available. The more they
practise, the more they will improve their skills.
In carrying out his teaching role, the healthcare personnel has to be alert to all the
conditions of learning and take steps to ensure that he maintains the conditions so
that the patients, their family members, colleagues, and learners in the clinical area
will benefit from the learning. Teaching in the clinical area is never an easy task
but the skill can be acquired through education and training.
ACTIVITY 1.5
Can you recall an incident from your clinical teaching/training

experience?
Try to remember the conditions of learning that were taken into account
by your tutor during the learning experience. Share in the myINSPIRE
forum.
 The healthcare personnel has an important role in teaching patients, patientsÊ

family members, colleagues and learners in the clinical area.
 To teach effectively, the healthcare personnel must be familiar with the

principles of learning.
 There are several factors involving learners and the environment which the
healthcare personnel needs to consider when planning teaching in the clinical
area.
 The factors that involve learners towards their learning include age, perceiving
them as individuals, their prerequisite knowledge, skills and attitude as well
as their sociocultural background.
 The clinical area is unpredictable, uncontrolled and more complex than a

classroom setting where learning is concerned.

Characteristics of learners Prerequisite knowledge and skills

Clinical area Principles of learning
Learning environment Teaching role
1. The least important characteristic of learners that needs to be considered in

learning is
A. age
B. sociocultural background
C. socioeconomic status
D. prerequisite knowledge and skills
2. Which of the following is NOT a principle of learning?

A. Perception is necessary for learning
B. Emotional climate affects learning
C. Process of trial and error is not a way of learning
D. Individuals must be motivated to learn
Greiner, A. C., & Knebel, E. (Eds.). (2003). Health professions education: A bridge to
quality. Washington, DC: The National Academy.
Homeyer, S., Hoffmann, W., Hingst, P., Oppermann, R. F., & Dreier-Wolfgramm, A.
(2018). Effects of interprofessional education for medical and nursing
student: Enablers, barriers and expectations for optimising future
interprofessional collaboration ă a qualitative study. BMC Nursing 17(1).
Siemens, G. (2005). Connectivitism: A learning theory for the digital age. Retrieved
from http://itdl.org/journal/jan_05/article01.htm

Topic  Curriculum
Design and
2 Development
LEARNING OUTCOMES
1. Describe the approaches to curriculum development and design;
2. Plan a course or session using the competency-based approach;
3. Describe the factors which influence curriculum development; and
4. Examine the design and development of a health science curriculum
to identify its strengths and weaknesses based on the strategies and
models of curriculum development.
 INTRODUCTION
The term „curriculum‰ is derived from the Latin word currere, which means
„running‰, „race course‰ or „run away‰, „lap‰ or „course‰ towards a goal. Thus,
curriculum means a course to be run in order to reach a certain goal or destination.
In this sense, education is a race with the goal as its aim and the curriculum as the
course, and leading to the goal. Simply put, curriculum refers to a course of study
at school or university with the subjects making up the course. It is an educational
journey that a learner embarks upon.
The traditional system of education used curriculum in a similar sense when it

insisted on the acquisition of mastery over certain skills and certain areas of
knowledge as the sole aim of education. Teachers are expected to teach their
learners to realise the aim of education by leading them through the curriculum
that is prescribed for the purpose.

TOPIC 2 CURRICULUM DESIGN AND DEVELOPMENT  21
Concepts regarding the meaning of curriculum, its purposes and nature have been
changing from time to time. Heidgerken (1965) refers to curriculum as „all the
content and learning activities planned by the school for a specific group of
learners to achieve a particular purpose.‰ Meanwhile according to Tan Sri Awang
Had Salleh (The Star, 29 May 1994, p. 23) in respect to education, a curriculum is a
„compass, planned and designed for purposes of teaching and learning activities
in and out of the classroom; in and out of the school; in and out of colleges,
polytechnic or universities.‰ Tan Sri Awang added that a curriculum also consists
of „planned curricular and co-curricular activities, and within them, formal and
non-formal‰. In other words, it includes informal teaching activities.
On the other hand, Pruitt et al. (2017) stated that a health system curriculum in
undergraduate medical education that uses a problem-based learning approach is
feasible. The majority of learners using this format in the health system curriculum
reported being prepared to improve individual patient care and optimise the
health systemÊs values.
2.1 CURRICULUM DEVELOPMENT

Curriculum usually defines the learning that is expected to take place during a
course or programme of study in terms of knowledge, skills and attitudes. It
should also specify the main teaching, learning and assessment methods, and
provide an indication of the learning resources required to support the effective
delivery of the course. A curriculum is more than a syllabus. A syllabus describes
the content of a programme and can be seen as one part of a curriculum. Most
curricula are not developed from scratch and all operate within organisational and
societal constraints.
The curriculum that is written and published (for example, course documentation)
is the official or formal curriculum. The aim of educational development is to ensure
that the official curriculum is delivered as the functional curriculum and there is no
mismatch as the development turns into implementation. The official curriculum
can also be distinguished from the hidden, unofficial or counter curriculum. Paul
WillisÊ work on the sociology of schooling for example describes how the informal
pupil group comprising „working class lads‰ has its own subculture and counter
curriculum which involves „mucking about‰, „doing nothing‰ and „having a laff‰
(Willis, 1977).

22  TOPIC 2 CURRICULUM DESIGN AND DEVELOPMENT
The hidden curriculum describes aspects of the educational environment and

learners learning (such as values and expectations that learners acquire as a result
of going through an educational process) which are not formally or explicitly
stated but which relate to the culture and ethos of an organisation. This highlights
that the process of learning is as important as its product and teachers need to be
aware of both formal and informal factors that impact learning.
Based on the above descriptions of curriculum, anyone responsible for developing

the curriculum for a course, programme or institution of learning has to consider
the factors that can influence the curriculum.
More to the point, it is crucial to appreciate that curriculum development is a

systematic process that encompasses various phases, namely planning, design and
application.
Before we move further, let us first examine the factors that influence curriculum
development.
2.2 FACTORS THAT INFLUENCE CURRICULUM

DEVELOPMENT
There are eight factors that can influence curriculum development, which are
explained in the following subtopics.
2.2.1 Societal Needs

Social changes have been brought about largely by the advancement of science and
technology, resulting in urbanisation and industrialisation. The urban-industrial
culture has created many problems that require cultural adjustments. Many of
these adjustments lead to health problems and have implications for healthcare
education. The type of society, health and social needs of patients, their families
and the community must be taken into consideration in curriculum development.
The main objective of professional healthcare education is to educate healthcare

learners who will possess sound judgement and are intellectually and morally
enlightened. They are also professionally equipped so that they are capable of
caring for the sick and function effectively in healthcare programmes, thereby
contributing to the health and welfare of the society.

Therefore, the study of the nature of society in which healthcare personnel is part
of the health needs of the society serves as an important guide in selecting
educational objectives and the development of a curriculum. For example, in
developing content for a health-related programme, one needs to consider
communicable diseases in the community, increased stress due to changes in
lifestyle and family pattern, better health due to longer lifespan and the need to
consider integrating geriatric care in the programme.
2.2.2 Political Factors

Political forces and power also influence the development of a curriculum.
Government policies, for example, affect the medium of instruction used in the
curriculum. Many healthcare diploma and degree programmes are now
conducted using the English medium to ensure that healthcare personnel are able
to function in both public and private healthcare agencies as well as to take up
healthcare occupations offered at the global level. Entry requirements for certain
courses are standardised through the controls set by government agencies such as
higher education and accreditation bodies within each country. In developing a
curriculum, therefore, entry requirements need to be clearly stated and must be
adhered to.
2.2.3 Learner Needs

The curriculum is developed for learnersÊ learning. Therefore, it is very important
to consider the needs of learners when developing any curriculum. For example,
if we have to develop the curriculum for Diploma in Medical Assistant, we need
to know the standard entry level and project what changes in behaviour are
expected of each learner as some registered healthcare personnel who can function
competently and effectively at the end of the three-year training. The gap between
what learners currently possess and what skills they are expected to have must be
studied in detail and mapped out in the curriculum content so that learners will
be provided with the learning experiences they need in order to gain what is
expected by the end of the programme.
The curriculum should incorporate an orientation programme for each new

learning situation. The learner is considered as a whole individual whose ability
to learn and to adjust is conditioned not only by his intellectual capacity but also
by his emotional make up, attitudes, social relationships as well as mental and
physical conditions.

2.2.4 Resources and Facilities

In developing a curriculum, it is essential to determine all the resources, both
material and human, that are necessary to implement the curriculum as well as
help learners achieve the expected outcomes of the programme. For example, in
planning a medical assistant course, the curriculum planner must ensure that the
institution has the necessary physical facilities and equipment to conduct the
training. The curriculum developer also has to ensure that human resources meet
professional standards, for example, ensuring that the college maintains a teacher-
learner ratio of 1: 30ă40 for classroom teaching and a clinical supervisor-learner
ratio of 1: 10ă15 for clinical teaching.
2.2.5 Subject Specialists

Much thought must be given to the content within the curriculum. Subject
specialists must be invited to give their input as the quality of the curriculum will
depend on the knowledge input provided by experts in the fields concerned.
Subject specialists can also suggest references to the content that they are familiar
with from different resources such as books and current developments in the field
or subject in order to make the curriculum relevant to current trends within the
scope of the curriculum.
2.2.6 Professional Standards

This is closely related to the political factor mentioned earlier. One example is the
very specific criteria that is related to the standard guidelines as set by the Medical
Assistant Board. Healthcare curriculum must be approved by the Medical
Assistant Board. The Medical Assistant Board also stipulates the registration of
assistant medical officers in order for them to practise patient care delivery. All
assistant medical officer graduates must pass a professional examination before
they can be given the title of Registered Assistant Medical Officer.

2.2.7 Philosophy of Education

Educational philosophy in relation to curriculum development refers to the value
pattern that determines the objectives, content and teaching methods of the
educational programme. The philosophy of healthcare education is a vital factor
in the curriculum because it forms the basis for the final selection of the aims and
objectives of the curriculum.
Because one of the major purposes of education is to bring about changes in the
behaviour of the learner, the type of changes to be achieved is one of the most
important problems in education. Educational philosophy provides the
knowledge and the guiding principles that serve as the criteria for the evaluation
of the curriculum process.
The philosophy of education adopted by a school or university involves factors

such as beliefs about learners and their capabilities, educational pedagogy and
principles, and education. In healthcare, there is the additional elements of patients
and clients. For example, if a university believes in lifelong and self-directed
learning, the curriculum will be designed to favour a method of teaching and
learning that encourages active and self-directed learners rather than learning
from a didactic lecture style. Another example is that if educators perceive patients
holistically, then we will ensure that learners are taught how to perceive a patient
wholly and in the process of caring for the patient, they will deliver individualised
care based on each patientÊs needs.
2.2.8 Theories of Learning

It is important to consider the learning theories that are incorporated into
curriculum development. This is to ensure that a well-rounded curriculum is in
place to help learners achieve the learning outcomes of the programme and obtain
maximum learning. Curriculum design and processes will affect the
implementation phase of the programme.
Curriculum development and the factors influencing it are illustrated in a

conceptual map as shown in Figure 2.1.

Figure 2.1: Conceptual map of curriculum development

Source: Malaysian Qualification Agency (2011)

ACTIVITY 2.1
Based on the conceptual map of curriculum development, identify some

factors in your area which you think can influence the curriculum of an
medical assistant programme (it can be at the level of diploma, bachelor
degree or postgraduate programme).
2.3 CURRICULAR CYCLE

According to the Malaysian Qualification Agency (MQA) (2011), the curricular cycle
„involves development through needs assessment, design and implementation
phases. After this, outcomes are reviewed and evaluated against the original needs
assessment. Needs change with societal expectations. The emphasis on different
aspects varies with the participantsÊ and teachersÊ perceived needs. The dynamic
curriculum requires change and resource management‰. Refer to Figure 2.2.
Figure 2.2: Curricular cycle

Source: Malaysian Qualification Agency (2011)
The overview explanation of the curriculum design cycle is as follows (MQA,

2011):
(a) The Code of Practice for Programme Accreditation (COPPA) and the Code
of Practice for Institutional Audit (COPIA) are concerned with the design
and development of formal curriculum. The formal curriculum has been
defined as a series of planned events that are intended to have educational
consequences;

(b) The formal curriculum includes the sequences in which the contents of a
particular programme are delivered either through conventional or non-
conventional mode. It also includes the books and materials that are to be
used. These are in addition to the objectives and learning outcomes of the
programme; and
(c) Typically, a curriculum design cycle has for stages as illustrated in Figure 2.2
and each stage involves a list of specific activities as shown in Table 2.1.
In developing a new programme or modifying an existing one, there are a number

of stages that must be completed within the curriculum design cycle as shown in
Table 2.1, together with the relevant and specific activities.
Table 2.1: Curriculum Design Activities for a Programme
Plan  Convince a curriculum committee

 Assess needs and issues
 Identify key issues as Malaysian Qualifications Framework (MQF)
levels and level descriptors, and institutional vision or mission
 Identify trends in the field of study or profession
Develop  Articulate programme philosophy
 States programme goals
 Sequence programme objective and outcomes
 Develop course or modules
 Identify and develop programme staff and physical resources
 Develop and identify learning-teaching activities, assessment tools
and procedures
Implement  Deliver the programme
 Assess the achievement of learning outcomes
Evaluate  Review the programme
 Determine the success of the programme
 Update the programme
Source: Malaysian Qualification Agencies (2011)

2.4 STAGES IN CURRICULUM PLANNING

There are many ways to approach curriculum planning. Torres and Stanton (1982)
recognised the curriculum process as having four main stages and based it upon
behavioural-objectives model.
2.4.1 Stage 1: Directive Stage

This initial stage lays the foundation for all other stages by identifying the beliefs.
Knowledge and concepts form the basis of the curriculum. The systematic
gathering of information is from existing literature and by exploring common
beliefs about the nature of healthcare profession. This leads to a statement of the
curriculumÊs philosophy, which in turn serves to influence each successive stage
of the curriculum process.
The specific meanings of key terms need to be spelled out in a glossary so that
everyone can see the way in which each particular term is interpreted. At this
stage, the characteristics of the learners for whom the curriculum is intended are
identified, in other words, the broad behaviours that will be expected of the
learners by the end of the course. In addition, this stage establishes the basis of
theoretical framework for the selection and sequencing of content.
2.4.2 Stage 2: Formative Stage

At this stage, the overall design of the curriculum takes shape and the design
should reflect the philosophy described in Stage 1 as well as reflecting the nature
of the healthcare profession. Objectives will be written for specific levels within
the course as well as for the overall course. They are derived from the broad
characteristics identified in the previous step.

2.4.3 Stage 3: Functional Stage

This is the stage in which the curriculum begins to assume a more practical form.
Consideration is given to approaches where the content can be organised and the
notion of model of healthcare profession is employed. A variety of teaching
methods and learning experiences is also determined, including both classroom
and clinical techniques. In addition, the methods of validating learning are decided
through the use of the behavioural objectives formulated in Stage 2. Three types of
evaluation are to be considered accordingly:
(a) Evaluation for continued learning ă The evaluation that provides feedback
for learners to improve their learning;
(b) Evaluation for grading ă These are examinations designed for grading and
should not be viewed as a learning activity; and
(c) Evaluation for curriculum revision ă This involves the assessment of the total
curriculum package and represents Stage 4.
2.4.4 Stage 4: Evaluative Stage

This final stage is initiated when the curriculum is completely implemented.
Hence, it is a summative evaluation. It comprises three significant aspects:
(a) Input evaluation ă What the learners bring to the course such as problem-
solving abilities;
(b) Evaluation throughout ă All the tests and activities that learners undergo as
they progress through the course; and
(c) Output evaluation ă Achievement of the characteristics identified in Stage 1:

Directive Stage.
2.5 CURRICULUM DESIGN AND PLANNING

The philosophical basis of a curriculum refers to the underlying values and beliefs
that influence the curriculum design and its content. Any decision that educators
make about a curriculum is influenced by its philosophical assumptions about the
epistemology (the nature of knowledge), society or culture, the individual
(specifically the learner) and learning (how a person learns and what learning
theories that the curriculum should be based on).

The relationships between them are shaped by the answers to key questions about:
(a) Assessment;
(b) Content;
(c) Learning interactions; and
(d) The connections between those elements.
Curriculum design should help ensure alignment between the answers staff build
into their design and those that learners find through their experience of the
curriculum. In Figure 2.3 the top question in each pair is a design question for staff.
The lower set of questions is commonly asked by learners to shape their approach
to learning. The approaches highlighted in Figure 2.3 have been refined and
contextualised.
Figure 2.3: Key elements and relationships in the curriculum

Sources: http://www.flinders.edu.au/teaching/teaching-strategies/curriculum-
development/curriculum-process.cfm
2.5.1 Educational and Professional Context

The educational and professional context has to be addressed and clearly defined.
This can reflect a number of factors including current or prevailing educational or
social ideology, culture, politics, economy, learners, teachers and parents,
commerce and industry, professional bodies, exam boards, funding bodies and
history or influence from the past. In any discipline, there may be current trends
in the general education that need to be dealt with, as well as specific trends in
healthcare education which relate to the healthcare system or context.
Higher education as a whole has been subjected to many changes and

developments as imposed by government agencies and changing public
expectations. In healthcare education, there have been additional changes that
reflect the change in the healthcare system as well as in the roles, responsibilities
and public perceptions of the healthcare profession.
With reference to the context in which the learners are learning, it is important that
the teacher is aware of the educational needs of the learners. This means thinking
about the needs of the learners as a group and as individuals. When teaching a
group of learners, there are many issues to consider such as how a teacherÊs style
may influence the group, group dynamics, how to deal with quiet or disruptive
learners, and how to utilise learning resources to the best advantage.
As mentioned earlier, there has been a shift in the style of curriculum in the
healthcare education ă from a „teacher as the expert‰ approach (which utilises
didactic teaching methods such as lectures) to a more learner-centred approach.
The main characteristics of adult learning are as follows:
(a) Learning is purposeful;
(b) Participation is voluntary;
(c) Participation should be active, not passive;
(d) Clear goals and objectives should be set;
(e) Feedback is required; and
(f) Opportunities for reflection should be provided.
Acknowledgement of the needs of adult learners should be built into the process
of curriculum development and delivery at all stages. The needs of adult learners
have particular relevance to the selection of teaching, learning and assessment
methods.
When planning or delivering a session or course to teach a group, the teacher

might ask the following questions:
(a) What level of understanding and experience do they have?
(b) What should I be expecting from the group in terms of knowledge, skills and
attitudes?
(c) What topics and course areas have they been studying before this particular
course or session?

(d) What are they going to do after the course or session and what specifically
should I be preparing them for?
(e) Does my teaching (in terms of level, pace and content) appear to be meeting
their needs?
(f) Have I built in opportunities for flexibility to address unforeseen learning

needs?
It is also important to think about individual learnerÊs learning needs. Therefore,

when teaching an individual learner, in addition to the earlier questions, the
teacher might ask the following questions:
(a) Does the learner have any particular learning needs or difficulties?
(b) Has the learner experienced difficulties with any previous course areas or
topics that might affect his progress?
(c) Does my teaching seem appropriate for this learnerÊs needs and style of
learning?
Research has demonstrated that although individuals learn in different ways and
bring different experiences and backgrounds to learning, there are certain types of
activities which can facilitate learning.
What do you think these activities are?
Teaching and Learning in the Clinical Context (Hutchinson, 2003) describes some
of the theoretical background and activities that affect learning.
In summary, the key aspects of learning are as follows:
(a) Learning occurs in four domains (Bloom, Krathwohl, & Masia, 1984):
cognitive (knowledge and intellectual skills), affective (feelings and
attitudes), interpersonal (behaviour and relationship with others) and
psychomotor (physical skills);
(b) Individuals have different learning styles. Therefore, courses should be

designed with a variety of learning (and teaching) methods;
(c) Learners need to be treated as people and there should be opportunities for
them to make contributions that are valued by teachers;
(d) Effective learning is active learning ă people learn best when they are
engaged in an active process;

(e) Learning has to be relevant to the learnersÊ own experience and needs, and
set within a clear context or framework. Relevance applies at a variety of
levels, namely at the overall structure of the course or subject, or at the use
of a particular terminology;
(f) Learning outcomes or objectives help learners to learn because they define
what learners have to do. The outcomes should be explicit and clearly linked
to the delivery and assessment; and
(g) Effective learning requires a safe environment. Learning is not always easy
and learners must feel comfortable and able to make mistakes. Feedback
should be constructive and timely.
2.5.2 Learning Outcomes

Learning outcomes are broad goals that describe what learners are supposed to
know or are able to do and may be based upon:
(a) The needs of the learner;
(b) The needs of society; and
(c) What the learner should know about a particular subject.
2.5.3 Learning Objectives

Objectives are the primary building blocks of a good curriculum design. They
support the learning outcomes in that each is a small step towards what the learner
is supposed to know or are able to do.
Objectives:
(a) Define specific outcomes or competencies to be achieved in terms of skills,

content mastery, attitudes or values;
(b) Form the basis upon which to select or design instruction materials, content
or techniques;
(c) Provide the basis for determining or assessing when the instruction purpose
has been accomplished; and
(d) Provide a framework within which a learner can organise his efforts to
complete the learning tasks.

Well-written objectives are carefully worded. They include qualifiers to restrict the
conditions and terms under which the objectives are met. The verbs (action words)
used in objectives are also important. In order for objectives to provide a useful
basis for creating test questions, they must contain verbs that describe observable,
measurable actions and specific levels of thinking because these are aspects that
can be tested.
Tips
Keep the following guidelines in mind when you write objectives to support
the learning outcomes in your modules:
(a) Sequence the content of each objective in a logical order, for example,
from simple to complex, from known to unknown, chronologically and
so forth;
(b) Avoid the use of verbs that represent actions or concepts that are difficult
to measure such as appreciate, be familiar with, believe, comprehend,
enjoy, know, learn, master and understand; and
(c) Avoid the use of vague qualifiers such as very, completely, fully, totally
and quickly.
2.5.4 Classifying Objectives

In the education environment, learning outcomes and objectives are often loosely
sorted into three groups, called domains. These domains are identified by an
educational psychologist named Benjamin Bloom, and may help you to transform
your objectives into test questions more easily. They are:
(a) Cognitive domain ă Encompasses intellectual or thinking skills;
(b) Psychomotor domain ă Encompasses physical skills or the performance of

actions; and
(c) Affective domain ă Encompasses attitudes and values.
For each domain, Bloom identifies several levels, each with a list of suitable verbs
to describe that level in the written objective. Table 2.2 describes the cognitive
domain and is based on information from Benjamin BloomÊs book, Taxonomy of
Educational Objectives (1956). The levels are arranged from the least complex level
of thinking to the most complex level of thinking.

Table 2.2: BloomÊs Taxonomy ă The Cognitive Domain
Cognitive Domain
Use these Verbs in Written Objectives to

Level and Meaning
Describe the Associated Cognitive Level
Knowledge: define, distinguish, identify, inquire, label, list,
The remembering of previously match, memorise, name, read, recall, recognise,
learned material (recall of facts). relate, repeat, record, select
Comprehension: associate, describe, differentiate, discuss,
The ability to grasp the meaning of explain, extend, generalise, give examples,
the knowledge being learned. illustrate, infer, interpret, locate, rearrange,
reorder, restate, rewrite, summarise, transform,
translate
Application: apply, calculate, choose, classify, demonstrate,
The ability to use learning materials develop, generalise, illustrate, operate, organise,
in a new way. practise, restructure, sketch, solve, transfer, use
Analysis: analyse, categorise, classify, compare, contrast,
To ability to break down the deduce, describe, detect, diagram, discriminate,
material into its parts so that its differentiate, distinguish, experiment, group,
organisational structure may be inspect, point out, put into lists, question, sub-
understood. divide, test
Synthesis: combine, compile, create, design, generate,
The ability to combine previous integrate, modify, plan, produce, propose, solve
experiences with new materials
from a whole new structure.
Evaluate: appraise, assess, choose, compare, conclude,
The ability to judge the value of the consider, criticise, evaluate, judge, measure, rate,
material for a given purpose. score, select, support, validate, value
Source: Bloom (1956)
In every module of the learning material, a variety of cognitive levels should be

represented in the objectives. To create a well-balanced learning experience, some
objectives in each module should deal with facts, some with concepts and some
with the application of the information. Assuming that the objectives are both
clearly defined and well written, this will also lead to test questions that can
address a variety of cognitive levels.

2.6 CURRICULUM DEVELOPMENT –

STRATEGIES AND MODELS
When planning a course, we will examine how teachers and course developers
need to think about their learnersÊ needs in terms of the broad context of
undergraduate and postgraduate education, vocational training, the needs of
professional bodies and the requirements from their own organisation.
The types of questions that curriculum planners might ask at the start of the
process should include the following:
(a) What sort of healthcare personnel do we want?
(b) How will we reflect health service changes and demands from external
agencies?
(c) How will we ensure links to postgraduate requirements and training

(specialist versus generalist)?
(d) What should the curriculum be like in terms of content, structure and
function?
(e) How should we establish links to assessment and evaluation?
(f) How do we identify and overcome barriers to change?
2.6.1 Strategies in Curriculum Development

Any curriculum needs to be developed in view of the organisation or context in
which it is going to be delivered. If a teacher is developing a small part of a course
or programme, it must fit (in terms of approach, level and content) with the overall
course. If a new course is being designed and developed, a number of approaches
can be taken and the issues need to be addressed to meet the needs of all
stakeholders involved.

A strategic issue that needs to be considered is whether the course design, delivery
and management are centralised or decentralised. This is often out of the control of
individuals involved in course development but it has impact on all aspects of
curriculum development. Centralisation can be seen at both national and
organisational levels. Centralised curricula tend to be more structured and orderly.
It is easier to ensure uniformity and has a standard approach to teaching and
learning. A centralised curriculum may allow better access to a wide pool of
expertise but may be less sensitive to local needs.
A decentralised curriculum tends to be more appropriate to meet learnersÊ local

needs and often ensures better ownership of the course by teachers. Decentralisation
can allow for a variety of approaches in design and delivery, and it also enables
comparisons of the strengths and weaknesses of each approach.
It can be useful to view curriculum development and design in light of the two
main schools of thought, namely the objective model and the process model.
Although the two models are not mutually exclusive, nevertheless, they represent
two different philosophical approaches.
(a) Objective Model

The objective model takes, as its major premise, the idea that all learning
should be defined in terms of what learners should be able to do after
studying the programme, from the perspective of learning outcomes or
objectives.
According to this model, curriculum design follows four steps:
(i) Reach agreement on broad aims and specific objectives for the course;
(ii) Construct the course to achieve the objectives;
(iii) Define the curriculum in practice by testing capacity to achieve

objectives; and
(iv) Communicate the curriculum to teachers.
Care must be taken so as not to focus on the objectives at a trivial level or

narrow specifications because this limits the teacher and valuable learning
experiences may be lost. Using an objective model enables the construction
of assessments that can be designed against learning objectives. The objective
model is in step with current developments at the national level, which
includes the use of subject benchmarking and programme specifications.

The objective model is a systematic approach to course planning. It forms

part of the outcome-based education (OBE), which states that „educators
should think about the desirable outcomes of their programmes and state
them in clear and precise terms. They should then work backwards or
„design down‰ in the jargon of OBE, to determine the appropriate learning
experiences which will lead to the stated outcomes. By using an outcome-
based approach, educators are forced to give primacy to what learners will
do and to organise their curricula accordingly‰ (Prideaux, 2000).
(b) Process Model

The process model assumes that content and learning activities have an
intrinsic value. They are not just a means of achieving learning objectives and
that translating behavioural objectives is trivialising. According to Stenhouse
(1975), there are four fundamental processes of education:
(i) Training (skills acquisition);
(ii) Instruction (information acquisition);
(iii) Initiation (socialisation and familiarisation with social norms and

values); and
(iv) Induction (thinking and problem solving).
Stenhouse (1975) claimed that behavioural objectives were only important in

the first two processes and it would not be possible to use objectives in the
initiation and induction processes. From this, it was suggested that
behavioural objectives were inappropriate for problem-based learning (PBL),
professional development or clinical problem solving.
Approaches to course design under the process model include the

„intellectual approach, which examines the subject matter in terms of
assumptions held in the discipline with regard to a particular body of
information, knowledge and skills. It asks the question, „should the course
be taught at the micro- level or the macro-level of conceptual analysis?‰ On
the other hand, creative or experiential approach involves learning „through
experience and generally through the dynamics of a group process.
Outcomes are defined in the existential moment of learning‰ (Fry, Ketteridge
& Marshall, 2003).
The PBL approach can fit under the objective or process approach although
pure PBL allows the learners to define their own learning goals. The
approach places the emphasis on the process of understanding the problem.
This is normally seen as objective-based through inference rather than
objective-defined.
The best approach to curriculum design is to combine the best of both

approaches according to the learnerÊs need, teacherÊs experience and
organisational structure and resources. For example, it is useful to design the
overall shape of the course, the main aims and learning objectives, broad
content areas and time allocation centrally but devolve or delegate the
detailed planning and design to the teacher who will be delivering the course
so that he will have ownership of the programme.
The way Medical Assistant Boards define broad curricular themes and
outcomes for nursing colleges are examples of a devolved approach.
However, it is important to retain some central control of the course so that
the results of evaluation and feedback can be addressed, and changes in one
part of the course can be made sensibly in view of the impact of the change
on other course elements. At national level, agencies with statutory
responsibilities for healthcare professionalsÊ education and training are
responsible for ensuring that courses delivered by separate organisations are
designed and delivered in line with their recommendations, objectives or
standards. At the organisational level, there should be inbuilt quality
monitoring mechanisms to ensure that teaching and learning, wherever it
occurs, is of a high quality.
2.6.2 Curriculum Development Models

In healthcare education and training, learners are required to acquire a complex
mix of knowledge, skills and attitudes. They are expected to be able to synthesise
and apply their learning to new and often demanding situations. In addition, they
are also expected to be lifelong learners, acquiring and utilising skills and attitudes
such as study skills and self-motivation throughout their working lives. Learners
are working in a constantly changing environment and because they work with
people (including patients, their families, colleagues and other healthcare
professionals), they constantly have to adapt their knowledge to meet expectations
from a range of people.
When we think about designing a course as well as the needs of the learners and
theories of learning, we also need to think about how the overall design of the
programme (timetabling and sequencing, teaching and learning methods) will
enable learners or trainees to acquire the defined knowledge, skills and attitudes.
Whichever design we choose, there has to be a sequence of learning. Learners need
to acquire certain information or skills before they can move on to understand or
apply others.

During the learning process, there is always a shift from the simpler building
blocks to the complex principles, a shift from novice to expert. This is often defined
as a spiral curriculum, one in which learning is seen as a developing process with
active reinforcement and assessment at key stages coupled with the acquisition of
new knowledge and skills. Curriculum planners need to facilitate this process for
their learners and ensure that they are ready to move onto the next stage of
learning. Assessment of some sort is usually used to determine readiness to move
from one stage to another.
The majority of healthcare education programmes in use today (whichever model

they adopt) would stress that they embody and utilise the learner-centred
approach. This approach emphasises adult learning methods and approaches, and
uses active learning (in which learners participate actively in the learning process)
rather than a more didactic, teacher-led approach, which traditionally saw learners
as passive recipients of knowledge, as empty vessels. A programme embodying
the learner-centred approach would typically be designed to enable learners to
define some of their own learning objectives, select learning resources and decide
the sequence and pace of learning. In addition, the programme would help them
to develop lifelong learning skills. This approach is more resource intensive as it
relies on smaller groups and teachers need much more advance planning. Learners
may also need to prepare themselves to shift from teaching that is more didactic
to active learning.
The prevailing curricular models of global healthcare education have a propensity

to take a competency-based approach with regard to the elements of the
curriculum training. The idea of competence means that it is crucial for learners to
be assessed against stated competencies and are deemed either competent or not
yet competent.
In healthcare education, the idea of being competent or not yet competent was
developed through the use of clinical logbooks. The supervisor will sign off in the
logbook once the learner has demonstrated competence. The determined skills and
procedures expected at each level are clearly defined. Korst (1973) suggested that
it is vital to identify those skills which all learners or trainees should show a high
degree of competence and others which only familiarity might be expected
(Newble & Cannon, 1994).
For curriculum planners, decisions should be made on how the competence will
be defined and determined, whether a blacker and white approach (competent
versus not yet competent) is taken or whether there will be expected degrees of
competence. Assessments such as the objective structured clinical examinations
(OSCE) are widely used to measure the level of competence in clinical skills.

Principles of Competency-based Approach:
(a) Systematic, based on learning outcomes or competencies deemed

essential for healthcare personnel;
(b) Provides learners with high quality learning activities that are designed
to help them master each task and periodic feedback designed to allow
learners to correct their performance as they go along;
(c) Requires learners to perform tasks to a high level of competency in work-

like setting; and
Individual learner differences in the mastery of a task are as much to do with

the learning environment as with the learners themselves.
In planning a competency-based programme (for example, clinical skills teaching

session), the following five steps need to be taken:
(a) Step 1: Carry out a required needs analysis of context and activities;
(b) Step 2: Carry out a task analysis. Put major activities into sub-tasks or
components, resulting in a list of specific knowledge, skills and attitudes that
will distinguish those who perform a task competently from those who do
not. The learner will learn this instructional content;
(c) Step 3: Derive the objectives from the competencies required and set criteria
for performance. Objectives must be realistic, measurable, achievable and
specific;
(d) Step 4: Define teaching and learning strategies; and
(e) Step 5: Determine assessment strategies.
In practice, we often find that a mix of approaches and methods are most
appropriate, and hardly any modern healthcare curriculum is purely subject-
based, integrated, PBL or competency-based but are synthesised. Choices must be
made about the approach in view of the specific needs and context. Once the
course is designed, it should be adhered to as much as possible.

2.7 ELEMENTS OF THE CURRICULUM

A formal curriculum (course or programme) can be seen as comprising a number
of elements that fall within the curricular cycle. Curriculum planners need to
ensure that these elements are addressed within the overall strategy and specific
professional or organisational context. Once these elements are in place and the
programme is being implemented (either through a pilot programme or fully),
systematic evaluation of the programme can take place.
Key Aspects of the Curriculum Include:
(a) Aims;
(b) Learning outcomes or objectives (knowledge, skills and attitudes);
(c) Content;
(d) Teaching and learning methods; and
(e) Assessment methods.
Supporting Elements Include:
(a) Learning resources (teachers, support staff, funding, books or journals, IT

support, classrooms);
(b) Monitoring and evaluation procedures;
(c) Clinical placement activities;
(d) Recruitment and selection procedures including promotional materials;

and
(e) Learner support and guidance mechanisms.

2.7.1 Aims and Learning Outcomes or Objectives

The aims and learning outcomes or objectives need to be developed to ensure that
the goal of producing competent graduates is achieved. Aims describe what the
teacher is trying to achieve (for example, to encourage learners to develop self-
directed learning skills) whereas goals usually describe what the course or
organisation is trying to achieve (for example, to inculcate professional values and
attitudes). These terms are often used interchangeably.
Learning outcomes guide teachers on what is expected of the learners upon

completion of the education or training programme. Learning outcomes also guide
learners on what they are expected to be able to do in terms of knowledge, skills
and attitudes after completing the programme or parts of it. Correct interpretation
of the outcomes will guide both learners and teachers on the choice of relevant
learning and teaching methods to achieve the intended learning. Those who are
responsible for setting examinations and other assessments will also need to
interpret the outcomes appropriately so that learnersÊ performance is tested
appropriately by relevant assessment techniques.
Course planners, at whatever level, need to think about the relationship between
learning outcomes or objectives, teaching and learning activities, assessment and
evaluation. Constructing a simple table on which the objectives can be mapped
against the activities can be a useful starting point, even when planning for a single
teaching session.
The following is an example of objectives, which might be found in a first year

healthcare education course (Fry, Ketteridge & Marshall, 1999). It can be used to
assist with course planning.
Objectives should:
(a) Be written in the future tense;
(b) Identify important learning requirements;
(c) Be achievable and assessable;
(d) Use language which learners can understand; and
(e) Relate to explicit statements of achievement.
Table 2.3 provides samples on learning outcomes, and what teaching and learning
activities and assessment can be conducted to suit the learning outcomes.

Table 2.3: Sample Learning Outcomes
Teaching and
Learning Outcome Assessment
Learning Activity
On completion of the session,
learners will be able to:
1. Describe the mechanisms  Learners to find relevant Short answer
to control blood pressure. articles on the Internet, questions as part of
which relate to the control the examination.
of blood pressure as
preparatory work.
 Mini lecture on the
mechanisms of controlling
blood pressure.
 Q&A discussion to ensure
understanding.
2. Take an accurate blood  Practical demonstration by OSCE
pressure reading using a a teacher followed by
range of equipment. learners practising in
pairs, in the clinical skills
lab with feedback from the
teacher.
 Repeat demonstration by
learners.
We start to write learning outcomes with a simple stem, which describes what the
learner will be able to do as a result of our teaching intervention.
For example:
On completion of the session/course/programme, the learner/trainee will be

able to:
Then we write what they will be able to do, which is the learning objective in itself.
It should always contain an operative word such as „perform or describe‰. These
words vary depending on whether the objectives are knowledge, skills or
attitudinal objectives. For example, we might use the terms „define, list, name,
recall or record‰ for the knowledge level of the cognitive domain. This is a lower
level than say the analysis level for which we might use words such as „analyse,
test or distinguish‰. BloomÊs taxonomy is often used to classify the three domains
(refer to Table 2.2).

Objectives ensure the coverage of each of the levels in the domains (as well as those
which cover deep, surface and strategic approaches to learning), which helps
teachers and course planners. Teaching and learning strategies can be planned in
order to encourage and facilitate learning in the different domains. Learners
should be made aware of the objectives at the start of the course or session. Try not
to cover too many outcomes in one session and try to be clear as to what you aim
to achieve.
One of the strengths of course planning using an objective approach is that the
objectives can be used as a measure for assessing learner performance. Teachers
can turn well-written objectives into assessment questions or as a starting point for
designing an examination.
Being aware of the different domains and of the different approaches to learning
and of learning styles and preferences means that teachers and course planners
can take a more systematic approach to course planning.
ACTIVITY 2.2
1. Find some examples of learning outcomes from a course which you

are familiar with. Do you think they are good examples or could
they be improved?
2. For your teaching practice sessions, start by writing some learning

outcomes. Using a matrix, determine how the learning outcomes
relate to the teaching and learning methods as well as assessment.
2.7.2 Content
The content of parts of the curriculum has to be studied in relation to other parts
so that the curriculum forms a coherent learning programme. It should comprise
and reflect a selection of knowledge, skills, values and attitudes that are relevant
and valued by the profession, subject discipline as well as the society. The content
is usually derived from objectives that form the basis for programme development
and can be simply defined as the knowledge, skills, attitudes and values to be
learned.
We should check that:
(a) The content reflects the task(s) that the learners will be doing after training;
(b) The content relates directly to the learning outcomes;

(c) The total time given to each element of the course is appropriate and that the
balance between theory and practice is appropriate; and
(d) The content is pitched at an appropriate level for the learners.
Ideas about course content can be gathered from many sources ă previous courses
or existing curricula at oneÊs own organisation, national professional or discipline
associations, textbooks, other organisational courses (which can often be found on
the Internet) and international bodies that have produced their own core curricula.
Once the outcomes and broad content areas have been defined, this can then be
developed into a programme of learning. Obviously, there will be constraints in
terms of time allocation, teacher availability and access to learning resources.
However, it is important for course planners to plan out a timetable for the course
early on in the planning process. This should include allocating time for each
element of the course and mapping out the sequence of learning in a logical
manner, which will enable learners to progress throughout the course. As we have
said earlier, curriculum development is an iterative process. There will be many
versions of the timetable and other course documents before the programme is
ready for implementation.
2.7.3 Teaching and Learning Methods

In many curricula, the choice of teaching and learning methods is not stipulated
and it is up to the teacher to select the most appropriate method for the subject in
order to achieve the intended learning. In some courses such as PBL curricula, the
learning method is explicit in curriculum design and guidelines will probably need
to be produced to support teachers and learners during the learning process.
The teaching and learning methods or learning experiences should be derived

from the content and learning objectives in a meaningful way. The methods or the
organisation of experiences should facilitate the attainment of respective objectives
in the cognitive, affective and psychomotor domains.
Points to keep in mind are as follows:
(a) How relevant are the teaching and learning methods with regard to the
content and learning outcomes?
(b) How are practical skills to be taught and supervised?
(c) How will learners be supported in independent learning and study (for
example, self-directed learning)?

(d) What resources are required and available to ensure effective teaching and
learning?
(e) Does the teaching promote critical and logical thinking at the level of the
learner?
(f) What are the constraints that will affect the teaching and learning process?
(g) Is the assessment method appropriate for the selected teaching and learning
method?
With developments in new technology, particularly in information technology,

there are many more opportunities for course developers to introduce innovative
teaching and learning methods. This will make learning more flexible. Learners can
study in their own time via the Internet or Intranet, and lectures may be conducted
over the Internet or via video conferencing. This will reduce the need for learners or
trainees (and teachers) to travel to the location of the training provider. Open
learning materials such as modules and workbooks can be developed. This can help
to encourage self-directed study and reflective practice. With careful planning and
careful matching of learning outcomes to teaching-learning methods and
assessments, technology can help to facilitate learning and use resources more
effectively and efficiently.
2.7.4 Assessment Methods

In designing the assessment method to measure learnersÊ performance, the starting
point should always be the stated learning outcomes. Assessments must check that
learners have achieved the learning outcomes in the various contexts as well as
determining the coverage of the content thus far. Teaching and learning methods
must support the assessment strategy. For example, if learners are expected to
perform well in multiple-choice questions, then a PBL course with a facilitative
teaching approach will not be appropriate. An assessment blueprint (or matrix) is
a helpful tool to map out the coverage of core content and learning outcomes
against the assessment methods.
Teachers should check a number of aspects relating to the assessment:
(a) Are the assessment methods, which relate to the assessment of knowledge,
skills and attitudes appropriate?
(b) Do the teaching and learning methods support the assessment strategy?
(c) Are the assessment methods reliable and valid?

(d) Are the assessment methods designed in such a way that learners can achieve
the minimum performance standards set in the curriculum? Is there capacity
for learners to demonstrate higher standards of performance (that is, can the
assessments enable discrimination between learners)?
(e) Are learners sufficiently assessed or are they being overly assessed?
(f) Are the regulations governing assessment procedures and awards clear and
easy to follow, and are they being applied appropriately and consistently?
2.8 PRE-TESTING OR PILOT TESTING THE

CURRICULUM
As we have seen in the earlier subtopics, there is no clear dividing line between
curriculum development and implementation. Once the curriculum has been
developed and tested, and revised as necessary, the curriculum is ready for
implementation. It is important that those who involved in implementing the
course (usually teachers and examiners) as well as the learners will interpret the
curriculum correctly because the written word is not always interpreted in the
same way by everyone. Ideally, the development and implementation should be
seamless and involve many of the same teachers and other staff as well as learner
representatives. This will help to ensure ownership of the new course and more
effective implementation.
Pre-testing or Pilot Testing

Prior to the actual implementation of the curriculum, it is preferable to pre-test or
run a pilot testing on part of or the whole of the curriculum. The main objective of
pre-testing or pilot testing is to try out the draft curriculum in a small scale, involving
a number of training situations and in the context in which the curriculum will be
used. This will help to highlight to the curriculum developers whether the
curriculum is understandable and relevant to the users and whether it works in
practice.
Based on the findings, the curriculum can be modified to meet the needs of the
potential learners. Sometimes there is the opportunity to field test the developed
course to a larger number of users in actual, real-life conditions.
Pre-testing and pilot testing can help to create a more appropriate course. This is
because, the curriculum often does not work as expected in practice because of
unforeseen situations or responses by learners or teachers. For example, when
introducing a new teaching-learning method or new topics into a curricula, it is

easy to underestimate the amount of preparation and additional training which

might be required of teachers. Tools and mechanisms must also be developed to
ensure a systematic evaluation of the testing or pilot testing process.
2.9 MONITORING AND EVALUATING THE

CURRICULUM
Monitoring can be defined as a continuous or periodic check by those who are
responsible for the course at every level. It should focus on processes and
performance with the objective of drawing attention to particular features that may
require corrective action. It includes putting activities in place to ensure that input
deliveries, work plans, expected output and other actions are proceeding
according to plan. Monitoring should enable curriculum planners to detect serious
setbacks or bottlenecks during the implementation process, which may cause the
programme to fail in achieving the expected learning outcomes.
2.9.1 Methods of Monitoring Curriculum

Implementation
(a) Observation ă This method is particularly valuable in the early stages of
implementing a course. However, it should be carried out separately from
the observations of teacher performance. The teaching and learning process
can be observed in a variety of settings. Forms can be used to record the
information in a standardised way. This is a time-consuming method of
monitoring and can be subject to observer bias.
(b) Feedback questionnaires ă Questionnaires can be used to collect information

from staff, learners and external people or groups who are involved in the
course. Information can be sought on every aspect of a course.
Questionnaires are useful to collect a large amount of information and can
be a rich source of data if both open and close questions are used.
Response rates can be low and care must be taken not to overload people
with questionnaires and to seek out ways in which responses can be
encouraged, for example, handing out questionnaires at the end of a teaching
session and giving time for learners to complete the questionnaire. It is a
common practice for questionnaires to be completed anonymously.

(c) Focus groups/meetings/interviews ă Structured or semi-structured meetings

(with individuals or groups) and focus groups can be another useful source
of detailed information about a programme. These are time consuming and
therefore, they are best used to probe into areas of concern or to follow up on
issues that have been identified through other means such as questionnaires.
It is good practice to set up regular meetings with learners and staff

representatives with the specific aim of reviewing the course or elements of
it. Curriculum committees can also be useful sources of information about
the course and they help to increase the ownership of the curriculum. Results
from such meetings must be fed back to the overall quality assurance
mechanism so that appropriate actions can be taken.
(d) Learner assessment results ă Results from both formative and summative
assessments should be analysed regularly in order to evaluate whether
individual assessments are performing reliably and validly as well as
whether minimum set standards are being achieved. Reports from external
examiners can also a very useful source of external information about the
course.
(e) Reports ă Internal reports, which the institution has to provide for its own
use (for example, absenteeism statistics), or reports from external agencies
can be useful sources of information about the course.
2.9.2 Evaluation
Evaluation is a system of feedback that is able to provide information to planners,
teachers, learners and decision makers. Evaluation is a process that involves
ongoing activities aimed at gathering timely information about the quality of a
course or programme.
Why Do We Need to Evaluate Our Courses?
(a) To identify successes and failures of the curriculum with the aim to correct
the deficiencies;
(b) To measure if the stated objectives have been achieved;
(c) To assess if the curriculum is meeting the needs of learners, community, and
other stakeholders; and
(d) To measure the cost effectiveness of the curriculum.

Some Relevant Questions to Ask When Evaluating a Course are as Follows:
(a) Are the learning objectives realistic and relevant?
(b) Do the different parts of the course relate to each other meaningfully in terms
of sequence and organisation?
(c) Are the subject matter and content relevant, accurate and up to date?
(d) Are the learnersÊ entry requirements well defined and at the right level?
(e) Are the course materials and delivery pitched at the right level for learners
during different parts in the course?
(f) Are the teaching and learning methods being appropriately measured?
(g) Are there sufficient time to ensure learning?
(h) Do the teachers have the knowledge and skills required to deliver the
curriculum?
(i) Are the identified learning resources adequate, appropriate and available for
use during the course?
 Curriculum design and development is a systematic process that encompasses

planning, design and implementation. Each of these phases consists of steps
aimed at performing designated curriculum development tasks.
 In teaching, a healthcare personnel needs to consider factors that can influence

curriculum development such as learnersÊ needs, societal needs, the
organisationÊs philosophy, learning theories, government policies, rules and
regulations as well as standards set by regulatory bodies.
 The purpose of viewing the healthcare curriculum in terms of the intellectual

development of the learners paves the way for the development of a process
and problem-centred curriculum.

Adult learning Curriculum development

Affective domain Learner-centred approach
Characteristics of learners Learning objectives or outcomes
Cognitive domain Psychomotor domain
Curricular cycle Syllabus
1. While planning the curriculum for a healthcare education programme, you

need to consider reflecting the philosophy of the curriculum and the nature
of healthcare education by identifying the course objectives. Which stage of
the curriculum planning are you working on?
A. Directive Stage
B. Formative Stage
C. Functional Stage
D. Evaluative Stage
2. Activities involved in a curriculum include ⁄
A. formal and non-formal activities
B. learning activities in the classroom
C. co-curricular activities
D. planned curricular activities

3. The requirement to acquire MUET Band 3 in order to graduate with a

bachelorÊs degree in healthcare in Malaysia relates to the following factor in
curriculum development.
A. Philosophy of education
B. Political factor
C. Theory of learning
D. Subject specialist
Bloom, B. S. (1956). Taxonomy of educational objectives: The classification of

educational goals. Volume 1: Cogitive domain. New York: David McKay Co
Inc.
Bloom, B. S., Krathwohl, D. R., & Masia, B. B. (1984). Taxanomy of educational

objectives: The classification of educational goals. New York: David McKay
Co Inc.
Fry, H., Ketteridge, S., & Marshall, S. (2003). Handbook for teaching and learning
in higher education. London: Routledge.
Heidgerken, L. E. (1965). Teaching and learning in schools of nursing: Principles

and methods. Philadelphia, PA: Lippincott.
Hutchinson, L. (2003). Teaching and learning in the clinical context. Retrieved from
https://faculty.londondeanery.ac.uk/e-learning/assessing-educational-
needs/Teaching_learning_in_clinical_context.pdf
Neeraja, K. P. (2006). Textbook of nursing education. New Delhi: Medical

Publishers (P) Ltd.
Newble, D., & Cannon, R. (1994). A handbook for teachers in universities and
colleges: A guide to improving teaching methods. London: Kogan Page.
Peyton, J. W. R. (1998). Teaching and learning in medical practice. Rickmansworth,

UK: Manticore Europe Ltd.
Prideaux, D. (2000). The emperorÊs new clothes: From objectives to outcomes.

Medical Education, 2000; 34: 168ă169.

Pruit, Z., Mhaskar, R., Kane, B., Barraco, R., DeWaay, D., Rosenau, A., &
Greenberg, M. R. (2017). Development of a health care systems curriculum.
Advances in Medical Education and Practice, Volume 8, 745ă753.
Stenhouse, L. (1975). An introduction to curriculum research and development.

London: Heinemann, 1975: 52ă83.
Tan Sri Awang Had Salleh. (1994, May 29). The Star. p. 23 Education.
Torres, G., & Stanton, M. (1982). Curriculum process in nursing: A guide to

curriculum development. Upper Saddle River, NJ: Prentice Hall.
Tyler, R. W. (1975). Basic principles of curriculum and instruction. Chicago &

London: University of Chicago Press.
Willis, P. E. (1977). Learning to labour: How working class kids get working class
jobs. London: Saxon House.
Winfred, M. Ogundeyion. (1976). Principles of curriculum development.

International Nursing Review. Nov/Dec. 23(6) Issue 210.

Topic  Clinical
Teaching
3
LEARNING OUTCOMES
1. Identify the strengths of clinical teaching;
2. Differentiate the roles of clinical teachers/preceptors;
3. Perform assessment for learning needs of the patients in the clinical
setting; and
4. Prepare and plan a clinical teaching session based on the learning
needs of the patient.
 INTRODUCTION
Clinical teaching practices can influence the quality of learning experiences for
healthcare learners. However, sound clinical teaching can also enhance health
teaching for patients, their families and colleagues. The setting of the practice is
critical to the learning process. Not only does it influence what is learned but also
it is a powerful force in determining the patterns of providing care, in forming
attitudes and perceptions, and in setting goals for outcome of care.
Teaching in protected time is common in lectures and seminars, and is often used
to teach clinical and communication skills. It may be also done for bedside teaching
using patients who have been specifically selected for teaching. On the other hand,
teaching in the service setting covers any type of teaching that accompanies clinical
work. This subtopic looks at teaching in a variety of different clinical settings and
suggests how clinical healthcare personnel can make optimum use of these settings
to teach learners effectively.

TOPIC 3 CLINICAL TEACHING  57
The analysis studies by Prideaux et.al. (2000) found that the clinical teaching and
clinical practice demonstrates that they are closely linked. As experts, clinical
teachers are involved in research, information retrieval and sharing of knowledge
or teaching. Good communication with trainees, patients and colleagues defines
teaching excellence. Clinicians can teach collaboration by acting as role models and
by encouraging learners to understand the responsibilities of other health
professionals. As managers, clinicians can apply their skills to the effective
management of learning resources. Similarly skills as advocates at the individual,
community and population level can be passed on in educational encounters. The
cliniciansÊ responsibilities as scholars are most readily applied to teaching
activities. Clinicians have clear roles in taking scholarly approaches to their
practice and demonstrating them to others.
3.1 CLINICAL TUTORING OR TEACHING

One of the most intense forms of small group teaching is the tutoring of learners in
clinical practice. This is conducted in very small groups, quite often on a one-to-one
basis. It is a central part of teaching in nursing and other health sciences. The
particular forms of clinical tutoring may vary but the principal elements are
common: learners engage in practical activities with live subjects under the watchful
eyes of experienced practitioners. They are learning by doing, in a setting where the
safety of the patients and learners is protected. In these situations, clinical tutors (also
referred to as clinical nurses/instructors/preceptors) usually have considerable
experience in their profession but may be new to teaching.
Because of the small number of learners involved, this form of teaching and
learning allows a good deal of room for individual approaches, however, there are
some basic principles which need to be observed.
The main challenge is to provide learners with the opportunity to learn through
observation and personal experience while protecting the welfare and dignity of
the patient at all times. The tutor must always maintain a double focus, being alert
to the situation and feelings of the patient while monitoring closely the learnersÊ
responses and thought processes.
A common pattern in clinical teaching is to start with the learners as observers, with
the clinician demonstrating and explaining a procedure. At an appropriate stage, the
learners will be involved in the conduct of the procedure, often starting with the
simpler aspects. This means that the role of the clinical tutor shifts as the learner

58  TOPIC 3 CLINICAL TEACHING
takes on increasing responsibility ă eventually the learner will conduct the entire
activity. In the demonstration stage, the important elements are clear with
systematic explanation of what is being done and why, and probing of the learnersÊ
understanding. As learner responsibility increases, the clinical teacherÊs role should
shift to that of a watchful observer, occasional assistant and colleague.
The importance of explaining why things are done in a certain way cannot be over-
emphasised. In all areas of learning, if learners are given a series of procedures to
follow without understanding the reasons for them, they are likely to resort to rote
learning of what seem to be arbitrary and unconnected details. If they grasp the
rationale or logic of the procedures, they will incorporate them into the conceptual
frameworks that they bring to the activity.
Probing of learnersÊ understanding entails skilful and focused questioning as well

as encouraging learnersÊ own questions. It is likely that there will not be sufficient
opportunity for this to occur during the clinical consultation, so it is essential to
provide the opportunity for a thorough debriefing after the conclusion of the
treatment and/or session. Lack of timely and relevant follow-up of this kind is
often identified by learners and clinical teachers as one of the main problems with
this form of teaching.
3.1.1 Principles of Clinical Teaching

After determining what specific teaching approach is best for the learners and for
the clinical setting, it is useful to apply general principles of clinical teaching.
Some basic tenets of learning include the following:
(a) Learning is evolutionary;
(b) Participation, repetition and reinforcement strengthen and enhance learning;
(c) Variety in learning activities increases interest and readiness to learn as well
as enhances retention; and
(d) Immediate use of information and skills also enhances retention.
3.1.2 Precepting and Your Practice

One essential ingredient drives the dayÊs activities ă your practice! On any day,
events and learning opportunities will arise that you could not predict or
incorporate into your initial plan for precepting. When you begin each precepting
day with the learners, have the general idea of the day as you expect it to unfold.

If you and the learners decide to pursue some unforeseen learning opportunities,
give the learners the responsibility for incorporating the activities that you had
originally planned.
Learn to perceive your practice setting with a view towards learning opportunities
for the learners. Filter your perceptions considering the learnersÊ objectives and the
unique opportunities available in your practice. Adjust your plan as opportunities
arise and as you observe the learnersÊ performance and identify new learning
needs. Flexibility is an important key to precepting success.
3.1.3 Teaching and Learning Situations

Hill (2007) suggested that teachers need to start with an understanding of where
the learners are in terms of their learning, the level they have reached, their past
experiences and understanding of learning needs and goals.
As part of the overall planning process for a teaching session, you will have
defined the aims of the session, the learning outcomes or objectives and possibly
an assessment. At the start of the session, these should be explained to the learners
to set the context for the learning. One of the responsibilities of the teacher is to
help align the stated, formal learning outcomes with the individual learnerÊs
educational needs. How can we do this during busy clinical sessions when we
might be involved in teaching many different groups of learners or trainees?
Assessing learning needs can be done relatively informally at the start of a teaching
session simply by asking the learners what they would like to learn or what they
expect to get out of the teaching session. Making this a routine part of any teaching
session helps to avoid those situations where the teacher is gamely plodding on
regardless, even though the learners are clearly disengaged with the process.
The first step is to establish a good rapport with learners so that you can work
together towards what should be a shared objective. If you have planned your
teaching session thoughtfully and learners are aware of the curriculum, the
learnersÊ needs and your plans for the teaching should be well aligned and there
will be no need for more than minor adjustments. Even though sometimes the
learnersÊ needs are somewhat different or additional to the stated learning
outcomes, it is important to teach the session according to the overall curriculum
or timetable. Explain this to the learners, acknowledge their needs and find ways
to meet their needs outside the current teaching session. This may involve
recommending reading, setting extra teaching sessions, setting up learning sets or
speaking with course coordinators.

On the occasions when you are asked to teach a session without much background
or with a fuzzy remit, you may find that there is very little alignment between
what you plan to teach and the learnersÊ needs. Again, discussing this and making
a sensible plan to meet needs is the best strategy.
During and towards the end of the teaching session, we need to keep in sight how
far the learners have travelled towards the learning goals, where might they have
gotten off-track or what further learning or practice may be required. Teachers
need to keep an eye on the tasks they want learners to achieve as well as the process
of learning, as both elements are required to ensure that learning needs are met. If
we go back to the learning journey model, the journey (process) will be very
different if you are flying, travelling by car or by boat; if you are travelling alone
or in a group; if all of you are setting off from the same place; or if you are being
led by a guide who is very familiar with where you want to go and has a good
route map in hand.
3.2 STRENGTHS OF CLINICAL TEACHING

Learner satisfaction with clinical teaching reflects not only the strengths of clinical
teachers but also the positive aspects of clinical education itself. Clinical education
has three distinguishing, positive characteristics:
(a) Problem-centred approach in the context of professional practice;
(b) Experience-based learning model; and
(c) Combination of individual and team learning.
3.2.1 Problem-centred Learning

The focus of clinical education is on the patient. Patient problems provide teaching
opportunities for the faculty and learning opportunities for learners. The richness
of that learning experience depends in large measure upon the faculty memberÊs
instructional skills and the patient mix available. Since clinical instruction takes
place in the context of professional practice, learner questions about the relevance
of what is to be learned are minimal and motivation is high. The learners actively
strive to emulate faculty and resident role models.

3.2.2 Experiential Learning

In clinical education, the process of learning is principally by doing. This form of
experiential learning differs from most classroom settings where the symbolic
medium is used to transmit information. In experiential learning, information is
generated through the sequence of steps themselves:
(a) The learner first acts in response to a particular situation and experiences the
consequences;
(b) The learner then infers the effects of action in the particular case;
(c) The learner next generalises understanding over a wider range of

circumstances; and
(d) The learner finally acts in a new circumstance, anticipating the consequences.
Experiential learning is time-consuming and requires repeated actions in sufficient

circumstances to allow for the development of a generalisation from experience.
When the consequence of action is separated in time and space, the learning
process is not effective.
3.2.3 Individual and Team Learning

Another major strength of clinical education is the combination of individual and
team learning. While learners are responsible as individuals for their learning
during a clinical placement, this learning experience is in the context of the work
team. Instructional time and effort are allocated in the context of teamwork and
team function. It was observed that as individual team members learn, they appear
better able to contribute and use the contributions of others to their teams.
Moreover, as teams develop their abilities to work together, they appear to
promote additional learning among their individual members.
Clinical education is a challenging experience for most learners because it allows

them to participate actively in the healthcare team, seek solutions to real problems
and learn by doing while caring for patients.

3.3 ROLES OF CLINICAL TEACHERS/

PRECEPTORS
Clinical teachers play a crucial role in assisting healthcare personnel learners to
apply theory learnt in the classroom into practice within the clinical environment.
The value of sound clinical teaching practices cannot be denied, assisting learners
to develop personally and professionally as well as in developing vital clinical
nursing skills (Fawcett & McQueen, 1994). Within the classroom, clinical
laboratories and clinical placements, learners view the clinical teacher as a role
model (Howie, 1988).
Although clinical teachers are generally considered to be experts within their

preferred clinical environments, assistance is required in providing further
education that will enhance the ability of clinical teachers to assist learners apply
learned theory into practice.
For effective learning to occur within the clinical setting, clinical teachers need to
understand the mechanisms in which learning takes place. Such knowledge can aid
the clinical teacher in adapting classroom learning into practice, in recognising
learning problems and developing strategies for overcoming these difficulties as
well as providing methods for enhancing the clinical learning experience. Flagler,
Loper-Powers and Spitzer (1988) viewed the clinical teacher as a first level quality
control, ensuring the maintenance of clinical practice standards.
3.3.1 Teaching by Role Modelling

Learners will learn from our role modelling whether or not we have purposefully
presented ourselves as role models. Two of the most significant aspects of
learning that are accomplished through role modelling are critical thinking and
professional role behaviour during interactions with patients, interdisciplinary
colleagues and others.

Your thinking is invisible. Similarly, the learnersÊ thinking process is also invisible,
therefore, you need to ask for responses that call for the learners to describe their
thinking. Make your thinking visible to teach judgment. Think aloud whenever
appropriate.
Brookfield (1990), an adult education authority, refers to our mistakes as our

„instructional friends‰. Our instructional friends teach us how to improve, what
to watch out for as well as many other valuable lessons. You will find learners will
be extremely attentive to your stories of valuable lessons learned from mistakes.
Obviously, you do not want to present yourself as an incompetent clown. However,

any wise, experienced professional will know that everyone makes mistakes
occasionally. Use an occasional line such as „I remember the time ⁄‰ or „I learned
this the hard way when ⁄‰
This approach is a role modelling that draws upon reflection on practice. With this
approach, you can sometimes prevent learner errors. Learners may also have
greater willingness to approach you with their uncertainties if they perceive that
you have a reasonable tolerance for error. This certainly does not mean you should
lower your performance standards or quality of care. Rather, the intent is that
when mistakes occur, as they inevitably will, use it as a learning opportunity as
well as apply whatever corrective action is necessary.
The approach that you model with your patients will profoundly affect the
learners. For example, asking the patientÊs permission for the learner to participate
in his care, protecting patient privacy, warning the patient of sensations or
discomfort, thanking the patient for accepting the learner, or offering to discuss
any questions with the patient and his family. In Table 3.1, Wiseman (1994)
identified salient role model behaviours as perceived by healthcare personnel
learners.

Table 3.1: Role Model Behaviours in the Clinical Setting
Demonstrate the use of equipment that is unique to the setting

Demonstrate healthcare procedures
Ask questions regarding the patientÊs condition
Report clinical data to staff personnel in a timely fashion
Use therapeutic communication skills with each patient
Interact with physicians in a confident manner
Identify self to patients when you first meet them
Demonstrate up-to-date healthcare practices
Ensure neat and clean professional appearance
Display a sense of humour under appropriate context
Demonstrate ability to care for patientÊs needs
Pitch in when necessary to assist learners
Demonstrate a caring attitude towards patients
Demonstrate a caring attitude towards learners
Keep confidential information to self
Be organised in the clinical setting
Be flexible when the situation requires a different approach
Have respect for agency personnel
Provide a positive atmosphere for learners to learn
Listen to learnersÊ points of view
Respect the patientÊs integrity
Encourage discussion of ethical dilemmas
Give positive feedback
Give negative feedback in a positive manner
Demonstrate accountability for own actions
Demonstrate an enthusiastic attitude towards nursing
Demonstrate problem-solving ability in the clinical setting
Source: Wiseman (1994)

3.3.2 Role as a Coach

The coach or trainerÊs role is often to promote practical skills, where the learner or
trainee is taken through the steps of learning how to perform some actions and the
skills are developed mainly through practice. It is the role of the coach to notice
when the learner has done wrong or is being ineffective, and where intervention
would be helpful. The coach can demonstrate good practice and go through the
steps carefully and slowly especially where mistakes are commonly made.
The term „coaching‰ is derived from a French term which means „to convey a
valued person from one point to another‰ (Gotlib, Jaworski, Zarzeka & Panczyk,
2018). In a sense, the term referred to as travel by a stagecoach-like conveyance,
fits well in the context of precepting a learner in practice.
Long recognised as an effective means of improving performance in sports and the

performing arts, coaching has more recently received attention as a means of
supporting professional development and improving the performance of the
management team. The coaching process parallels the precepting process which
involves defining goals, planning means to achieve goals, sharing information and
demonstrating techniques, role modelling, giving corrective feedback, changing
strategy to address changing situations as well as clarifying and validating
perceptions.
Characteristics of the coaching relationship as applied to precepting (Farley, 1990):
(a) Preceptor or coach and learner forge a partnership;
(b) Preceptor and learner commit to produce result;
(c) Preceptor and learner accept each other non-judgmentally;

(d) Preceptor agrees to encourage the learner to improve. Meanwhile, learner

agrees to listen to the coachÊs interpretations;
(e) Preceptor acknowledges the uniqueness of each learner, each relationship

and each situation;
(f) Preceptor and learner prepare for coaching encounters and practise their
roles in the coaching relationship;
(g) Preceptor and learner must give and receive information and feedback; and
(h) Preceptor and learner integrate into the team and exhibit a willingness to go
beyond what is already achieved.
Effective coaching practices is experimental and qualitative research supports the

idea that several specific coaching practices are linked to improved teacher
practice. Despite this point, coaching practices with the strongest evidence for
improving teacher practice and learner outcomes include the following:
(a) Observation;
(b) Modeling;
(c) Performance feedback; and
(d) Alliance-building strategies also referred to as „relationship-building

strategies‰).
Figure 3.1 show us the techniques of effective coaching.

Figure 3.1: Techniques of effective coaching

Sources: https://www.air.org/sites/default/files/NCSI_Effective-Coaching-Brief-
508.pdf
This subtopic of the brief provides a review of these high-quality coaching

practices. The observation refers to direct monitoring of the teacher in a learning
environment. The primary purpose of observation is to enable a coach to engage
in other coaching practices such as modeling or providing performance feedback
Modeling occurs when a coach demonstrates how to use the practice. Modeling is
most typically used by a coach when a teacher is not correctly using a practice with
the learner or does not know how to use that practice. Providing performance
feedback is a third critical coaching practice and entails the coachÊs presentation of
data to the teacher on his or her teaching practice.

ACTIVITY 3.1
Decide which coaching techniques to apply in the situations in the boxes

shown below:
Which Coaching Technique(s) Would You Use in These Situations?

(a) When the learner performs well.
(b) When the learner does not meet expectations and you do not know the
reason.
(c) When the learner fails to try or tries to fail.
Possible Reason: Possible Coaching Techniques:
 Learner does not match role
expectations.
 Learner is unclear about performance
expectations.
 Learner perceives that performance
expected is not really important.
 Learner lacks skill.
Possible Reason: Possible Coaching Techniques:
 Learner lacks desire or motivation to
perform at expected level.
 Real or imagined barriers interfere with
the performance.
 Learner may receive more reward (for
example, attention) for poor
performance than for good performance.
 Learner has not received adequate
performance feedback.
 Learner does not perceive positive
outcomes (or rewards) for good
performance.
* Check the possible answers at the end of this topic.

3.3.3 Role as a Supervisor

„Clinical supervision‰ is a term used to describe a formal process of professional
support and learning, which enables individual healthcare personnel learners to
develop knowledge and competence, assume responsibility for their own practice
as well as enhance client protection and the safety or care in complex clinical
situations. This clinical supervision is a practice-focused professional relationship
involving a practitioner reflecting on practice and guided by a skilled healthcare
personnel supervisor (Kirk, Auth & Eaton, 2000; Lyth, 2000).
In order to provide effective supervision, supervisors require many of the same

skills as the mentor (see Subtopic 3.3.6 on mentoring). However, while mentors act
as personal guides, often working alongside the learner, supervisors often have an
additional formal role in monitoring the progress. Supervision requires clarity
about the nature of the learning that is required and supervisors are usually
experts in carrying out the responsibility for the work area and for the learnersÊ
progress.
This role entails appraising or assessing the learner formally and producing
reports on the progress. The issue for supervisors is often about when to intervene
and when to allow learners to learn through self-discovery. Individuals approach
problems in different ways and have different learning styles. Supervisors,
therefore, must be sensitive to the way in which each learner or trainee tackles the
problem so as not to impose their own approach inappropriately.
Ideally, every learner has a named educational supervisor ă a consultant in the

specialty or a principal in general practice. Educational supervisors are expected
to oversee the education of learners, to act as their mentors and are responsible
for ensuring that learners or trainees are making the necessary clinical and
educational progress during the process.
3.3.4 Role as a Facilitator

The word „facilitator‰ is used in preference to the word „teacher‰ in experiential
learning situations whereby learners learn from practical experience, for example,
in supervised practice in hospitals. This type of learning requires more facilitation
and less direct teaching compared to learning in the academic environment.
Facilitation implies that the activity is one of support rather than initiating. The
experience belongs to the learner and the facilitator helps the learner to get the
most out of the experience by providing appropriate resources and intervening in
support of the learning.

The clinical facilitator has an important liaison role. He should provide positive
support for healthcare personnel as well as being involved in issues relating to
learner achievement and performance. Providing regular feedback to healthcare
personnel regarding their experience and the ability to supervise learners is an
essential part of the clinical facilitatorÊs role, enabling healthcare personnel to
develop both professionally and personally.
The facilitator role is a difficult one for the traditional teacher in that it involves
careful listening and eliciting responses rather than giving of oneÊs own
knowledge. It usually requires that the tutor be learner-centred, helping learners
to express what they understand by respecting them for who they are rather than
what they should be. There are different models of facilitation. At one extreme, the
learner is an autonomous learner who is in total control of content and process,
with the facilitator supporting.
Where healthcare personnel are working with more challenging learners,

facilitators are able to debrief and develop strategies to support learners
appropriately. This helps reduce frustration and promotes attitudes and
behaviours that can lead to successful outcomes.
3.3.5 Role as a Counsellor

There is a difference between counselling and guidance. Teachers sometimes have
to adopt a counselling role when learners have difficulty finding their direction,
when they have personal problems that affect learning or to clarify why their
learning is not progressing as it should.
It is more common, however, for teachers to adopt a guidance role whereby

providing comfort, support and a friendly ear is often enough. Guidance usually
involves a more directive form of help. With guidance, a teacher will probably:
(a) Give information without any attempt at evaluating or pronouncing value

judgements on the content;
(b) Offer advice based on knowledge and experience; and
(c) Structure the learnerÊs learning experience by taking positive action in the
form of direct intervention.
Counselling is a process whereby counsellors provide help for learners with

personal problems that affect their educational progress. The source of the
problem that results in a need for counselling may be related with life outside the
workplace. Non-directive counselling provides a setting, a relationship, the
conditions and the opportunities for a client (learner) to discuss the situation that

has led to the meeting with the counsellor. Attitudes, thoughts and feelings can be
aired in a non-threatening atmosphere, alternative courses of action can be
explored and the consequences of each option can be assessed. In the end, it should
be the learner and not the counsellor who will discover answers and solutions, and
make decisions as to the course of action to be taken. The counselling role is
therefore one of facilitating, by providing an arena as well as the conditions that
will allow learners to recognise and resolve their problems.
Some of the important basic counselling skills that a teacher may adopt are:
(a) Icebreaking;
(b) Drawing out;
(c) Listening;
(d) Managing silence;
(e) Clarifying;
(f) Reflecting back;
(g) Questioning;
(h) Summarising;
(i) Advising;
(j) Target setting; and
(k) Prescribing.
3.3.6 Role as a Mentor

The concept of the mentor is as a wise counsellor, a good friend and a role model.
The term „mentor‰ has traditionally been used in the business sector to describe
powerful individuals who take a protégé under their wings with the aim of using
their power and influence to shape and advance that personÊs career. When we use
it in our context, we imply that it is something to do with the provision of support
and being a suitable role model. Within the field of medical or healthcare
education, a mentor is one who:
„⁄ guides another individual (the mentee) in the development and

re-examination of his own ideas, learning as well as personal and professional
development.‰

The key activities of a mentor can be described as providing academic, personal

and professional support to the mentee. As you can see, there will be some degree
of difficulty if the same person is providing mentoring support, running appraisals
as well as being in charge of hiring and firing!
Being involved in a successful mentoring relationship can be enormously fulfilling

and can help you to make wise and appropriate decisions about your teaching
career. As a mentor, you need to understand and respect both the purpose and
process of mentoring and to understand the nature and breadth of your teaching
and support of the learning role.
The mentor needs to be a friend, someone with whom one can share failures as
well as successes. It is sensible to reach an agreement at an early stage about issues
around the boundaries of the relationship. Both the mentor and the mentee need
to constantly reflect on the remit of the relationship and situations when another
person or role is more suitable to deal with an issue.
The type of mentoring relationship described assumes that the mentee has some
say in choosing his mentor. In some schemes, a mentor is assigned to a mentee
when he joins a department or unit and it is assumed that the relationship will
work. In practice, usually the relationships flourish when the mentor and mentee
have compatible expectations from the relationship. There is evidence that two
elements which contribute to successful mentoring are having mentors who are
trained in mentoring skills and where the aims and outcomes of the mentoring
process are clearly defined and agreed. In addition to these classic roles, the mentor
needs to be accessible in both time and geography, and be respectful of
confidentiality and autonomy.
ACTIVITY 3.2
Apart from your face-to-face teaching activities, can you list the other
roles that you play or have played when interacting with learners?

3.4 ASSESSING LEARNING NEEDS IN CLINICAL

SETTING
The role of a clinical teacher is complex in terms of combining teaching activities
with clinical commitments and of contextualising the activities within the
programmes, professional requirements and individual learnersÊ needs.
One way of thinking about the teacherÊs role in relation to learners is to think in
terms of the learning journey in which learners are engaged. Because learners are
working towards a professional qualification in the course of their studies, clinical
teachers have to understand what the programme comprises in terms of the defined
learning outcomes, content and assessment. As such, the learning needs of learners
are already pre-defined in terms of the curriculum, syllabus or programme of study.
The curriculum will be written down and each teaching or learning event needs to
be relevant to the overall programme (refer to Topic 2).
Familiarising yourself with the intended or expected learning outcomes is a vital

first step in assessing learning needs and planning teaching-learning activities.
Although each learner in a defined programme (for example, healthcare personnel
or other allied health) will be following a broadly similar programme of study
leading to a common assessment and professional qualification, their individual
experiences, learning styles and expectations from the programme will vary. This
means that their individual learning needs will also be different and if the teacher is
to help each learner to achieve the defined learning outcomes, attention needs to be
paid not only to the learning programme but also to the needs and abilities of the
individuals.
Therefore, teachers are involved in assessing learning needs in the classroom, at

the bedside or in the consulting room, both formal and informal ways. However,
clinical teachers are often also involved in supporting learners in their professional
and personal development as well as in guidance and supervision activities such
as appraisal and career advice.
There are many opportunities for assessing learning needs and setting learning
outcomes with learners on a day-to-day basis. SpencerÊs (2003) article, Learning
and teaching in the clinical environment, describes a range of aspects and activities
that are concerned with helping clinical teachers to optimise teaching and learning
opportunities which arise in daily practice such as planning, using appropriate
questioning techniques and teaching in different clinical contexts. Such techniques
often involve discussing learnersÊ performance or understanding. The techniques
are built into everyday practice.

In this module, we will look at two main aspects of assessing learning needs,
namely in teaching situations and as part of continuing professional development
(CPD) or personal and professional development.
3.4.1 What to Achieve?

One of the main tasks of the clinical teacher in working with learners is to support
the learners in raising the awareness of their own strengths and areas for further
development. One widely used model that summarises self-knowledge at any one
time is the Johari Window (1955). Refer to Table 3.2.
Table 3.2: Johari Window (1955)
Known to Self Unknown to Self

Known to Others Open arena Blind spot
Unknown to Others Hidden (façade) Unknown
According to Table 3.2, the open arena is where a person feels he is able to be
himself, is authentic and his behaviour is routinised. Through feedback, formative
(developmental) assessment, appraisal and support, the task of the clinical teacher
is to help the learner expand the open arena so that he starts to become aware of
or feel able to reveal those aspects that fall under the other three areas:
(a) Blind spot ă Others can see the learnerÊs deficiencies or gaps but the learner
cannot. Formative assessment techniques and a trusting relationship can
help the learner become aware of his learning needs;
(b) Hidden or façade ă Aspects where the learner is aware of the needs, gaps or
deficiencies but others are not. This requires trust to be developed between
the clinical teacher and the learner so that the learner feels able to admit
weaknesses or deficiencies or reveal his fears; and
(c) Unknown ă The teacher and the learner work together to identify areas for
development.

In another model as shown in Table 3.3, those assessing educational needs can help
the learner to move through the stages in the competency model of professional
development (Proctor, 2001; Hill, 2007).
Table 3.3: Stages of the Competency Model of Professional Development
Unconscious Conscious Conscious Unconscious

Incompetence Incompetence Competence Competence
Learner Low level of Low level of Demonstrates Carries out
competence. competence. competence but tasks with
Unaware of Aware of skills are not conscious
failings. failings but fully thought. Skills
does not having internalised or are internalised
full skills to integrated. Has and routine.
correct them. to think about Little or no
the activities. conscious
awareness of
detailed
processes
involved in the
activities.
Clinical Supportively Uses a range of Helps learner to Raises
Teacher: helps learner to skills and develop and awareness of
Assessing recognise techniques to refine skills, details and
learning or weaknesses, assess learnerÊs reinforces good unpacks
educational identifies areas development in practice and processes for
needs for relation to competence more advanced
development defined through learning. Helps
and becomes expectations for positive regular the learner to
aware of the level and feedback and identify any
learning or stage of focuses on areas areas of
development learning. Helps for weaknesses or
needs and thus learner to development bad habits that
conscious of his develop and and refinement he may not be
incompetence. refine self- of skills, aware of.
assessment additional
skills. Reassures knowledge
and supports required and an
the learner. integration of
competences.
Sources: Proctor (2001) & Hill (2007)

3.4.2 When to Assess?

One of the goals of professional education is to facilitate the learners towards being
independent and self-directed so that they have the capability to learn throughout
their professional lives. This does not happen automatically. Teachers have a key
role in helping to facilitate this and one way to embed it into the learning process
is to involve learners in identifying their learning needs.
Working with learners to assess their own educational needs is also a key part of
this cycle. Learners need to be made aware of and be reminded of the overall
learning outcomes of the programme, teaching session or clinical activity in which
they are engaged in.
Identifying and assessing learning needs is part of the experiential learning

process (Kolb, 1984). Kolb suggested that learning happens in a circular fashion.
Learning is experiential (learning by doing) and that ideas are formed and
modified through experiences. These ideas underpin the idea of the reflective
practitioner and the shift from novice to expert, which occurs as part of
professional development.
This cycle is similar to the planădoăreflectăreview cycle, which is often used in

appraisals.
Figure 3.2: The planădoăreflectăreview cycle

We can see that the ideas underpinning both the models are such that the learner
and teacher work together to identify shared needs, plan learning or development
activities to meet those needs, carry out activities and then reflect and review
against the needs or identified learning outcomes. The process is cyclical, iterative
and learner-centred.
In practical terms, the teacher will identify when to assess the learning needs of
individuals or groups of learners. Certainly, this should be at the start of a
programme, meeting or teaching session. However, time should also be built in
during the course of a programme or session to review the progress and to ensure
effective and appropriate learning is taking place. At the end of a session or course
of study, it is important to plan the next steps and to link the learning to where the
learner is going to next.
3.4.3 Who to Assess?

In the previous subtopic, we looked specifically at assessing learning needs in
teaching situations and suggested that ideally this should be a shared endeavour
by learners and the teacher. Assessment of learning needs is a key step in the
formative assessment processes that are ideally included within a learning
programme.
As Wood (2007) noted, „Formative assessment can play a major role in the
acquisition of lifelong learning skills by helping learners to self-regulate their
learning activities⁄ formative assessment is a two-way process between the
learner and the teacher, placing the learner at the centre of the activity.‰
Assessment (both formative and summative) is often teacher-led. However, there

are other groups, individuals and activities that contribute to how learnersÊ
learning needs are assessed, both in teaching situations and in the course of
professional development planning.
(a) Self-Assessment by the Learners

One of the overall goals of healthcare education and training is to develop
learnersÊ capabilities to carry out critical self-reflection of their own
performance. This helps them become more effective, self-directed and
independent professionals. Teachers play a key role in helping learners
develop these skills by providing opportunities for self-assessment of their
clinical competence, knowledge, understanding and attitudes, and by
pointing out where there is a mismatch between self-perception and
observed behaviours. Building in simple questions such as „How do you
think that went⁄?‰ opens up opportunities for learners to routinely reflect
on and review their performance.

(b) Assessment by Teachers

Wood (2007) suggested, „Assessment is usually seen as the province of
teachers.‰ This includes assessment of educational needs. The advantages of
teacher assessment of the needs is that highly competent teachers have
experience with the programme and „can evaluate work (or performance)
against a reference framework that reflects the preset learning objectives and
the level expected of learners or trainees at a particular stage in a course⁄
(teachers can then) make a judgement on the work and provide⁄ feedback⁄
on that judgement.‰
Highly competent teachers (Wood, 2007 in citing Sadler, 1998) are

knowledgeable and have a positive attitude towards their teaching practice.
They are able to empathise with learners, are reflective of their own and
othersÊ skills and want to see learners improve and develop. However, there
is often variability between the different skills, experience and expertise of
the teachers, and not all teachers have the same level of interest in and
empathy towards learners.
3.4.4 Assessment Linked to the Course/Programme/

Professional or Regulatory Body
These are the formal means (such as examinations and clinical assessments) in
which the learner is assessed at regular points against defined criteria. Passing
allows the learner to progress to the next stage. Well-designed assessments
provide opportunity for feedback to the learner, which in turn helps him identify
where his learning has been effective and also where he has a particular area for
improvement or further study. Teachers who are responsible for learners can use
the assessment results as one of the means to measure learnersÊ progress and
identify as well as agree with the learning needs.
ACTIVITY 3.3
Can you think of other individuals who may be involved or other means
by which educational needs might be assessed?

3.4.5 Tools for Assessing Educational Needs

We have considered some of the approaches to assessing learning needs in earlier
subtopics and the links in which learners learn through experiential means (for
example, Kolb, 1984) as well as through a variety of teaching and learning
methods. Learners also have different learning styles and strategies (Honey &
Mumford, 1982; Felder, 2002), in other words, they react and respond to different
situations or teaching methods in different ways.
This subtopic summarises some of the most commonly used tools to assess
learning or educational needs. Many of the tools described were developed under
different contexts. However, they can all be used and adapted to fit a range of
situations involving learners.
In the clinical environment, the generic tools and techniques are supplemented
and focused towards developing clinical competence and confidence within a
variety of contexts. A number of formative (developmental) workplace-based
assessment tools can be used to help identify and clarify learning needs. The
following is a list of some of the most widely used tools:
(a) Confidence and competence rating scales;
(b) Case analysis;
(c) Clinical audit;
(d) Peer observation of practice;
(e) Professional conversation;
(f) Feedback from patients, staff and other health professionals (for example, 360À
degree appraisals);
(g) Consultation analysis;
(h) Joint consultations, clinics or surgeries;
(i) Logbooks, diaries and journals;

(j) Personal development plans;
(k) Portfolios; and
(l) Significant incident or event analysis.
Many of these methods may also be used in summative assessment and any
summative assessment can be used as a means of assessing learning needs. In
practice, the distinction between formative and summative assessment is blurred.
What is important is that the purpose and intended future use of any assessment
tool is clear to both learner and assessor from the outset.
3.5 PREPARATION AND PLANNING FOR

CLINICAL TEACHING
In addition to the roles and personal qualities of the preceptor that have already
been mentioned, preparation and planning have also been noted as the key
components to a successful experience for all learners. The goal is to provide
settings and experiences in which learning can occur with minimal disruption to
agency operations and patient needs and expectations. Awareness of the
placement goals as well as the learnerÊs personal goals is essential. Thus, there
needs to be communication with faculty prior to the learnerÊs arrival and
discussion of goals with the learner before beginning clinical activities.
3.5.1 Preparing for the Day

Preparation of the clinical setting is essential in order for learning to be successful,
especially on a busy day. All members of the practice setting must be aware of the
learnerÊs arrival and expected length of stay in terms of daily schedule and length
of calendar time to be spent in the setting. Aspects such as scheduling patients,
arranging for examination room availability, providing space for charting and
planning for learner access to patient records need to be addressed. It will also help
to meet the learner for the first time before the first day of the rotation by planning
for a brief learner interview before the first day begins.
Discussion should include a review of the learnerÊs goals, learning style and
past experiences. The learner can be asked to arrive with a duly completed
questionnaire, which includes the mentioned information and contact details.

The preceptor also needs to share some of his history and usual teaching style. The
preceptor should describe the institution, the types of conditions cared for, and the
mission of the institution. Any specific standards or guidelines that the site has in
place that govern learner behaviour or qualified healthcare personnelÊs roles need
to be shared at this time. A tour of the site and introduction to staff will help. For
each day of the preceptorship, further planning should occur.
Review of the appointment list for the day and identification of appropriate
patients for the learner to be involved with is a good idea. The preceptor needs to
communicate clearly to learner the expectations with regard to number and types
of patients seen, amount of time available to spend with each patient and amount
of preceptor time available to the learner. Clearly delineated expectations will help
the learner perform as optimally as possible while not compromising the care of
patients.
Explaining where the difficulties lie and where the learning opportunities will
likely appear is essential. The expert preceptor is constantly doing „invisible
planning‰ ă thinking ahead about other activities that will be helpful to the
learnerÊs progress (Skeff, Bowen & Irby, 1997). Learners want to be helpful and be
involved in clinic work.
Focus on the learner by stating, for example, „We will review the cases for the
morning over lunch‰ or „Keep a 3 by 5 card for questions you may have during
the day and we will address them during the last 20 minutes of the day or when
we have a break in the schedule.‰
The following steps in planning for clinical teaching may assist you to schedule
efficient and proper interventions.
3.5.2 Planning for Clinical Teaching: The Basics

Step 1: Do the Ground Work
(a) How many learners or trainees?
(b) How long will they be with you?
(c) What have they done before?
(d) What will they do next?

(e) What do they hope or expect to do with you?
(f) What are the intended learning outcomes of this attachment or placement?
(g) How will they be assessed?
(h) Who else is involved in their teaching and learning at this point?
(i) What are your expectations of them?
ACTIVITY 3.4
1. Can you answer all of the above questions for the learners who are
currently with you, or those who are due next?
2. If not, how might you find out?
3. When are you going to do it?
Allocate some time now!
Step 2: Review Possible Learning Resources
(a) Where can teaching take place?
Examples: OutpatientsÊ unit, theatre, ward, clinics, patientsÊ homes, skills

lab, simulation centre
(b) Who else might be involved in teaching?
Examples: Other members of the multidisciplinary team, patients, carers,

other trainees or learners
(c) What special resources do we offer?
Examples: Skills centre, specialist clinic, simulation centre, centre of

excellence

ACTIVITY 3.5
Take a few moments to identify all the potential learning resources that
are available to learners who are attached to you.
(a) Which are the ones that you use the most and why?
(b) Which are the ones that you do not use and why?
(c) Are there other resources that your colleagues use that you might
share?
(d) When you have done this, can you identify at least one change in
your existing practice to encourage better use of resources?
Step 3: Review Approaches to Teaching and Learning that Might be Used

This is the heart of the planning process and is the aspect that offers greatest
flexibility in terms of how you make best use of teaching and learning time.
Here, you will be asked to review your current practice and have the opportunity
to consider how other clinical teachers have approached this aspect of teaching.
This third step is divided into three key aspects of teaching in clinical settings:
(a) Teaching during scheduled tutorial or teaching time;
(b) Teaching where patients are involved; and
(c) Self-directed and peer learning approaches.
3.6 RELATIONSHIP WITH THE PATIENT OR

CLIENT
There are obviously major ethical issues involved in situations where learners
work directly with patients or clients. The welfare of the patient or client must be
the over-riding consideration in all circumstances. Informed consent is an absolute
requirement. Departments involved in clinical teaching have established
procedures for informing their subjects and obtaining consent. This may not be the
tutorÊs responsibility, however, it is important that tutors are familiar with the
procedures and check that they have been followed. If there has been any
breakdown in the system, the tutor must follow this up with the appropriate staff
member. If the subject of a procedure changes his mind about allowing the learner
to conduct it, this decision must be accepted immediately.

When meeting the patients with a learner or group of learners for the first time, be
sure to use their names, introduce yourself and the learners, and explain how you
are going to proceed. Ask if they have any questions. Impress on learners the need
to treat these patients with courtesy and respect, and to keep them informed. This
instruction will carry little weight unless this behaviour is modelled to learners at
all times. Some of the most important education that takes place in clinical contexts
is learning about the interpersonal side of professional-patient relationships.
Clinical tutors have a role in helping learners to develop their skills in patient
management and will often be asked to assess their competence in this area.
3.7 FEEDBACK
Feedback from an educational or clinical supervisor is a vital source of information
to learners or trainees. Such feedback helps learners or trainees to identify
their strengths and weaknesses which, in turn, allow them to improve their
performance in order to meet teaching-learning goals.
3.7.1 Giving Feedback

Here are some helpful tips for giving positive and negative feedback on
performance:
(a) Let the learner speak first ă Before you give your opinion on the good and
the bad, hear what the learner thinks. He often has a realistic view;
(b) Begin with the good points ă Always find strengths before highlighting the
weaknesses. A person who feels good about himself will be more willing to
consider deficiencies;
(c) Be specific rather than general;
(d) Plan a solution for each problem ă Never leave the learner without any idea
of what can be done to improve the problem;
(e) Show interest and involvement ă Show an interest in helping and solving the
problem rather than scoring points. Coach, counsel and be seen as being
concerned;
(f) Be constructive ă Show that a problem exists. Be descriptive rather than

evaluative. Describing what we actually see or hear reduces the need for the
receiver to react defensively. Involve the other person in defining the
problem and encourage him to suggest improvements. Do not expect to find
an immediate solution but move towards one;

(g) Deal with one point at a time ă Do not collect a catalogue of incidents to be
dealt with at one time. Deal with problem as it arises. Help the learner to see
the possible relationship between one instance and another;
(h) Criticise the act, not the individual ă Help the trainee to see the consequences
of the actions. Try not to invoke the person to be defensive or aggressive,
from which nothing can be achieved;
(i) Do not hyperbolise ă Never use words like „always‰, „never‰, „too often‰
and so forth. Be realistic about the size of the problem;
(j) Do not joke about the matter ă Never criticise in the form of a joke, which
cannot be interpreted nor can it be dismissed;
(k) Do not compare ă Never make comparisons with other people. Any
comparison should be with the personÊs own potential;
(l) Be productive ă Your criticism should be seen as helpful and able to move
the person towards a solution;
(m) Take into account the receiverÊs needs as well as your own; and
(n) Check that the receiver has understood ă If you can, get him to rephrase the
feedback to see if it is what you had in mind.
Remember
Feedback is usually better when invited rather than imposed.
Communication is a two-way process and feedback is probably the best way of

getting evidence on the effectiveness of our communication. It enables us to learn
about how others see us and about how we affect them.
3.7.2 Receiving Feedback

Following are the tips when receiving feedback:
(a) Listen to the people who is giving feedback. Accept what they are saying as
genuine and helpful. Try to understand their feelings, what they are
describing and what they are suggesting that you do;
(b) Accept feedback as a gift;
(c) If possible, check the feedback with a third party;

(d) Give the feedback serious consideration, weigh the consequences of

changing or not changing, and express your thoughts and feelings about the
alternatives;
(e) Communicate your decision to the feedback givers;
(f) Tell them what they could do which might help you to change; and
(g) Thank the feedback givers for their concern and help.
3.7.3 Benefits of Giving and Receiving Effective

Feedback
Following are the benefits when giving and receiving effective feedback:
(a) Individuals build up confidence and self-esteem, which leads to the ability
to master concepts and develop study and cognitive skills;
(b) Those providing guidance develop a range of skills including leadership and
communication skills, which they are able to apply at other situations. They
also gain a deeper understanding of their own subject area;
(c) Staff gets regular feedback on how teaching is being received by the learners;
and
(d) Educational institutions and employer organisations are able to provide

support and benefit from a more effective learning community and
improved retention rates.
 The strengths of clinical teaching are significantly from those of problem-

centred learning, experiential learning as well as individual and team learning
approaches.
 A clinical teacher or preceptor is a role model, coach, supervisor, facilitator,

counsellor and mentor.
 Assessing the learning needs of learners or trainees is an activity that clinical

teachers carry out daily, both formally and informally.

 A nurse needs to consider several factors when planning for teaching in the
clinical area.
 The welfare of a patient or client must be the over-riding consideration in all

circumstances.
 Feedback helps learners or trainees to identify their strengths and weaknesses

which, in turn, allow them to improve their performance.
Clinical area Learning environment

Coach Learning needs
Counsellor Mentor
Experiential learning Problem-centred learning
Facilitator Supervisor
Individual and team learning Teaching role
1. Which of the following statement is true regarding the purpose of self-

assessment by learners?
A. To replace the assessment by teachers, thus reducing teachersÊ burden.
B. To provide full satisfaction to learners by eliminating assessment

validation.
C. To help learners become independent and effective self-directed

professionals.
D. To give opportunities to learners to highlight their strengths and

motivations.

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A. Speak in general so that the learner does not feel offended.
B. Give opportunity to the learner to talk first before giving the feedback.
C. Compare the learnerÊs performance with others to instigate sense of

competitiveness
D. Begin with the learnerÊs weaknesses before highlighting the strengths

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Topic  Preparing for
Clinical
4 Teaching
Sessions
LEARNING OUTCOMES
1. Discuss possible approaches in identifying the learning needs of
patients and their family members;
2. Illustrate Bloom's taxonomy of learning domains by listing them in
your journal;
3. Set learning outcomes for a clinical teaching session; and
4. Create a teaching plan for a clinical teaching session.
 INTRODUCTION
Teaching in the clinical area is a complex process. Principles used in classroom
teaching can be applied but they have to be adapted to fit the clinical environment,
which is often not within the teacherÊs control. This is because the clinical
environment revolves around and is focused on the patient. The dynamic situation
in the patientÊs condition, together with the dynamic environment within which
the whole hospital system works, makes the teaching role of the healthcare
personnel more complex. Therefore, the assistant medical officer needs to do much
planning before he starts to teach learners in the clinical area.
This topic will systematically guide you in preparing for your clinical teaching
sessions. Figure 4.1 shows the steps involved in a clinical teaching session.
However, before you embark upon teaching your learners (patients and their
family members) you need to identify their learning needs appropriately.
TOPIC 4 PREPARING FOR CLINICAL TEACHING SESSIONS  91
Figure 4.1: Steps in clinical teaching session

Sources: Slideshare.net
4.1 IDENTIFYING LEARNING NEEDS OF

PATIENTS
In the previous topic, you have learnt to assess the learning needs of your learners
in the clinical setting. This topic will emphasise largely on how to identify the
learning needs of the patients and their family members.
In the clinical area, the healthcare personnel will monitor the learning needs of the
patients and their family members by observing and talking to them. In the process
of carrying out his daily duties and responsibilities, the healthcare personnel
has to be very sensitive to the need for knowledge, updating in skills and
competencies, and be aware of his lack of understanding in any areas related to
the practice of nursing. The need can be with regard to the care of patients not
only during their hospital stay but also in the plan for aftercare when they are
discharged. A patientÊs follow-up management and continuity in care in order for
him to remain in a good state of well-being, and be able to cope and adapt to the
changes as a result of the patientÊs illness are also important concerns for the
healthcare personnel and the patient.
The healthcare personnel identifies patient learning needs based on information

gained from his own individual assessment of the patient. Questions posed to the
patient will focus on what he knows and understands about his condition, what
form of treatment he is receiving and whether he knows how to carry out any
aspect of care that requires his participation. Another source for identifying
learning needs is information gained from the type of questions and concerns
raised by the patient and his family.

92  TOPIC 4 PREPARING FOR CLINICAL TEACHING SESSIONS
The following guidelines will help you to organise your work better when
assessing the learning needs of your patients and their family members:
(a) Use all appropriate sources of information. Review the patientÊs medical
records. Read the history of medical problems as well as diagnoses, physical
examinations, documentation of the healthcare assessment and the nursing
interventions that have been performed. The patient and his family or
support persons are the best source of needs assessment information.
(b) Identify the knowledge, attitude or skills needed by the patient, his family or
support persons. Learning can be divided into three domains, namely
cognitive, affective and psychomotor. You may categorise learning that is
planned for the patient into the following three areas:
(i) Cognitive learning which involves the storing and recalling of new
knowledge and information;
(ii) Affective learning which includes changes in attitudes, values and

feelings; and
(iii) Psychomotor learning that has occurred when a physical skill has been
acquired.
(c) Assess emotional and experiential readiness to learn. Readiness does not
mean the patientÊs physical ability to learn. The readiness to learn in an adult
may be related to a social role. Being assured that they are partners in the
teaching-learning process gives adult learners the sense of control that they
are accustomed to in their daily living.
(d) Assess the patientÊs ability to learn. The teaching approach must be
appropriate to the developmental stage of the learner. You should assess
the patientÊs intellectual development, motor development, psychosocial
development and emotional maturity. Chronological age does not guarantee
maturity.
(e) Identify the patientÊs strengths. Learning strengths are the patientÊs personal
resources, which include psychomotor skills, above-average comprehension,
reasoning, memory or successful learning in the past. For example, if the
patient knows how to cook, this knowledge can be useful when learning
about a special diet.
(f) Use anticipatory guidance. Anticipatory guidance focuses on psychologically

preparing a person for an unfamiliar or painful event. When a patient knows
what to expect, anxiety is reduced and he is able to cope more effectively.

To sum up, the learning needs of a learner in the clinical environment depend
greatly on the individualÊs need for learning. The amount and type of teaching also
has to be individualised to meet the specific needs of a particular learner.
In this instance, we can see that it varies from teaching in the classroom where one
lesson is taught to the whole group of learners. Alternatively, in the clinical area,
teaching is usually conducted on a one-to-one basis to meet very specific learning
needs of specific persons (they can be the patient, family members, colleagues or
learner) present in the area of clinical practice.
Illustration for Identifying a Learning Need

Example: A mother who has just given birth to her first baby expresses her
concern that she does not know how to bathe her baby and change his diapers.
She is also concerned whether she can breastfeed her baby. In this case, the
nurse has to plan several teaching sessions to meet the learning needs of the
mother.
Firstly, the healthcare personnel needs to talk to the mother and plan to show
her how to change the babyÊs diapers when the opportunity arises such as when
the baby wets his diapers. Then, the healthcare personnel needs to plan for a
session to teach and show the mother how to bathe the baby. Opportunities
must be made available for the mother to handle and bathe the baby under the
healthcare personnelÊs supervision. Another relevant session would be to teach
the mother how to breastfeed her baby. You can see that for this mother, her
learning needs are many compared to another mother who has had two or more
babies and has already known all that the first mother did not know. For the
second mother, the healthcare personnel may identify her learning needs as the
need for knowledge in family planning and caring for her own health and
spacing the birth of each child to allow her body to recuperate from each birth.
In whatever situation, the healthcare personnel must set specific objectives for each
teaching session, be it in the classroom or the clinical area. Learning in the clinical
setting must be planned and sequenced the same as classroom instruction
(Hudson, 1993). Setting objectives is therefore essential once the healthcare
personnel has successfully identified the learning needs of the patient, family, staff
or learner.
Before you proceed to learn more about learning objectives and how to set
objectives for a teaching session, an overview of some educational models will
facilitate your understanding.

4.2 EDUCATIONAL MODELS

Two educational models can help us understand how learning outcomes or
objectives relate to learnersÊ professional development as they move along the
novice to expert continuum.
The first is found in BloomÊs taxonomy of objectives in the cognitive domain (1956),
which describes how learning objectives which are related to cognitive
development increase in complexity as learners develop deeper understanding,
start to apply the knowledge and ultimately synthesise and evaluate what they
have learned.
You will recognise from your own experience that as your clinical understanding
develops, you became better able to handle complex information from multiple
sources and synthesise it quickly and precisely to make consistently accurate
diagnoses and decisions.
Figure 4.2 shows how the six levels increase in complexity as learners advance
through formal education. BloomÊs model can be used to help write learning
objectives or outcomes where they are mapped on to the appropriate level,
depending on what learners are expected to achieve. It is crucial that when you are
planning for any teaching sessions, build in some opportunities (even if they are
quick checks and rechecks) to make sure that learners have the background
knowledge and understanding before you move into the higher-level domains.
Figure 4.2: BloomÊs cognitive level

Source: Kolb (1984)

A common mistake in writing outcomes is that they are at the wrong level, that is,
either expecting learners to be able to do something for which they are not yet
ready or inappropriately linking them to particular teaching and learning methods
or assessments.
Although this model runs somewhat counter to more experiential learning

approaches in which learning happens by doing (Kolb, 1984), BloomÊs taxonomy
has been highly influential in all areas of education.
Another model that is particularly useful in thinking about learning outcomes

in relation to assessment of clinical competence is MillerÊs (1990) pyramid (see
Figure 4.3).
Figure 4.3: MillerÊs pyramid for assessing clinical competence

Source: MillerÊs (1990)
MillerÊs pyramid model is similar to BloomÊs taxonomy in that there is a marked

shift (as professionals develop expertise) from being able to demonstrate
knowledge that underpins clinical competence. For example, from knowing the
theory (learned from video) to demonstration and reading (how to take a history
or perform physical examination) to performing the action whereby theory
(intellectual skills), psychomotor skills and professional attitudes are synthesised
and internalised into a seamless routine that can be carried out in different
contexts.
Both the models help us to match learning outcomes with what we might expect
the learner to be able to do at any stage. Learning outcomes and their assessment
for learners or trainees usually relate to knowledge and understanding at a more
basic level (possibly in an artificial or limited context) than the actual high-level
performance expected.

Before you engage in writing the learning outcomes, an exploration on the learning
domain, particularly BloomÊs taxonomy of learning domain, will certainly inspire
you to produce fruitful and proper learning outcomes.
4.3 BLOOM’S TAXONOMY OF LEARNING

DOMAINS
Taxonomy means a set of classification principles or structure and domain simply
means category. BloomÊs taxonomy underpins the classical knowledge, attitude
and skills (KAS) structure of learning method and evaluation.
BloomÊs taxonomy (in full it is BloomÊs taxonomy of learning domains or strictly

speaking, BloomÊs taxonomy of educational objectives) was initially (the first part)
published in 1956 under the leadership of American academic and educational
expert, Dr Benjamin S. Bloom. He was inspired to develop a system (or taxonomy)
of specifications to enable educational training and learning objectives to be
planned and measured properly, thus improving the effectiveness of developing
mastery instead of just transferring facts for mindless recall.
Hence, when Benjamin Bloom chaired a committee of educational psychologists

for the American education, his creation of BloomÊs taxonomy, whose aim was to
develop a system of categories of learning behaviour to assist in the design and
assessment of educational learning, was granted.
BloomÊs initial attention was focused on the cognitive domain. Collectively, he had
progressed further in merging another two distinctive domains, namely affective
domain and psychomotor domain. This notion, which made up the whole Bloom
taxonomy, continues to be useful and very relevant to the curriculum planning
and design of schools, colleges and university education, adult and corporate
training courses, teaching and lesson plans, and learning materials. It also serves
as a template for the evaluation of training, teaching, learning and development
within every aspect of education and industry.
4.3.1 Domains of Bloom’s Taxonomy – An Overview

BloomÊs taxonomy model is in three parts or overlapping domains, as follows:
(a) Cognitive domain (intellectual capability ă knowledge or think);
(b) Affective domain (feelings, emotions and behaviour ă attitude or feel); and
(c) Psychomotor domain (manual and physical skills ă skills or do).

This has given rise to the obvious shorthand variations on the theme, which
summarises the three domains, for example, KAS, Do-Think-Feel and others.
In each of the three domains, BloomÊs taxonomy is based on the premise that the
categories are ordered in degree of difficulty. An important principle of BloomÊs
taxonomy is that each category (or level) must be mastered before progressing to
the next. As such, the categories within each domain are levels of learning
development and these levels increase in difficulty. Learners should benefit from
the development of knowledge and intellect (cognitive domain), attitude and
beliefs (affective domain) and the ability to put physical and bodily skills into effect
ă to act (psychomotor domain).
Table 4.1 is a simple, adapted at-a-glance representation of BloomÊs taxonomy. The

definitions are intended to be in simple modern day language to assist explanation
and understanding. This simple overview can help you (and others) to understand
and explain the taxonomy. Refer to it when considering and getting to grips with
the detailed structures. This overview helps to clarify and distinguish the levels.
Table 4.1: Overview of the Domains of BloomÊs Taxonomy
Cognitive Affective Psychomotor

Knowledge Attitude Skills
1. Recall data 1. Receive (awareness) 1. Imitate (copy)
2. Understand 2. Respond (react) 2. Manipulate (follow
instructions)
3. Apply (use) 3. Value (understand and 3. Develop precision
act)
4. Analyse (structure or 4. Organise personal 4. Articulate (combine,
elements) value system integrate related skills)
5. Synthesise (create or 5. Internalise value 5. Naturalise (automate,
build) system (adopt become an expert)
behaviour)
6. Evaluate (assess, judge
in relational terms)

4.3.2 Domains of Bloom’s Taxonomy – Detailed

Structures
BloomÊs taxonomy provides an excellent structure for planning, designing,
assessing and evaluating training and learning effectiveness. The model also
serves as a checklist in which you can ensure that training is planned in order to
deliver all the necessary developments for learners, trainees or learners. In
addition, it also serves as a template in which you can assess the validity and
coverage of an existing training, be it a course, a curriculum or an entire training
and development programme for a large organisation.
(a) Cognitive Domain (Intellect ă Knowledge ă „Think‰)

The cognitive domain of BloomÊs taxonomy (1956) is as follows:
Table 4.2: BloomÊs Taxonomy ă Cognitive Domain
Cognitive Domain
Examples of Key Words (Verbs
Activity to be which Describe the
Category or Behavioural Trained, or Activity to be
Level
Level Descriptions Demonstration and Trained or
Evidence to be Measured at Each
Measured Level)
1 Knowledge Recall or Multiple-choice arrange, define,
recognise test, recount facts or describe, label, list,
information statistics, recall a memorise,
process, rules, recognise, relate,
definitions; quote reproduce, select,
law or procedure state
2 Comprehension Understand Explain or interpret explain, reiterate,
meaning, restate meaning from a reword, critique,
data in oneÊs own given scenario or classify, summarise,
words, interpret, statement, suggest illustrate, translate,
extrapolate, treatment, reaction review, report,
translate or solution to a discuss, rewrite,
given problem, estimate, interpret,
create example or theorise,
metaphor paraphrase,
reference, example

3 Application Use or apply Put a theory into use, apply,

knowledge, put practical effect, discover, manage,
theory into demonstrate, solve execute, solve,
practice, use a problem, manage produce,
knowledge in an activity implement,
response to real construct, change,
circumstance prepare, conduct,
perform, react,
respond, role-play
4 Analysis Interpret Identify constituent analyse, break
elements, parts and functions down, catalogue,
organisational of a process or compare, quantify,
principles, concept, or measure, test,
structure, deconstruct a examine,
construction, methodology or experiment, relate,
internal process, making graph, diagram,
relationships; qualitative plot, extrapolate,
quality, reliability assessment of value, divide
of individual elements,
components relationships,
values and effects;
measure
requirements or
needs
5 Synthesis Develop new Develop plans or develop, plan,
(create or build) unique procedures, design build, create,
structures, solutions, integrate design, organise,
systems, models, methods, resources, revise, formulate,
approaches, ideas, parts; create propose, establish,
ideas; creative teams or new assemble, integrate,
thinking, approaches, write re-arrange, modify
operations protocols or
contingencies

6 Evaluation Assess Review strategic review, justify,

effectiveness of options or plans in assess, present a
whole concepts terms of efficacy, case for, defend,
in relation to return on report on,
values, outputs, investment or cost- investigate, direct,
efficacy, viability; effectiveness, appraise, argue,
critical thinking, practicability; project-manage
strategic assess
comparison and sustainability;
review; judgment perform a SWOT
relating to analysis in relation
external criteria to alternatives;
produce a financial
justification for a
proposition or
venture, calculate
the effects of a plan
or strategy; perform
a detailed and risk
analysis with
recommendations
and justifications
(b) Affective Domain (Feeling, Emotions ă Attitude ă „Feel‰)

BloomÊs taxonomyÊs second domain, the affective domain, promotes
structure and sequence for developing attitude, which is now commonly
expressed in the modern field of personal development as beliefs. As with
the other domains, the affective domain provides a framework for teaching,
training, assessing and evaluating the effectiveness of training and lesson
design and delivery as well as retention by and affect upon the learner.

Table 4.3: BloomÊs Taxonomy ă Affective Domain
Affective Domain
Key Words (Verbs
Examples of
which Describe
Experience, or
Category or Behavioural the Activity to be
Level Demonstration and
Level Descriptions Trained or
Evidence to be
Measured at Each
Measured
Level)
1 Receive Open to Listen to the teacher ask, listen, focus,
experience, or trainer, take attend, take part,
willing to hear interest in session or discuss,
learning experience, acknowledge,
take notes, turn up, hear, be open to,
make time for retain, follow,
learning experience, concentrate, read,
participate do, feel
passively
2 Respond React and Participate actively react, respond,
participate in group discussion, seek clarification,
actively active participation interpret, clarify,
in activity, interest provide other
in outcomes, references and
enthusiasm for examples,
action, question and contribute,
probe ideas, suggest question, present,
interpretation cite, become
animated or
excited, write,
perform
3 Value Attach values Decide worth and argue, challenge,
and express relevance of ideas debate, refute,
personal and experiences; confront, justify,
opinions accept or commit to persuade, criticise
a particular stance
or action

4 Organise or Reconcile Qualify and build, develop,

Conceptualise internal quantify personal formulate, defend,
Values conflicts; views, state modify, relate,
develop value personal position prioritise,
system and reasons, state reconcile, contrast,
beliefs arrange, compare
5 Internalise or Adopt belief Self-reliant; behave act, display,
Characterise system and consistently with influence, solve,
Values philosophy personal value set practice
(c) Psychomotor Domain (Physical ă Skills ă „Do‰)

The psychomotor domain was apparently established to address skills
development relating to manual tasks and physical movements. However, it
also concerns and covers modern day business and social skills such as
communication and IT equipment operation. Whatever the training
situation, it is likely that the psychomotor domain is significant.
The DaveÊs version of the psychomotor domain is featured most prominently

here because in many peopleÊs views, it is most relevant and helpful for
work-related and life-related developments.
Table 4.4: BloomÊs Taxonomy ă Psychomotor Domain
Psychomotor Domain (Dave)

Key Words (Verbs
Examples of
which Describe the
Activity or
Category or Behavioural Activity to be
Level Demonstration
Level Descriptions Trained or
and Evidence to
Measured at Each
be Measured
Level)
1 Imitation Copy action of Watch teacher or copy, follow,
another; trainer and repeat replicate, repeat,
observe and action, process or adhere
replicate activity
2 Manipulation Reproduce Carry out task re-create, build,
activity from from written or perform, execute,
instruction or verbal instruction implement
memory

3 Precision Execute skill Perform a task or demonstrate,

reliably, activity with complete, show,
independent of expertise and high perfect, calibrate,
help quality without control,
assistance or
instruction; able to
demonstrate an
activity to other
learners
4 Articulation Adapt and Relate and construct, solve,
integrate combine combine,
expertise to associated coordinate,
satisfy a non- activities to integrate, adapt,
standard develop methods develop, formulate,
objective to meet varying, modify, master
novel
requirements
5 Naturalisation Automated, Define aim, design, specify,
unconscious approach and manage, invent,
mastery of strategy for use of project-manage
activity and activities to meet
related skills at strategic need
strategic level
(Based on RH DaveÊs version of the psychomotor domain)
Until this point, you should have a better idea of the taxonomy of learning to assist
you in planning your teaching sessions. Therefore, as a healthcare personnel
teacher you have to be able to specify the specific domain of each objective covered
and work towards achieving the learning experience for the learner to accomplish
a specific behavioural change in the area concerned.
4.4 PREPARING FOR CLINICAL TEACHING

SESSIONS
Clinical teachers may be involved with learners and trainees on a variety of
different programmes, which are required to achieve a diverse range of learning
outcomes or objectives. Teachers who better understand the relationship between
learning outcomes and the planning and delivery of educational activities can help
learners receive more from their education and training.

Take note that every teaching session must be preceded by the setting of learning
outcomes and activities. The purpose of having learning outcomes is to identify
what learners are expected to learn, how they will learn it and what level of
competency they must achieve at the end of the learning session. In planning and
setting learning outcomes for a teaching session, you need to first gather some
information about the learners and the topic to be taught. This can be achieved by
asking some simple questions such as the following:
(a) How do I plan learning activities to promote learning?
(b) Who are the learners?
(c) What do I want them to learn, do or feel at the end of the learning experience?
(d) What do they already know?
(e) What content should be included?
(f) How should the content be organised?
(g) What learning methods should be used?
(h) How should they be assessed?
(i) What type of learning environment should be provided?
After having gathered the necessary information, you can start to write the
instructional objectives for the teaching session. Do you know what instructional
objective is all about and what is the difference between instructional objectives
and learning outcomes?
Read the following subtopics carefully and give your full attention so that at the
end of the subtopics, you will be able to illustrate and articulate learning objectives
accurately.
4.4.1 Overview of Instructional Objectives

Instructional objectives are also called performance objectives, behavioural
objectives or simply learning objectives. All of these terms are used
interchangeably. Objectives are specific, outcome-based, measurable and describe
the learnerÊs behaviour after instruction. What does that mean? Let us take a closer
look.

The instructional objectives of a lesson plan describe the teacherÊs educational

intent for the learners, in other words, the desired learning outcomes. Think about
our 4 key questions ă for each of them, ask what is it that we want learners to be
able to do after the instruction. The objective defines the „it‰.
Objectives are not brief descriptions of lesson content or descriptions of activities

in which learners participate in. Well-written objectives describe what learners will
be able to do after learning the lesson. At the time of writing a lesson plan, the
teacher must identify the learning outcomes so that the lessonÊs activities are
directed toward the desired result. If the objectives are not clear, the teacher may
very well end up with other outcomes that are unexpected or undesirable.
There are some basics to keep in mind when constructing instructional objectives.
The actual format for instructional objectives varies according to educational
publications. However, good objectives are learner-oriented, observable, clear and
unambiguous, and descriptive of the learning outcomes.
(a) Learner-oriented
An instructional objective describes what change will take place in the
learner. Many instructional objectives begin with the phrase, „The learner
will be able to ⁄ ‰ The focus is on the learner, not the teacher. Some writers
have included instructional objectives that states, for example, „Teach how
to check the temperature‰ or „Show a video on checking the temperature.‰
These objectives focus on teacherÊs activity, not learner learning. Remember
that instructional objectives describe what the learner will be able to do after
completing the lesson.
(b) Observable
Lesson writers differ in the level of specificity that they seek in describing
learner-learning outcomes. Sweeping generalisations and highly itemised
instructions for each learner should be avoided. It is important, however, to
write objectives in a way that specifies how learners might demonstrate that
they have learned the idea or skill in question.
Consider the following objectives:
(i) Learners will be able to understand the difference between classical

conditioning and operant conditioning.
(ii) Learners will be able to list in their journals the differences between
classical conditioning and operant conditioning.

The first objective is very general and it does not state how learners might
demonstrate their understanding in an observable manner. What does it
mean to „understand‰ the principles of behavioural theory? This type of
objective does not provide adequate information to the teacher about what
learners will be able to do after completing the lesson, nor does it guide the
teacherÊs evaluation of whether learners have achieved the objective.
The second objective, however, clearly identifies the expected learner

behaviour.
(c) Clear and Unambiguous

The key to a clear and unambiguous instructional objective is a clearly stated
verb describing an explicit action that the learner should be able to do. Refer
to the excerpts from the domains of BloomÊs taxonomy in Subtopic 4.3.1 for
a great resource of examples of verbs that clearly describe what learners will
be able to do at various levels of learning.
A clear objective will include an appropriate verb denoting an observable

action as well as an accompanying object of that verb.
Example: Learner will be able to define productivity as output divided by

input.
This objective explicitly identifies what the learner will be able to do. The
learner will be able to define productivity in a specific way. The objective is
unambiguous in that there is only one possible meaning for the statement.
Furthermore, most observers would be able to judge whether learners have
achieved that objective.
(d) Description of a Learning Outcome

Lesson objectives differ from lesson activities or procedures. Lesson
objectives focus on what the learners will achieve by completing the lesson.
An objective stating that „Learners will practise graphing demand curves‰
does not specify a learning outcome. It specifies a learning activity that is
designed to help learners reach a certain outcome.
We will now learn more about setting learning outcomes for a teaching session.

4.4.2 Setting Learning Outcomes

This subtopic highlights setting learning outcomes in the clinical context, which
relates closely with the earlier subtopic on identifying learning needs of the
learners. It looks at how teachers can best support individual learners and
summarises ways in which learning outcomes can be set.
Perhaps this definition of learning outcome can give you a clear picture in order
for you to employ the criteria for developing complete objectives.
Learning outcome is a precise statement of intent which describes a proposed

change of behaviour in the learner.
(a) How to Write a Learning Outcome?

In writing a learning outcome, you should:
(i) Focus on learner performance and not on teacher performance;
(ii) Focus on product, not process;
(iii) Focus on terminal behaviour, not subject matter; and
(iv) Include only one general learning outcome in each objective.
As much as possible, learning outcomes should also be written using the

SMART acronym, which stands for:
(i) Specific;
(ii) Measurable;
(iii) Acceptable to you;
(iv) Realistic to achieve; and
(v) Time-bound with a specific deadline.

Learning outcome is also a statement that describes the competency or

performance capability to be acquired by the learner. The following are three
characteristics that are essential in ensuring clear statements of the learning
outcomes:
(i) Behaviour ă Firstly, an outcome must describe the competency to be

learned in term of performance. The choice of the verb is all-important
here. Frequently used terms such as „know, understand, grasp and
appreciate‰ do not meet this requirement. If the verb used in stating an
outcome identifies observable learner behaviour, then the basis for a
clear statement is established. In addition, the type or level of learning
must be identified. Refer to Subtopic 4.3.1 for a description of the types
of learning outcomes and their respective levels.
(ii) Criterion ă Secondly, an outcome should make clear how well a learner
must perform in order to be judged adequately at the acceptable level
of performance. This can be done using a statement that indicates the
degree of accuracy, quantity or proportion of correct responses or the
like.
(iii) Condition ă Thirdly, an outcome should describe the condition under

which the learner will be expected to perform in the evaluation. The
tools, references or other aids that will be provided or denied should
be made clear. At times, a simple statement can easily imply one or
even two of the elements. At other times, however, it may be necessary
to clearly specify each element of the objective in detail.
To illustrate the elements mentioned, let us look at the following learning

outcome:
After a 30-minute clinical teaching session, the patient will be able to

perform self-administration of insulin correctly.
(i) The behaviour or change referred to in the learning outcome is

„perform‰. The change in behaviour is „the patientÊs ability to perform
self-administration of insulin.‰ Before the teaching session, the patient
does not know how to perform self-administration of insulin.
However, after the 30-minute teaching, the patient will be able to
perform self-administration of insulin correctly.

(ii) The condition refers to „after a 30-minute clinical teaching session.‰
(iii) The criterion refers to the patientÊs ability to perform the procedure
correctly.
(iv) Lastly, the content refers to the „self-administration of insulin‰.
ACTIVITY 4.1
At the end of the 30-minute demonstration, the learner will be able to

administer intramuscular injection to a patient safely.
Given a learning outcome statement above, identify the four elements of

the learning outcome.
(b) Why are Learning Outcomes Important?

Learning outcomes are important because they guide the:
(i) Selection of content;
(ii) Development of an instructional strategy;
(iii) Development and selection of instructional materials; and
(iv) Construction of tests and other instruments for assessing and

evaluating learner-learning outcomes.
(c) What is the Difference between a Goal and a Learning Outcome?

Goal is a statement of the intended general outcome of an instructional unit
or programme. A goal statement describes a more global learning outcome.
On the other hand, learning outcome is a statement of one of several specific

performances, the achievement of which contributes to the attainment of the
goal.
A single goal may have many specific subordinate learning outcomes.
Example: The goal of the Learning Assessment course is to enable learners

to make reliable and accurate assessments of learning.

ACTIVITY 4.2
Test in writing learning outcomes:
Identify an area for teaching. For the healthcare personnel to achieve the
learning outcomes, she/he has to develop and plan a session to deliver
the essential content. Write three learning outcomes for teaching a
healthcare personnel learner in the ward (one outcome for each of the
three domains, namely knowledge, skills and attitude).
4.5 PLANNING A TEACHING PLAN

Lesson planning is a special skill that is learned in much the same way as other
skills. It is quite another thing to have the skill to develop your own lesson plans.
When you are able to create your own lesson plans, it means that you have taken
a giant step towards owning the content you teach and the methods you use, and
that is a good thing.
Acquiring lesson planning skill is far more valuable than being able to use the
lesson plans developed by others. It takes thinking and practice to hone this skill,
it does not happen overnight. However, it is a skill that will help to define you as
a teacher.
Knowing „how to‰ is far more important than knowing the „what‰ when it comes
to lesson plans. It is one of the important markers along the way to becoming a
professional teacher. There is no one best way to plan lessons. Regardless of the
form or template, there are fundamental components in all lesson plans that you
should learn to write, revise, and improve. The old adage, „Practice doesnÊt make
perfect; perfect practice makes perfect‰ is at the core of learning this skill.
4.5.1 Characteristics of a Good Lesson Plan

Good lesson plans do not ensure that learners will learn what is intended but they
certainly contribute to it. Think of lesson plan as a way of communicating, and
without a doubt, effective communication skills are fundamental to all teaching.
Lesson plans also help new or inexperienced teachers to organise content,
materials and teaching methods.

When you are learning the craft, organising your subject-matter content via lesson
plans is fundamental. Like most skills, you will get better at it the more you do it
and think of ways of improving your planning and teaching based on the feedback
from your learners including patients and/or their family members. Developing
your own lesson plans also helps you „own‰ the subject-matter content that you
are teaching, which is central to everything good teachers do.
Effective lesson plans communicate; ineffective ones do not. Teachers create lesson
plans to communicate their instructional activities regarding specific subject
matter. Almost all lesson plans developed by teachers contain learner learning
objectives, instructional procedures, the required materials and some written
descriptions on how the learners will be evaluated. The teaching plan for clinical
teaching is no exception.
In addition, lesson plans ought to be appropriately developed. The stages in lesson

plan development are described in the next subtopic.
4.5.2 Stages of a Lesson Plan

The lesson plan has various stages of development. The stages can be seen from
the following outline:
Stage 1 Prepare the lesson plan thoroughly.

Stage 2 Introduce the lesson.
Stage 3 State the aims of the lesson clearly.
Stage 4 Use an appropriate and interesting method for the teaching session.
Stage 5 Use an imaginative application of what has been planned.
Stage 6 Revise the lesson thoroughly before the actual teaching session.
We will now go through each stage in the development of a lesson plan in more
detail.
(a) Stage 1: Prepare the Lesson Plan Thoroughly

The healthcare personnel teacher needs to plan:
(i) How much to teach, the level and prerequisite knowledge, skills and
attitude;
(ii) The method of teaching to be used; and
(iii) The general objectives and learning outcomes ă precisely what is to be

achieved ă within a stated time frame.
The healthcare personnel teacher also needs to:
(i) Prepare materials or teaching aids for the lesson; and
(ii) Ensure that learners are prepared for the class.
(b) Stage 2: Introduce the Lesson

During this stage, the healthcare personnel teacher needs to:
(i) Plan a suitable introduction ă The teacher sets the atmosphere or mood
for the lesson. At this stage, the teacher gets the learners together to
focus on a subject. The teacher has to get the learners involved in a
process of disengaging their thoughts from their present occupation
and engage them in the new topic or activity; and
(ii) The teacherÊs activity is specifically focused on developing an

appropriate, interesting and stimulating set induction (this will be
covered in detail later in the module).
(c) Stage 3: State Aims of the Lesson Clearly

Following a successful set induction, the teacher has to state the objectives
and learning outcomes clearly for the new lesson. It is important for learners
to know the purpose and outcomes of the lesson. A clear statement of the
objectives will help learners follow and keep track of the class.
(d) Stage 4: Employ an Appropriate and Interesting Teaching Method

The teacher must select the best method to present the lesson plan during the
teaching session. The presentation of the lesson plan contents depends on
three factors:
(i) Environment;
(ii) Teacher; and
(iii) Learners.
The guiding principle in the choice of methods should be:
(i) Based on the understanding of learners in the class;
(ii) Clearly understood by the teacher;
(iii) Stimulating to learners; and
(iv) Leading learners to a sense of achievement and purpose.

In the presentation of the teaching method used, the teacher has to ensure
that there is application of all micro-teaching skills when teaching relevant
concepts as well as in relating the concepts to principles and inserting audio-
visuals appropriately to reinforce the teaching-learning session.
Application of micro-teaching skills includes the following (which will be

covered in detail later in the module):
(i) Explaining;
(ii) Illustrating;
(iii) Questioning and reinforcement;
(iv) Links; and
(v) Mini-closures.
(e) Stage 5: Devise an Imaginative Application

At this stage, the teacherÊs lesson plan has to match the interesting
presentation via an interesting application. This is vital in presenting content
and at the same time enabling the learners to see and experience the practical
application. The teacher must also be able to actively express her thoughts
and feelings in the application of the teaching method.
(f) Stage 6: Revise Lesson Thoroughly Before the Actual Teaching Session
Finally, the teacher needs to revise what she has planned thoroughly to
ensure that she has mastery of the contents in her teaching plan. Dunhill
(1964) exerted that an excellent teacher „teaches little but revises much‰. The
teacher has to plan for reinforcement and feedback. This will reinforce the
learning by causing learners to „see‰, „say‰ and „do‰ the things that the
teacher has presented to the learners orally. All lessons must conclude with
an emphatic summary of what has been taught (final closure).
As a teacher, the healthcare personnel has to plan the teaching by integrating

all the stages in the development of a lesson plan whenever he is required to
conduct a teaching session in the clinical area.
In the clinical setting, learning is very much competency-based. It involves the

mastery of specific knowledge and skills and is learner-centred or participant-
centred. Therefore, in planning a teaching plan in the clinical area, the healthcare
personnel has to be reminded of two very relevant key terms that need to be
considered at all times ă skill and competency.

(a) Skill refers to a task or group of tasks performed to a specific level of

competency or proficiency, which often uses motor functions and typically
requires the manipulation of instruments and equipment; and
(b) Competency refers to a skill that is performed to a specific standard under

specific conditions.
Competent healthcare personnel is one who is able to perform a clinical skill to a

satisfactory standard and possesses the ability to demonstrate the attainment or
mastery of clinical skills performed under certain conditions to specific standards.
In planning a teaching plan in the clinical area, the healthcare personnel has to be
very clear about the skills that learners are supposed to acquire the competency in.
The healthcare personnel also has to be very clear and specific in how he is going
to measure the level of expected competency that learners are supposed to achieve.
Therefore, from the initial stage of planning, the healthcare personnel must have
thought through thoroughly the criteria to be used to measure each activity and
performance objectively in order to ensure that learners achieve the skills planned.
The healthcare personnel, therefore, needs to consider all the factors concerning
the learner. He needs to consider the conditions in the learning environment and
select an appropriate method to achieve the learning objectives for the learner in
order to be a competent practitioner in the healthcare profession.
The main decision areas in healthcare teaching include the following:
(a) Teacher;
(b) Learner;
(c) Subject;
(d) Resources and environment;
(e) Goals and objectives; and
(f) Method of teaching.
Figure 4.4 illustrates the different decision areas that the healthcare personnel
needs to consider when planning a teaching plan.

Figure 4.4: Flow diagram showing main decision areas in healthcare teaching
Source: James (1975)
Note: One of the main decision areas for any teacher is to decide on the method of
teaching to be adopted in getting learners from their starting points to their goals.

ACTIVITY 4.3
Based on what you have learnt so far, describe the stages involved in
creating a lesson plan.
 A healthcare personnel who is involved in teaching in the clinical area needs

to identify their learning needs of his learners (learners, patients and their
families) prior to the teaching session.
 Based on the identified needs, he must gather information on factors that

would affect the teaching session.
 Until today, BloomÊs taxonomy of learning domains remains the most widely
used system of its kind in education particularly, as well as in industry and
corporate training. It is easy to see why this is so because it is such a simple,
clear and effective model when it comes to explanation and application of
learning outcomes, teaching and training methods, and measurement of
learning outcomes.
 Learning outcome is a statement of what learners will be able to do when they

have completed the learning session. Learning outcomes have their roots in
instructional analysis and the definition of entry behaviours. They form the
basis for subsequent instructional design activities.
 Once a topic has been confirmed and the learner for the clinical teaching
session has been identified, the healthcare personnel sets the learning
outcomes for the session.
 The objectives of the teaching session have to be written precisely and clearly
to facilitate the measurement of the outcomes of the session.
 Guided by the learning outcomes, the nurse will develop a teaching plan for
the clinical teaching session.

Affective domain Elements of objectives

Behaviour Goal
BloomÊs taxonomy of learning Instructional objectives
domains
Learner-oriented
Clinical teaching session
Learning needs
Cognitive domain
Learning outcomes
Competency
Psychomotor domain
Criterion
Teaching plan
Educational models
1. Which one of the following is not included as a basic element in an objective

statement?
A. Behaviour
B. Content
C. Attitude
D. Condition
2. A well-written objective is all of the following except if it ⁄
A. begins with an adjective.
B. includes at least a behaviour and content.
C. is observable and measurable.
D. is precisely stated.

Abbat, F. R. (1992). Teaching for better learning. A guide for teachers of primary
health care staff (2nd ed.). Geneva, World Health Organisation.

meaningful learning in the clinical setting. College Quarterly, Vol 8(3): 1ă7.
Anderson, L. W, Krathhwohl, D. R. et al. (2001). A taxonomy for learning, teaching,

and assessing: A revision of BloomÊs taxonomy of educational objectives:
http://www.ablongman.com
Fuszard, B. (1989). Innovative teaching strategies in nursing. Gaithersburg,

Maryland: Aspen Publishers.
Greaves, F. (1979). Teaching nurses in the clinical setting, Part II. Nursing Mirror,
1st March.
James, D. E., & Raybould, E. (1975). A guide for teaching nurses. Oxford, London:
Blackwell Scientific Publications.
Jarjoura, J. (2003). Mentorship ă A key part of nursing practice. Registered Nurses

Association of Ontario (RNAO) Practice Page. Vol 2(3) July.
Kolb, D. A. (1984). Experiential Learning: experience as the source of learning and

development. New Jersey: Prentice-Hall.
Paterson, B. (1994). Developing and maintaining reflection in clinical journals.

Nurse Education Today, 211ă220.

New York: Basic.
Schuster, P. M. (2000). Concept mapping: Reducing clinical plan paperwork and

increasing learning. Nurse Educator: 25(2), 363ă371.
Stockhausen, L. (1994). The clinical learning spiral: A model to develop reflective

practitioners. Nurse Education Today: 14, 363ă371.
Taylor, B. (2000). Reflective practice: A guide for nurses and midwives. NSW:
Allen & Unwin.
Thorne, S. E., & Hayes, V. (1997). Nursing praxis: Knowledge and action. London:
Sage Publications.

Topic  Preparing a
Lesson Plan
5
LEARNING OUTCOMES
1. Discuss the importance of a lesson plan;
2. Develop a proper lesson plan for a theory session; and
3. Prepare an appropriate lesson plan to teach a particular healthcare
skill.
 INTRODUCTION
Lesson plans are highly organised outlines that specify the subject matter to be
covered, the order in which the information will be presented and the timeline for
delivering each section or component of the subject matter.
Lesson planning is usually taught in schools, colleges or universities as a skill that

initially involves developing an objective based on a curriculum or set of explicit
subject-matter goals for a given plan. The next step requires the sequencing of a
number of activities in which the teacher and learners interact in some ways.
Following this interaction, there is an assessment and the next lesson begins in the
unit or other sequence that follows a curricular structure. However, some variables
that relate to the instructional activities should also be considered.
With a lesson plan, the teacher can use it for assessment during and after teaching.
The teacher can evaluate the success of a teaching session by assessing whether he
is able to achieve the lesson objectives and outcomes.
What follows are detailed descriptions on all aspects of a lesson plan.

120  TOPIC 5 PREPARING A LESSON PLAN
5.1 WHAT IS A LESSON PLAN?

Lesson plans are basically lesson notes prepared by the teacher before teaching.
Lesson plans can vary from a fully prepared lesson plan to a brief outline of lesson
notes. Lessons are developed based on the purpose of the teaching session and the
intentions of the teacher.
A daily lesson plan is developed by the teacher to guide the instruction. Planning
the instruction is much more difficult than delivering the instruction. Planning is
when you look at the curriculum standards and develop lesson content that
matches those standards. All details should be written down to assist the smooth
delivery of the content. The extent of the detail will vary depending on the number
of years of experience that the teacher has and the number of times he has taught
the lesson.
Obviously a teacher with several or many years of experience may have plans that
are much less detailed than beginner teachers. There will be requirements
mandated by the college system that employs you with regard to your
responsibilities.
Basically there are two types of lesson plans, namely for teaching a knowledge-
based (theory/cognitive) or a skill-based (practical/psychomotor) session. Thus,
they are categorised as knowledge or skills lesson plans (Illustrations of each type
will be shown in a later section).
5.2 PURPOSE OF A LESSON PLAN

The purpose of a lesson plan is really quite simple ă it is to communicate. You
might ask, communicate to whom? The answer to this question, on a practical
basis, is YOU! The lesson plans that you develop are to steer you towards
organising your materials and yourself for the purpose of helping your learners
achieve the intended learning outcomes. Whether a lesson plan fits a particular
format is not as relevant as whether or not it actually describes what you want,
and what you have determined is the best means to an end.
Therefore, if you agree that the purpose of a lesson plan is to communicate, then
in order to accomplish that purpose, the plan must contain a set of elements that
are descriptive of the process.

TOPIC 5 PREPARING A LESSON PLAN  121
In summary, lesson plans are specifically prepared and used by teachers to:
(a) Guide in organising teaching materials;
(b) Aid memory and recall of teaching content;
(c) Consider factors that may otherwise be ignored;
(d) Encourage logical development; and
(e) Anticipate difficulties and problems.
To make sure your lesson plan will teach exactly what you want it to, you need to
develop clear and specific objectives. Please note that objectives should not be
activities that will be used in the lesson plan. They should instead be the learning
outcomes of the activities.
To make the objectives more meaningful, you may want to include both the broad
and narrow objectives. The broad objectives would be more like goals and include
the overall goal of the lesson plan.
5.3 BASIC LESSON PLAN MODEL

Depending on the college or university practice and authority, a lesson plan may
be highly detailed. For example, the plan may identify each point to be covered
within the class session and assign a specific portion of the class time for
presentation. All the individual points are presented in a specific order and must
be completed by the end of the class session.
In other jurisdictions, the teacher will still be expected to identify what will be
covered in the session for that day. However, there may be some flexibility as far
as the order of presentation and how much time to spend on each individual point.
Regardless of which model is authorised, the fundamental components have to be
incorporated. Table 6.1 shows a basic lesson plan model, typical components and
explanations as well as „directions‰ for writing your lesson plan. Lesson plan
models are not identical (different institutions may use slightly different models),
however, the major components are found in all models.

Table 5.1: A Basic Lesson Plan Model
What is the unit that this lesson is a part of? Write the name of the
Unit Name
unit.
Lesson Title What is the title of the lesson? Write a descriptive title of the lesson
that identifies the content for the reader.
Lesson Author Who is the author of the lesson plan? Enter your name.
Grade Level/ What is the grade level and subject area in which this lesson is
Subject Area written for? Enter the grade level and subject area that this lesson
is designed for.
Time Allotted for How many class meetings (or hours) will this lesson take for
Lesson completion? Write the time planned for the lesson.
Short Description Write a brief overview (approximately 50 words) of your lesson
of Lesson that explains the content to the reader. Write the lesson
description.
Classroom Layout How are the class and the learners organised for this lesson?
and Grouping of Determine how to organise the learners for the lesson. Where will
Learners learning take place? How will the room be organised? How will
the learners be grouped? There are a number of grouping decisions
that a teacher will have to make. What size should a group be?
Should the instruction be delivered to individuals, in pairs, small
groups, half class or a whole class? What should the composition
of the group be determined by? Should the learners be organised
in homogeneous groups such as same ability, interest or skill
levels, or should they be organised in heterogeneous groups
of mixed abilities, interests, cultural backgrounds, gender, test
scores or others? After you have made these decisions, write the
organisation plan for this lesson. Write the classroom layout and
the grouping plan for the lesson.
State Curriculum Refer to the curriculum standard that you are working on. List the
Standards appropriate curriculum standard for your lesson.
Learning Learning outcomes of the lesson refer to what you want the
Outcomes learners to be able to do when the lesson is over. Write the learning
outcomes for the lesson.
Materials, What materials, resources and technology will be needed for the
Resources and lesson? List all materials (textbook, other books, maps, calculators,
Technology research data guides), technology resources (computers, printer,
scanner, Internet connection, digital cameras) and web addresses
that are needed for this lesson. If you are using copyrighted
materials, you must include the title, author, date, city and
publisher. List (1) materials (2) resources and (3) technology
resources needed for this lesson.

LearnersÊ Present Prerequisite skills are skills that learners must already have before
Level of they can succeed with the content of a lesson. Do the learners have
Performance and adequate knowledge to complete the lesson successfully? What
Skills prerequisite skills must the learners have to complete the lesson
content? Include technological skills. List any prerequisite skills a
learner should have in order to begin this lesson.
Instructional There are a number of items to consider under the procedures
Procedures section of the plan. Each lesson should begin with a lesson set
which is an introduction to the lesson. In this segment, you should
relate this lesson to previous learning and to real-life experiences.
Explain the importance of the learning to the learners and
determine what procedures you are going to use to teach the
content. The set is followed by the key questions that you plan to
use to develop the lesson, motivate the learners, facilitate thinking
or monitor the learning process.
Techniques and activities include the teaching strategies that will

be used. What instructional strategies (instructional methods) will
you use in this lesson? There should be a variety of strategies
(methods) used. There should also be time for guided practice and
review to get feedback from the learners. How will you promote
learner participation in the lesson? This is referred to as learner
involvement while the environment of the classroom is referred to
as learning environment. After you have determined these factors,
you must determine how you are going to close the lesson.
Closure is the summation of the lesson, how it will relate to future

lessons and can contain „one more example‰.
Write the instructional procedures for the lesson. Write the step-
by-step procedures for this activity. The steps should provide
enough information for the activity to be replicated in another
classroom with the same or similar results. Remember to use
present tense and active voice. Your lesson should detail how you:
Gain attention, present objectives, relate to present knowledge,
engage learners in learning, provide for practice, provide feedback
and close the lesson.
Supplemental Finally, you must determine the supplemental activities. These
Activities: may be the class work, homework or enrichment activities that you
Extensions and want to use with this lesson. Extensions are additional activities to
Remediation expand learning on the lesson content. Remediation activities
include methods to reteach the learning for learners who need
more instruction or practice. Write the supplemental activities for
the lesson.

Assessment How will you measure the learnersÊ success? Formally or

informally? Formal evaluation of learnersÊ work requires that a
grade is taken while informal evaluation might be monitoring of
work or class discussion. This section should contain a description
of the assessment process, the criteria for achievement and
performance levels. The criteria should directly align to the
learning outcomes and instruction. Describe your plan for
providing feedback to your learners. Write the assessment
methods for the lesson.
Learner Products Learner products are the artefacts that are created by learners
(Optional ă during the implementation of the lesson. Such products might
Depends on Your include a report, newsletter, diagram, slideshow, drawing,
Learning database and so forth. Write the learner artefact that will be an
Objectives) outcome of this lesson.
5.3.1 What are Instructional Methods?

Instructional methods are ways that information is presented to learners. Such
methods fall into two categories, namely teacher-centred approach and learner-
centred approach. There is no best approach to instruction. Some goals are better
suited to teacher-centred approach while others clearly need a learner-centred
approach (Shuell, 1996).
5.3.2 What is Teacher-centred Approach?

In teacher-centred approach, the teacherÊs role is to present the information that is
to be learned and to direct the learning process of the learners (Shuell, 1996). The
teacher identifies the lesson objectives and takes the primary responsibility for
guiding the instruction by explaining the information and modelling. This is
followed by learner practice. Methods that fall under the teacher-centred approach
includes demonstration, direct instruction, lecture and lecture-discussions.
5.3.3 What is Learner-centred Approach?

Grounded in constructivism, learner-centred approach involves instructions
where the teacher is a facilitator (or guide) and the learners construct their own
understanding. There are a number of methods in this category such as case study,
collaborative learning, problem-based learning, simulation, discussion and role-
play.

5.4 COMPONENTS OF A LESSON PLAN

A basic lesson plan has a preamble and a body. The components are explained in
the following:
(a) The preamble consists of an account with essential information concerning

the lesson (subject, date or time, number of learners, learning objectives and
learning outcomes).
(b) The body consists of a specific format. The format of the body varies.
It usually comprises two or three columns.
A Completed Lesson Plan Format

A completed lesson plan format has the following contents:
(i) Cover page;
(ii) Learning Outcomes of the session;
(iii) Prerequisite knowledge and skills; and
(iv) Lesson notes.
An example of contents in cover page is as follows:
Cover Page
Lesson Topic:
1. Programme/Level of learners
2. Number of learners
3. Date/time
4. Venue
5. Instructor/Lecturer/Teacher

An example of lesson notes format is as follows:
Teacher Activity Audio-visual /

Content
(Estimate Time Allocated) Teaching Aids
Set induction One of the main Observation chart
(2 minutes). observations is to check the with BP recording.
patientÊs blood pressure
(BP). It is important that
healthcare personnel learn
to check BP correctly.
Body: 1. What is BP? PowerPoint slides.
Theory ă Concepts, 2. Equipment required for Sphygmomanometer
theories, definitions, checking BP. set.
explanations,
3. Skills required for Checking blood
illustrations, questioning,
checking BP. pressure with a BP
mini-closures
4. Demonstrate checking set.
(15 minutes).
the BP.
Skill ă Demonstration and
return demonstration 5. Return demonstration
(30 minutes). of checking the BP.
6. Record the BP.
Conclusion/Final closure 1. Correction of return PowerPoint slides.
ă Questions and feedback demonstration.
(10 minutes). 2. Reinforce learning.
3. Emphasis on
importance of checking
BP.
It would be helpful to have a page at the end of the lesson notes to write
down important feedback for improvement if you are teaching the same
topic again.

An example page for self-feedback is as follows:
Self-feedback for Improvement

Strengths: Return demonstration session ă All learners have the
opportunity to practice.
Limitations: Nil
FAQs (frequently asked questions): How do you identify the diastolic

pressure when the sounds are not clear?
Actions for improvement: Explain the physiology related to BP.
Provide instructions for learners in the return demonstration.
Teaching in the clinical area usually involves a skill. However, there may be
occasions when a teaching session in the clinical area may also involve the
knowledge component. For that purpose, we will now look at two types of lesson
plans, namely teaching of knowledge and teaching of skills.
5.4.1 Preparing a Lesson Plan for Theory or

Knowledge Session
When teaching knowledge, the teacher has to decide:
(a) How much of each topic to teach (do a content analysis and decide on the
details needed for the lesson);
(b) Which facts need to be learned;
(c) Which facts will make the lecture interesting; and
(d) Which facts should be recorded for reference.

When planning to teach a topic on knowledge, the teacher has to decide on the
facts that needed to be taught and start with the task that must be covered. Then
he must decide on the themes to be covered. Place the themes in a sensible order
with logical sequence and associated links. He needs to think through each theme
to decide how much detail is needed.
5.4.2 Preparing a Lesson Plan for Skills Teaching

Teaching a skill involves a lecture demonstration session. It is recommended for a
lecture demonstration to focus on theory and practice. As a basic guide, one third
of the allocated time in a lecture demonstration session should be spent on the
theory component. Two thirds of the time on practical demonstration by the
teacher or expert and return demonstration by the learner.
When teaching a skill, the teacher has to:
(a) Describe the skill;
(b) Explain what the skill is;
(c) Why is the skill important; and
(d) When should the skill be used.
Subsequently, the teacher has to demonstrate the skill. In demonstrating the skill,
the teacher allows the learner to see how the expert uses the skill correctly and
visibly. The teacher explains all the steps and emphasises the important points.
Handouts on the checklist may be useful to reinforce the steps.
After teaching and demonstrating the skill, the teacher must arrange for return
demonstrations of the skill. This is made possible through the practice sessions by
the learners. Every learner should be given an opportunity to practise the skill
while being guided and coached by a supervisor.
For additional information, you can refer to Teaching for better learning: A guide
for teachers of primary healthcare staff (2nd ed.) by Abbat (1992).

5.4.3 Illustration of Tasks in Lesson Planning

In order to prepare a lesson plan, the healthcare personnel has to be very clear
about the task or topic to be taught. After deciding on the task or topic, the
healthcare personnel needs to conduct a task analysis, which is to analyse the task
or content of the topic.
Task Analysis/Behavioural Analysis involves:
(i) A study of the final behaviour required of the learner and is broken
down into its component parts (it can be done for the whole course or
a lesson); and
(ii) Behaviour ă Ways of feeling, doing and thinking ă actions and

movements that can be observed.
Let us use a simple illustration. The task selected for the illustration is to boil
water using an electric kettle.
Boiling water is the task. The teaching session will involve giving a lecture
demonstration on the topic of „boiling water‰. The teacher who is to teach
the task of boiling water will need to perform a task analysis of boiling water.
Example 1: Task of Boiling Water
Learning Outcome:
The final behaviour expected of the learner is to be able to boil water
correctly.
Before one can boil water, there are many component parts to be achieved.
These component parts can be viewed from three behavioural aspects:
(i) Feeling (affective);
(ii) Doing (psychomotor); and
(iii) Thinking (cognitive).

All the three (affective, psychomotor and cognitive) behavioural aspects

must be seen, heard or felt along with action verbs that are specific and
unequivocal.
A breakdown of the component parts of the task of boiling water is shown

in the following:
(i) Learning outcome: Demonstrate the skill of boiling water.
(ii) Task analysis:
2. Knowledge
1. Skill Component 3. Attitude Component
Component
1.1 Take kettle. 2.1 Electric kettle ă 3.1 Aware of the uses
1.2 Rinse the inside of spout, element, and potential
the kettle. wire, plug. dangers of the
2.2 Reason why the electric kettle.
1.3 Fill the kettle with
water up to three kettle is filled up to 3.2 Aware of the
quarters full. the level below the dangers of hot
spout. boiling water.
1.4 Replace the lid.
2.3 Technique of 3.3 Appreciate the
1.5 Wipe the outside of
replacing the lid importance of
kettle dry.
(slide projection of boiling water
1.6 Dry hands. the lid first). correctly for safe
1.7 Check that the head 2.4 Reasons for drying use.
of the wire is dry. hands.
1.8 Connect wire to the 2.5 Technique of fixing
kettle. wire to socket of
1.9 Connect wire to the kettle.
wall socket. 2.6 Signs of boiling.
1.10 Switch on. 2.7 Reasons for boiling
1.11 Wait for steam to water.
spew out of the
spout.
1.12 Wait for 5 minutes.
1.13 Switch off.

Cover Page
 Lesson topic: Boiling water using an electric kettle
 Programme/Level of learners:
 Number of learners:
 Date/time:
 Venue:
 Instructor/Lecturer:
Learning Outcomes
By the end of the session, the learner should be able to:
1. Differentiate the various components of an electric kettle;
2. Identify the signs of boiling;
3. Anticipate the potential dangers of the electric kettle;
4. Appreciate the importance of boiling water correctly for safe use;
5. Assemble the different parts of an electric kettle correctly; and
6. Demonstrate the skill of boiling water safely and correctly.
Prerequisite knowledge and skills: Personal hygiene and electrical power

supply

(iii) Lesson Notes:
Teacher Activity
Audio-visual/
(Estimate Time Content
Teaching Aids
Allocated)
Set induction Scenario of vomiting due to drinking Picture of
(2 minutes). tap water. vomiting and
Body: 2.1 Electric kettle ă spout, element, diarrhoea.
Theory ă Show wire, lid socket. Picture of a kettle
kettle concepts, or an actual
2.2 Reason why the kettle is filled
theories, product.
up to the level below the spout.
definitions,
explanations, 2.3 Technique of replacing the lid
illustrations, (slide projection of the lid first).
questioning, 2.4 Reasons for drying hands.
mini-closures 2.5 Technique of fixing wire to the
(15 minutes). socket of the kettle.
2.6 Signs of boiling.
2.7 Reasons for boiling water.
Skill ă 1.1 Take the kettle.
Demonstration 1.2 Rinse the inside of the kettle.
and return
1.3 Fill the kettle with water up to
demonstration
three quarters full.
(30 minutes).
1.4 Replace the lid.
1.5 Wipe dry the outside of the
kettle.
1.6 Dry hands.
1.7 Check that the head of the wire
is dry.
1.8 Connect wire to the kettle.
1.9 Connect wire to the wall socket.
1.10 Switch on.
1.11 Wait for the steam to spew out
of the spout.
1.12 Wait for 5 minutes.
1.13 Switch off.

Conclusion/Final 3.1 Aware of the uses and potential Picture of good

closure ă Questions dangers of the electric kettle. health due to
and feedback 3.2 Aware of the dangers of hot drinking properly
(10 minutes). boiling water. boiled water.
3.3 Appreciate the importance of
boiling water correctly for safe
use.
You have just been shown an example of performing a task analysis of a daily
activity, that is, boiling water using an electric kettle. Let us now look at one
more example involving a healthcare procedure, checking a patientÊs pulse.
Example 2: Checking a PatientÊs Pulse

The task analysis for the psychomotor domain will focus on the learner
acquiring the skill of checking a patientÊs pulse correctly.
Task analysis of checking pulse:
2. Knowledge
1. Skill Component 3. Attitude Component
Component
1.1 Locate the sites for 2.1 Knowledge about 3.1 Aware of the
checking pulse pulse. importance of
(palpate using the 2.2 Knowledge on taking the pulse
terminal pulp of factors that can correctly.
your index, middle affect a personÊs 3.2 Aware of the
and ring fingers). pulse rate. importance of
1.2 Check pulse itself 2.3 Knowledge on what interpreting the
(count the number is a normal pulse. pulse accurately.
of beats per minute). 3.3 Appreciate the role
2.4 Knowledge on
1.3 Record pulse in an abnormal pulse. and responsibilities
observation chart. of the healthcare
personnel in
checking pulse.
The outcome derived from the task analysis on checking pulse will help the
healthcare personnel in deriving the learning outcomes for the teaching session.
The learning outcomes for the task of checking pulse covering all the three
domains can be identified clearly and can be stated for the teaching session.

Learning Outcomes:
The learning outcomes for a simple healthcare procedure of checking pulse are
shown in the following:
At the end of a 30-minute teaching session on „Checking Pulse‰, the

participants should be able to:
1. Define what pulse is;
2. Explain the factors that affect pulse rate;
3. Locate the sites for checking pulse;
4. Check pulse correctly;
5. Record the pulse rate correctly in an observation chart;
6. Differentiate between a normal and an abnormal pulse rate;
7. Appreciate the knowledge and skill in measuring pulse rate;
8. Explain the importance of the role of the healthcare personnel in checking

and charting the pulse of a patient correctly; and
9. Explain the importance of the role of the healthcare personnel in

interpreting the pulse of a patient correctly.
Lesson Notes:
What is Pulse?
A wave of distension and elongation felt in an artery wall due to the contraction
of the left ventricle forcing about 60ml to 80ml blood into the artery.
Characteristics of Pulse
1. Rate ă Measurement of heartbeat obtained by counting the number of

apical or peripheral pulse waves over a pulse point.
2. Rhythm ă Regularity of heartbeat (length of time between beats should be

the same).

3. Volume ă Measurement of the strength or amplitude of force exerted by

ejected blood against arterial wall with each heart contraction (normal,
weak, strong).
4. Tension ă Artery wall should feel soft and pliant under the fingers.
Pulse Points (Figure 5.1 to Figure 5.6)
Figure 5.1: Locating the carotid pulse Figure 5.2: Accessing the brachial
pulse
Figure 5.3: Locating and palpating the Figure 5.4: Examination of the
radial pulse popliteal artery
Figure 5.5: The posterior tibial artery 5.6: The dorsalis pedis artery

Requirement:
Watch with a second hand
Technique:
Palpate using the terminal pulp of your index, middle and ring fingers for the
radial pulse at your wrist.
Count the number of beats per minute.
Source: Jarvis (2012)
ACTIVITY 5.1
Group Activity
Prepare a lesson plan for a lecture demonstration for the following:
(a) Measuring apex beat
(b) Measuring blood pressure
Sample Answer for Activity 5.1:
Measuring Apex Beat
Learning Outcomes:
At the end of the course, the participants should be able to:
(i) Explain what is an apex beat.
(ii) Describe the factors that affect apex beat.
(iii) Identify the site for measuring apex beat.
(iv) Demonstrate the skills in measuring apex beat.
(v) Differentiate between a normal and an abnormal apex beat.
(vi) Demonstrate the knowledge and skill in measuring apex beat.

Lesson Contents:
What is Apex Beat?
(i) Apex beat or heartbeat is the sound produced every time heart valves
close.
(ii) Two sounds separated by a short pause can be distinguished. They are
described as lub dup.
(iii) Lub is a fairly loud sound due to the closure of the atrioventricular
valves during ventricular systole (contracts).
(iv) Dup is a softer sound which is due to the closure of the aortic and
pulmonary valves during ventricular diastole (relaxes).
Requirements:
(i) Stethoscope
(ii) Spirit swab or medicated swab
(iii) Watch with a second hand
(iv) Pen
(v) Observation chart
Procedures:
1. Explain the procedure to the patient.
2. Provide privacy.
3. Place patient in a comfortable position (sitting or lying down).
4. Expose the left side of the patientÊs chest.
5. Count to fifth intercostal space from the angle of Louis (between fifth
and sixth costal bones).
6. Draw an imagery midclavicular line until it meets the fifth intercostal

space.

7. Place diaphragm of stethoscope over the fifth intercostal space in the

midclavicular line (slightly below the nipple).
8. Count apex pulse for 1 minute.
9. Record in an observation chart.
Measuring Blood Pressure
Learning Outcomes:
At the end of the course, the participants should be able to:
(i) Explain what is a sphygmomanometer;
(ii) Explain what blood pressure is;
(iii) Describe the factors that affect a personÊs blood pressure;
(iv) Identify the site for measuring blood pressure;
(v) Demonstrate the skills in measuring blood pressure;
(vi) Differentiate between a normal and an abnormal blood pressure; and
(vii) Demonstrate the knowledge and skills required in measuring blood

pressure.
Lesson Notes:
What is Blood Pressure?
(i) Blood pressure is the force of blood pushing against the arteries of the
body. Each time the left ventricle contracts, it pumps blood into the
arteries.
(ii) Systolic Pressure ă Maximum pressure felt on an artery during the left
ventricular contraction (systole).
(iii) Diastolic Pressure ă Resting pressure felt on an artery during

ventricular relaxation (diastole) after each contraction.
Requirements:
(i) Stethoscope
(ii) Sphygmomanometer
(iii) Pen
(iv) Observation chart

Procedures:
1. Explain the procedure to the patient.
2. Ensure that the patient has rested for 15 to 30 minutes.
3. Position the patient in a recumbent, supine or sitting position.
4. Expose patientÊs upper arm.
5. Place the sphygmomanometer on the bed or table.
6. Place the mercury manometer upright.
7. Apply the cuff firmly 3cm to 4cm above the bend of the elbow.
8. Connect the rubber tubing of the cuff to the rubber tubing of the
manometer.
9. Palpate pulse at the antecubital space.
10. Inflate the cuff until pulsation is not palpable.
11. Locate the level of the mercury where the pulsation is last palpable.
12. Release the air from the rubber pump.
13. Place the earpieces of the stethoscope to the ears.
14. Place the chest piece of the stethoscope over the located pulsation.
15. Inflate the cuff.
16. Listen carefully while inflating the cuff until the first pulsation sound
is heard.
17. Continue inflating the cuff until 20mm to 30mm above the last
pulsation sound is heard.
18. Allow the air out slowly from the cuff 2mm ă 3mm/pulse.
19. Observe the level of mercury descent in the manometer.
20. Listen carefully for the first pulsation sound while observing the level
of the mercury.
21. Continue allowing air out of the cuff at the eye level.

22. Observe the level of mercury and the pulsation sound until a change of
pulsation sound from loud thumping to soft thumping is heard. Allow
the air out until the cuff is flat.
23. Disconnect the rubber tubing.
24. Return the cuff to the sphygmomanometer.
25. Tidy up the patient.
26. Chart the observation in the blood pressure observation chart.
27. Report for any abnormality.
Note: A sphygmomanometer must be placed on a flat level surface at the same

level as the heart.
Note: The first pulsation sound is the Systolic Pressure and the change in pulsation
sound from strong to soft is the Diastolic Pressure. Example: If the first pulsation
sound (Systolic) is at 120 and the breaking sound (last sound) is 80 (Diastolic), it is
recorded as 120/80mmHg.
ACTIVITY 5.2
1. Identify an area for teaching in the clinical area that you are
currently attached to.
2. What are the factors you need to consider in order to plan for the
teaching session?
3. Write the learning outcomes for the teaching session.
4. Develop a lesson plan for the teaching session.
5. Discuss your teaching plan with your tutor.
There is no right or wrong format or method of developing a lesson plan.

Nevertheless, as mentioned earlier, the various pertinent elements of a lesson plan
must be included because they have their particular reasons and benefits.

 The two types of lesson plan ă knowledge and skills ă principally relate to
whether it is meant for teaching a theoretical or a practical session.
 Each part of a lesson plan should fulfil certain purposes in communicating the
specific content, learning outcomes, learning prerequisites, what will happen,
sequence of learner-teacher activities, materials required and the actual
assessment procedures. Taken together, these parts constitute an end (the
objective), the means (what will happen and the learner-teacher activities) and
an input (information about learners and necessary resources).
 At the conclusion of a lesson, the assessment informs the teacher how well
learners have actually attained the objective.
 In spite of which model of lesson plan is utilised, the fundamental components

have to be incorporated.
Assessment Learning outcomes

Instructional objectives Lesson plan
Instructional procedures Material and technological resources
Instructional strategies Prerequisite skills
Knowledge Skills
Learner product State curriculum standards
Learner-centred approach Teacher-centred approach

1. A lesson plan is a means of communication. To whom does it communicate

to?
A. Teacher
B. Learner
C. Institution
D. Curriculum
2. Which of the following method falls under the teacher-centred approach?
A. Simulation
B. Demonstration
C. Return demonstration
D. Collaborative learning
Abbat, F. R. (1992). Teaching for better learning: A guide for teachers of primary
health care staff (2nd ed.). Geneva: World Health Organisation.

meaningful learning in the clinical setting. College Quarterly, Vol 8(3): 1ă7.
Fuszard, B. (1989). Innovative teaching strategies in nursing. Gaithersburg,

Maryland: Aspen Publishers.
Greaves, F. (1979). Teaching nurses in the clinical setting, Part II. Nursing Mirror,
1st March.
James, D. E., & Raybould, E. (1975). A guide for teaching nurses. Oxford, London:
Blackwell Scientific Publications.
Jarjoura, J. (2003). Mentorship ă A Key Part of Nursing Practice. Registered Nurses

Association of Ontario (RNAO) Practice Page. Vol 2(3) July.

Jarvis. (2012). Physical examination & health assessment (6th ed.). Elsevier
Saunders, Canada. ISNB: 978-1-4377-0151-7
Paterson, B. (1994). Developing and maintaining reflection in clinical journals.

Nurse Education Today, 211ă220.

New York: Basic.
Schuster, P. M. (2000). Concept mapping: reducing clinical plan paperwork and

increasing learning. Nurse Educator: 25(2).
Stockhausen, L. (1994). The clinical learning spiral: A model to develop reflective

practitioners. Nurse Education Today: 14, 363ă371.
Stritter, F. T., & Flair, M. D. (1980). Effective clinical teaching. Maryland, U.S.:
Department of Health, Education and Welfare. National Medical
Audiovisual Centre.
Taylor, B. (2000). Reflective practice: A guide for nurses and midwives. NSW:
Allen & Unwin.
Thorne, S. E., & Hayes, V. (1997). Nursing praxis: Knowledge and action. London:
Sage Publications.
Zubrizarreta, J. (1999). Teaching portfolios: An effective strategy for faculty

development in occupational therapy. American Journal of Occupational
Therapy 53(1), 51ă55.

Topic  Conducting
Teaching
6
LEARNING OUTCOMES
1. Explain the component skills in presenting a teaching session;
2. Discuss the components of each core teaching skill;
3. Conduct a microteaching for a theory session and skill session; and
4. Discuss the uses of different teaching aids in making teaching
effective.
 INTRODUCTION
From your interactions with patients, their family members, staff and learners in
the area where you are working, you have identified a learning need and the topic
to be taught in the clinical area. You have learnt how to write learning objectives
and how to develop a teaching plan for the clinical teaching session. What you
now have is a lesson plan ready for implementation. In order to deliver the
teaching plan effectively to the identified learner (the patient, family, staff or
learner) in the area of your clinical practice, you need to acquire some basic
presentation skills.

TOPIC 6 CONDUCTING TEACHING  145
6.1 PRESENTATION SKILLS
Figure 6.1: Healthcare Team in Clinician Setting

Source: https://thedo.osteopathic.org/2017/09/quiz-whats-ideal-medical-specialty-
personality/
The delivery of a teaching plan involves some specific skills, which are often
referred to as component skills in teaching or micro-teaching skills. A training
technique instituted at Stanford University in 1963 (Cooper, 1966) to develop
specific teaching skills is known as the process of microteaching. Once you have
acquired the component skills, you will be in a better position to present your
teaching plan with more confidence and with good organisation and sequence.
This is important because your learners will be able to understand and follow your
teaching session with much ease and pleasure.
Before engaging in microteaching skills, consider the following stages of oral

presentation to support your preparation for the teaching session:
 Preparation for the presentation;
 Day of the presentation; and
 At the end of the presentation.

146  TOPIC 6 CONDUCTING TEACHING
(a) Preparation for the Presentation

This stage takes into account the following areas of consideration:
(i) Topic
(ii) Audience
(iii) Place
(iv) Methodology
(v) Time
(vi) Facilities available
(vii) Preparation: Outline and Content
 Prepare lesson plan
 Write for presentation
(viii) Selection of appropriate audio-visual aids
(ix) Rehearsal
(x) Confirmation of date, time and venue
(b) Day of the Presentation
(i) Before presentation:
 Dressing
 Presentation materials
 Arrive 15 to 30 minutes earlier
 Prepare the place
 Test facilities

(ii) During presentation:
 Self-introduction
 Opening or set induction
 Posture or movement
 Voice
 Eye contact
 Facial expression
 Questioning at intervals
(c) At the End of the Presentation
(i) Question time
(ii) Conclusion
6.2 MICROTEACHING
Microteaching is a method of practice teaching in which the videotaping of a small
segment of a learnerÊs classroom teaching is made and evaluated at later time. It is
a scaled-down, simulated teaching encounter that is designed for the training of
both pre-service and in-service teachers. It has been used worldwide since its
invention at Stanford University in the late 1950s by Dwight W. Allen, Robert Bush
and Kim Romney.
Microteaching has been developed as a course in many teacher-training

institutions around the world. It readily combines theory with practice. When one
considers that teacher trainees in many training programmes conduct their
practice teaching under inadequate supervision with no learner feedback, the
relative merits and economy of microteaching become more and more apparent.

The use of microteaching within teacher education is seen as an on-campus way

of introducing pre-service teachers to the complexities of teaching and as a bridge
that connects theory to practice (Pringle, Dawson & Adams, 2003). Throughout the
years, various components have been changed or added to the format of on-
campus micro-teaching performances.
The purpose of microteaching is to provide teachers with the opportunity for the
safe practice of an enlarged cluster of teaching skills while learning how to develop
simple, single-concept lessons in any teaching subject. Microteaching helps
teachers improve content and methods of teaching, and develop specific teaching
skills such as questioning, the use of examples and simple artefacts to make the
lessons more interesting, the use of effective reinforcement techniques as well as
introducing and closing the lesson effectively.
Microteaching offers the advantages of both a controlled laboratory environment

as well as a realistic practical experience. It is hardly a substitute for teaching
practice but it offers advantages such as close supervision, manageable objectives
that are established according to individual trainee needs and progress, continuous
feedback, an unprecedented opportunity for self-evaluation, immediate guidance in
areas of demonstrated deficiency and the opportunity to repeat a lesson whenever
desired. When these advantages are combined with the economy of resources
required to obtain them, microteaching becomes a valuable training method under
many conditions throughout the world.
Immediate, focused feedback and encouragement, combined with the opportunity

to practise the suggested improvements in the same training session, are the
foundations of the micro-teaching protocol.
6.2.1 Process of Microteaching

A micro-teaching session typically involves recording a short lesson in front of a
small peer group in order to receive feedback on oneÊs teaching style. This exercise
gives participants the opportunity to practise teaching and receive feedback
in a non-threatening and supportive environment. Microteaching also allows
participants to gain a new perspective on their teaching through simulating the
perspective of the learners. Micro-teaching participants are able to literally see
how they teach through the eyes of „learners‰ă in this case, their fellow peer
participants ă and through observing themselves during the teaching session via
recorded playback.

In a true micro-teaching session, participants only present for five minutes and are
recorded. The video is then played back in front of all the participants. One variant
of microteaching is to record longer teaching presentations and prepare DVDs for
the participants to view later during a confidential follow-up consultation.
6.2.2 Benefits of Microteaching

Visual feedback (through watching a recorded lesson) has been found to provide
one of the most effective means of evaluating teaching strengths and identifying
areas for improvement. Microteaching enables both intrinsic (self-assessment)
and extrinsic (peer review) assessment of teaching behaviours. Several skills and
behaviours have been identified as essential to the development of effective
teaching. Through microteaching, one can seek to identify and improve these
observable teaching skills and behaviours. The practice of any combination of the
said skills and behaviours in a micro-teaching session can lead to improved
performance in the classroom. Some of the skills and observable teaching
behaviours include:
(a) Oral presentation skills (voice modulation and articulation, enthusiasm,

gestures, non-verbal cues, clarity of explanations and examples);
(b) Organisation skills (structure of lesson, strong opening and closing, good
transitions between sections, clear learning objectives, effective use of time
and good pacing);
(c) Relating to learners (speaker engages the audience, material is audience-

appropriate, effective questioning, use of real-life examples); and
(d) Effective use of teaching aids (handouts, blackboard, presentation software,

overhead transparencies, props, charts and others).
Aside from helping to identify teaching skills to be improved as well as teaching

strengths, micro-teaching sessions can also provide an opportunity for the
following:
(a) Practising part of a lecture, running an activity, explaining a procedure

before you have to deliver a course or demonstrating a lab procedure for the
first time;
(b) Practising a guest lecture that you have been asked to deliver in someone
elseÊs course;
(c) Practising a job talk before you visit a institution when applying for jobs;

(d) Practising public speaking skills before you address learners for the first
time; and
(e) Polishing your questioning techniques or your opening and closing skills, if
you are already an experienced instructor.
Please Note: All micro-teaching presentations must be interactive! Even job

talks and lectures need to be interactive (involve communication with the
audience) in order to be effective. Micro-teaching lessons cannot simply involve
the straight delivery of content. Interaction with the audience is required.
Part of micro-teaching activity is getting feedback from peers as the audience for
the session.
6.2.3 Peer Observation and Evaluation

The process of peer observation involves faculty peers in evaluating the teaching
process and its possible relationship to teaching and learning. The focus is on
verbal and non-verbal behaviours of both the „student teacher‰ and the „learners‰
in the classroom.
Peer observation can produce the following evidence:
(a) Comments on the relationship between student teacher acts and learner
behaviours;
(b) Comparison against methods which peers consider to be good; and
(c) Specific suggestions for the student teacher to improve his teaching.
The processes of observation and evaluation require a very high degree of

professional ethics and objectivity. Effective peer observation requires training in
observational and analytical skills. Less subjective peer observations require time
for multiple reviews.
Major strengths of peer observation are:
(a) Peers are familiar with college goals, priorities, values and faculty problems;
(b) Peer observation helps the faculty to upgrade their own profession; and
(c) Peer observers can be chosen from student teacherÊs content area.

Major weaknesses of peer observation are:
(a) Data is often biased due to previous data, personal relationships and peer
pressure;
(b) Peer relationships may suffer; and
(c) Possible bias due to student teacher preference for own teaching methods.
Overall, key authors on peer observation agree that peer observation of classroom
teaching is one useful part of a peer evaluation process.
Purpose of Peer Observation and Evaluation

Peer observations may be used for both formative feedback and improvement of
instruction as well as for summative assessment in making personnel decisions.
Peer observations are particularly useful for faculty self-assessment and
improvement. The student teacher who wishes to analyse his or her own teaching
and learner learning can benefit from a colleagueÊs observation. Such classroom
observations can be flexible and informal. In contrast, observations for personnel
decision making need to be more formalised and standardised to ensure fairness,
reliability and credibility.
6.3 MICRO-TEACHING SKILLS

You have studied the concept of microteaching and were aware of the significance
of microteaching in teacher training programmes. It is essential to practise the
teaching skills in order to become better teachers.
Teaching skill is a set of teaching behaviours of the teacher, which is especially

effective in bringing about desired changes in learnersÊ behaviour. These skills can
be assessed by means of an observation scale. Teaching skill, which cuts across
subject areas, has been identified and found to be very useful for teachers.
The set of the teaching skill includes skills in:
(a) Setting induction;
(b) Probing questions;
(c) Explaining;
(d) Illustrating with examples;

(e) Reinforcement;
(f) Stimulus variation;
(g) Classroom management; and
(h) Making conclusion (closure).
6.3.1 Setting Induction

The word „set‰ refers to an attitude of mind that influences how a person views
things. To induce is to initiate or to facilitate.
Therefore, set induction refers to the pre-instruction procedures used by the

teacher to clarify goals of the instruction and to motivate learners to learn. A set is
also done to help learners see the relevance of the learning task. It provides a
cognitive link from what was done before to what will follow in the instructional
sequence. It is appropriate to place set induction activity at the beginning of the
clinical teaching session to help learners become excited about the subsequent
learning experience.
Examples of set induction include:
(a) Motivating learners in various ways so that they are interested in the main
lesson;
(b) Letting learners know the learning outcomes or outline of the lesson;
(c) Telling learners why they need to learn a lesson; and
(d) Relating previous learning to the present lesson.
Your set induction should be interesting, able to help learners become interested
in the main part of the lesson and should be relevant to the lesson. The
communicative link must be clear. Give cues to learners to help them understand
the lesson as well as remember the materials presented in the body of the lesson.

6.3.2 Probing Questions

A teacher often uses questioning to get feedback from learners to find out how
well the learners understand the materials taught. This will indicate the
effectiveness of the teaching session. Questioning by the teacher during the
teaching session can arouse learnersÊ interest and curiosity. It also provides
opportunity for learners to assimilate and reflect on the information acquired.
Questioning has to be planned and purposeful. Purposeful questioning
encourages learner participation and increases their understanding.
The types of questions a teacher can pose to learners include:
(a) Factual questions requiring learners to recall information, for example,

„What happened to the patient after you have administered the treatment?‰
(b) Descriptive questions that require organisation of thought, for example,

„Describe the visit you made‰.
(c) Clarifying questions in the form of getting more information or asking

learners to justify a response, for example, „Tell me more about the dressings
used in the care of this wound.‰ or „Why is this type of dressing used?‰
(d) Questions can be used to help learners refocus on a particular subject, for
example, „How does this dressing promote healing?‰
(e) Higher-order questions may be used to get learners to think beyond the facts,
for example, „What conclusions can you make from the use of different
dressings for different wounds?‰
There is a technique in asking questions. The teacher must always bear in mind
that questioning is done for a purpose, at the appropriate time of the teaching
session. The question should be worded correctly, simply and clearly so everyone
understands it. Questions posed should be thought provoking and not just require
a „Yes‰ or „No‰ answer.

Ask questions in the correct way by doing the following:
(a) Pose (word and ask the question);
(b) Pause (have a very brief period of silence to allow learners to think about the
question); and
(c) Pounce (call on a learner).
Reword or repeat the question if necessary and discourage chorus answers.
The way a teacher responds to answer a question is very important. It will

determine the future participation of the learners. If an answer is wrong, the
teacher must handle the situation tactfully. If the answer is correct, the teacher
must give praise and reinforcement to the learner.
Very often when the teacher asks questions in the class, different situations may
arise, for example:
(a) The learners may provide no response;
(b) The learners may provide incorrect responses;
(c) The learners may provide partially correct responses; or
(d) The learners may provide the correct response.
How to deal with all these situations effectively is the main theme of this skill.
In case of no response or incorrect response, the teacher can go deep into the
learnerÊs response by asking several questions about what he already knows and
lead him to the correct response. When the response is correct the teacher may help
the learner to go deep into the content by asking questions on how, why and what.
The skill involves a series of questions to go deep into the learnerÊs responses.
You are correct if you say that questions should be well structured. This means
the question should be simple, concise and grammatically correct. It should be
addressed to the whole class instead of only one learner. This is because the
purpose of the question is to make the whole class think about the point or issue
that is being discussed. Learners should be given some time to think about the
question and then the teacher should point towards one learner to respond to the
question.
How do we deal with the different situations (learnersÊ responses) mentioned

earlier?

Let us discuss five different techniques for different situations:
 Prompting;
 Seeking further information;
 Redirection;
 Refocusing; and
 Increasing critical awareness.
(a) Prompting
This technique means to go deep into the learnerÊs response when the
response is incorrect or when there is no response. Then a series of hints or
prompts are given to the learner through step-by-step questioning in order
to lead the learner to the desired or correct response.
(b) Seeking Further Information

This technique is used when the learnerÊs response is incomplete or partially
correct. The teacher helps the learner to clarify or elaborate, or to explain his
initial response by asking more related questions or creating situations in
which the learner is made to think and respond.
(c) Redirection
This technique involves asking the same question to another learner. The
main purpose of this technique is to increase more learner participation.
When there is no response or incorrect response from the learner, prompting
should be preferred to redirection.
(d) Refocusing
This technique is used when the learnerÊs response is correct. This involves
comparing the phenomenon in his response with other phenomena in which
there is either a similarity or difference, or when there is a relationship
between the two situations. How is one situation different or similar to
another situation? How does the learnerÊs response relate to other situations?
Such questions are put forward to the learner.
(e) Increasing Critical Awareness

This technique is used when the learnerÊs response is correct. The teacher
puts forth higher order questions to stimulate thinking beyond what the
learner already knows. This involves the „how‰ and the „why‰, and
sometimes the „what‰ type of questions to the point being discussed.

Effective questioning is considered a vital component of adult education

and an integral part of teaching in the medical or healthcare profession.
Questioning can:
(i) Clarify concepts;
(ii) Reinforce learner understanding;
(iii) Arouse curiosity;
(iv) Emphasise key points;
(v) Stimulate interest; and
(vi) Promote learnersÊ higher-order thinking.
6.3.3 Explaining
You may have experienced that during the teaching-learning process of some
concepts, principles and phenomena, merely describing the theme does not ensure
that learners understand them. The teacher has to give proper explanation and
reasons to bring clarity and understanding to what is being taught.
Let us look at the components of this skill, broken down into the doÊs and the
donÊts as shown in Table 6.1 and Table 6.2.
Table 6.1: The DoÊs of the Explanation Skill
Do Description
Beginning statement The purpose of this statement is to create readiness among the
learners to pay attention to the point being explained. It is the
introductory statement to begin an explanation.
Explanation links These are words and phrases, which are mostly conjunctions
and prepositions, generally used by the teacher to make her
explanation more effective. Examples: the result of, such that, the
cause of, the function of, the consequence of, so that, due to, as a
result of and so forth.
Concluding This is the statement made at the end of the explanation. It
statement includes the summary of all the main points mentioned in the
explanation.
Questions to test These are short questions to test or evaluate the learnersÊ
learnerÊs understanding of the concept after the explanation.
understanding

Table 6.2: The DonÊts of the Explanation Skill
DonÊt Description
Irrelevant statements These are statements that are sometimes made by the teacher
during the explanation, which have nothing to do with the
presented concept. These statements do not contribute to the
understanding of the explanation but create confusion in the
minds of the learners.
Lacking in continuity This happens when the sentence remains incomplete or are
reformulated in the middle of the statement. Other causes
include:
 A statement that does not logically relate to the previous
statement.
 When a topic or content previously taught is being referred
to without showing the relationship to what is being
explained.
 When there is no sequence of space or place.
 Use of inappropriate vocabulary or technical terms, which
are unknown to learners.
 Use of vague words and phrases. Examples: some, much,
seems, many, in fact, actually and so forth. In addition, there
are words and phrases such as „you see‰, „okay‰, „correct‰
and so forth, which are part of the teacherÊs mannerism.
6.3.4 Illustrating with Examples

You must have observed that some abstract ideas or concepts are very difficult to
teach. In spite of the teacherÊs best efforts to explain the concepts, he is unable to
convey the true sense and meaning of the concepts. This difficulty can be solved
easily if the teacher masters the skill of illustrating with examples.
The purpose of using examples is to explain the meaning of difficult terminologies,

ideas, concepts, theories and principles. Using examples in teaching helps learners
to understand and apply them to other situations.
Some guidelines on the effective use of examples are as follows:
(a) Use simple examples;
(b) Proceed from simple to complex;
(c) Use examples that are relevant to the learnersÊ experience;

(d) Relate examples to the ideas being taught; and
(e) Check learnersÊ understanding by asking them to give some examples to

illustrate the point being discussed.
What are components of the skill of illustrating with examples? Let us see in
Table 6.3.
Table 6.3: Components of the Skill of Illustrating with Examples
Component Description
Formulating simple A simple example is one that is related to the previous knowledge
example of learners. It should be according to the age level, grade level and
the background of learners.
Formulating An example is considered to be relevant to the concept when the
relevant example concept or the rule can be applied to the example. This means that
the concept or rule is explained by the example.
Formulating An example is considered to be interesting if it can arouse the
interesting example curiosity and interest of the learners. This can be judged by the
attending behaviour of the learners. If the learners keenly pay
attention to the example, then it is really interesting.
Using appropriate Appropriateness of media refers to its suitability to age level,
media for examples grade level and maturity of the learners to the unit taught. The
decision about the nature of media, regardless verbal or non-
verbal, depends on the nature of the concept.
Using examples by This involves the teacher giving examples that are related to the
inducto-deductive concept or rule in order to clarify it. The learners formulate the
approach rule based on the examples given. Subsequently, the teacher will
ask the learners to provide examples to test if they have correctly
understood the concept.
6.3.5 Reinforcement
Reinforce means to strengthen or to praise. When a behaviour is reinforced, it is
more likely to be repeated (ThorndikeÊs law of effects). Reinforcement, therefore,
represents things we say or do to encourage positive learner behaviour.
The purpose of reinforcement is to create a positive classroom atmosphere and

to motivate class participation. Reinforcement also encourages weak learners to
express themselves.

Every responding learner in the class needs social approval of his behaviour. To
satisfy this need, he is always eager to answer each question known to him.
Learner participation in the class is maximised if the teacher encourages the

learners with:
(a) Statements like „good‰;
(b) Certain non-verbal expressions such as smiling and nodding the head; and
(c) Paying attention to the responding learner.
The main theme of the reinforcement skill is that encouraging remarks of the
teacher increases while discouraging remarks decreases the learner participation
in the learning process.
The skills of reinforcement is shown in Table 6.4.
Table 6.4: Six Skills of Reinforcement
Skills of Reinforcement Description

Positive verbal The following are some positive comments that the teacher
reinforcement can give towards a correct response by the learner:
 Using words and phrases like „good‰, „very good‰ and
„excellent‰.
 Repeating and rephrasing the learnerÊs response.
 Using the learnerÊs idea in the development of the lesson.
 Using extra verbal cues such as „um‰ and „aha‰ to
encourage the learner.
 Using prompts such as „carry on‰ and „think again‰ to
help the learner to give a correct response.
Positive non-verbal The teacher gives comments to the learner for his correct
reinforcement response without the use of words. Instead, the teacher may
nod his head, smile, pat the learner on his shoulders, look
attentively at the responding learner or write the learnerÊs
answer on the whiteboard. The teacher encourages the
learner to participate actively during the development of the
lesson.
Negative verbal The teacher gives comments on the incorrect or partially
reinforcement incorrect response by saying that the learnerÊs response is
incorrect or making sarcastic remarks such as „idiot‰ or
„stupid‰. Such behaviour of the teacher discourages learner
participation and should never be used.

Negative non-verbal The teacher shows his disapproval without using words.
reinforcement This involves frowning, staring and looking angrily at the
responding learner when he gives a wrong response. This
type of teacher behaviour creates fear in the minds of the
learner and decreases learner participation.
Wrong use of This is a situation where the teacher does not give
reinforcement reinforcement but the situation demands for it (for example,
encouraging response).
Inappropriate use of This is a situation when the teacher does not encourage the
reinforcement learner with respect to the quality of his response. He uses
the same type of comment for every response.
6.3.6 Stimulus Variation

A stimulus is anything that provokes a reaction. To vary is to change or to be
different. Variation refers to a change in teaching. A stimulus variation, therefore,
is changing the stimuli in order to keep learners alert and interested in the lesson.
A very important point for teachers to bear in mind is that learners can get bored
during the teaching session. One way to prevent boredom during the session is to
use stimulus variation.
How can you vary the stimuli during your teaching session? You can achieve this
by varying your teaching style and interaction with the learners by:
(a) Varying your tone, pitch or volume of voice;
(b) Facial expressions;
(c) Hand, head and body movements;
(d) Gestures;
(e) Eye contact;
(f) Focusing and emphasising on certain points to get learnersÊ attention

(verbally, non-verbally, through gestures); and
(g) Pausing to capture learnersÊ attention (for example, pausing at the end of a
segment either before or after asking questions will help to draw learnersÊ
attention).

Figure 6.2: Vary the stimulus by engaging all the five senses
The teacher can vary the stimulus by engaging all the five senses (see Figure 6.2)
and switching the sensory channels in her teaching. For example, varying from
oral presentation to showing learners visual aids or engaging the sense of touch.
In teaching, it is recommended to use a variety of audio-visual aids to stimulate
all the senses and enhance learning. The following wisdom on learning from
Confucius is commonly quoted by teachers:
What you hear, you forget.

What you hear and see, you remember.
What you hear, see and do, you understand.
Variation can also be in the form of your interaction with your learners. Interaction
styles with learners can vary from teacher-group to teacher-learner or learner-
learner. You should try to use a variety of interaction styles to stimulate learner
participation and keep your learners on their toes.

The learning pyramid (refer to Figure 6.3) illustrates clearly the different
percentages of benefits gained by learners when teachers adopts different teaching
methods. Take note of the high retention value for the methods of discussion
group, practise by doing and teaching others.
Figure 6.3: The learning pyramid
For the success of any lesson, it is essential to secure and sustain the attention of
the learners. Learning is optimum when learners pay full attention to the teaching-
learning process. How to secure and sustain the attention is the main theme of the
stimulus variation skill.

Based on psychological experiments, it is known that an individualÊs attention

span tends to shift from one stimulus to another very quickly. It is very difficult
for an individual to attend to the same stimulus for more than a few seconds.
Therefore, in order to secure and sustain the attention of learners towards the
lesson, it is imperative to include variations in the stimulus during the learning-
teaching process. This is because attention is the necessary prerequisite for
learning.
The seven skills of stimulus variation are given in Table 6.5.
Table 6.5: Seven Skills of Stimulus Variation
Skills of Stimulus
Description
Variation
Movements This refers to making movements or moving from one place to
another with some purpose. Examples: from writing on the
whiteboard to conducting experiment, to explaining the chart or
model, to paying attention to the learner who is responding to some
questions.
Gestures These include movements involving the head, hand and body parts
in order to arrest attention, to express emotions or to indicate
shapes, sizes and movements. All these acts are performed in order
to enhance teaching effectiveness in a more expressive manner.
Change in speech When the teacher wants to show emotions or to emphasise on a
pattern particular point, he may adopt sudden or radical changes in tone,
volume or speed of the verbal presentation. The change in the
speech pattern makes the learners more attentive and creates
interests in the lesson.
Change in When two or more persons communicate their views with each
interaction style other, they are said to be interacting with one another.
In the classroom, the following three styles of interactions are
possible:
 Teacher → Class (Teacher talks to class and vice versa)
 Teacher → Learner (Teacher talks to learner and vice versa)
 Learner – Learner (Learner talks to learner)
All types of interactions should complement each other to secure
and sustain learnersÊ attention.

Focusing (verbal The teacher draws the attention of the learners to a point in the
and gestural) lesson either by using verbal or gestural focusing. In verbal
focusing the teacher makes statements such as „look here‰, „listen
to me‰ or „note it carefully‰. In gestural focusing, the teacher points
towards an object with his finger or underline the important words
on the blackboard, for example.
Pausing This means for the teacher to „stop talking‰ for a moment. When
the teacher becomes silent during teaching, it will pique the
curiosity of the learners at an instance, thus drawing their attention
back to the teacher. The message given at this point will then be
easily received by the learners.
Oral-visual When the teacher verbally provides information to the class, it is
switching called oral medium. When the teacher shows maps, charts and
objects without saying something, it is called visual medium. If the
teacher is giving information to the learners through any one
medium (oral, visual or oral-visual) for a long time, it is possible
that the learners will lose attention to what the teacher is conveying
to them. Therefore, it is essential for the teacher to change the
medium rapidly in order to secure and sustain the learnersÊ
attention to what he is saying. There are three types media:
 Oral ⇄ oral-visual: When the teacher speaks and then shows
objects, charts or models and explains their various parts. This
is switching from oral to oral-visual.
 Oral ⇄ visual: When the teacher speaks and then shows objects,
maps, charts or the globe. This is switching from oral to visual.
 Visual ⇄ oral-visual: when the teacher demonstrates the
experiment silently and then explains the phenomenon with the
help of a chart, map or diagram. This is switching from visual
to oral-visual.
These devices are used interchangeably to secure and sustain
learnersÊ attention throughout the lesson.
6.3.7 Classroom Management

You must be aware that learning is effective when the learner actively participates
in the learning activities of the class. The main purpose of the skill is to achieve
maximum participation of learners in the development of the lesson.
The eight skills of classroom management are given in Table 6.6.

Table 6.6: Eight Skills of Classroom Management
Skills of Classroom
Description
Management
Calling learners by Learners are generally attentive when they are called by their
their names names. Though this seems simple, it has great significance in
obtaining learner participation. Good learner participation helps
in controlling the learning activities.
Making norms of The teacher gives clear instructions to learners to follow the
classroom behaviour norms of classroom behaviour. Learners should not be engaged
in any other activities while the teacher is teaching. The
instructions provide good classroom management.
Giving clear This includes giving specific instructions to the learners such as:
instructions  „Stand up and answer when you are asked a question.‰
 „Raise your hand if you know the answer to the question.‰
 „Listen attentively when the teacher is teaching.‰
 „Do not answer as a group but answer individually.‰
Ensuring sufficient The teacher should allot work to each learner, keeping in view
work for each the individual differences. This act of the teacher will prepare
learner each learner for active learner participation.
Keeping learners in After teaching a concept, the teacher should check the
sight effectiveness of his teaching. He may assign an activity such as
drawing a diagram and levelling its parts. The teacher should go
to each learner to check his work. If needed, the teacher should
give further instructions for improvement.
Shifting from one While teaching a concept in the class, the teacher may be
teaching activity to engaged in many academic activities such as explaining,
another smoothly illustrating and questioning. He should shift from one activity to
another smoothly. Before shifting to the next activity, the teacher
must ensure that his learners are able to understand or follow
the concept under study.
Recognising and In order to ensure the attending behaviour of the learners, the
reinforcing teacher should use verbal and non-verbal communication, for
attending behaviour example, smiling and nodding his head when his learner gives
the correct response. This type of teacher behaviour is very
effective in stimulating classroom-learning environment.
Checking If a learner is not behaving properly in the learning situation
inappropriate or may not be attentive mentally, he should be immediately
behaviour checked. He should be directed to behave properly according
immediately to the appropriateness of the situation. This will increase the
attending behaviour of the learner, leading to better class
management.

6.3.8 Closure
Closure refers to the conclusion of a teaching session or segment of a teaching
session. Mini-closures are used at specific points during a lesson to review major
points before proceeding to the next point. A final closure is used at the end of a
teaching session to highlight major points in a teaching session and to link new
knowledge to future learning.
Closure is complementary to set induction. Closure is achieved when the major

points of a lesson or part of a lesson are summarised. However, closure is more
than a summary of the contents of the lesson. In addition to stating the main points
of the lesson, closure acts as a link between new knowledge and past knowledge
as well as a link to future learning. A final closure is used at the end of the lesson
to signal the completion of the teaching session.
A mini-closure is used as a link between one concept and another. It is appropriate,

therefore, to have a mini-closure after the teacher has covered one concept before
moving on to a new concept, idea or problem. A mini-closure at specific points of
the teaching session can help learners in following the flow of the session. Using
mini-closures gives the learners an idea of where they are and where they are
going.
Closure can be achieved in the following ways:
(a) When completing a lesson or part of a lesson:
(i) Provide a consolidation of concepts, which have been covered before

moving on to subsequent learning;
(ii) Review major points throughout the lesson using an outline;
(iii) Relate the lesson back to the guiding principle; and
(iv) Summarise the discussion, including the main points covered in the
teaching session.
(b) Making connections between previously learned knowledge, currently

presented information and future learning:
(i) Review sequence by moving from known to unknown contents;
(ii) Apply what has been learnt to similar examples and cases; and
(iii) Extend content to new situations.

(c) Allowing learners the opportunity to demonstrate what they have learned:
(i) Allow learners to practise the new learning; and
(ii) Provide a summary for the learners.
Application of all micro-teaching skills in teaching as well as devising an

imaginative application to presenting the teaching plan will ensure effectiveness
of the teaching session. As a teacher, you need to match an interesting presentation
with an interesting application. You need to reinforce by causing your learners to
„see‰, „say‰ and „do‰ the things that you have orally presented to the learners
(remember to incorporate planned reinforcement and feedback). All lessons must
conclude with an emphatic summary of what has been taught (final closure).
ACTIVITY 6.1
Select a topic from your teaching subject. Plan a micro-teaching session

on the topic using the components of the teaching skill in appropriate
situations.
Be sure to obtain feedback from your tutor.
6.4 ADVANTAGES OF MICROTEACHING

Microteaching has several advantages. It focuses on sharpening and developing
specific teaching skills and eliminating errors. It enables understanding of
behaviours that are important in classroom teaching. It increases the confidence of
the student teacher. It is a vehicle of continuous training that is applicable not only
to teachers at the beginning of their career but also to senior and experienced
teachers. It enables the projection of model instructional skills. It provides expert
supervision and constructive feedback, and above all, it provides for repeated
practice without the any adverse consequences to the teacher or his learners.
ACTIVITY 6.2
Create a checklist of the different stages involved in making a

presentation. Have a quick review of the main points to help you make
an effective presentation. Discuss this with your coursemates.

6.5 AUDIO-VISUAL TEACHING AIDS

Learning and teaching is the concern of all teachers. Nevertheless, learning is a
complex process. Learning can be defined as a change in disposition, a relatively
permanent change in behaviour over time and this is brought about by experience.
Learning can occur because of newly acquired skills, knowledge, perception, facts,
principles, new information at hand and so forth. Learning can be reinforced with
a variety of learning aids because these aids can stimulate, motivate as well as
maintain the learnerÊs attention during the instructional process.
Learning aids are instructional materials and devices through which teaching and
learning are carried out in schools. Examples of learning aids include visual aids,
audio-visual aids, real objects and many others. Visual aids are designed materials
that are made locally or produced commercially. They come in the form of wall
charts, illustrated pictures, pictorial materials and other two-dimensional objects.
There are also audio-visual aids for teaching such as radio, television and all sorts
of projectors with sound attributes.
In presenting a teaching session, a teacher often needs some forms of teaching aids
to make the class more interesting and to add clarity in the teaching-learning
process as well as effectiveness in achieving the learning objectives.
Why do you need to use audio-visual aids in your lesson? Consider the following:
(a) To maintain a high level of interest in the lesson;
(b) To promote greater learner participation; and
(c) They can be used at all levels of learning.
Teachers could use various teaching aids to make the teaching session more
effective. We will look at some of the common teaching aids used by teachers.

Figure 6.4: Using audio-visual aid in a nursing class

Source: http://www.ngcsu.edu
There are three main categories of audio-visual aids:
(a) Sound media ă Includes disc recording, magnetic tapes and broadcasts;
(b) Non-projected media ă Includes handouts, programme books, real objects

and specimen, models, graphics, whiteboard, flipcharts and bulletin board;
and
(c) Projected media ă Includes still pictures, posters, videos, films, slides,
overhead slides and computer graphics.
The healthcare personnel teacher can select the most appropriate teaching aid to
enhance the presentation of his teaching session. The teacher has to ensure that he
is skilful in using the selected teaching aid. Otherwise, instead of enhancing, it will
make the teaching session less impactful to the learners.

ACTIVITY 6.3
Recall a teaching session that you have recently attended.
(a) What were the teaching aids used by the teacher?
(b) Comment on the effectiveness of the use of the teaching aids in

enhancing the lesson.
6.6 QUALITIES OF A TEACHER

A teacher is an individual who plays the most vital role in the development of any
human being. The future of any learner depends on the quality and dedication of
his teacher. It is the teacher who inspires interest in learners to develop and achieve
whatever aims they have set for themselves.
6.6.1 Characteristics of a Good Teacher

A good teacher must enjoy working with people. He must have great enthusiasm
for the subject(s) being taught ă even if he is not an expert or lover of a particular
subject, he can still teach it well if he enjoys imparting knowledge and is good at
communicating.
As far as character is concerned, the one quality that a teacher must have is
patience. As a teacher, you must never, ever be annoyed with learners just because
they do not understand something. You must have a sense of humour and (very
importantly) create an atmosphere where everyone knows they can ask questions,
try out new ideas and maybe make mistakes in a supportive environment.
A teacher must always be in charge of the teaching-learning process. It is very good

if the learners decide on certain aspects such as how learning takes place and what
they learn. However, the class will be much happier and more productive if
everyone knows that the teacher is a professional who knows what he is doing and
can be entrusted to run the lesson effectively.
There is a famous saying that says, „A teacher is like a lighthouse which shows the
right path to people in darkness.‰ Take the examples of great teachers such as
Socrates, Aristotle, Luqmaan, Confucius and the like, who have changed the
world. Until today, their teachings are still affecting people throughout the world.
To be a teacher is in fact a great responsibility. The teacher should try to possess
the qualities of such great teachers although that is not an easy task at all.
Patience, persuasiveness, endurance, having faith and consistency are core

characteristics of a teacher. A teacher must possess leadership qualities and
practice what he says in order to enable his learners to emulate him. He must have
great confidence and strong willpower to coax the best results from his learners.
He must be a master in his subject and have full command of the knowledge.
Dedication and devotion towards his learners is a must. Always be ready to give
time to his learners. He must also be someone who is easy going, uses simple
language in a very lively way so that learners are comfortable in his presence
instead of fear. He must be a man of character indeed.
Besides having excellent knowledge, a teacher must have great moral values
because he will be setting an example for the future generation of healthcare
personnel. He should not only teach matters which are to studies alone but also
play a vital role in learnersÊ welfare and counselling. He must have a friendly and
polite personality so that learners will not think twice about sharing something
regarding their studies or daily life problems. There are many considerations, both
small or big, that affect how well a teacher is respected by the society.
As a teacher, you have knowledge, skills and your personal style of teaching. You
need these qualities to achieve your goal as a teacher. You need patience to
motivate the learners, to challenge them without pushing them beyond their
comfort level. Remember to never humiliate a learner in front of his peers. Instead,
you should counsel him privately.
6.6.2 Roles of a Teacher

The following are eight fundamental roles of a teacher:
(a) Organiser ă Teaching in the classroom involves careful organisation of tasks

and activities that the learners are to be engaged in. You should direct the
learners in the roles and tasks that they will undertake. Tell the learners
exactly what they need to do and how they should do it;
(b) Guide ă Having organised the activity and instructed the learners as to their
roles, you should remain discreetly on hand to act as a guide in case some
learners do not fully understand the activity;
(c) Motivator ă You may find that some learners are resistant to the type of
learning that you would like them to engage in. As such, you will be called
upon to motivate the learners and to get them interested in the activity;

(d) Monitor ă You will often have to act as a monitor, being alert on what is going
on in the classroom;
(e) Assessor ă You will need to check and decide when and how to give
feedback;
(f) Tutor ă On a one-to-one basis, give individual attention, guidance and a

helping hand to learners to learn more efficiently;
(g) Facilitator ă Encourage learners to communicate with each other; and
(h) Controller ă Be in complete control of the class.
A good teacher must have full command of his subject. He must also have a
commanding personality as well. Higher education degrees are necessary to
become a teacher but to become a great teacher, loyalty and sincerity to the
profession is required. If one is sincere in his profession, he will maximise his effort
to make himself successful.
Additionally, a good teacher:
(a) Cares about the learners;
(b) Listens to the learnersÊ concerns;
(c) Is a true friend to learners, which may mean not being liked at all times;
(d) Cares about how learners develop as a person;
(e) Exemplifies what he teaches;
(f) Strives to develop learners into self-teachers;
(g) Knows the material and presents it well;
(h) Is aware of what the learners know and do not know;
(i) Is a self-teacher;
(j) Strives to develop learners into moral individuals;
(k) Is moral;
(l) Strives to develop learners into self-motivated individuals;
(m) Is motivated;

(n) Strives to develop learners into self-disciplined individuals;
(o) Is disciplined;
(p) Challenges learners to their full potential;
(q) Does not discourage learners;
(r) Is flexible;
(s) Caters as much as possible to each learnerÊs individual needs;
(t) Realises that he is a finite human being; and
(u) Works with others (such as other teachers and learners, patients and their
family members and colleagues) to accomplish goals.
 Microteaching is a method of practice teaching in which the videotaping of a

small segment of a learnerÊs classroom teaching is made and later evaluated.
 There are specific skills in presenting a teaching session.
 Several primary teaching skills have been identified in the development of

effective teaching. These are incorporated into the micro-teaching session so
that the practice of any one or a combination of the skills can be identified and
employed in a teaching situation.
 The skills include set induction, explaining and illustrating with examples,
questioning, reinforcement and closure.
 Teaching aids can contribute to the effectiveness of a teaching session.
 The different teaching aids include sound media, non-projected media and
projected media.
 Deep knowledge of the subject, patience, persuasiveness, endurance, faith and

consistency are core characteristics of a teacher. In addition, a teacher must
possess leadership qualities and should practise what he says in order to
enable his learners to emulate him.

Audio-visual aids Probing

Classroom management Presentation skills
Closure Projected media
Explaining Questioning
Illustrating with examples Reinforcement
Learning pyramid Set induction
Micro-teaching skills Sound media
Non-projected media Stimulus variation
Peer observation
1. The micro-teaching skill used to help learners see the relevance of a teaching
session is called ⁄
A. set induction
B. stimulus variation
C. explaining
D. closure
2. Teachers often need to use examples to make their teaching clear to the
learners. The relevant skill involved is called ⁄
A. questioning
B. explaining
C. illustrating
D. reinforcement

3. Varying stimuli in teaching can only be achieved by ⁄
A. verbal cues
B. non-verbal cues
C. body movements
D. teaching style
Allen, D., & Ryan, K. (1969). Microteaching. London: Addison-Wesley.
Cooper, J. M. (1966). Microteaching: A description. Stanford, California: Stanford

University Press.
Greaves, F. (1979). Teaching nurses in the clinical setting, Part II. Nursing Mirror.
1st March.
Harden, R. M., & Caimcross, R. G. (1980). Assessment of practical skills: The

objective structured practical examination (OSPE). Studies in Higher
Education, 5(2).
Harden, R. M., & Gleeson, F. A. (1979). Assessment of clinical competence using

an objective structured clinical examination (OSCE). Medical Education, 13,
41ă54.

Topic  Evaluation in
Healthcare
7 Education
LEARNING OUTCOMES
1. Identify the purpose of evaluation in healthcare education;
2. Discuss the characteristics of evaluation; and
3. Discuss the different tools and methods used for the evaluation of
learners in the clinical area.
 INTRODUCTION
Educational evaluation is a complex, continuous process and it is an integral
part of teaching and learning. It is the process of judging the effectiveness of
educational experiences through careful appraisal. Educational evaluation is made
in relation to the learning objectives that have been stipulated in the curriculum.
Thus, cognitive, affective and psychomotor learning outcomes are measured in the
evaluation process. The success and failure of teaching depends upon teaching
strategies, methodologies and aids. Evaluation can help to improve instructional
procedures.

TOPIC 7 EVALUATION IN HEALTHCARE EDUCATION  177
7.1 DEFINITIONS AND THE MEANING OF

EVALUATION
„In the UK, the term ÂevaluationÊ tends to mean identifying the effects and
judging the effectiveness of some learning experiences (for example, a lesson)
or a course of a complete curriculum. In the US, the term is used for the
assessment of learnerÊs attainment.‰
(Derek Rowntree, Dictionary of Education, 1981)
„Evaluation is essential in the never-ending cycle of formulating goals,

measuring progress towards them and determining new goals, which means
objective quantitative evidence. But it is broader than measurements and
implies that considerations have been given to certain values and standards,
and the interpretations of the evidence have been in the light of the particular
situation.‰
(Clara M. Brown, 2015)
„Evaluation is the process of determining to what extent the educational

objectives are being realised.‰
(Ralph Tyler, 1950)
From the educational point of view, evaluation is a systematic, continuous process

of determining:
(a) The extent in which specified educational objectives that are previously
identified and defined are attained;
(b) The effectiveness of the learning experiences provided in the classroom; and
(c) How well the goals of education have been accomplished.

178  TOPIC 7 EVALUATION IN HEALTHCARE EDUCATION
7.2 PURPOSE OF EVALUATION IN

HEALTHCARE EDUCATION
At every point of the learning process, evaluation is an attempt to discover the
extent of effectiveness of the learning situations in bringing about the desired
changes in learners. As such, the overall purpose of evaluation is to provide
information to enable each learner to develop according to his potential within the
framework of educational objectives.
Bloom (1956) has stated the central purpose of educational evaluation. The
following is the excerpt to give emphasis to healthcare education:
To appraise the status of and changes in the learnerÊs learning behaviour;
(a) To determine the level of knowledge and understanding of the learner,

periodically in his classes at various phases of the year or semester;
(b) To determine the level of the learnerÊs clinical performance competency at

various stages;
(c) To become aware of the specific limitations of the individual learner or an

entire class, as a basis for further teaching;
(d) To diagnose each learnerÊs strengths and weaknesses, and to suggest

remedial measures that may be needed;
(e) To motivate the learnerÊs learning by measuring his performance or

achievement and to inform him of his success;
(f) To help the learner acquire the attitude and skills in self-evaluation;
(g) To help the learner become increasingly self-directing in his study;

(h) To provide additional motivation in examination, offering opportunities to

practise critical thinking, application of principles, making judgement and so
forth;
(i) To estimate the effectiveness of teaching and learning methods, subject

content and instructional media in reaching the goals of individual courses;
(j) To appraise the efficiency of teachers in providing learning experiences and

the effectiveness of instructions and classroom activities;
(k) To improve instructions, evaluation and evaluation tools; and
(l) To provide a basis for modification of the curriculum and course.
7.3 CHARACTERISTICS, COMPONENTS AND

PRINCIPLES OF EVALUATION
The following subtopics will introduce you to the characteristics, components and
principles of evaluation.
7.3.1 Characteristics of Evaluation

Evaluation has the following characteristics:
(a) Evaluation is a Continuous Process

Evaluation forms an integral part of the total system of education and is
intimately related to the objectives, content and learning activities. The
relationship among these elements and the evaluative procedures is shown
in Figure 7.1.

Figure 7.1: Schematic view of evaluation process

Sources: MQA (2014)

(b) Evaluation Includes Academic and Non-academic Subjects

Evaluation in its broader sense includes examination of academic and non-
academic aspects of education. However, the emphasis is upon academic
subjects.
(c) Evaluation is a Procedure for Improving Products

Evaluation is the process of making judgment, which is to be used as a basis
for planning including for improving products, processes and goals.
(d) Evaluation Discovers the Needs of an Individual and Designing Learning

Experiences that will Solve the Needs
The purpose of any evaluation initiative is to discover the needs of the
individual being evaluated. Subsequently, to design learning experiences
that will meet those needs.
(e) Evaluation is used to Ascertain the Values of an Enterprise

Evaluation is a process in which the values of an enterprise are ascertained,
primarily with respect to educational purposes.
(f) There is Correlation between the Educational System and the System of
Evaluation
Evaluation is always with reference to the objectives of a particular system
of education. In view of the objectives of the education system, a
comprehensive programme of evaluation should include knowledge,
affective and psychomotor domains.
(g) Evaluation is a Complex Process

The complexity of the evaluation process means it needs corporate efforts
from teachers, learners and the administrative staff of the college or
university. It involves elements that can bring about cohesiveness or
coordination for the whole activity.

7.3.2 Components of Evaluation

The components of evaluation are as follows:
(a) Specifying learning outcomes;
(b) Collection of evidence about learnersÊ progress through reliable data;
(c) Analysis and interpretation of learnersÊ performance;
(d) Diagnostic appraisal to indicate the level of performance; and
(e) Redefining and readjusting the instructional objectives based on feedback.
7.3.3 Principles of Evaluation

The following principles are to be considered in evaluation:
(a) Considering the interrelationships among objectives, instructions or learning

experiences and evaluation;
(b) Determining and clarifying what is to be evaluated;
(c) Selecting evaluation techniques in terms of achieving the objectives;
(d) Combining a variety of evaluation techniques for comprehensive evaluation;
(e) Knowing the strengths and limitations of various evaluation techniques; and
(f) Taking evaluation as a means to an end, not an end in itself.
7.4 TYPES OF EVALUATION

Evaluation is a judgmental process and as such, it reflects the beliefs, values and
attitude of the learners. Evaluation can be formative (diagnostic) or summative
(certifying).

7.4.1 Formative Evaluation

The term „formative‰ denotes an ongoing or systematic assessment of learnersÊ
achievement while the course or instructional programme is in progress.
„Formative evaluation is concerned with the judgment made during the

design and/or development of a programme, which is directed towards
modifying, forming or otherwise improving the programmes before it is
completed.‰
(AJ Nitke, 1983)
„Formative evaluation is used to monitor learning progress during instruction

and to provide continuous feedback to both learners and teacher concerning
learning successes and failures. Feedback to learners reinforces successful
learning and identifies the learning errors that need correction. Feedback to
the teacher provides information for modifying instruction and prescribing
group and individual remedial work.‰
(NE Gronlund, 1985)
7.4.2 Summative Evaluation

The term „summative‰ refers to assigning a grade for learnersÊ achievement at the
end of the term, course or instructional programme.
„Summative evaluation typically comes at the end of a course (or unit) of

instruction. It is designed to determine the extent to which the instructional
objectives have been achieved and is used primarily for assigning course
grade or certifying learner mastery of the intended learning outcomes.‰
(NE Gronlund, 1985)
„Summative evaluation is conducted at the end of the instructional segment

to determine if learning is sufficient or complete to warrant moving the learner
to the next segment of instruction.‰
(Rl Ebel and Frisbi, 1986)

Table 7.1 summarises the differences between formative and summative

evaluations.
Table 7.1: Differences between Formative and Summative Evaluations
Characteristic Formative Evaluation Summative Evaluation

Purpose  To monitor the progress of  To check the final status of
the learners by getting the learners
feedback
Content focus  Detailed  General
 Narrow scope  Broad scope
Methods  Daily assignments  Tests
 Observations  Projects
Frequency  Daily  Weekly, Quarterly, etc.
ACTIVITY 7.1
Reflect on all the evaluations of the courses that you are currently
undertaking. Identify which are formative and summative evaluations.
7.5 CLASSIFICATION OF EVALUATION

Evaluation can also be classified into the following:
(a) Norm referenced; and
(b) Criterion referenced.
In norm referenced evaluation, the test is devised to spread out learners so that
accurate grading of their abilities might be facilitated. For example, a test in which
the best learner obtains full marks while the poorest learner obtains no mark at all.
This type of assessment is commonly used.
In criterion-referenced evaluation, a number of course objectives are set and a

learnerÊs performance is compared against the targets set but not against the
performance of his classmates.

7.6 TECHNIQUES OF CLINICAL EVALUATION

In clinical teaching, the teacher can use various tools for clinical evaluation, which
involves evaluating the knowledge, skills and attitudes of learners. The main
method of evaluation in the clinical area is observation. Tools used for evaluation
in the clinical area must allow the teacher to rate the learners while observing them
when they are performing the skills. The evaluation tools include checklists,
anecdotal records and rating scales.
7.6.1 Checklists
To help the teacher evaluate learners in the clinical area, a series of checklists with
broad rating scales can be used. This technique is used for evaluating interest,
attitudes and values of the learners. It includes certain statements with „Yes‰ or
„No‰ responses. Learners have to select either of the two options.
An example of a checklist is shown in Table 7.2. They are useful to determine the
strengths and weaknesses of the learners in specific areas and they indicate where
discussions of these with the learner will be useful, and give pointers as to what
and how much additional instruction will be needed to bring the learnerÊs ability
up to an acceptable standard.
Checklists are also used to identify learnersÊ learning progress in terms of

achievement, difficulties and potential.
To make effective use of checklists, the teacher has to:
(a) Know each learner reasonably well as an individual;
(b) Work with the learner or observe him reasonably often in order to identify
and discuss learning problems that the learner may have; and
(c) Question the learner to test his knowledge on a broad range of healthcare
topics which are relevant to the clinical area that he is working in.
The most important single purpose of using a checklist is to get reliable objective
information that will help the teacher ascertain how well the learner is learning
and identify the strengths and weaknesses of the learner so that remedial actions
can be taken to help him acquire the necessary skills for his job functions.

Checklists can be easily developed and written according to the steps of how a
procedure was taught. For example, to assess a learnerÊs skills in assembling a
laryngoscope, the following checklist in Table 7.2 can be used:
Table 7.2: Checklist for Assembling a Laryngoscope
Steps of the Procedure Yes No

1. Collect the following ă Laryngoscope handle and cap
ă Laryngoscope blade and bulb
ă Batteries
2. Insert batteries into the handle.
3. Screw on the cap of the handle tightly.
4. Tighten the bulb on the blade.
5. Fix the blade into the groove on the head of the handle.
6. Pull the blade downwards until it hooks properly.
7. Pull the blade outwards until it is at a right angle to the handle.
8. Check that the light is on.
9. Unlock the blade from the head of the handle.
10. Detach the blade from handle.
11. Remove batteries.
12. Put back the equipment on the resuscitation trolley.
ACTIVITY 7.2
Select a medical procedure that you are familiar with and develop a
checklist.

Checklists are effective and valuable in evaluating the competency of a learner.

However, as mentioned earlier, evaluation in the clinical area involves more than
skills alone. We also need to evaluate the learnerÊs attitude. To make up for the
limitation of the checklist, anecdotal records and rating scales are incorporated as
tools for evaluation in the clinical area.
7.6.2 Anecdotal Records

An anecdotal record is a report of critical incidents (both positive and negative)
about a learner or staff during the period of work in the clinical area. Descriptions
of critical incidents by the teacher or the healthcare personnel in charge are
recorded as they are observed. Details with regard to the setting of the incident,
date, time, what had happened, people involved and the nature of the incident are
recorded as accurately as possible, without any personal views or feelings from
the recorder.
This is followed by a section that is allocated for analysis of the incident by the
teacher or healthcare personnel in charge. This section will have contents that are
related to the objective evaluation of the learnerÊs behaviour and attitude during
the incident. This feedback is given to the learner immediately. The learner gets to
read the contents of the anecdotal record and gives his own comment and
explanation for what had happened. The teacher reinforces the right behaviour
and attitude expected of the learner. Feedback to the learner or staff and
suggestions for correction and improvement will be recorded and read by both
parties ă the teacher and the learner or staff.
At the end of the feedback session, the learner will be given the opportunity to
write her comments and put her signature on the document alongside those of the
teacher who had evaluated and counselled her.
An example of the format for a simple anecdotal record is shown in Table 7.3.

Table 7.3: Example of a Format for a Simple Anecdotal Record
Anecdotal Record Format
Report of incident
1. Date: 2. Time:
1. Setting (Ward ă)
2. Description of incident:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Analysis/Interpretation of incident:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Comments/Feedback;
___________________________________________________________________________
___________________________________________________________________________
Teacher:
___________________________________________________________________________
___________________________________________________________________________
Learner:
___________________________________________________________________________
___________________________________________________________________________
Name of learner: ____________________ Signature of learner:
Date/Time: ________________________
Name of teacher: ___________________ Signature of teacher:

7.6.3 Rating Scales

Rating scales are also used for evaluation in the clinical area. Rating scales have an
advantage over checklists. Besides the specific scores for each behaviour, rating
scales have additional values for each behaviour standard. The additional values
can be in the form of a numerical scale rating, lettered rating, graphic rating or a
combination of descriptive and graphic ratings.
For example, you are required to assess a healthcare personnelÊs competence in

formulating a healthcare plan for the patient. The expected standard behaviour is:
„The healthcare personnel formulates and records an appropriate care plan for
each patient assigned, based on observations of and information about the
patient.‰
Using the specific standard of expectation, the healthcare personnel can be

assessed on how he carries out his duties in caring for the patients.
(a) Numerical Rating Scale

Numerical Rating Scale is used in an effort to quantify the actual level of the
healthcare personnelÊs performance that meets the behavioural standards
described by circling the appropriate number. Thus, circling number 1
indicates „Unsatisfactory‰, 2 if it is „Below Average‰, 3 for „Average‰, 4 for
„Above Average‰ and 5 for „Outstanding‰.
Example:
Unsatisfactory Below Average Average Above Average Outstanding

1 2 3 4 5
(b) Numerical Rating Scale (Alternate Form)

Numerical Rating Scale can also be constructed without defining or giving a
description of the meaning of every rating point. It is also known as the
Numerical Rating Scale (Alternate Form). The actual level of the healthcare
personnelÊs performance that meets the behavioural standards is defined or
anchored only at both the endpoints of the rating scale. The number 5
represents the highest level of performance while the number 1 represent the
lowest level.
Example:
Unsatisfactory ⁄⁄⁄⁄⁄⁄⁄⁄..⁄⁄⁄⁄⁄⁄⁄⁄⁄⁄⁄⁄ Outstanding

1 2 3 4 5

(c) Lettered Rating Scale

Rating scales can also be described in the form of letters. Hence, the Lettered
Rating Scale is represented by letters instead of numbers. The directions are
the same as for either forms of the Numerical Rating Scale.
(d) Graphic Rating Scale

The directions in this rating scale indicate the degree in which the healthcare
personnelÊs performance meets the behavioural standards described by
placing an X anywhere along the horizontal line.
Never Seldom Occasionally Frequently Always
(e) Descriptive (Graphic Rating Scale)

The directions of this rating scale indicate the healthcare personnelÊs
performance in the following areas by placing an X at the point on the
horizontal line that best describes his performance.
Table 7.4: Descriptive (Graphic Rating Scale)
1 2 3 4 5
Spends little Observes and Formulates and Formulates and Formulates and
time interacts with records the records the records an
observing assigned healthcare plan healthcare plan appropriate
and patients; may for each for each healthcare plan
interacting formulate the assigned patient assigned for each patient
with assigned healthcare but the plan is patient; usually assigned, based
patients; plan but not based on on observations
seldom seldom individualised. observations of of and
formulates or records it. and information
records the information about the
healthcare about the patient.
plan. patient; the
healthcare plan
is usually
appropriate to
each patientÊs
needs.

We have covered the content related to observing learners in the clinical area and
the tools commonly used by the healthcare personnel in evaluating staff or learners
in clinical teaching. There are other methods that can be used for clinical
evaluation. They are Objective Structured Clinical Examination (OSCE) and
Running Assessments.
7.7 OBJECTIVE STRUCTURED CLINICAL

EXAMINATION (OSCE)
The OSCE was developed in the 1970s at the University of Dundee in Scotland
(Harden & Gleeson, 1979; Harden & Caimcross, 1980) to eliminate or improve the
weaknesses found in clinical examinations.
OSCE is not an examination method. It is an evaluative framework or format in

which different types of examination methods can be incorporated to test the
domains of knowledge, skills and attitudes. In an OSCE, the learner is observed
while he performs a task under specified and controlled conditions. Learners are
assessed on how they perform specific components of a task. It is an example of a
summative evaluation.
In OSCE, the examiner is able to test a wide range of skills. By using „set pieces‰,
the examiner is able to sample effectively the total practical skills of the learner.
7.7.1 How OSCE is Conducted to Evaluate the

Competency of Healthcare Personnel
In an OSCE, the learners rotate through a series of stations containing either
clinical materials or questions. They have a limited time for each station.
At certain stations, they are observed while taking a history or carrying out certain
clinical skills or procedures and are marked by one or more examiners on their
skills.
Since the correct method of history taking, clinical skills or procedures being tested
are predetermined by the examiners and checklists were used, the examination is
relatively objective.

In OSCE, the elements of behaviour to be assessed are defined and agreed upon
by the examiners before the examination. The examiners can evaluate the
performance of each learner on the objective evidence accumulated during the
examination.
In OSCE, all learners sit for a similar examination and each learner will see a
number of examiners. The examiners use checklists when marking a learnerÊs
performance or his written answers.
7.7.2 Organisation of the OSCE

The OSCE is organised in the following manner:
(a) Advanced Planning

The OSCE must be planned in advance, ideally six months before the actual
examination. The planning focuses on:
(i) What is to be examined and the decision on the allocation marks for
each component and the passing mark;
(ii) Briefing of the examiners and staff concerned;
(iii) Selection and briefing of simulated or real patients; and
(iv) Preparation of checklists, instructions to examiners, development of

scenarios and questions.
(b) Competencies to be Tested

Competencies to be tested can be divided into knowledge, skills and
attitudes. When the content of the examination and the date of the
examination have been finalised, the following needs to be carried out:
(i) Appointment of an examination coordinator who will be responsible

for the detailed conduct of the examination;
(ii) A meeting of all examiners and staff involved will be organised to

discuss the examination;
(iii) At least one reserve examiner should be appointed;

(iv) A timekeeper has to be appointed;
(v) Learners need to be briefed on the day of the examination by an

appointed staff;
(vi) Sufficient time should be allocated for preparation of checklists,

instructions to examiners and learners, list of learnersÊ names, list of
stations, the examiners involved and the equipment required;
(vii) A plan of the sitting arrangements of the stations;
(viii) Patients, if involved, should be selected in advance to allow the

examiner to examine them and for necessary documentation. Patients
should be briefed on what is expected of them;
(ix) Learners should be briefed in advance;
(x) The scoring should be planned in advance;
(xi) All instruments to be used should be checked for availability and

whether they are in functioning condition; and
(xii) Refreshments for patients, examiners and learners should be arranged,

where appropriate.
(c) Organisation on the Day Before Examination
(i) The layout of the examination should be discussed the day before the
examination, thus ensuring there is sufficient time to make changes if
necessary;
(ii) The stations should be clearly signposted on the evening before the
examination;
(iii) The equipment required for the examination should be checked to

ensure that they are in good working order and are organised
accordingly; and
(iv) The examiners will be given a final brief.

(d) Organisation on the Day of the Examination
(i) The coordinator should be in the examination setting at least one hour
before the start of the examination;
(ii) He should check the position and numbering of each station and carry
out a final check on the models and simulated patients used;
(iii) The equipment should be laid out at the station where it will be
required;
(iv) The learners will be briefed in an area adjacent to the setting of the
examination and given the opportunity to ask questions;
(v) Learners are allowed into the examination setting and directed to the
station where they are to begin the examination;
(vi) When all learners are in position, the examination starts at a given
signal, usually a bell or buzzer, which should be clearly audible;
(vii) The timekeeper should ring the bell at five-minute intervals;
(viii) If there is a second group of learners to be examined on the same day,

check that they have assembled at the briefing area before the end of
the first part of the examination so that they do not discuss the
examination with their colleagues who have just completed the first
part of the examination; and
(ix) Thank all who helped with the examination when the examination is
completed, including the staff and patients.
(e) After the Examination
(i) Arrange for the results of the examination to be computed and for the
checklists to be marked as previously planned;
(ii) Give feedback to the learners. Make available the correct answers and
discuss the examination with the learners, in particular areas where the
general performance was poor;
(iii) Note any problems arising from the examination so that similar
mistakes can be avoided in subsequent examinations;
(iv) Checklists and questions should be carefully stored for future

examinations; and
(v) The learnersÊ performance should be discussed with faculty members

so that deficiencies can be corrected.

7.8 RUNNING ASSESSMENT

What is a running assessment and how is it different from the OSCE?
Running assessments are basically a form of continuous assessments that are

conducted in the clinical area. How many of you can recall vividly your learner
nursing days when your tutor came to the ward and assessed you on your
performance of specific skills in a procedure during your clinical posting?
All of us have undergone running assessments. Healthcare personnel learners are

assessed during every clinical posting on various procedures by different tutors.
For example, during the foundation block in healthcare education, healthcare
personnel may be assessed on checking temperature and vital signs, providing bed
baths, making beds, providing oral care and so forth. In medical nursing posting,
they may be assessed on administration of oral medication, giving of injections
(subcutaneous, intramuscular or intra-dermal), reading central venous pressure
and assisting with certain procedures. Meanwhile, in the surgical nursing posting,
they may be assessed on simple dressings, dressing wounds with drains, removal
of sutures, underwater chest drainage, pre-operative procedures and other
procedures.
7.8.1 Characteristics of Running Assessment

During the assessment, the teacher evaluates the learnerÊs competency in a single
procedure. The assessments are conducted continuously throughout the period of
learning. Over time, a series of procedures would have been assessed by different
teachers for the individual learner. Since learners are assessed only on a single
procedure at any one time, it is very time consuming. Due to its demand on time
and personnel resources, it is not commonly practised as an examination method.
Teachers can, however, use continuous assessments to supervise their learners.
Teachers can use it as a formative assessment to keep track of learnersÊ progress
and also to develop learner competency in the clinical area.
The advantage of continuous assessment is that the teacher has direct interaction
with the learner and can give immediate feedback and suggestions for
improvement. The teacher can continuously assess the learner until he achieves
the required level of competency.
The concept of running assessment is to evaluate a learnerÊs competency in

performing a specific procedure at one point and time. The purpose is to assess the
level of competency attained by the learner at the time of assessment for his level
of study.

7.8.2 Planning for Running Assessments

Conducting running assessments needs planning. Running assessments are very
often a team effort. The teachers who are involved with supervising the learners
in the clinical area will have to decide in advance what skills are relevant for the
level of training as well as the specific procedures and skills to be assessed.
Checklists and all documentations for recording and reporting the continuous
assessments have to be prepared in order to enable the teachers to conduct the
running assessments smoothly.
At the beginning of the period of posting, the learners will be informed when the
running assessments will be conducted as well as the procedures and skills that
are expected from the learners for their level of learning. Learners are usually given
a period of learning and the opportunity to practise the skills based on the
objectives of their posting prior to the start of the running assessments. Learners
will be informed of the time when the running assessments are to take place.
When it is time for the assessment, the teacher will identify a patient who requires
a certain procedure. The teacher will then identify the learner and inform her,
without advance notice, that she is required to perform the procedure. The learner
will proceed to carry out the complete procedure as she normally does for the
patient under his care. The teacher follows and observes the learner throughout
the whole procedure and grades his performance using a checklist. During the
procedure, the teacher may ask the learner questions where appropriate.
At the end of the procedure, the teacher has a feedback session with the learner.
The feedback will include the result of the assessment on how well the procedure
was carried out. Details about strengths and weaknesses demonstrated by the
learner will be highlighted together with suggestions for improvement. If the
learner fails to perform satisfactorily, she will be informed and another repeat of
the same procedure will be conducted on another day. This process is continued
until the learner achieves a satisfactory level of performance in the skills being
assessed.
Using the same approach, the learner will be assessed continuously on a number
of procedures. Running assessments can be implemented in the clinical area at any
time according to the availability of activities for the learner or staff to perform the
procedure in order to assess the required skills.

ACTIVITY 7.3
1. What are the differences between OSCE and running assessments?
2. Which approach do you prefer to use as a clinical assessment? Give

reasons to support your answer.
 Evaluation in healthcare education provides the final evidence of whether

learning has been accomplished and some insights into whether the teacher
was effective.
 In clinical teaching, the teacher is also involved in evaluating the learner and
the learning situation.
 Different tools and methods can be used for the evaluation of teaching in the
clinical area.
 The tools used for evaluation in the clinical area include checklists, rating scales
and anecdotal records.
 Other approaches used for evaluation in the clinical area include the OSCE and
running assessments.
 The objective structured clinical examination (OSCE) can be used to evaluate

learners on multiple skills during one examination setting while running
assessments can be used to evaluate only one learner and one procedure at a
time.
 Running assessments that are conducted over a period of time can be used to
assess learners on a range of skills in the clinical area.

Evaluation Running assessments

Formative evaluation Summative evaluation
OSCE
1. Which kind of evaluation utilises the allocation of marks by means of

comparing the various performances of learners?
A. Formative
B. Summative
C. Norm referenced
D. Criterion referenced
2. The best tool to evaluate a learner when checking temperature of the patient
in the clinical area is a ⁄
A. checklist
B. numerical rating scale
C. anecdotal record
D. lettered rating scale
Allen, D., & Ryan, K. (1969). Micro-teaching. London: Addison-Wesley.
Bloom, B. S. (1956). Taxonomy of education objectives: The classification of

educational goals. Volume 1: Cognitive domain. New York, NY: David
McKay.
Cooper, J. M. (1966). Micro-teaching: A description. Stanford, California: Stanford

University Press.

Greaves, F. (1979). Teaching nurses in the clinical setting, Part II. Nursing Mirror.
1st March.
Guidelines to Good Practices: Assessment of Students (2014). Malaysian

Qualification Agencies
http://www.nwlink.com/~donclark/hrd/bloom.html
Harden, R. M., & Caimcross, R. G. (1980). Assessment of practical skills: The

objective structured practical examination (OSPE). Studies in Higher
Education, 5(2).
Harden, R. M., & Gleeson, F. A. (1979). Assessment of clinical competence using

an objective structured clinical examination (OSCE). Medical Education, 13,
41ă54.

Answers
TOPIC 1: ASPECTS OF EDUCATION IN
HEALTHCARE
Assessment
1. C
2. C
TOPIC 2: CURRICULUM DESIGN AND

DEVELOPMENT
Assessment
1. A
2. A
3. B
TOPIC 3: CLINICAL TEACHING

Assessment
1. C
2. B

ANSWERS  201
TOPIC 4: PREPARING FOR CLINICAL TEACHING

SESSIONS
Assessment
1. C
2. A
TOPIC 5: PREPARING A LESSON PLAN

Assessment
1. A
2. B
TOPIC 6: CONDUCTING TEACHING

Assessment
1. A
2. C
3. D
TOPIC 7: EVALUATION IN HEALTHCARE

EDUCATION
Assessment
1. C
2. A

MODULE FEEDBACK
MAKLUM BALAS MODUL
If you have any comment or feedback, you are welcome to:
1. E-mail your comment or feedback to modulefeedback@oum.edu.my
OR
2. Fill in the Print Module online evaluation form available on myINSPIRE.
Thank you.
Centre for Instructional Design and Technology

(Pusat Reka Bentuk Pengajaran dan Teknologi )
Tel No.: 03-27732578
Fax No.: 03-26978702


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NBMH4143

Teaching for Healthcare Personnel

Copyright © Open University Malaysia (OUM)

Module Writer: Assoc Prof Dr Lim Pek Hong

Moderator: Prof Dr T K Mukherjee

Enhancer: Mispan Mangon

Developed by: Centre for Instructional Design and Technology

First Edition, August 2019 [NBBS1304, April 2018 (rs)]

Copyright © Open University Malaysia (OUM)

Topic 1 Aspects of Education in Healthcare 1

Topic 2 Curriculum Design and Development 20

Copyright © Open University Malaysia (OUM)

2.3 Curricular Cycle 27

Topic 3 Clinical Teaching 56

Copyright © Open University Malaysia (OUM)

3.3 Roles of Clinical Teachers/ Preceptors 62

Topic 4 Preparing for Clinical Teaching Sessions 90

Copyright © Open University Malaysia (OUM)

4.5 Planning a Teaching Plan 110

Topic 5 Preparing a Lesson Plan 119

Topic 6 Conducting Teaching 144

Copyright © Open University Malaysia (OUM)

6.4 Advantages of Microteaching 167

Topic 7 Evaluation in Healthcare Education 176

Copyright © Open University Malaysia (OUM)

Copyright © Open University Malaysia (OUM)

COURSE GUIDE DESCRIPTION

As an open and distance learner, you should be acquainted with learning

Copyright © Open University Malaysia (OUM)

Table 1: Estimation of Time Accumulation of Study Hours

COURSE LEARNING OUTCOMES

1. Discuss the teaching function of healthcare personnel;

3. Identify factors that need to be considered when planning a teaching session;

4. Demonstrate a teaching session using the selected teaching approach;

5. Evaluate a teaching session based on expected outcomes; and

6. Analyse the teaching role of healthcare personnel.

Copyright © Open University Malaysia (OUM)

Topic 1 gives an introduction to the dimensions of educational process in a

Topic 2 discusses the curriculum design and development in healthcare education.

Copyright © Open University Malaysia (OUM)

Topic 4 initiates the preparation of clinical teaching sessions by identifying the

TEXT ARRANGEMENT GUIDE

Copyright © Open University Malaysia (OUM)

Self-Check: This component of the module is inserted at strategic locations

Activity: Like Self-Check, the Activity component is also placed at various

Copyright © Open University Malaysia (OUM)

Jarjoura, J. (July, 2003). Mentorship ă A key part of nursing practice. Registered

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and

Neeraja, K. P. (2006). Textbook of nursing education. New Delhi, India: Jaypee

Schon, D. A. (1983). The reflective practitioner: How professionals think in action.

Copyright © Open University Malaysia (OUM)

TAN SRI DR ABDULLAH SANUSI (TSDAS)

Copyright © Open University Malaysia (OUM)

Copyright © Open University Malaysia (OUM)

Education is a process of bringing out the best in learners. It aims to produce

Education in healthcare profession is task-intensive and involves performance-

Copyright © Open University Malaysia (OUM)

medical curriculum while on the other hand, it can be potentially compromised in

1.1 DIMENSIONS OF EDUCATIONAL PROCESS

Figure 1.1: Four dimensions of the educational process in healthcare

(a) Substantive Dimension

(b) Procedural Dimension

Copyright © Open University Malaysia (OUM)