Clinical teaching

Definition, Roles, Principles & Competent Teachers

Group 1
Definition
Clinical teaching is process of learning at the clinical situation.
Not about teaching: Support critical thinking with the real patient with
clinical practice.
• centre of medical education.
• Traditionally it has taken place in large teaching hospitals or academic
medical centres. Indeed, education has been described as the `heart
and soul of academic medical centres’.
• There is now a recognition that the patient mix in teaching hospitals,
with a high proportion of acute, short-stay patients is no longer
representative of the distribution of disease in the widercommunity.
PRINCIPLES
 Principle of Effective Clinical Teaching
1. Efforful and challenging learning is durable and result in long-term retention
Ex: use patients of graduated difficulty (agitated, anxiety, angry) to enchance
student learning of history taking and medical interviewing

2. Effective teachers create opportuties for continuous learning, to help

students continually develop and acquire skills and knowledge to improve
clinical performance
Ex: teach students continues learning skills (ed read and abstract medical
journals), provide technique for critically evaluating research findings or
guidelines and demonstrate how to apply these techniques.
Principle of Effective Clinical Teaching
3. Frequent & regular assessment enhance student learning, capitalizing on the
texting effect
Ex: using memory to recall or retrieve facts of knowledge is more effective than
reviewing content or re-reading text.  forward effect of testing.

4. Spaced practice and Learning is more effective than massed practice

Ex: Combining initial block practice (producing rapid learning) with spaced practice
(producing reduced forgetting) maximizes the efficiency of learning principles.
Tips: space out learning in “chunks” of time over several days, rather than in a
massed block.
Principle of Effective Clinical Teaching
5. Deliberate Practive and learning is effective for improving knowledge or
performance

Deliberate practice: is a purposeful, planned and structured activity with the

specific goal for improving knowledge or performance (keys: structured task,
prior knowledge, focus and motivation, and repetition)

Ex: Create deliberate practice opportunities for clinical learners using

structured tasks based on prior knowledge, with oppostunities for reflections;
repeat the process as a needed to achieve mastery. Provide immediate,
constructive, formative feedback
Principle of Effective Clinical Teaching
6. Feedback is very important to facilitate learning and improvement of skills.

Novice learners are susceptible to illusions of knowing, especially when

engaging in unproductive strategies such as re-reading text, underlining,
highlighting, watching recorded lectures. While tests, quizzes, and other forms
of objective feedback should always be part of any learning activity to maximize
the learning and to correct the illusion of knowing  improved practice

Ex: use credible feedback (objective score) to maximize learning and check the
illusion of knowing. (Neither “great work!” nor “how did you ever pass the
boards?” is useful)
 Principle of Effective Clinical Teaching
7. Interleaved and varied practice maximizes learning in the clinical environment
Principles:
- activate prior knowledge and prepare instructions
- use the principles of deliberate practice with the interleaving process
- Make each task effortful and challenging.
- Review prior knowledge so as to consolidate and integrate new learning;
capitalize on the spacing effect.
- Track progress with the test and performance data  confirm progress and
identify diagnostic information about areas in need of remediation
Tips: use example from various categories mixed together when teaching skills,
procedures or content. Eg: vary the area for physical exam from patient to patient
when teaching palpation skills
Principle of Effective Clinical Teaching
8. Advanced organizers activate prior knowledge that facilitates new
knowledge integration

Learning is based on some complex processes of receiving information

and combining it with pre-existing knowledge. One such process in
learning is subsumption  new material is related relevant ideas that
students already have.

Tip: provide an advanced organizer in the form of a diagram, sketch or

bullet points of the material, skill or procedure.
Principle of Effective Clinical Teaching
9. Engaging all learning styles  appropriate to the material to be
learned.

Empirical evidence clearly shows that matching instruction to learning

style does not improving learning.
Principle of Effective Clinical Teaching
10. Schematic

Jean Piaget  dual processes of assimilation (taking information into schemas, or

patterns of thought or behavior) and accommodation (changing the schemas as a
result of new information).

Schemas: perceptions, ideas, action  together.

Ex: develop a cognitive map by relating schemas to each other and to the whole in
teaching skills, knowledge, or procedures  interrelations between various
schemas.
Competencies
4 Attributes of Competent Clinical teacher
- Clinically competent: knowledge base and professional attributes

Technical knowledge and skills with personal characteristic which relate

to responsibility  Good role model  in area: etich, cultural
competence, reputation as skilled practitioners, up to date.

- Efficient organizer: efisien in organize the material, time, consistency,

good concentration  external behaviors (can be observed)
Attributes of Competent Clinical teacher
- Group Communicator: proficient with group management 
expertise in global communication and possession of good social skills

- Person-centered: able to recognize the needs of the individual (either

patient or student)  similar personal statement: empathises,
sensitive, guided.
BASED ON CASE
Problems Identified
• Go to patient with no briefing or discussion
• No gain attention by recalling prior knowledge
• Student Readiness is not assessed
• No observation
• Clear instructions and procedure are not provided
• Deliberate practice is not provided
• Not organized and managed-well
• No feedback