There are lots of variations on learning theories but effectively we work in an environment where the socio cognitive theory/situated learning theory probably fit best. Lave and Wenger[i] talk about a community of practice and a periphery to central role, whereby one starts out in the periphery and through a period of time, observations and modelling, work their way into the centre to become leaders. Vygotsky[ii][iii] explores the concept of zone of proximal development whereby we increase our competence by scaffolding upwards, initially with support/advice until we attain mastery. Miller’s pyramid outlines the prism of clinical competence.[iv]
The adult learning pattern is based on concepts of self directed learning, personal experience, readiness to learn, orientation to learning-problem centred rather than subject centred, motivation to learn and relevance. This is highlighted by Knowles.[v]
The adult learning style is explored by Kolb.[vi] This starts with an experience, for example, a difficult intubation, then reflecting on this experience where one explores the inconsistencies between the experience (practical) and understanding (theory), then conceptualizing- talking to others about the experience and/or coming up with new ideas or techniques and finally active experimentation (applying the new idea to practice).
The lesson plan may have a role in expanding on the conceptual aspect in Kolb’s learning cycle as outlined above.
Constructing the lesson plan- 3 key components:
The objectives need to align with the College curriculum and should aim to assist the listener to be a better doctor based on one or more of the eight domains outlined and relevant to their stage of training.[vii] For example, under medical expertise, the provisional trainee should learn to recognise the potential difficult airway and know when to call for help, while the Advanced Trainee in their later stages might be prepared to intubate using the various difficult airway equipment available but also cognizant to call for help from the anaesthetist too.
To help specify your ILO, these questions are useful:
The taxonomy can be described as a pyramid as well.
Be creative- problem based scenarios are better than the didactic style. Be aware of the adult learning pattern and styles. Engage the learners. Use different teaching modalities- online, invite patients in, panel format, online quiz format etc. A free online tool I have used is: https://getkahoot.com/
I think it’s a lot easier when the presenter puts on the ‘facilitator’ hat rather than have to assume that of a teacher. Get the learners to drive the session.
To this end, it is important that the learners have a list of pre-reading material.
Check for understanding
A lesson isn’t useful unless the learners absorb and understand the information. In Erin’s presentation on the sick asthmatic patient, he invited the advanced trainees to determine the ventilator settings for the intubated patient and the induction drugs to be used, while he could have quizzed the provisional trainees regarding the physiological changes that occur in asthma and the intermediate group on how NIV would work to decrease the work of breathing.
Realistic time line
It may not be possible to present all aspects in one lesson, so consider separating the lesson. Refer back to the objectives of the lesson.
Close the loop
We don’t like doing this. Ideally, all lessons/programs should be evaluated and feedback provided. Again, referring back to Kolb’s cycle, this is how we’re going to learn and improve. There needs to be feedback and reflection. I’ve included a copy of the generic hospital evaluation form but there is a role for peer observation of teaching (POT). Farrell from University of Melbourne provides a good explanation of POT and a marking template as well.[x]
Challenges completing the lesson plan
Gestalt perspective - that’s how I was taught and that’s what I’m comfortable with. It’s not what others want. (Please read attached document on my reflections)
Lack of guidance- we’re not taught how to teach
Lack of feedback and evaluation (Consider Peer Observation of Teaching, POT)
I’ve included some of my reflections on how to improve the lesson plan using currently practised educational theories and styles. It’s not meant to be a guideline or protocol but to expand your views as you develop your teaching style. The references I’ve included are all hyperlinked and are mostly linked to easy reading sites and not articles.
The templates used for feedback include:
1. Pendleton Method- 4 aspects.
a) What did the learner think went well?
b) What did you, the observer think went well?
c) What did the learner think went badly?
d) What did you, the observer think went badly?
One of the difficulties that I've encountered with this model, is that it can be a bit rigid, also if you think about it, most of us would like to start with what we think went badly and not well. Anyway, it's a good model to fall back on when the conversation gets stuck.
2. Set-Go as part of the Calgary-Cambridge method
This is probably more natural but careful not to 'sandwich' the feedback though.
3. The consensus is that the 'sandwich model' of feedback is probably not ideal any longer- don't cover the bad news with good news on either side.
From a supervision perspective and giving feedback, consider,
1. Microskills teaching- one minute preceptor model
If you look at it closely, the 4th microskill is effecively sandwiched (not good) between 2 episodes of bad news so it may be worthwhile plugging the 5th skill with the 3rd.
2. SNAPPS model.
Supported by the College as well.
In summary, what I've given you is I hope a template on how 'best' to provide feedback to our juniors when they present their patients to us. We all do it to various degrees in our practice and I'm hoping that this will give you a guide as to whether you're doing it appropriately or whether there are some aspects that you could improve on.
So,consider SNAPPS model; within the discussion, consider SET-GO; and focusing down further, consider Hattie-Timperley and feedback on the task, process or reflection but not on the learner. Finally, think adult-centred learning, get the juniors to do most of the talking, exploring options and reflecting.
Again, let me know if you have any questions. For those interested and as part of your development/ITAs/WBAs, it might be worthwhile to have a peer or senior observe how you supervise and feedback to the juniors, then offer you some feedback of the process.