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.