Teaching is a demanding and complex task. This guide looks at teaching and what it involves. Implicit in the widely accepted and far-reaching changes in medical education is a changing role for the medical teacher. Twelve roles have been identified and these can be grouped in six areas in the model presented: (1) the information provider in the lecture, and in the clinical context; (2) the role model on-the-job, and in more formal teaching settings; (3) the facilitator as a mentor and learning facilitator; (4) the student assessor and curriculum evaluator; (5) the curriculum and course planner; and (6) the resource material creator, and study guide producer. As presented in the model, some roles require more medical expertise and others more educational expertise. Some roles have more direct face-to-face contact with students and others less. The roles are presented in a 'competing values' framework-they may convey conflicting messages, e.g. providing information or encouraging independent learning, helpi...

AMEE Guide No 20: The good teacher is more than a lecturer - the twelve roles of the teacher

Context One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal. Over the last 30 years there has been considerable debate within the health sciences education literature regarding the model that best describes how expert clinicians generate diagnostic decisions.

Purpose  The purpose of this essay is to provide a review of the research literature on clinical reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e. conscious/controlled) versus non-analytic (i.e. unconscious/automatic) reasoning strategies) as an orienting framework.

Discussion  Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implications are drawn from this overview for clinical teachers.

What every teacher needs to know about clinical reasoning

Context
Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.

Purpose
To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.

Content
The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.

Conclusions
The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2923.2000.00758.x

Effective supervision in clinical practice settings: a literature review

This article considers how doctors learn to reason in the clinical environment and recommends practical approaches that clinical teachers can use to promote the development of strong diagnostic reasoning skills in their students.

/pdf/educational-strategies-to-promote-clinical-diagnostic-2j8g4yrmmj.pdf

Educational Strategies to Promote Clinical Diagnostic Reasoning

Medical education is a lifelong process embracing premedical experience, undergraduate education, general clinical training, specialist or vocational training, subspecialty training, and continuing medical education. Although medical education was once seen as the province of medical schools and teaching hospitals, large and increasing numbers of practitioners now provide teaching and promotion of learning outside the traditional environment.

Over the past decade both the university sector and the NHS have seen considerable change and increased accountability for their activities, and all the signs suggest that the next 10 years will be no different. Simultaneously, medical schools are having to acknowledge the implementation of new curricula, the consequences of new health service priorities, an increase in the number of medical students, and the implications of the report from the National Committee of Enquiry into Higher Education, chaired by Sir Ron Dearing.1

The most recent recommendations of the General Medical Council's education committee were intended to promote an approach to undergraduate medical education and to give a perspective on its aims, which differ substantially from those of traditional curricula.2 Although the 13 principal recommendations are now well known, at the core is the promotion of the merits of learner centred and problem oriented approaches to learning, which aim to produce doctors better equipped with the adult learning skills necessary for them to adapt to, and meet, the changing needs of the community they serve.

The pedagogic shift from the traditional teacher centred approach, in which the emphasis is on teachers and what they teach, to a student centred approach, in which the emphasis is on students and what they learn, requires a fundamental change in the role of the educator from that of a didactic teacher to that of a facilitator of learning.3

Our aim was to explore some of the …

https://depts.washington.edu/dbpeds/Teach2Teach(Step2)-Learner%20centred%20approaches.pdf

Learner centred approaches in medical education

In order to identify the components of knowledge that effective clinical teachers of medicine need, the author carried out a qualitative study of six distinguished clinical teachers in general internal medicine in 1991. Using data from interviews, a structured task, and observations of each ward team, he identified six domains of knowledge essential to teaching excellence in the context of teaching rounds: clinical knowledge of medicine, patients, and the context of practice, as well as educational knowledge of learners, general principles of teaching and case-based teaching scripts. When combined, these domains of knowledge allow attending physicians to engage in clinical instructional reasoning and to target their teaching to the specific needs of their learners. The results of this investigation are discussed in relation to both prior research on teacher knowledge, reasoning, and action and faculty development in medicine.

David M. Irby

Papers

What clinical teachers in medicine need to know.