A Faculty Development Newsletter
July, 2001
Newsletter Overview
The theme for our newsletter this month is, "effective clinical teaching. " Our preceptor highlight is on Dr. Charles Curtis of Saint Joseph Health Care Center in Warren, Ohio.
Preceptor Highlight
By Robbin Kirkland, Ph.D., Coordinator, Curriculum and Faculty Development
Charles Curtis, D.O., is the Director of the Internal Medicine Residency Program at St. Joseph Health Center, Warren, Ohio. Dr. Curtis has served as the hospital’s Chief of Staff and he holds the rank of Clinical Associate Professor of Internal Medicine, Ohio University College of Osteopathic Medicine. As a veteran clinical teacher with more than 35 years of teaching experience, Dr. Curtis believes that characteristics descriptive of effective clinical teachers can be grouped into three categories: (1) Academic Abilities;(2) Personality Traits;(3) and Organization Skills. Among those characteristics that could be described as “Academic Abilities”, Dr. Curtis suggests that an effective clinical teacher must have a “broad knowledge of his/her program”, “knowledge of contemporary clinical issues”, strong verbal and written “communication skills”, and articulation of “common” as well as significant “rare” clinical cases. Dr. Curtis believes that an effective clinical teacher must be willing to “share” and “incorporate personal and professional experiences in teaching trainees, particularly in the development of differential diagnosis. Also of critical importance, Dr. Curtis notes that effective clinical teachers tend to “target” clinical questions, content, and other learning experiences on the basis of the trainee’s level of education and training.
Keeping one’s “ego in check”, exhibiting characteristics of personal and professional maturity, being a good role model, exhibiting enthusiasm and a positive work attitude were mentioned as some of the “Personality”characteristics of effective clinical teachers. In addition, Dr. Curtis believes that effective clinical teachers tend to avoid excessive intimidation as a teaching approach and confronts delicate matters as privately as possible to avoid trainee embarrassment. Similarly, Dr. Curtis suggests that effective clinical teachers seem to model and exhibit excellent “bedside manners” and demonstrate empathy and respect in every aspect of patient care. Overall, Dr. Curtis suggests, an effective clinical teacher should have a personality that causes the learner to feel comfortable in exploring ideas, asking questions, and engaging in self directed learning.
In terms of “Organization Skills”, effective clinical teachers tend to take considerable pride in developing clear expectations regarding learning experiences, particularly those that lend structure to the clinical rotation. Similarly, Dr. Curtis believes that the “clinical agenda” that is designed by clinical teachers must contain assigned readings that are relevant, following-up regarding assignments of any type, reviewing the trainee’s progress notes and orders, and designating time for quality feedback and evaluation are critical organization skills.
In summary, the ability to exhibit the characteristics described by Dr. Curtis on a daily basis may be viewed by some as a tough task. Yet, there is no debate regarding the fact that trainees, patients, and medical education would benefit greatly from the efforts of those who are willing to embrace and practice the characteristics noted by Dr. Cutis which medical education research supports as benchmarks for effective clinical teachers.
Related Research
Information gathered from almost 200 trainees, Irby, et.al. (1991) identified several “characteristics of clinical teachers in ambulatory care settings”. Specifically, the extent to which clinical teachers “involved learners in the learning process”, “communicated expectations” regarding trainee performance, “stimulated interest,” and “interacted skillfully with patients” were found to be among the “most important characteristics” of clinical teachers as identified by trainees. Other essential characteristics that were identified focused on the extent to which the clinical teacher “possessed broad knowledge of medicine”, “enjoyed teaching and patient care”, demonstrated caring concern for patients”, “was personable and approachable”, “showed respect for others”, and showed “enthusiasm” in the learning experience. As Douglas, Hosokawa, and Lawler (1988) note, it is likely that the “worst clinical teachers” would indeed “lack these attributes and possess negative personal characteristics”. According to these researchers, “the best teachers are experts or masters of their subjects because they can lead the learner to the highest levels of learning.” Similarly, a clinical teacher should not be “an animated textbook” or viewed as just “dispensers of knowledge.” Rather, Douglas, Hosokawa , and Lawler suggest, “the test of a teacher is not so much how much has been taught nor how much has been learned-it is how well the learners have learned to learn.” Furthermore, the effective clinical teacher, as described by these researchers, tends to provide “organization, feedback, encouragement, and experience”.
While noting some of the same characteristics previously mentioned, Banner and Cannon (1997) indicate that “effective teaching” requires “order”. Specifically, the “goals of classes and courses” must be “clearly set, that they be explained and justified, that the manner of achieving them be clear, that the presentation of materials conducive to reaching them be appropriate, and that all activities be directed somehow to their attainment.” Banner and Cannon also insists that “order arises from a teacher’s leadership” and that it is the “teacher” who must “establish the organization and atmosphere” of the learning climate.
In an effort to assist clinical teachers in measuring their teaching effectiveness, Westberg and Jason (1993) developed an instrument compromised of 16 items. The respondents are asked to indicate the extent to which particular behaviors are exhibited utilizing a 4-point rating scale that ranges from “Always” to “Never”. Some of the behaviors or characteristics measured include: teaching interests and commitment, “capacity to work collaboratively with others”, enthusiasm, ability to adapt to change, and role modeling. In practice, it may be difficult to remember each of the characteristics noted above. But, what we can remember is own learning experiences as trainees and try to exhibit “good” teaching habits. “Good teachers” as expressed by Banner and Cannon, “have the ability somehow to imagine themselves in their students’ places, and then to help those students imagine themselves in other times, locations, and circumstances not immediately present to their senses and, for the most part, never previously experienced”.
Clinical teachers and trainees are encouraged to review these and other studies in more detail. Please continue to add to your teaching/learning “tool kit”.
References
Banner, J and Cannon, H. The Elements of Teaching. 1997. pp.51-67.
Douglas, K., Hosokawa, M., and Lawler, F. A Practical Guide to Clinical Teaching In Medicine. 1988. pp.10-11 and 38-43.
Irby, D., Ramsey,P., Gillmore, G., and Schaad, D. Characteristics of Effective Clinical Teachers of Ambulatory Care Medicine. 1991. in Academic Medicine.66(1991):pp.54-55.
Westberg, J. and Jason,H. Collaborative Clinical Education. 1993. p.47.
Teaching Tips for Effective Clinical Teaching
1. Make a commitment to share your knowledge and experience.
2. Strive to embrace and exhibit characteristics of effective clinical teachers.
3. Remember your own experiences as a trainee and exhibit characteristics that you have found to be effective in stimulating learning.
4. As much as possible, try to structure some aspects of the clinical learning experience, but also leave opportunities available for trainee self-directed learning.
5. Always be aware of the many “hats” that you wear as role model-physician, teacher, person, learner, and as an “official” and sometimes “unofficial” mentor.
6. Conduct a periodical “self-assessment” and trainee generated assessment of your teaching effectiveness. Use the characteristics of effective clinical teachers previously discussed as possible benchmarks.
Teaching Resources on the Web
Society of Teachers of Family Medicine (STFM) website for the office based teacher at http://stfm.org/teacher/hub.html. This site has numerous articles on clinical teaching that can be viewed and printed.
The Effective Preceptor monograph at http://www.oucom.ohiou.edu/fd/monographs/effective.htm provides excellent information on clinical teaching.
Curriculum Update
Students in the new Clinical Presentation Continuum curriculum have now completed two full years of training. This summer they are taking additional clinical blocks (e.g. OB/GYN, Peds, Geriatrics) to prepare them for clinical rotations beginning this fall.
Our year 2 CPC students will be coming to the CORE sites in September which is not far away. To help familiarize preceptors with the new CPC curriculum we are publishing a hard copy and an on-line version of a CPC Bulletin each month. This bulletin is designed to familiarize everyone at the sites with the new curriculum so they will be more prepared to interface with the students. the bulletin is only one page so it is a "quick read." Five issues (Jan., Feb., March, April, May and June) have been mailed. If you are not on the mailing list to receive the bulletins and would like the hard copies sent to you monthly, please call Christina McGuire in the Office of Faculty Development at 740-593-2215 and she will add you to the mailing list. To see all the issues online, just go to our faculty development web page at http://www.oucom.ohiou.edu/fd/ and click on Monthly CPC Bulletin.
Academic Leadership Fellowship News
The 2001-2002 Academic Leadership Fellowship (ALF) will begin in August. We can take up to twelve participants in the program. Stipends are available for interns and residents. For detailed information on the fellowship go to our home page at http://www.oucom.ohiou.edu/fd/ and click on Academic Leadership Fellowship.