Train-the-Trainer Manual:

Teaching Methods Linda Pinsky, MD Linda Pinsky, MD

1, 21, 2Sara Kim, PhD Sara Kim, PhD

2 2

11 Department of Medicine, Department of Medicine, 22 Department of Medial Education Department of Medial Education

and Biomedical Informaticsand Biomedical InformaticsUniversity Of WashingtonUniversity Of Washington

Seattle, WA, USASeattle, WA, USA

Outline of Sections Outline of Sections

Curriculum Lecturing Teaching in small groups Teaching the Hidden Curriculum

Section I Curriculum Large Group Lecturing Teaching in Small groups Teaching the Hidden Curriculum

Purpose of Curriculum• Expresses how educational ideas will be translated into

practice.

• Builds on identified needs in training gaps, new educational programs, quality improvement of existing programs.

• Serves as a blueprint specifying the scope and components of how teaching and learning will take place.

• Informs instructional content, teaching strategies, assessment, evaluation methods, and intended learning outcomes.

Sources for Identifying Curriculum Needs

NeedsNeeds

GuessGuessat Needsat Needs

Observe Observe LearnersLearners

StructuredStructuredInterviewInterview

ObserveObserveExpertExpert

ExistingExistingDataData

Ask theAsk theExpertsExperts

LiteratureLiteratureReviewReview

Written Written SurveySurvey

Assessment

Prideaux D. ABC of learning and teaching in medicine. BMJ. 2003 Feb 1;326(7383):268-70.

Curriculum Cycle

Section II Curriculum

Large Group Lecturing Teaching in small groups Teaching the Hidden Curriculum

Three Principles of Large Group Lecturing

Characteristics of Large Group Teaching

Communicates personal enthusiasm of the speaker on the subject matter

ShortcomingsBenefits

Conveys a large amount of factualmaterials to a large group efficiently

Permits maximum teacher control

(type and materials, structure)

Models to learners how an expert approaches and delivers knowledge

Results in passive learning In students

Assumes that learners are learningat the same pace and same level of understanding

Not suitable for higher levels oflearning such as application, analysis, and synthesis

Effectiveness hinges on the lecturer’sverbal skills (tone, pitch, pace)

Structureof

Lecture

Body

Planning

IntroductionConclusion

PlanningPlanningIdentify Topic

Decide on Goals

Assess the Audience

Gather Materials

Prepare the Lecture

Practice the Lecture

1

2

3

4

5

6

Preparation-IntroductionPreparation-Introduction

Organizing Organizing IntroductionIntroduction1. Gain Attention1. Gain Attention

Stories, examples, questionsStories, examples, questionsStartling, relevant ideasStartling, relevant ideas

2. Provide Preview/Review2. Provide Preview/ReviewPreview main pointsPreview main pointsReview previous Review previous

learninglearning

3. Establish Climate3. Establish Climate

Preparation - BodyPreparation - Body

Flow of Your LectureFlow of Your Lecture

1

2

3 4

Organizing the Body11. . Select and Organize Three Main PointsSelect and Organize Three Main Points

Cluster main ideasCluster main ideas Organize progression Organize progression

2. Illustrate Key Points2. Illustrate Key Points Select 2-3 sub-pointsSelect 2-3 sub-points Provide representationsProvide representations

3. Vary Presentation3. Vary Presentation Mix text with visualsMix text with visuals

Preparation - ConclusionPreparation - Conclusion

Delivering Dynamic Presentations

Adapted from David M. Irby, PhD, UCSFAdapted from David M. Irby, PhD, UCSF

Visuals: RationaleVisuals: Rationale

Illustrate IdeasIllustrate Ideas Focus AttentionFocus Attention Increase LearningIncrease Learning Capture AttentionCapture Attention

Impact of Visuals on RecallImpact of Visuals on Recall

%%RecaRecallll

Presentation - Visual Aids

Use multiple mediaUse multiple media1

Limit information postedLimit information posted2

Colors for emphasisColors for emphasis3

Consistent visible typeConsistent visible type4

Use of images, video clipsUse of images, video clips5

Presentation - Dynamics

EnthusiasmEnthusiasm

Body MovementBody Movement

GesturesGestures

Voice ProjectionVoice Projection

Eye ContactEye Contact

Strategies for Involving LearnersStrategies for Involving Learners

Ask questions and pose problemsAsk questions and pose problemsAsk for questionsAsk for questionsGive assignmentsGive assignments

QuestionnairesQuestionnaires TasksTasks

Divide audience into groups to workDivide audience into groups to workAllow time to write a summaryAllow time to write a summary

Section III Curriculum Large Group Lecturing

Teaching in Small Groups Teaching the Hidden Curriculum

1: Build Trusting Relationships and Fostering Collaboration

2: Use Clear Ground Rules During First Meeting

3: Determine Learner’s Experiences, Needs, Strengths, and Interests

4: Help Learners Understand Or Develop Learning Goals

5: Discuss and Decide How to Work Together

6: Facilitate the Learners’ Active Participation

7: Monitor the Flow of the Session and Group Process

8: Observe the Learner’s Behavior

9: Facilitate the Flow of Session

10: Deal with Learners Affecting Group Process Negatively

11: Deal with Disagreements, Managing Conflicts Constructively

12: Facilitate the Achievement of Learning Goals

13: Process and Summarize What Occurred During the Session

Tasks for small group teaching

1: Build Trusting Relationships and Foster Collaboration

Listen carefully and respectfully to learners Help learners recognize when they are being collaborative Help learners become increasingly more responsible for

group functions and products

2: Use Clear Ground Rules During First Meeting

Welcome learners and provide overview of session & goals Introduce yourself Invite learners to introduce themselves Discuss how learners will be evaluated

Tips for TasksTips for Tasks

3: Determine Learner’s Experiences, Needs, Strengths, and Interests

Listen to / observe learners prior to start of sessions

Gather information at opening of first session

Constructively use information you gather

Begin all sessions diagnostically, asking learners how they are doing, whether there have been important new developments since last meeting, whether they have had any reflections about last session

Remain diagnostic; pay attention to way learners participate, their communication, and learning patterns.

Tips for Tasks

4: Help Learners Understand or Develop Learning Goals Discuss pre-formulated learning goals and how the goals can

help their future work Help learners develop their own learning goals by:

• Finding out their previous experiences devising learning goals• Helping them understand the rationale for setting their own goals as

lifelong, active learners• Challenging them to consider what they want from session• Giving them examples of learning goals to help get started

5: Discuss and Decide How to Work TogetherStrategies/activities for achieving learning goalsLearners’ role and responsibilitiesYour role and responsibilities

Tips for Tasks

6: Facilitating Learners’ Active Participation Build sessions around issues that concern learners Use resources (videos, poems, excerpts from stories, plays) that bring issues

to life Use questions more than statements Foster interactions among learners Determine why some learners don’t or seem not to participate Help learners from different backgrounds/ different styles be part of group

7: Monitoring Flow of Session & Group Process Monitor group’s progress in relation to agreed-upon agenda, schedule, and

contract Reflect on your experiences in group Be aware of what you may be communicating

Tips for Tasks

8: Observe the Learner’s Behavior

Are learners facilitating group process

eliciting ideas from others,

listening attentively,

rephrasing a statement to facilitate understanding,

asking for clarification,

volunteering for constructive group activities

Do learners’ behaviors negatively impact group?

Are any learners adopting consistent rules?

How do learners relate to each other? to you?

What nonverbal messages are learners conveying?

How are learners affecting each other’s behavior?

Tips for Tasks

9: Facilitate the Flow of the Session

Interrupt the group and ask for reflections on the process

Provide feedback to group

Keep the group focused on intended purposes

Help the group transition to new topics or tasks

Discuss alternative directions

“Three important areas have come up.

We can only deal effectively with one at a time.

Let’s spend a few minutes deciding which one to deal with

first.”

Make mid-session changes in goals and/or strategies

Provide changes of pace, if needed

Tips for Tasks

10: Deal with Learners Affecting the Group Process Negatively

Be diagnostic; try to understand origins & nature of problem Carefully observe what is happening Characterize problem Get to the source of behavior Wait for group members to intervene Intervene in stages by giving learners non-verbal feedback; reminding learners about ground

rule; giving verbal descriptive feedback Reinforce positive behavior

11: Deal with Disagreements and Managing Conflicts Constructively

Identify the nature of the conflict and who is involved Create an environment where learners can discuss disagreements before they become conflicts Help learners listen to each other Help learners negotiate a solution (separate people from the problem; focus on interests, not

positions)

Tips for Tasks

12: Facilitate Achievement of Learning Goals

Keep the goals in mind

Foster self-assessment and provide constructive feedback

13: Process / Summarize What Occurred During Session

Allow sufficient time

Make sure learners understand why time should be taken for summarizing

and processing

Reflect with learners on what group accomplished

Reflect with individual learners on what they learned

Reflect with learners on how they worked together

Make plans for follow up and next session

Take time for your own reflection and planning

Tips for Tasks

Behavior Management Behavior Management

Side conversation

Pause; ask them to share with group

Group tangents

“I think we are a little off track."

Dominates group

Ask what others think; suggest to hear from someone else; Have specific object passed that one must request before speaking

Negative comments

“Let’s get back to…” “What do others think about this?”

“How can we turn this negative into a positive”

“Clown”Allow laughter. “Let’s get back on track”

Other behavioral distractions

Move towards the individual involved, pause and make eye contact

Non-participation

Assign tasks: call on non-participants

Quiet, non-committal

“Who haven’t we heard from yet?”

Quick Tips for Small Group Teaching

Adapted from Greger C, Corner R. The Clinical Teaching Handbook

Section IV Curriculum Large Group Lecturing Teaching in small groups

Teaching the Hidden Curriculum

Physician Charter on Medical Professionalism

American Board of Internal Medicine (ABIM)

American College of Physicians (ACP)

European Federation of Internal Medicine

Published simultaneously in

Annals of Internal Medicine (2002: 16:136-242)

Lancet (2002; 359:520-522)

Medicine’s Core Responsibilities-

• To place the interest of patients before that of the physician

• To set and maintain standards of competence

and integrity

• To provide expert advice to society on matters of health

Physician responsibilities

Commitments to:• professional competence

• honesty with patients

• patient confidentiality

• maintaining appropriate relations

with patients

• improving quality of care

• improving access to care

• a just distribution of finite resources

• scientific knowledge

• maintaining trust by managing

conflicts of interest

• professional responsibilities

Goethe

If we take people as they are, we make worse.

If we treat them as if they were what they ought to be, we

help them to become what they are capable of becoming --

How to teach professionalism

• Using Goethe’s

approach

X X

X

X

How to teach professionalism

• Didactic teaching

• Transparent role modeling

• Meta-cognition (“reflecting aloud”)

• Structured autonomy & facilitated reflection

Pharmaceutical promotion may be the tip of the iceberg of

professionalism

Teaching approaches:

Discuss pharmaceutical marketing and conflicts of influence as practical examples of challenges of professionalism that learners will face

Try to avoid being judgmental or self-righteous in your teaching

Try humor if it fits