Medical Edircaiion, 1976, 10, 250-254
Changing attitudes of medical teachers towards medical education J A N E T G A L E , R . W . S. T O M L I N S O N
AND
J. A N D E R S O N
Department of Medicine, King’s College Hospital Medical Scliool. London
and objectives of our workshop method of medical teacher training (Anderson er al., 1972, 1974), therefore, are not confined to the cognitive domain, but also include the affective domain. The workshops are planned and managed not only to present new methods and information, but also equally importantly to encourage in the participants more favourable attitudes towards medical education (Gale et al., 1974). One of the stated aims of our workshop is: ‘To encourage the teacher in those attitudes towards his teaching which will contribute to the aims of the students and medical education.’ The inclusion of attitudinal objectives is a crucial part of each workshop, since if the practice of medical education is to improve then it is largely dependent upon the attitudes of clinical teachers towards their own teaching and their students’ learning. This paper discusses, firstly, attitude change Key words: *TEACHING; *ATTITUDEOF HEALTH achieved during four workshops and, secondly, a PERSONNEL;*EDUCATION,MEDICAL; LEARNING; follow-up study to determine the participants’ present PROBLEMSOLVING ; QUESTIONNAIRES ; STATISTICS ; involvement and interest in medical education. LONDON
Summary
If medical education is to improve, this is largely dependent upon the attitudes of clinical teachers towards their own teaching and their students’ learning. The aims and objectives of our workshop method of medical teacher training therefore includes some in the affective domain. Based on the theory of cognitive dissonance the experience-linked practical problem solving approach of the workshop encourages behaviour change, presuming this to cause ‘attitude change’. Testing by means of a specially constructed and validated Likert-type attitude scale shows that attitudes do improve significantly and consistently over the 5 days of our workshops. A follow-up study shows these effects to be maintained and taken back to the participants’ own medical schools.
Method of teaching and testing attitudes Introduction
Although the nature of the relationship between attitudes and behaviour is a matter of some controversy (Thomas, 1971) the workshops were planned according to the viewpoint that teaching for attitudinal change is most effective when the appropriate behavioural change is first encouraged. This approach was based on the theory of cognitive dissonance which states, as the classic experiment of Festinger & Carlsmith (1959) demonstrated, that forced behaviour change ‘causes’ attitude change in order to allow consistency between the two. In our workshops we therefore eschew authoritarian teaching and lecturing in favour of small group work centred on probem-solving tasks, based on real situations which the participants will have met in their own medical
In medical education attitudes and values are equally as important as knowledge and skills. It is therefore necessary to define affective (attitudinal) objectives for students and ensure that these are met. That teachers have, so far, paid little attention to this aspect of medical training may be due to a lack of awareness of the importance of their own attitudes and how they change. Measuring and teaching for affective objectives is certainly possible and practical in medical school, but this necessitates that the medical teacher’s own attitudes be considered. The aims Correspondence: Mrs Janet Gale, Assistant Director, BLAT Centre for Health and Medical Education, BMA House, Tavistock Square, London W C l H 9JP.
250
Changing attitudes of medical teachers towards medical education
schools. Such an experience-related approach ensures that practical and useful problems are solved in the process of group work. To reinforce this, participants put their learning into practice by planning and making a short film for the purpose of either teaching students or teaching teachers, thereby implementing the principles taught during the course of the workshop. An attempt is made, then, to change behaviour in the belief that attitudes will follow suit. We have measured the change of attitude by means of a specially constructed attitude scale of the Likert, five response-choice type, which was validated according to the usual procedures (Edwards, 1957). The scale consisted of twenty-five items which deal with the areas of relevance of educational research, evaluation, the role of objectives, medical teacher training and teaching methods. Workshop participants completed the attitude scale at the beginning of the course and again at the end. This study surveys four consecutive workshops, those of December 1972, June and December 1973, and June 1974. The same attitude scale was used throughout and completed both before and after the course by forty-five workshop participants from the disciplines of medicine (including general medicine, psychiatry and pathology), surgery (including general surgery, obstetrics, and gynaecology, and anaesthetics), dentistry, the basic sciences and nursing. Each workshop also included at least the same number of medical students as there were small groups.
Statistical evaluation Two-way analysis of variance was calculated on the results of the surveys of each workshop separately, except that of December 1973 for which complete detailed data was not available. This type of analysis determines the significance of the difference of (a) the participants’ attitudes, (b) responses to the items, and (c) attitudes before and after the workshop. The test applied also analysed the interaction between the times of testing and the responses to each attitude item. This allowed us to determine whether the changes in attitude were uniform across items or whether the change only occurred in some of the items. Lack of interaction between the items and times of testing would suggest that change is uniform across all twenty-five items of the attitude scale. The results of the December 1973 workshop were also subjected to two-way analysis of variance, but
25 1
yielded only information about the overall homogeneity of the responses to items and the significance of the difference between the overall responses before and after the workshop. Information about the responses of each participant to each attitude item before and after this workshop was not available.
Results Table 1 shows that there was a significant change in attitudes towards medical education during each of the first four workshops. Considering the first workshop, December 1972, the interaction between attitude items and times of testing is not significant (F-0.956, N.S.). It can therefore be expected that certain constant differences will be maintained between attitude items from the pre-workshop test to the post-workshop test. The significance level associated with attitude items (F-3.441; P
Changing attitudes of medical teachers towards medical education J A N E T G A L E , R . W . S. T O M L I N S O N
AND
J. A N D E R S O N
Department of Medicine, King’s College Hospital Medical Scliool. London
and objectives of our workshop method of medical teacher training (Anderson er al., 1972, 1974), therefore, are not confined to the cognitive domain, but also include the affective domain. The workshops are planned and managed not only to present new methods and information, but also equally importantly to encourage in the participants more favourable attitudes towards medical education (Gale et al., 1974). One of the stated aims of our workshop is: ‘To encourage the teacher in those attitudes towards his teaching which will contribute to the aims of the students and medical education.’ The inclusion of attitudinal objectives is a crucial part of each workshop, since if the practice of medical education is to improve then it is largely dependent upon the attitudes of clinical teachers towards their own teaching and their students’ learning. This paper discusses, firstly, attitude change Key words: *TEACHING; *ATTITUDEOF HEALTH achieved during four workshops and, secondly, a PERSONNEL;*EDUCATION,MEDICAL; LEARNING; follow-up study to determine the participants’ present PROBLEMSOLVING ; QUESTIONNAIRES ; STATISTICS ; involvement and interest in medical education. LONDON
Summary
If medical education is to improve, this is largely dependent upon the attitudes of clinical teachers towards their own teaching and their students’ learning. The aims and objectives of our workshop method of medical teacher training therefore includes some in the affective domain. Based on the theory of cognitive dissonance the experience-linked practical problem solving approach of the workshop encourages behaviour change, presuming this to cause ‘attitude change’. Testing by means of a specially constructed and validated Likert-type attitude scale shows that attitudes do improve significantly and consistently over the 5 days of our workshops. A follow-up study shows these effects to be maintained and taken back to the participants’ own medical schools.
Method of teaching and testing attitudes Introduction
Although the nature of the relationship between attitudes and behaviour is a matter of some controversy (Thomas, 1971) the workshops were planned according to the viewpoint that teaching for attitudinal change is most effective when the appropriate behavioural change is first encouraged. This approach was based on the theory of cognitive dissonance which states, as the classic experiment of Festinger & Carlsmith (1959) demonstrated, that forced behaviour change ‘causes’ attitude change in order to allow consistency between the two. In our workshops we therefore eschew authoritarian teaching and lecturing in favour of small group work centred on probem-solving tasks, based on real situations which the participants will have met in their own medical
In medical education attitudes and values are equally as important as knowledge and skills. It is therefore necessary to define affective (attitudinal) objectives for students and ensure that these are met. That teachers have, so far, paid little attention to this aspect of medical training may be due to a lack of awareness of the importance of their own attitudes and how they change. Measuring and teaching for affective objectives is certainly possible and practical in medical school, but this necessitates that the medical teacher’s own attitudes be considered. The aims Correspondence: Mrs Janet Gale, Assistant Director, BLAT Centre for Health and Medical Education, BMA House, Tavistock Square, London W C l H 9JP.
250
Changing attitudes of medical teachers towards medical education
schools. Such an experience-related approach ensures that practical and useful problems are solved in the process of group work. To reinforce this, participants put their learning into practice by planning and making a short film for the purpose of either teaching students or teaching teachers, thereby implementing the principles taught during the course of the workshop. An attempt is made, then, to change behaviour in the belief that attitudes will follow suit. We have measured the change of attitude by means of a specially constructed attitude scale of the Likert, five response-choice type, which was validated according to the usual procedures (Edwards, 1957). The scale consisted of twenty-five items which deal with the areas of relevance of educational research, evaluation, the role of objectives, medical teacher training and teaching methods. Workshop participants completed the attitude scale at the beginning of the course and again at the end. This study surveys four consecutive workshops, those of December 1972, June and December 1973, and June 1974. The same attitude scale was used throughout and completed both before and after the course by forty-five workshop participants from the disciplines of medicine (including general medicine, psychiatry and pathology), surgery (including general surgery, obstetrics, and gynaecology, and anaesthetics), dentistry, the basic sciences and nursing. Each workshop also included at least the same number of medical students as there were small groups.
Statistical evaluation Two-way analysis of variance was calculated on the results of the surveys of each workshop separately, except that of December 1973 for which complete detailed data was not available. This type of analysis determines the significance of the difference of (a) the participants’ attitudes, (b) responses to the items, and (c) attitudes before and after the workshop. The test applied also analysed the interaction between the times of testing and the responses to each attitude item. This allowed us to determine whether the changes in attitude were uniform across items or whether the change only occurred in some of the items. Lack of interaction between the items and times of testing would suggest that change is uniform across all twenty-five items of the attitude scale. The results of the December 1973 workshop were also subjected to two-way analysis of variance, but
25 1
yielded only information about the overall homogeneity of the responses to items and the significance of the difference between the overall responses before and after the workshop. Information about the responses of each participant to each attitude item before and after this workshop was not available.
Results Table 1 shows that there was a significant change in attitudes towards medical education during each of the first four workshops. Considering the first workshop, December 1972, the interaction between attitude items and times of testing is not significant (F-0.956, N.S.). It can therefore be expected that certain constant differences will be maintained between attitude items from the pre-workshop test to the post-workshop test. The significance level associated with attitude items (F-3.441; P
