IN BRIEF
Teaching General Practitioners to Teach
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only.
M. R. SALKIND, P. CULL, L. SOUTHGATE and J. FULLER
Well over 1,000 general practitioners are now linked with Departments of General Practice in the United Kingdom and are engaged in teaching medicine to medical students. The confusion of identity which they experience as clinicians and educators is important and is reflected in their behaviour when they themselves are being taught to teach. Background The Department of General practice and Primary Care at St Bartholomew’s Hospital, London, in common with most other departments of general practice, uses a group of teaching practices to which medical students are attached during their fourth or fifth year. All the teachers in these practices are established principals but differ widely in their level of teaching skills and knowledge of educational methods. To increase these skills regular meetings are held by the Department, during which discussion of educational principles and techniques takes priority. These meetings have shown that in demonstrating and discussing undergraduate teaching, tutors take refuge in clinical problems or the consultation. For example, in a session involving a tutor teaching minor respiratory disorders, the observing doctors discussed at length the merits and hazards of prescribing antibiotics instead of considering the teaching style and analysing the content of the teaching. The academic staff have considerable difficulty in controlling this situation, so a method was devised to overcome,this recurrent problem. Medical students attached to the teaching practices reported that health education was seldom a formal part of the practice policy, although pragmatic health education of patients did take place. They also felt that prescriptions were * often given unnecessarily and that overprescribing stemmed from the attitudes of patients and doctors. It was decided to combine these observations in teaching the tutors, thus avoiding as far as possible clinical situations in which teachers could find refuge. M. R. Salkind, PH.D, FRCGP, FRC.PSYCH, is Director, and Lesley Southgate. M.SC. MB, CH.B, MRCGP and Jon Fuller, MB, BS, MRCGP. DRCOG, are Inner City Lecturers, The Academic Department of General Practice and Primary Care: Peter Cull, F M ~ A .FsiAD. AIMBI, is Director, Audio Visual Department, all at The Medical College of S t . Bartholomew’sHospital, London E9.
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Method
A full-day meeting was scheduled, the aims of which were: (1)to engender a team spirit amongst tutors, (2) to demonstrate aspects of basic educational methodolgy, namely the concepts of objectives, curriculum and evaluation. ‘Curriculum’in this context was seen as including teaching strategies, materials, settings and content of the materials (Tiberius 1977). The objectives of the day were as follows: 1. To enable’ tutors to construct a health education programme for patients or other health care professionals. 2. To - articulate the educational objectives for the programme. 3. To plan a curriculum for teaching the programme, bearing in mind the characteristics of the learners to whom it was directed. 4. To encourage tutors to view teaching patients-an activity that all family doctors engage in if only to a limited extent -as an analogue of teaching medical students. After a general introduction, tutors were familiarized with the aims of the day and were split into four groups, each led by one member of the Department of General Practice and a resource person from the Audio-visual Department of St Bartholomew’sHospital. Each group was asked to prepare an education programme on the subject of ‘overprescribing’in general practice. The strategies were defined for each group by the Department but wide choice was possible within the guidelines. *Group 1. To prepare a poster display for-patients (a moving poster display unit was available). *Group 2. To prepare an audio tape for patients, to be played in the surgery waiting room. *Group 3. To prepare a video film for general practitioners at a postgraduate centre. .Group 4.To prepare a video film of the group activities of the day for presentation to other tutors, on the theme of educating patients about overprescribing during the consultation.
Medical Teacher Yo13 No 4 1981
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only.
Figure 1. Tutors were asked to devise posters for patients on the subjeGt of ouerprescribing.
Achievement of the objectives was evaluated by: 1. Peer assessment of the presentation of the four programmes during the final plenary session. 2. Asking each GP tutor to assess the educational objectives of each of the groups of which he was not a member. This was to be done during the viewing and discussion of the group projects, at the end of the afternoon. 3. Assessment by each group leader of the discussion of objectives, the characteristics of the different learners and the appropriate use of different strategies, which took place during the group work. The group leaders also monitored the proportion of time during which the group escaped into discussion of clinical cases or consultations.
varied, showing charts, diagrams, interviews and discussion amongst general practitioners. The video presentation for the tutors showed a role play of a consultation which demonstrated agreed group objectives for the behaviour of the general practitioner when prescribing for a minor illness. This was followed by group discussion of the role play, and whether or not the objectives were met. The group leaders’ evaluation was that the groups had indeed defined objectives and strategies clearly and had worked at meeting and using them. During the final session of the day the analogy between these activities and teaching medical students within the practices was revealed and discussed. The importance of the questions, ‘what are we trying to teach?’ and ‘to whom are we teaching it?’ was a recurring theme of the discussion.
Results The poster display (Figure 1) was designed for the waiting room, and was amusing, informative and clearly directed towards patients of differing sophistication, in that the message was clearly presented in words and pictures. The group leader noted detailed discussion within the group of the type of patient for whom it was designed. The audio tape was designed for patients, as a basis for group discussion or individual listening in an anteroom. It took the form of amusing interviews with two ‘patients’ visiting their doctors. The film for general practitioners was formal, but
Reference Tiberius, R. G., Interpreting educational concepts for the teaching family physician: some parallels between patient care and undergraduate clinical education,JournaZ of Family Practice, 5 , 395-398. Acknowledgements We thank the following for their assistance: Dr Paul Julian, Dr James Carne and Gillian Hayhurst of the Department of General Practice and Primary Care; and Brian Jolly, Bryony Carfrae and Alan Waller, of the Audio Visual Teaching Department. We also thank all the General Practice Tutors of the Department of General Practice and Primary Care, and Mrs I. Clay for the organization involved.
Tape-slides for Community Nurses A list of audiotape-slide programmes and sets of slides that have been found useful for community nurses in training and for keeping up to date is available from Graves Medical Audiovisual Library. The programmes are listed under the following topics: Management and communication topics Nursing procedures A selection of clinical topics Psychology Medical Teacher V o l 3 No 4 1981
Patients at home Theelderly Some aspects of rehabilitation Strokes and stroke rehabilitation Rehabilitation aids Aspects of terminal care The programmes are available for sale, hire or hire by annual subscription from GMAL, Holly House, 220 New London Road, Chelmsford, Essex. Tel: 0245 83351).
139
Teaching General Practitioners to Teach
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only.
M. R. SALKIND, P. CULL, L. SOUTHGATE and J. FULLER
Well over 1,000 general practitioners are now linked with Departments of General Practice in the United Kingdom and are engaged in teaching medicine to medical students. The confusion of identity which they experience as clinicians and educators is important and is reflected in their behaviour when they themselves are being taught to teach. Background The Department of General practice and Primary Care at St Bartholomew’s Hospital, London, in common with most other departments of general practice, uses a group of teaching practices to which medical students are attached during their fourth or fifth year. All the teachers in these practices are established principals but differ widely in their level of teaching skills and knowledge of educational methods. To increase these skills regular meetings are held by the Department, during which discussion of educational principles and techniques takes priority. These meetings have shown that in demonstrating and discussing undergraduate teaching, tutors take refuge in clinical problems or the consultation. For example, in a session involving a tutor teaching minor respiratory disorders, the observing doctors discussed at length the merits and hazards of prescribing antibiotics instead of considering the teaching style and analysing the content of the teaching. The academic staff have considerable difficulty in controlling this situation, so a method was devised to overcome,this recurrent problem. Medical students attached to the teaching practices reported that health education was seldom a formal part of the practice policy, although pragmatic health education of patients did take place. They also felt that prescriptions were * often given unnecessarily and that overprescribing stemmed from the attitudes of patients and doctors. It was decided to combine these observations in teaching the tutors, thus avoiding as far as possible clinical situations in which teachers could find refuge. M. R. Salkind, PH.D, FRCGP, FRC.PSYCH, is Director, and Lesley Southgate. M.SC. MB, CH.B, MRCGP and Jon Fuller, MB, BS, MRCGP. DRCOG, are Inner City Lecturers, The Academic Department of General Practice and Primary Care: Peter Cull, F M ~ A .FsiAD. AIMBI, is Director, Audio Visual Department, all at The Medical College of S t . Bartholomew’sHospital, London E9.
138
Method
A full-day meeting was scheduled, the aims of which were: (1)to engender a team spirit amongst tutors, (2) to demonstrate aspects of basic educational methodolgy, namely the concepts of objectives, curriculum and evaluation. ‘Curriculum’in this context was seen as including teaching strategies, materials, settings and content of the materials (Tiberius 1977). The objectives of the day were as follows: 1. To enable’ tutors to construct a health education programme for patients or other health care professionals. 2. To - articulate the educational objectives for the programme. 3. To plan a curriculum for teaching the programme, bearing in mind the characteristics of the learners to whom it was directed. 4. To encourage tutors to view teaching patients-an activity that all family doctors engage in if only to a limited extent -as an analogue of teaching medical students. After a general introduction, tutors were familiarized with the aims of the day and were split into four groups, each led by one member of the Department of General Practice and a resource person from the Audio-visual Department of St Bartholomew’sHospital. Each group was asked to prepare an education programme on the subject of ‘overprescribing’in general practice. The strategies were defined for each group by the Department but wide choice was possible within the guidelines. *Group 1. To prepare a poster display for-patients (a moving poster display unit was available). *Group 2. To prepare an audio tape for patients, to be played in the surgery waiting room. *Group 3. To prepare a video film for general practitioners at a postgraduate centre. .Group 4.To prepare a video film of the group activities of the day for presentation to other tutors, on the theme of educating patients about overprescribing during the consultation.
Medical Teacher Yo13 No 4 1981
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only.
Figure 1. Tutors were asked to devise posters for patients on the subjeGt of ouerprescribing.
Achievement of the objectives was evaluated by: 1. Peer assessment of the presentation of the four programmes during the final plenary session. 2. Asking each GP tutor to assess the educational objectives of each of the groups of which he was not a member. This was to be done during the viewing and discussion of the group projects, at the end of the afternoon. 3. Assessment by each group leader of the discussion of objectives, the characteristics of the different learners and the appropriate use of different strategies, which took place during the group work. The group leaders also monitored the proportion of time during which the group escaped into discussion of clinical cases or consultations.
varied, showing charts, diagrams, interviews and discussion amongst general practitioners. The video presentation for the tutors showed a role play of a consultation which demonstrated agreed group objectives for the behaviour of the general practitioner when prescribing for a minor illness. This was followed by group discussion of the role play, and whether or not the objectives were met. The group leaders’ evaluation was that the groups had indeed defined objectives and strategies clearly and had worked at meeting and using them. During the final session of the day the analogy between these activities and teaching medical students within the practices was revealed and discussed. The importance of the questions, ‘what are we trying to teach?’ and ‘to whom are we teaching it?’ was a recurring theme of the discussion.
Results The poster display (Figure 1) was designed for the waiting room, and was amusing, informative and clearly directed towards patients of differing sophistication, in that the message was clearly presented in words and pictures. The group leader noted detailed discussion within the group of the type of patient for whom it was designed. The audio tape was designed for patients, as a basis for group discussion or individual listening in an anteroom. It took the form of amusing interviews with two ‘patients’ visiting their doctors. The film for general practitioners was formal, but
Reference Tiberius, R. G., Interpreting educational concepts for the teaching family physician: some parallels between patient care and undergraduate clinical education,JournaZ of Family Practice, 5 , 395-398. Acknowledgements We thank the following for their assistance: Dr Paul Julian, Dr James Carne and Gillian Hayhurst of the Department of General Practice and Primary Care; and Brian Jolly, Bryony Carfrae and Alan Waller, of the Audio Visual Teaching Department. We also thank all the General Practice Tutors of the Department of General Practice and Primary Care, and Mrs I. Clay for the organization involved.
Tape-slides for Community Nurses A list of audiotape-slide programmes and sets of slides that have been found useful for community nurses in training and for keeping up to date is available from Graves Medical Audiovisual Library. The programmes are listed under the following topics: Management and communication topics Nursing procedures A selection of clinical topics Psychology Medical Teacher V o l 3 No 4 1981
Patients at home Theelderly Some aspects of rehabilitation Strokes and stroke rehabilitation Rehabilitation aids Aspects of terminal care The programmes are available for sale, hire or hire by annual subscription from GMAL, Holly House, 220 New London Road, Chelmsford, Essex. Tel: 0245 83351).
139
