My teaching philosophy has evolved since the time of my own postgraduate training, when I first realized that I wanted to develop myself as a teacher. Initially, I simply emulated the practices of those whose teaching affected me most as a learner. I subsequently sought the advice and mentorship of some of the senior educators at my hospital, which included their observation and feedback on my techniques. I began to read, sporadically, education literature that was recommended to me by my mentors, but focused less on theory than on effective delivery. Finally, I have begun to seek the direct feedback of my learners. (I had unconsciously avoided this until recently, as I always felt unqualified as a teacher and did not wish to have this confirmed!) Having begun to do so, I have now been able to achieve an honest appraisal of my own strengths and weaknesses, and move forward by addressing the consistent themes in learner feedback. In future I wish to make my teaching more rigorous and theoretically based. This statement outlines the current state of my teaching practices.
Learning in a medical context requires particular attention to the setting. Medical teaching is most effective when trainees are given an appropriate volume of work - enough that they are actively involved in problem solving and learning through action, but not so much that they are run off their feet with no chance to reflect, to acquire new information, or to be taught. As a teacher on the medical wards and in the clinics, I have the responsibility to "regulate" the learning environment. I do this in a number of ways, including influencing the practices of the other ward and clinic professionals to help them understand the needs of medical learners in their setting. I try to take on some of the workload when it threatens the learning experience. Finally, I deliver teaching in a number of ways – ranging from informal, single-issue, short discussions, to full-length explorations of topics – and the balance of teaching methods is often dictated by the intensity of the other demands on the trainees’ time and attention. Overall, I believe it is important to integrate teaching of medical topics into the everyday, real-world situation of the learners; the most learning occurs when both the teaching and the rest of the learners’ environment are adjusted to allow the most complete integration possible.
The selection of learning material is based upon the learners’ needs. Whenever I encounter a new group of learners, I conduct an informal needs assessment. Many of the topics I cover in a structured program such as a clinic seminar series, or an academic half-day, are dictated by “externally derived” needs such as training program requirements. Within these larger goals, however, individual learners differ with regard to previous experiences, level of understanding, and aptitude for the topics being taught. I make an effort to understand the “average” level of prior knowledge and comfort with a topic before I teach it, in addition to making note of the “range”, by asking the learners explicitly before we begin. On a less structured level, such as in choosing topics for bedside or informal teaching on a ward rotation, I leave the choice of topics up to the learners, and encourage them to base their preferences upon the clinical material we see on the wards, in order to facilitate the reinforcement of learning (as described below). For some, deciding upon their “internally derived” needs is an unfamiliar and sometimes uncomfortable experience. I believe that each learner should be encouraged to practice an “internal inventory” of their learning needs on an ongoing basis, and that doing so is actually a reflective learning experience in itself. I choose to do this most often in a practice-based learning setting such as the medical ward, because I believe that identifying learning needs and addressing them, while practicing, is an integral part of effective clinical practice.
Naturally, in order to be an effective teacher of medical content, I must be knowledgeable about the topic myself. It is also important, in a medical setting, to be seen by the learners as knowledgeable. To be seen otherwise greatly undercuts the effectiveness of whatever is being taught. An advantage of being a general internist is that I am forced to keep current on a broad range of medical topics, to a level where I can use this knowledge every day. When I read for my own professional development, I think of strategies of explaining the content to others. Doing this has major benefits for my own fact retention, and helps me identify the conceptual difficulties that learners might have. Thus, when choosing content to teach, I will ensure that I have sufficient competence in the subject before teaching it – including knowing a prepared strategy for delivering the material.
When I teach, I strive for a clear and engrossing experience for the learners. I use a number of strategies to do this. First, I try to gain their full attention early – having been a medical trainee myself, I know that learners’ attention may be compromised at any time by other demands or issues that may interrupt or preoccupy them. I often use humour early on to gain their attention; at other times, I ask a provocative or confusing question and bring the learners into the discussion by requiring them to resolve something that I have said. I then move to a highly structured outline of what we will be discussing - I give the learners a “road map” of where the session will lead. I find that this helps learners to understand the scope of the session and keep track of their progress in it. As I deliver the content of the session, I pause at pre-determined points to check for understanding of the material, and summarize what I have said so far. At any point, I may ask the learners to make logical connections out loud, or analyze statements I make using new information, in an effort to maintain their involvement throughout the session. I try to lighten the intensity of the session regularly with humour. Finally, at the end of the session, I repeat explicitly what the major themes of the session were, with notes on how to apply this knowledge after the session.
Working and teaching in a busy clinical realm allows ample opportunity for learners to reinforce their new knowledge and skills with real-world material. Surprisingly, however, many of them do not realize how to do this explicitly. In the follow-up to a teaching session, I make concrete links between what we discussed and the real-life issues we are dealing with, and I emphasize the ways the knowledge can be applied to the current situation.
I also provide learners with supplemental reading material and guidance on how to continue to build their understanding after the session. I emphasize reflecting on how to improve their performance with the new information, with the goal of increasing their overall clinical competence.
Finally, I offer myself as a resource to contact for further discussion, particularly if anything that was presented was not completely clear to some of the learners. While this offer has rarely been taken up, on the few occasions when it has, I have had a chance to improve someone’s learning in a highly individualized way, and I have gained a rich insight into how to address the difficulties of learners in general.
I have described how my teaching philosophy has developed, and how it is put into practice. My current teaching philosophy can best be summarized as giving the learners the best possible environment for their needs; understanding their needs, both “internal” and “external”; keeping them engaged in their learning; and encouraging reflection and integration of the new knowledge in their practice. I, too, am a learner in this process – I learn about each of my trainees, and about my own abilities to reach them with every teaching session I deliver. By this process, and by addressing the issues raised by learner feedback, I endeavour to increase my own skill in delivering the most effective teaching that I can.