Thank you for viewing this presentation.

We would like to remind you that this material is the property of the author.

It is provided to you by the ERS for your personal use only, as submitted by the

author.

2016 by the author

Principles of teaching and learning: a practical perspective

Dr. Walther N.K.A. van Mook Internist-intensivist,

Chair of Professional Behaviour Committee Faculty of Health, Medicine and Life Sciences

Maastricht University Medical Centre

Conflict of interest disclosure I have no real or perceived conflicts of interest that relate to this presentation.

This event is accredited for CME credits by EBAP and EACCME and speakers are required to disclose their potential conflict of interest. The intent of this disclosureis not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial productsor services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remainsfor audience members to determine whether the speaker’s interests, or relationships may influence the presentation. The ERS does not view the existence of theseinterests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation. Drug or device advertisement is forbidden.

Outline

societal changes and professonal role changes

curriculum changes and changes in concepts of medical education

the Three C’s of medical education, consequences medical school/workplace

learning styles, retention of what is learned

competency based training and importance of context

learning climate

take home messages

internal quality control (re)registration

higher demands patient(organisations)

‘shared care’, ‘care’ vs ‘cure’, teamwork

costs

healthcare management

philosophy patientcare patients/doctors

(r)evolution informationtechnology

knowledge skills, technology

complexity of care

private vs professional life part-time work

attitude

WBIG, WGBO hours restriction

external quality control legislation

feminisation

2005

cardiac surgery Nijmegen

errors, patient safety

Societal changes

Contemporary professional

Accountable to others

Partnership model, teamwork

Shared decision making

Evidence-based practice

Continuous professional development mandatory

External quality control

Knowledge and information overload

Care

Art

Traditional professional

Accountable to oneself

Solo, individual

Decision made by doctor

Experience-based practice

Attention to professional development lacking

Internal quality control

Very gradual increase in knowledge and information

Cure

Science

Present Past

Professional role changes

Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.

Or….

Lit. Chantler. Lancet 1996:353: 9159: 1178-81

Traditional to integrated curricula

Traditional curriculum

teacher-centred determined by disciplines, departments and deans no over-all design, no integration theory/practice few educational formats

Integrated curriculum

student-centred determined by societal needs and graduate profile thematic, modular structure variety of educational formats

Changes in concepts of ME

Teaching Transfer of knowledge skills professionalism context to context

Individual learning Isolated knowledge Theoretical knowledge

Learning Construction of knowledge

Collaborative learning Contextual learning Theory and practice + application in practice + problem solving

How?

More authentic problems

Increasing complexity

Real life projects

Authentic assessment C ontextual

C onstructive C ollaborative

Context influences learning

influence of social pressure

average pressure, average task: correlation 0.41 strong pressure, difficult task: correlation 0.31

9% of variance of person’s behaviour determined by individuals attitude!

akrasia

challenge not ‘hard’ cases

tempting to leave the clearly visible path, driven by day-to-day routine (fatigue, hunger, stress etc)

Lit.:Acad Med 2007 82(1): 46-50 Rees; BMJ 1995 311(6998): 182-4 Mays

Importance of context

Lit.: Rev Gen Psych 2005 9: 214-227 Wallace

Professional lapse

How?

Less direction

Increasing independent learning

More demand driven

Portfolio assessment; self/peer assessment C ontextual

C onstructive C ollaborative

How?

Smaller groups

Group assignments

More ICT support

Learning task = assesment; include group work in assessment C ontextual

C onstructive C ollaborative

Consequences medical school

skills labs small group sessions problem-orientated experience-based early introduction of patients student-centred teacher-guided

Consequences workplace?

ideal environment for learning motivating authentic directed towards practical application direct observation/feedback many different tasks variety of patients

Workplace based learning

learning by doing on the job training job-embedded learning

What the literature tells us…

limited observation

limited supervision

limited direct feedback many routine tasks depending on patient mix in the department learning by doing, see one, do one, teach one learning from near accidents role models not always ideal relative lack of attention for generic competency

domains

Other lessons….

Effective experiential learning requires deliberate practice feedback reflection workplace should be more structured role modeling/role of teacher domain independent skills, e.g. PB

Kolb cycle (1983)

Learning phases and styles

concrete experience starts by experiencing: activists

reflective observation reserved, tests the water: reflectors

abstract conceptualising explanatory models, concepts, constructs:

theoretisists active experimenting: test theory in practice: pragmatists

Four learning styles

Perception/processing continuum

And…

not always in the same order we learn differently we tend to enter the cycle at preferred points

not always in the same degree/intensity we learn best if we move thru the cycle

we all learn from our own experience origin of the typical styles distinction thinker, doer

Four typologies

Also specialty dependent?

The cone of learning

.

Participatory Teaching Methods

Passive Teaching Methods

National Training Laboratories, Bethel, Maine, USA Bales, E. 1996

An itterative process

Experiencing/acting

Reflection on action

Conceptualisation of essential aspects

Develop and choose alternatives

Apply to new contexts and situations

1 5

2

3

4

Korthagen, F.A.J. (2002)

Applicable the workplace

discipline-orientated curricula

theme-orientated curricula

problem-orientated curricula

competence-orientated (or outcome- directed)

Back to history….

Nowadays….

• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional

• American (ACGME) structure Patient care Medical knowledge Practice-based learning

& improvement Interpersonal and

communication skills Professionalism Systems-based

practice

Nowadays….

• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional

31

An overarching competence?

Classical CanMEDs flower Modifications van Mook/van Luijk

All professionals are experts, but not all experts are professional!

farmer sports public maintenance

doctor conductor businessman

Generic?

Paraguay Punjab Jordan

Malaysia United States Spain

Generic?

Most important….

• patient mix/exposure to practice • opportunities for supervised/independent examinations • supervision and feedback received • organisation quality • limited number of students at one time • educational sessions • positive attitude of staff towards students • student being part of a team

Measures to improve effectiveness….

student study guides/navigation plan ‘teach the teacher’ trainings/FDPs more direct observation and feedback include protected time for selfstudy integration of learning and assessing in the workplace by using mini-CEX, logbooks etc.

Hallmarks of a good teacher.

.

is critical provides and aks for feedback respects the trainee schedules time for educational issues contributes/creates a safe learning

environment is enthousiastic stimulates gradual independence modeling, coaching, fading

• stimulates reflection

Boendermaker, P.(2003)

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

Cognitive apprenticeship Cognitive apprenticeship

Modelling Exploration

Reflection Articulation

Coaching Scaffolding

Modelling demonstreert, denkt hard op, gedraagt zich als rolmodel

Coaching Observeert, geeft feedback, biedt assistentie

Scaffolding Biedt ondersteuning, stelt het niveau van de student vast,

bouwt ondersteuning geleidelijk af

Articulatie Stelt vragen aan de student

en stimuleert de student om zelf vragen te stellen

Reflectie Stimuleert student te reflecteren op zijn sterktes/zwaktes

Exploratie Stimuleert student om leerdoelen te formuleren Learning climate

Collins, Brown & Newman, 1989 Stalmeijer, 2011

Learning climate

Learning and teaching climate

.

D-RECT: Dutch Education Climate Test: 11 factors, 50 questions

MCTQ: Maastricht Clinical Teaching

Questionnaire: 5 factors, 21 questions

Team Q

Plos One 2014 Slootweg et al: Team Q Med Teacher 2011 Boor et al: D-RECT Acad Med 2010 Stallmeijer et al: MCTQ

medical school

student

residency

resident

life long learning

specialist

cooperation/teamwork working climate non-compliance guidelines errors complaints

Evidence? (literature study)

Lit. Med Educ 2005 Stern; NEJM 2005 Papadakis; Ann Int Med 2008 Papadakis

Learning curve….

Communication problems

Knowledge/skilss problems

Maslow, A. H. (1954)

Take home messages

.

clear navigational plan for students/teachers faculty development programmes specific and generic skills informal, experience based learning,

complemented with formal sessions observe, feedback, reflect, discuss gradual independence complement with assessment safe learning climate

“It may not be a perfect wheel, but it’s a state-of-the-art wheel.”

End

Walther N.K.A. van Mook MD PhD Internist-intensivist Department of Intensive Care Maastricht University Medical Centre+ P. Debyelaan 25 PO Box 5800 6202 AZ Maastricht, Netherlands E-mail: w.van.mook@mumc.nl

Copyright