Teaching One To One

Dr Alastair McGowan

Sept. 2003

TONTO

• Role model for clinical practice

• Role model for life long learning

• Assessment in the workplace

• Applicable to many settings

Components of the curriculum

Purpose wise judgements in uncertainty

Content

Teaching strategy role modelling

Assessment primacy of practice

Evaluation feedback built in

Curriculum design

• What educational purposes should we seek to attain?

• What educational experiences are likely to attain that purpose?

• How can these be organised effectively?• How can we determine whether these purpose are

being attained?

Tyler,R. 1949

What are we trying to assess ?

“Competence”

(shows he/she can do it)

“Performance”

(actually does it )

Competence Vs Performance

Is it reasonable to assume that competence is a good indicator of performance?

• Review of 18 studies assessing the relationship of competence and performance– Most use loose definitions

– Unable to support concept of a direct relationship

Rethans JJ, van Leeuwen Y, Drop R, van der Vleuten C, Sturmans F. Competence and performance: two different concepts in the assessment of quality of medical care. Family Practice 1990;7(3):168-74

Competence Vs Performance

• Study of GP’s– Standardised patients seen in normal surgeries

– Repeated in controlled practice environment

• Mean score for performance 49% lower than competency score

• Scores directly related to consultation time

Principles of assessment

• Valid - measures what it purports to measure

• Reliable - measures performance consistently

• Feasible - is practical, deliverable, affordable

• Educational - trainee learns from process

• Acceptable - those involved have confidence in it

Observed Clinical Practice

Hawthorne effect:

under observation, performance may differ

from normal behaviour

If not by magic then…

Directly observe it

TONTO

• One to one teaching

• Role reversal

– Ensuring competence

– Demonstrating excellence

• Record of training

TONTO

direct observation of practice

working environment

real patients

uses structured recording sheets

measures performance

TONTO

• Trainer and trainee work together

• reduction in clinical service provided by the team

but

• some service is provided

• likely positive effect on efficiency overall

TONTO Training :

• One day course– Demonstration of process– Mainly hands on with SpRs– Some educational theory

Principles of assessment

• Valid - measures what it purports to measure assessor dependent• Reliable - measures performance consistently assessor dependent • Feasible - is practical, deliverable, affordable no sorting hat available• Educational - trainee learns from process assessor dependent• Acceptable - those involved have confidence in it initial experience positive