Planning a Teaching Episode

Preparation

A good teaching episode will depend on good planning from you, the teacher, and good communication with the learners. It is important to have some knowledge of the learners and their experiences and learning needs. You will need to decide on your chosen format, although you may wish to combine different styles of teaching to some extent. Some of the choices might be

One-to-one teaching

The factors that will determine which you choose will include the number of learners whom you will be teaching, the agenda for your teaching session and the length of time available to you. You might structure your session or you might want to leave sections of the time for the learners to direct the teaching style and content.

You should have some idea about the accommodation available to you (you might want to speak to the practice manager or senior partner to find out what times and places are usually used for teaching in the practice). If you choose to carry out your teaching episode at a different location outside the practice, you may need to liaise with the local postgraduate medical education centre or even a private conference facility. The room layout may be difficult to change but if you have the chance it would be better to plan this according to your needs. For example, removing tables and arranging chairs in a circle in advance could enhance group discussion or arranging tables with groups of chairs might enhance group work. Proficiency with any technology (including user names and passwords for computer software) will be an asset if you are using unfamiliar equipment. You should also ensure that you have a contact whom you can speak to during the teaching session (e.g. for temperature control or unexpected technological problems). Many of these issues can be avoided by making a visit before the date and arriving early on the day.

In a primary care setting, you might be teaching people who have previously had a wide range of experiences. You might be teaching clinical or non-clinical staff or a mixture of these (Box 1). Clinical staff might include professionals from nursing backgrounds and doctors of different levels of experience. It is important not to feel daunted by this. In planning your teaching episode, you will need to assess what your learners are likely to know already and you might even learn something from the experience yourself. If you are teaching a junior doctor, who has just completed a respiratory medicine attachment, think about the areas that he or she is unlikely to have covered in hospital. For example, the relatively well patients who come for their asthma review but where the practice needs to assess their control with objective measures. This can be a good time to show the learner the way things are done in your particular practice (e.g. shortcuts on the computer system, setting up a template and how to consult with such a patient without it turning into a box-ticking exercise). Your learner may have pre-existing ideas about the subject. A mind-mapping exercise might be a good way to start the session off. This would work well with an individual as well as a team (Fig. 1). You write the main point at the start and then keep writing the words or phrases that spring to mind and link to each concept as they occur.

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Figure 1

An example mind map that may result from a teaching episode on asthma

Knowing your audience will help you to put the new material into context for the learners. For example, as a GP in an alternative providers of medical services practice, I was working with non-clinical staff who had never before worked in a GP surgery. However, on closer questioning, it transpired that some members of staff had worked in hospital and in other National Health Service (NHS) settings. Nowadays patient groups may also request a doctor to come and facilitate their own learning and, if you are teaching such a patient group, you may wish to contact the group ahead of time asking them the following:

Do they have asthma?

Using your skills to find out more about your learners in this way can help you to engage their attention and also to select what you are going to impart in your teaching.

Learning styles

When you were a medical student, you might have come across questionnaires that assess learning styles. There are a variety of such questionnaires available. Some of them can be accessed online. Asking your learner to share with you the sort of learning style he or she prefers might help you to decide what style of teaching you are going to use. For example, www.vark-learn.com has a questionnaire that you can use to see whether you are more visual, aural, reading/writing or kinaesthetic.

Visual learners will tend to want to see pictures, diagrams and figures. Aural learners will prefer to hear the materials and may like to listen to recordings. The learners who prefer to read and write will want to go and look at books or write things down. Kinaesthetic learners will prefer to do things practically and learn this way.

When planning your teaching episode, you may want to take the VARK learning style into account and have an element of all four learning styles in your teaching. I have used the table below to explore how I might teach about asthma reviews depending on the learning style (Table 1).

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Table 1

Learning styles and tips

Learning style	Tips
Visual	Show pictures of inhaler technique, display results from a peak flow reading chart, display the results from a lung function test.
Aural	Talk to the learner and keep his or her interest by asking questions, play a recording from a consultation (with the patient's consent to use this for educational purposes), play them a recording of different breathing sounds and ask them questions about them.
Reading/writing	Ask the learner to read some leaflets in advance, get them to write a leaflet, ask them to complete a questionnaire, ask them to write a list of the main learning points.
Kinaesthetic	Demonstrate inhaler technique, get the learner to handle some placebo inhalers and demonstrate technique to you, ask them to show you how they would do a peak flow recording.

There are other learning style and personality questionnaires. Some of these may prove useful if you are going to have repeated teaching episodes with a single learner, which happens frequently between GP trainer and GP registrar. An example of such a questionnaire is the Myers-Briggs Type Indicator, which allows you to assess the learner's degree of

Extroversion versus introversion. An extrovert person may respond better to class discussion, answering questions and doing presentations. An introvert learner may not respond to being nominated by you to answer questions and may need to work on something, such as presentation skills, that is unnatural to them.

This may influence how you choose to teach. The indicators are combined to give you an overall profile of your learner, so you would not specifically concentrate on only one aspect of the style.

Another example is the Honey and Mumford learning style questionnaire which gives rise to the following indicators:

Activist—this type of learner will like to do things so you should plan activities or actions for them in the teaching episode. For example, testing your inhaler technique.

In a short teaching session with multiple learners, it may be hard to adapt to everyone's learning styles but an awareness of the learners' needs will still be helpful. Learners may also adapt to your teaching style or change in their style over time. This can occur especially if a learner has been used to a very different learning environment prior to coming to primary care (e.g. a doctor who may have come to you as their first attachment in primary care after working only in secondary care overseas).

Establish your learner's needs

If you are teaching a learner who has gaps in his or her knowledge, then this is the ideal chance to find out what they need to know. Using Johari's window (Luft, 1969) is a great way to explain to your learner that there will always be things that we know we do not know (conscious incompetence) and things that we do not know we do not know (unconscious incompetence) (Table 2). The challenge in teaching learners about the things that neither of you have realized that they do not know is obvious. This is where bringing prior evidence of learning and a learning log can help so that these unknowns may be identified.

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Table 2

Johari's window

	Known to self	Unknown to self
Known to others	ARENA	BLINDSPOT
Unknown to others	FAÇADE	UNKNOWN

Ask your learners if they can bring examples of asthma patients whom they have dealt with. There might be a particular incident that made them uncomfortable (e.g. a receptionist might bring a significant event of a patient who had an asthma attack in the waiting room). This can be presented to you in advance so you can prepare something based around the incident or incorporate it into your session.

Showing the learners the idea of PUNs and DENs (patient's unmet needs and doctor's educational needs) can help here. In practice, this will mean whenever you meet a patient where you do not know something, you keep a log of this and subsequently this becomes your educational need. They are also a good opportunity to link to the ePortfolio and learning logs. This idea can also be adapted for non-clinical staff, whereby they keep a log of areas or issues where they have felt unprepared.

If the learning episode is a tutorial, you might want to give the learner a questionnaire to complete in advance that will expose areas of ignorance or to highlight the importance of your topic. For example, prior to a teaching session about patient referral for a foundation doctor, you might use these questions:

Would you refer a 15-year-old girl on salbutamol, beclometasone inhaler and a leukotriene-receptor antagonist with nocturnal cough and occasional wheeze to hospital?

This might be a good icebreaker and emphasize to the learner the reasons for the session.

Pitch your teaching at the appropriate level

Teaching a respiratory specialist nurse about the management of asthma may be intimidating but pitching your teaching at the appropriate level will make this a more productive process for both learner and teacher. Good teaching is like good consultation skills. You want to ensure that you check with the learner what they already know. This can be harder when you have learners from different backgrounds with mixed needs. For example, when teaching the practice nurse, medical student and foundation doctors together you might want to set up your learning session with varied tasks or tasks where each learner can adopt their usual work role. In such a mixed group, it is important to bring learners to a similar point early on in the session, as learning is more productive when information is constructed in the context of previous knowledge. You can use the varying knowledge and experiences of different group members to do this in a way that is inclusive, embraces different learning styles and enhances contributions. So with the example of asthma, you can set up a problem-based learning scenario where the case develops needs where each different learner feels involved.

Thus, by the end of the session, the scenarios become progressively more demanding and all learners have something they can contribute to the learning process. They may teach one another something about the topic and also about their roles within the team.

Adapt your teaching to the circumstances

It is important to ask yourself what has brought about the teaching episode that you are involved in. In a new practice environment you might want to achieve the aims of your role in the practice, such as to ensure the staff are adequately trained to perform their role. You might be a doctor taking responsibility for another more junior clinical colleague and therefore you will want to ensure that your learner achieves their learning needs to fulfil a service and remain safe. The teaching may be to address a point that you are trying to make, for example your own political view of the NHS system. You might also be trying to learn about a topic yourself while also getting your learner to learn something. Teaching can be a great chance to challenge pre-existing beliefs and update knowledge for colleagues who may be unaware of recent advances in evidence-based medicine. It can also be a non-threatening natural environment in which to do so.

Feedback

Getting feedback is crucial to a successful teaching experience and also important for you to ensure that you learn from the experience as well. How you choose to obtain feedback will be influenced by the time available, number of learners and how likely they are to respond. You can choose to use

Verbal feedback

If you choose to design a questionnaire, it should be simple and quick to administer so that learners can quickly give their feedback and you can easily make sense of their comments. A simple questionnaire that you can adapt can be found on the web site of the British Council (Box 2). It is aimed at people teaching English but the questions are broad and could be adapted for most teaching sessions.

Peer review of your teaching may also assist you to improve your teaching style. The colleague who assesses you will be able to sit in and give you feedback later. In order to make the exercise more constructive, you might agree two aspects for him/her to concentrate on [e.g. (i) Do I engage with the learner's learning style? (ii) Do I summarize effectively?] The colleague should be able to see things about your teaching that you cannot because he or she is not distracted by teaching or learning.

Summary

Through planning teaching episodes regularly and obtaining feedback, you will gain confidence in teaching. You should find this a learning experience for yourself and find this a good way to become familiar with how other learners think. Through using learners' learning styles, you can adapt your teaching methods for their benefit. For a group of learners, using a variety of learning styles will make your teaching more effective. If you find that you have an interest in developing your teaching skills, there are a number of short courses run by universities and deaneries. There are also distance learning courses. Some courses allow you to accumulate credits that can lead to a formal teaching qualification, such as a Postgraduate Certificate in Medical Education.