FAMILY MEDICINE EDUCATION IN ASIA PACIFIC REGION
1995
New Century
Hotel
Taipa,
Macau
June 15-
17, 1995
WONCA Asia Pacific Working Party and
Associacao
dos Medicos de Clinica Geral de Macau
Host
Associacao
dos Medicos de Clinica Geral de Macau
WONCA
ASIA
PACIFIC
WORKING
PARTY
WORKSHOP
1995
PROCEEDINGS ON WORKSHOP 2:
FAMILY MEDICINE EDUCATION IN ASIA PACIFIC: CLINICAL TEACHING
JUNE
15-17, 1995
New
Century Hotel
Taipa,
Macau
Host
Organization:
Associacao
dos Medicos de Clinica Geral de Macau
TABLE OF CONTENTS
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FOREWORD |
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Dr Lindsey Knight |
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Convenor |
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WONCA Asia Pacific Working Party |
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PREFACE |
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Dr Zorayda E.Leopando, M.D. |
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WONCA Regional Vice-President for Asia Pacific |
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ORGANIZING COMMITTEE
AND EDITORIAL BOARD |
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EXECUTIVE SUMMARY |
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PLENARY PAPERS |
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The Family Medicine Clinical Teacher |
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Prof Wesley E. Fabb |
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Educational Planning in Clinical Teaching |
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A/Prof Goh Lee Gan |
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Assessing Clinical Performance in Family Medicine |
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Dr Neil Spike |
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WORKSHOP RESULTS |
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1. Assessing Learner’s Needs for Developing Learning Plans |
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2. Clinical Teaching Skills: The Consultation |
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3. Clinical Teaching Skills: Small Group Teaching |
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4. Clinical Teaching Skills: Clarifying and Fostering Learning |
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CONCLUSION AND RECOMMENDATIONS |
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BACKGROUND PAPERS |
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Faculty Development Program in Family Medicine for Asia Pacific |
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Course Proposal and Program |
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Course Report |
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LIST OF PARTICIPANTS |
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ORGANIZING COMMITTEE
PROJECT DIRECTOR: A/Prof Zorayda E. Leopando
DEPUTY DIRECTOR: A/Prof
Goh Lee Gan
Host Organizing Committee
Over-all Chair: Dr Jorge Leitao Pereira
Secretary :
Dr Carlos Canhota
Treasurer: Dr
Chau Chi Hong
Facilities Coordinator: Dr Tito Lopes
Members:
Dr Chan Im Kuan
Dr Cheang Seng Ip
Dr Fong Hou Meng
Dr Irma Almeida
Dr Jose Baptista Pereira
Dr Kun Sai Hoi
Dr Maria August Drago
Dr Maria Dillard Fonseca
ADVISERS:
Prof
Wesley Fabb
Chief Executive
Officer, WONCA
Dr
Eddie T. Chan
Regional Vice-President
for Asia Pacific, WONCA
Dr
Lindsey Knight
Convenor, WONCA Asia Pacific Working Party
EDITORIAL BOARD FOR THE PROCEEDINGS
A/Prof Zorayda
E. Leopando
A/Prof Goh Lee Gan
Prof John Richards
Dr Jorge Leitao
Pereira
Dr Carlos Canhota
Editorial Consultants
Prof Wesley Fabb
Dr Lindsey Knight
PREFACE
Teacher training in Family Medicine
is a priority project in the Asia Pacific Region. This is a need identified by most of the WONCA member
organizations.
Standards and levels of development of Family Medicine Education in the region vary from country to country. This is due to the fact that Family Medicine has variety in its time of existence. Thus, you will find that the level of participation from various member organizations vary. Some countries send lecturers and facilitators while others come as workshop participants. Others contribute various resources. Teacher training activity in the region is a cooperative endeavor.
The
Workshop on Clinical Teaching held in Macau on June 15-17, 1995 was another
resounding success. The
spirit of sharing was very evident in the 4 workshops held and in the plenary
sessions too. Discussions
were lively and productive, as
you will see when you read the proceedings.
These
Proceedings are again intended not only to record the workshop but as a learning
tool for teachers in Family Medicine. This is a follow-up to the Manila proceedings
“ A Workshop on Core Curriculum”
which the region produced in 1993.
The document covers the “How’s and Why’s” in teaching and learning.
I
would like to express my deepest appreciation to the following who have made
the workshop and these proceedings a success:.
·
The Organizing Committee from Macau led by Jorge,
Carlos and Tito -- your efficiency and warm hospitality is incomparable. You really made our stay
in Macau memorable.
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The sponsors of the activity :
Astra HK, Banco Comercial de Macau, Camara Municipal das Ilhas, Direccao dos Servicos de Turismo de Macau,
Dr Edmund Ho , Fundacao Oriente, Leal Senado de Macau, Sociedade de Turismo
e Diversoes de Macau. Thank you for the support you have given which has contributed greatly to the success of the session.
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To Wes, my predecessor Eddie and my working team
Lee Gan -- thank you for all
the effort you have put into this program. Preparing for this activity covered 2 years and
5 countries. The planning meetings
we had although hectic were
enjoyable.
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To all the participants,
thank you for your active involvement.
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To the Editorial Board,
thank you for your patience and contribution.
Zorayda E. Leopando, M.D.
Project
Director
Regional
Vice President of WONCA for Asia Pacific
1996
PLENARY PAPERS (1)
THE FAMILY MEDICINE CLINICAL TEACHER
Professor Wesley E. Fabb
INTRODUCTION
A Family Medicine teacher is a role model, motivator, knowledge and skill disseminator, assessor and researcher.
ROLE
MODEL
Role modeling is the most important thing that teachers do. We do it all the time. No matter what we are doing, whether good or bad, the trainees are watching every move we make.
There are four important aspects of role modeling: embodiment of values, exemplar of attitudes, champion of standards, and demonstrator of process.
Embodiment
of values
The teacher is an embodiment of values. There are many examples.
One of these is being a caring and nurturing person. To be such a person, we must learn to value people. We must be patient centered.
We must be focused on the doctor-patient relationship. We value this most important relationship - between our patients and ourselves. However, we cannot deal with just the patient, we need to think of the family to which the patient belongs because the family is a very important determinant of health and illness. The sick person is influenced by the family and vice versa.
We must value community data (cultural, economic). We need to be community minded.
We value contextual information (family, community and work).
We value continuity of care; we keep records. We value comprehensive care; we are available and accessible.
--------------------------------
Professor of Family Medicine, Department of Family and Community Medicine,
Chinese University of Hong Kong; Chief Executive Officer, World Organization
of Family Doctors
Exemplar
of attitudes
The attitudes we exhibit are really important.
To students, we need to be positively helpful. We need to build their esteem. We should not put down, but rather, we should build up. One of the big problems of today is that many people have lost their self-esteem. We must behave congruently. Whatever we do, we must be consistent. We must exhibit awareness, openness, and genuineness.
To patients, we need to avoid negative stereotypes such as: being unapproachable, being domineering, being condescending and adopting a ‘know-all’ attitude. Patients are much better at reading the doctor than we are at reading the patients. They are very sensitive in picking up anything that is disparaging or negative coming from doctors.
Champion of standards
The teacher is a champion of standards. He defines criteria (What things are important?) and sets standards (What quality is acceptable?). He helps his students to achieve these standards.
Demonstrator of process
The teacher is a demonstrator of process. He shows how, explains why, and reflects on an action that has been taken.
The teacher is a motivator. He inspires by example, excites by challenge, challenges with questions, and he promotes reflection
KNOWLEDGE AND SKILLS DISSEMINATOR
The teacher is a knowledge and skills disseminator. In this context, he disseminates concepts, principles, guidelines and rules of thumb, essential facts, and essential skills.
There are several tasks that the teacher undertakes as a knowledge and skills disseminator. He:
· exudes enthusiasm (in this way he get the attention of his students all the time and this facilitates learning),
· focuses attention to important areas of the subject and areas that are likely to be problematic to comprehend,
· set objectives for the learning task,
· checks prior learning,
· tries to make learning meaningful and memorable,
· Facilitates encoding /recall of information so that he student is able to retrieve when this is needed,
· assesses learning.
The main purpose
of learning is to be able to get the information from memory when this is required
later. In other words, if one learns
something and it disappears into a black hole, it is no use.
The teacher facilitates
encoding /recall of information so that the student is able to retrieve it
when this is needed. One way is through the use of mnemonics. The idea behind
mnemonics is to inject sense into apparently senseless material. For example,
the mnemonic “Ten zebras beat my cow
“ makes remembering the branches of the facial nerve memorable.
It stands for temporal, zygomatic, buccal, mandibular and cervical branches.
Another way of helping the student learn is to get the student to go beyond “what is it?” to think about “how” and “why”, to relate the new information to his existing knowledge and to use the new information as often as possible.
Explicit categorisation
of the subject helps the student store information. For example, we can categorise
the learning of a medical condition as the presenting symptoms, differential
diagnosis, impor-
tant physical signs, relevant investigations and
management. The
latter can be categorised further into specific treatment, symptomatic treatment,
supportive treatment, and indications for referral and follow-up care.
Explicit categorisation is also helpful in patient education.
ASSESSOR
The teacher is also an assessor. He
· establishes what to assess
· determines how this is to be done
· designs valid assessment tools
· reliably assesses the student, and
· gives constructive feedback.
RESEARCHER
The teacher is also a researcher. The activity of research has been labelled as “organised curiosity”.
The teacher is a “reflective doctor”. He
· asks pertinent questions like “why?”, because it will keep students thinking all the time,
· formulates plausible hypothesis,
· designs sound research,
· collects data reliably,
· analyzes data validly through the use of the right methods of analysis,
· draws conclusions fairly.
CONCLUSION
To be a family medicine clinical teacher is a challenging job. It is also a rewarding one. In the process of teaching, one teaches oneself to be a better teacher and a better doctor too. ¨
PLENARY PAPERS (2)
EDUCATIONAL PLANNING IN CLINICAL TEACHING
Assoc Prof Goh Lee
Gan
DEFINITIONS
Educational planning may be defined as planning of learned experiences that the trainer wishes the learner to be exposed to achieve learning goals. Educational planning (syn. Curriculum planning) puts the syllabus into operation. Curriculum is the combination of methods and the syllabus.
INTRODUCTION
Educational
planning can be looked upon as trying to help the learner arrive at an intellectual
or skill destination. The logical questions to ask then are: “Whre are you
now and where do you want to go?” (aims and objectives); How are you getting
there? (the methods of learning), and “How do you know you have arrived? (assessement).
“Where
are you now?” is an important starting point because the postgraduate doctor,
unlike the undergraduate doctor does not start with a clean mental slate. The clinical teacher needs to plan the learning
experience to continue from what he already knows.
To be effective, educational planning needs to be adult learner oriented. The need to establish what the learner already knows has been mentioned. The other principles of adult learning are described below:
· Adults come to learning situations with a variety of motivations and expectations. Check these out.
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Head, Division of Family Medicine,
Department of Community, Occupational and Family Medicine; National University
of Singapore
· Adult learning often involves relearning rather than new learning. Respect their previous knowledge and motivation to learn. It is necessary to bring enthusiasm and to recognize that there is a possibility of resistance to change.
· Adults prefer problem solving to didactic teaching. A lot of resources come from each of us.
· Adult learners can serve as co-teachers. Do not overlook the potential of peer teaching.
· Feedback is more important than tests and formal evaluation.
THE
LOGICAL LINKS OF EDUCATIONAL PLANNING
Planning forges the logical links between
· intentions (objectives),
· methods (teaching and learning activities) and
· assessment of student learning.
The educational planner has to define the intentions, the methods of learning and teaching, and the type of assessment to be done on the learning that has taken place.
There are three domains of objectives:
· Knowledge (cognitive)
· Skills (psychomotor)
· Attitude (affective)
Knowledge objective
An example of knowledge objective is: Be able to identify benign and malignant skin lesions.
Three subgroups of knowledge objectives may
be recognised: ability to recall information, understand and apply knowledge,
and solve problems.
In clinical learning, the student is taught to look at the case from a problem-solving point of view. Clinical teachers are often given some fixed topics to cover. But very often, he can teach anything he wants by concentrating on problem solving skills.
An example of skills objective is: Be able to establish why the patient came.
Skills objective can also be stated in the standard of performance required:
- very qualified or very competent,
- familiar with or competent, and
- awareness.
Skills objective can also be stated as:
- able to perform,
- able to interpret,
- have observed.
An attitude objective is more abstract. One example is: Be able to demonstrate willingness to be critically evaluated by peers.
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Clinical
consultation skills
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At the end of the course, the participant must be able
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to take a comprehensive history |
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to perform a complete physical examination |
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to draw up a problem list |
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to gather information that he/she needs |
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To relate to the patient and make sure that
resources have been used to the best advantage. |
The scope of learning and teaching activities is wide. They are shown in Figure 2.
Figure 2. Scope of Learning
and Teaching Activities
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One to one |
Case
discussion |
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Topic discussion |
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Random case analysis |
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Direct observation
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Small group |
Case
discussion |
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(10-15 members) |
Topic discussion |
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Problem solving |
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Portfolio learning |
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Gaming
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Workshop |
Discussion |
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Problem
solving Brainstorming Buzz
groups Role
play
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It is important to relate assessment to objectives.
There are two forms of assessment.
· Formative --- giving feedback
· Summative - grading competence
Assessment drives what is learnt and how it contributes to the study.
OTHER EDUCATIONAL PLANNING
CONSIDERATIONS
Sequencing
Sequencing in the context of medical education is the order the objectives of learning are organised.
Principles to be observed in sequencing are:
· a logical or historical development of the subject
· emphasizing important themes or concepts
· proceeding from what students know to what they do not know
· proceeding from concrete experience to abstract reasoning
· starting from unusual, novel and complex situations and working backwards towards understanding
Course co-ordination
and administration
This is an important part of educational planning. The activities of various teachers need to be co-ordinated such that there is minimal overlap of the topic. The speakers need to be told the teaching requirements to be fulfilled.
Allocation of time
Time tabling is very important. The time allocated must be sufficient. For a presentation of a topic, 20 minutes is a good time allocation unit. For a workshop with a report back activity, one hour or an hour and a half may be needed.
Allocation of teaching rooms, clinics, laboratories
and equipment
If there are workshops, “break out” rooms for small group discussion will be needed. For clinical teaching in the consultation room, the allocation will be one to two learners to a room.
Where audio-visual equipment is needed, technical staff must be considered unless the trainer is able to operate it. Clerical staff may be needed to register learners at the beginning of a course.
Provide good teaching environment
A quiet environment is needed.
EDUCATIONAL PLANNING IN THE CONTEXT OF CLINICAL TEACHING
There are several ways that one can try to improve the clinical tutorial.
· Move from a disease oriented approach to a problem solving oriented approach.
· Plan the teaching. Do you have fixed topics to cover or do you have a free hand? Be sure what you intend to cover.
· Involve the student. Make it clear that all are to participate and come prepared with cases for presentation and read up aspects of the literature.
· Provide a good teaching environment. Encourage active participation; be a facilitator, not a fountain of knowledge.
· Concentrate on problem solving. Bring a case on the topic; avoid conducting tutorials in which you or your students present topics
A
plan for a problem-solving tutorial
Some thoughts and preparation as well as a procedure are needed for a problem-solving tutorial.
· A week before the tutorial, designate one or two students to prepare a case for presentation. Tell them they are to be prepared on all clinical and theoretical and theoretical aspects of the case.
· At the start of the tutorial, outline the aims of the exercise.
· Get the prepared students to give the presenting complaint or allow the patient to tell the story.
· Stop, and ask the other students what they think the problem or diagnosis could be. Ask them to justify their suggestions. Encourage the other students to react to these suggestions.
· Allow the presentation of more data.
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