Ten Tips for Effective Teaching

Eugene Orientale, Jr, MD

(Fam Med 1998; 30(5):326-7.)

For most physicians, embarking on teaching is much like parenting. It is a job that we perform with little preparation or experience. Like parenting, on-the-job training ultimately gives us the experience we need to become more proficient. I am often reminded of this fact by my wife, who teaches special education. Her preparation at the undergraduate and graduate levels gave her the skills necessary to perform her job as a teacher. On the other hand, few physician educators receive any formal education in teaching. As a result, despite the best of intentions, physicians will commit many blunders in their attempts to educate both students and residents. No brief article on medical education in private practice can do justice to the challenge of this task. However, after practicing in a residency environment for the past 7 years, I have made some observations. I have assembled these into a “Top 10 List” of dos and don’ts for working with physicians in training.

1. Be a Role Model and Mentor
Contrary to the words of National Basketball Association athlete Charles Barkley, whether he likes it or not, he is a role model. We are also role models. As physicians, our actions and lifestyles will speak louder than our words. Students and residents observe how we conduct ourselves both personally and professionally. What we do in our spare time, what we value, and how we conduct our personal lives conveys subtle but important messages to our physicians in training.

2. Teach Learning
“What we should seek to instill in our colleagues is not so much learning as the spirit of learning” (Woodrow Wilson). It is well worth remembering that little of the factual knowledge we convey to our pupils is actually retained. Thus, if we can convey enthusiasm for the process of learning—the thought, research, and investigation—then we have met an important educational objective. The process of how we learn as physicians eclipses and surpasses the content of any factual data.

3. Care for Patients
It has been said that the secret in caring for patients is in caring for the patient. Our ability to listen and convey empathy, as well as our behind-the-scenes gestures and comments, are observed and scrutinized by our pupils. If we expect our learners to demonstrate empathy, we must first demonstrate it.

4. Avoid Salesmanship
As family physician educators, we are often placed in the dual role of instructor and recruiter. My experience with more than 300 volunteer clinical faculty who participate as instructors for medical students tells me that we pursue our role with zeal. Many of us have little doubt that more family physicians could help solve the current US health care crisis. Unfortunately, our enthusiasm is often misperceived as overzealousness. The students we seek to attract to our profession are often repelled by our uniqueness. As a result, we should teach more and recruit less. It is easy to forget that bright young medical students can make reasonable decisions if they are given objective data and some reasonable guidance. We must refrain from trying to make our pupils into family physicians. Rather, by demonstrating how we practice the art and science of medicine, we reveal that our specialty has a legitimate place within the context of health care delivery and that it represents an attractive career decision.

5. Take a Team Approach
In a busy day of clinical practice, teaching a student or resident can seem like more of a burden than a joy. But it need not be this way. By adopting a proactive and constructive team approach to instruction, a medical student or resident can easily be incorporated into a busy ambulatory and inpatient practice. After carefully assessing a learner’s educational level, a learner can be reasonably incorporated into one’s everyday routine. A second- or third-year medical student can take a patient’s history and perform a physical examination. A fourth-year medical student can pre-round on hospital inpatients. And, a resident can often function at the level of a junior colleague. By taking a team approach, an instructor makes a conscious decision to share clinical responsibilities with the student. This certainly makes learning most enjoyable for all involved.

6. Listen to the Student
Recent medical studies indicate that physicians typically interrupt their patients before they speak a mere 20 seconds, often hardly enough time to convey their history and chief complaint. Similarly, we often don’t critically listen to our learners. How often do we get personal information and educational background information on our students? The typical answer is “not often enough.” To write the best educational prescription of goals and objectives for our students, the instructor must obtain both subjective and objective data from the pupil. Listen critically to students, and their actions and words will tell you what they need to learn the most.

7. Provide Constructive Feedback
We are our own worst critics. There is a natural tendency for each of us to see our glass as half empty rather than half full. By providing constructive feedback to our learners, our criticisms and praise will be more easily assimilated. My experience indicates that the more constructive the feedback, the more likely that the learning objective will be obtained.

8. Challenge the Learner
We sometimes forget that medical students and resident physicians are among the best students in our country. These elite learners have risen to their level of education because of their aptitude for learning. Thus, it behooves us to challenge the learner. Family practice provides us an endless array of learning opportunities every day, in both clinical diagnosis and therapy. Our challenge is to invite participation in our everyday diagnostic and therapeutic dilemmas.

9. Make Time—Don’t Be Too Busy
Many of us are always in a rush. Perhaps it is due to our compulsive personalities. Sometimes, our pace is dictated by our hectic schedules and the demands of clinical practice. More often than not, it is a combination of both. A good teacher will find the time to meet the needs of his or her students. In doing so, the teacher acknowledges the importance of learning and validates students’ interests and needs. The converse is also true. If one is constantly putting off questions and dismissing students’ concerns, the educational process is quickly derailed.

10. Challenge Yourself
When I first began teaching medical residents, I would review the office and inpatient schedule to mentally prepare myself for those with whom I would be working. Admittedly, I would breathe a sigh of relief when I found myself assigned to the finer residents! With time and experience, I became more confident in my teaching role, and now I find myself actually cherishing the opportunity to work with any of the residents, because each represents a unique and interesting challenge; no two learners are alike. I find it challenging to constantly adapt my teaching style to better suit the needs of my pupils. Consequently, teaching has become much more rewarding.

I don’t want to imply that simply by following these 10 tips that you will excel as a teacher, but I do hope that these concepts will become part of your teaching style. Teaching is a little like playing golf; you can only become good at it with a lot of hard work. I believe that family physicians make excellent teachers because they are intrinsically motivated to teach. After all, teaching our patients is one of our primary clinical objectives. Good luck in your next teaching role!

Tips for Teaching Writing

Roy Peter Clark, senior scholar at the Poyntner Institute for Media Studies and a longtime writing coach, offers the following advice:

• Free students to write every day, far more than any teacher could grade. The idea is to give students enough practice in writing to improve significantly.
• Write with and for students. They benefit from seeing a teacher work through a problem or challenge presented by writing.
• Demystify the writing process for children. Teach writing as a craft, letting students know that they all can take steps to improve their work.
• Confer with students and get them to talk about their writing. Talking about reading and writing provides them with the tools they need to grow.
• Give students support and encouragement. Never use writing as a form of punishment and never write anything negative on a student's paper if you are not willing to write something positive.
• Teach students to rewrite. It may be more helpful for students to revise one story five times than for them to work on five different stories.
• Create an environment in which students can learn from each other. It's important to train students to support their fellow writers, ask good questions, and articulate specifically what works for them in a story.
• Let students discover some of their own writing ideas. Students need to see their world as a well of story ideas-and they can't do that if they get all their writing prompts from teachers.
• Emphasize writing based on real life. Children have written wonderful fiction about places they've visited, and it tends to be much more detailed and the quality of writing tends to be much better than when they just sit there and think something up.
• Publish the best work of every student. There are dozens of ways to make a writing public, from reading it aloud to putting it in a class booklet to putting it on a web site.
• Teach mechanics in the context of writing. There's no reason to learn how to spell or use correct grammar unless it's to help communicate a message or to make a meaning clear and powerful.
• Don't forget to teach the kinds of writing that are for learning and discovery, such as notetaking and outlining, which are valuable in all parts of the curriculum.