- Email: [email protected]
Criticality, research, scholarship and teaching: Osteopaths as educators – what makes a good teacher?
Available online at www.sciencedirect.com
International Journal of Osteopathic Medicine 11 (2008) 52e55 www.elsevier.com/locate/ijosm
Commentary
Criticality, research, scholarship and teaching: Osteopaths as educators e what makes a good teacher? Sarah S. Wallace a,b,c,* a
British School of Osteopathy, University of Bedfordshire, UK b College Etudes d’ Osteopathique, Montreal, Canada c University of Wales, UK
Received 13 February 2008; received in revised form 26 February 2008; accepted 26 February 2008
Abstract Current educational healthcare practice expresses curriculum content in conceptual themes which include attributes required by competent professionals. These together with the demands of statutory and voluntary osteopathic regulators provide a challenge to osteopathic teachers on account of the various models employed in the delivery of osteopathic education. There is an expectation that, in addition to being a competent osteopathic practitioner, the osteopathic teacher has to demonstrate professional and educational expertise, together with a self-awareness of their personal limitations. They have to be a role model and mentor to students, as well as being able to make professional judgements about students’ performance. Furthermore, the osteopathic teacher is expected to know what they should be teaching and what students are required to learn. Ó 2008 Elsevier Ltd. All rights reserved. Keywords: Osteopathic medicine; Education
1. Introduction In the last 20 years there has been an increase in the number of osteopathic educational programmes within the university sector, including the validation of already existing and mature independent programmes and the initiation of new programmes contained within the university itself. Similarly, courses within continental Europe have either established links with osteopathic educational institutions within the UK, or have acquired their own validated status either with a UK university or a local one within their community. This status of osteopathic education, together with the drive to achieve professional regulatory status and political recognition for the osteopathic profession, has * 59, Cornwall Road, Cheam, Surrey SM2 6DU, UK. E-mail address: [email protected] 1746-0689/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijosm.2008.02.001
led to further development and maturation of the structure of the osteopathic education providers, that in turn have increased the demands upon those who teach within these institutions. This paper is an overview of some of the teaching and learning strategies currently employed in the delivery of osteopathic education, and the capabilities that make a good osteopathic teacher.
2. What is currently happening in osteopathic education? Over this 20-year period, throughout healthcare education there has been a shift away from ‘old-style’ learning with didactic teaching methods (chalk and talk), limited learning resources and set textbooks with theory focussing on the ‘how’ of healthcare delivery rather than the ‘why’ of healthcare delivery. Furthermore, students enmeshed in
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
the old-style teaching methods are not typically encouraged to challenge or question practitioners or teachers. Concurrent to this ‘shift’ is the move away from a syllabus of training with detailed and concise statements in relation to learning, and a move toward a curriculum that emphasises learning. The teacher is now expected to be a facilitator of learning and to create a stimulating learning environment for the student experience.1 The current international structure of osteopathic education varies from full-time four- or five-year programmes, part-time courses, to that of four- to five-day seminars held several times a year. Each of these providers claims to provide a pathway that allows for the acquisition and development of professional attributes and skills sufficient to practice as an osteopath. As Hays2 identifies, it is current educational practice to express curriculum content in conceptual themes which include the attributes required by competent professionals. This is reflected in the standards of capabilities required for safe and competent practice as set by osteopathic regulatory bodies or professional associations.3 Curricula are therefore usually structured to allow for the application of knowledge skills in practice, and not just simply the acquisition of knowledge. Acquired skills include a wide range of communication, clinical examination, procedural and information management skills, along with those of treatment planning and patient management. Likewise, the acquisition of a wide range of personal and professional behaviours are now included in the attitudinal aspects of curricula, such as those related to legal issues and ethical considerations. These acquired and attitudinal skills, together with the practical know-how needed to practise osteopathy, are delivered in a number of different ways depending upon the curricula, the theoretical and practical content and cited learning objectives, the strategies of implementation, the structure and mode of the programme, and the learning resources available. Within the curricula of osteopathic programmes, there are usually a number of planned learning opportunities for the student to acquire the necessary knowledge and skills required. In the classroom situation there is variability in the teaching and learning strategies employed. This appears to range from the traditional didactic teaching to problem-based learning and further self-directed learning activities. The latter are seen to be most effective when a suitable resourced learning environment supports their implementation. Problembased learning and self-directed learning strategies integrate basic and clinical science curriculum strands and themes into clinical problems that demand constructive preparation by the teacher to encourage students to develop and refine the knowledge and skills that are relevant to the clinical setting. The onus is therefore on the teacher to be able to recognise and employ
53
a range of individual teaching methods depending upon the needs of the students and the subject matter.4 The acquisition of clinical and technical skills within the classroom environment is achieved by ‘coaching’4 where the teacher is expected to introduce, explain, contextualise and then demonstrate a particular technique. With tutorial support the student then practises the procedure, usually on colleagues, being expected to progressively acquire the necessary skill base prior to proceeding to its application and integration into clinical practice. This requires an awareness on the part of the teacher as to the knowledge and skill level of student novices, and the teacher must allow the ‘learner to be free’ to learn and recognise the parameters of safe practice while maintaining control over the clinical situation. Successful implementation of these strategies is dependent on the osteopathic provider in assisting their faculty to understand where their individual contribution fits within the curriculum structure. Likewise the onus is on the teachers to have detailed knowledge or expertise with what they are expected to help the students learn. This emphasises the need for both teachers and students to become familiar with curricula content and objectives, the depth and level of student learning required, and the ability to shift between various teaching and learning strategies. Failure to do so results in the delivery of a hidden or potential curriculum which could be dependent on the interests and understanding of individual teachers who may not observe the boundaries of the approved curriculum.5 The majority of current osteopathic education providers have established teaching clinics which are serviced by senior students under the guidance and supervision of osteopathic practitioners. Within these facilities, the students progressively acquire clinical responsibility for their patients. Institutions that do not provide clinical facilities may offer mentoring placements, supervisor placements or clinical placements to their students with osteopathic practitioners in the community setting. Osteopathic education providers that do not provide students an opportunity for clinic-based learning, should ensure that there are well planned, structured and quality assured opportunities for the student to integrate propositional and procedural knowledge with developing practical skills and professional attributes under the supervisory guidance of clinical teachers. Learning in the ‘clinical’ environment provides a focus on the real problems encountered in professional practice.6 The clinical teachers or staff members working therein provide a role model for professional thinking, behaviour and attitudes. Furthermore, it is the only setting within which the skills of case history taking, physical examination, clinical reasoning and decisionmaking, treatment and management planning and implementation, communication skills and professionalism can be taught and integrated as a whole. Central to this
54
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
process is the requirement that the teacher implements formal and informal assessment strategies that provide sensitive, contextual constructive feedback, and further learning opportunities that assist a student to progress through the programme.6 Such clinic-based learning is not so much about the acquisition of propositional knowledge but more about the development of clinical reasoning skills,4 the promotion of learning through active experience followed by reflection, and the integration of professional knowledge and basic sciences into the clinical learning environment. This appears to be undertaken in the majority of circumstances by employment of apprentice-style learning, emphasising the importance of the clinical tutor as a guide and role model.7 The student is seen to be an apprentice to a more experienced clinician, with an opportunity to learn to deal with the complexities of practice life. Initially, learning is achieved by watching, then performing tasks under supervision until sufficient competence is reached and then assuming an increasing degree of clinical responsibility for patients.2 Such exposure is considered to have a strong influence on student learning, as the role model that clinicians provide as teachers has a powerful effect on how students learn and the knowledge they gain in the clinical setting.7 It is not uncommon for osteopathic education providers to also provide clinic-based learning opportunities for junior students in the clinical setting. These range from observation of senior colleagues to participation in simple clinical tasks, such as shadow case history taking. As a consequence, the learning opportunities that arise as a student progresses through a programme are arguably more powerful than those demanded by an explicit curriculum and also provide an opportunity to shape the students’ values, assumptions and professional craft knowledge through implicit means.5 The effectiveness of clinical learning depends on the professional clinician acting in a supervisory role. The types of problems often encountered in the clinical setting include a lack of teacher awareness of the objectives of the clinical encounter, and the competence of the student, with teaching being incongruent or lacking in continuity with the remainder of the curriculum.8 There may also be a bias toward focusing on the recall of factual knowledge rather than the development of problem solving skills and attitudes. Other problems include inadequate supervision, failing to acknowledge the demands of the supervisory role, and the lack of constructive robust, but appropriately sensitive, feedback with little opportunity for reflection and discussion.6 The role of the clinical teacher as a mentor could be argued to underpin effective supervision and coaching in both the clinical, practical and classroom environments. Mentoring9 is considered to be a multifaceted concept providing personal support and rigorous professional development leading to the acquisition and
enhancement of competence. The process of such a mentoring framework is dynamic and should evolve over time as the relationship between the teacher and student matures and provides an opportunity for the student to become self-aware of their attitudes and beliefs as they acquire competence.7 Therefore the onus is on the teacher to engage with the student in co-enquiry, providing motivation and support together with target setting and problem solving ultimately encouraging reflection and therefore learning. In applying these personal and professional attributes of affirmation, inspiration and challenge, the teacher requires an ability to prioritise and acknowledge as to whether there is a need to counsel or to coach the student.10 In order to optimise the student learning experience, the onus is on the clinical teacher to make effective use of timetabling opportunities where implemented, to ensure that reflection and reflective practice are key dimensions in the development of student expertise. Both reflection on and about clinical activities is part of an overall approach to acquiring professional competence encompassing knowledge, technical ability, as well as interpersonal and cultural competence.11,12 Also central to the success of the student learning experience is the balance of tutorial e teacher support offered to the student. This appears to be more consistently effective where there is mixed composition of levels of proficiency and expertise within the clinical or tutorial teaching team providing a spectrum for the student learning experience. At one end is the practitioner who is able to inspire and motivate the student, but is unable to clearly articulate their reasoning processes as they are based on intuition and experience, and may not have had or are removed from theoretical understanding.2 At the other is the proficient practitioner who is able to explain from a more logical perspective the underpinning reasoning process. In between, is the practitioner who is able to shift from one dimension to the other depending on the clinical context and their recognition of the needs of the student.13 The experienced teacher therefore should be able to combine learner-centred approaches with sound educational practices, broad learning experiences, attention to student learning and concern for the development of professional expertise and judgement.14 Spencer6 reinforces this by considering that effective teaching depends on a teacher’s individual communication skills, and in particular those of questioning and providing explanations. Both, he argues, should be underpinned by attentive listening with sensitivity to the student’s verbal and non-verbal cues. In addition Spencer notes that effective sequenced questioning also provides an opportunity to promote student thinking at a higher cognitive level which may develop new understanding.
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
3. What are the attributes of a good teacher of osteopathy? Harden and Crosby15 consider that there are several different roles that a clinical teacher should be able to fulfil, demanding professional expertise and knowledge, and also educational expertise. Some teachers will only be required to fulfil one role, whilst others will be required to fulfil several. The first role is that of an information provider, both within the classroom and clinical setting. Others roles include being a role model as a reflective practitioner within all teaching settings, combined with that of a learning facilitator and mentor. The teacher also needs to become proficient in making accurate judgements about student performance, and be able to recognise that assessment is seen as part of a constructive relationship that reinforces student learning. A further requirement is that an osteopathic teacher should be a competent clinician, together with an awareness of their personal limitations and need to acquire or hone further knowledge and skills as required. They should be an effective facilitator of learning, and be able to reflect on the personal attributes and skills they bring into their teaching environment, and indeed the role they fulfil. In addition they are required to be more than familiar with what they are expected to teach and what they are expected to help students learn, as well as the various teaching and learning strategies that are required to be employed to ensure effective student learning. Hays2 considers that the correlation between clinical expertise and educational expertise is poor, as the academic roles of teaching, assessing and managing are not usually part of clinical training. He argues that, depending on the personal capabilities of the clinician, some can acquire these skills more easily than others. However, due to the maturation of management structures and quality assurance mechanisms in place within the current osteopathic educational institutions, it is now less common that osteopathic teachers may find themselves teaching without any preparation or professional educational development, and with little understanding of curriculum and assessment processes. Osteopathic teachers may find themselves involved either at committee level, or within a module or clinic tutorial team, contributing to curriculum and assessment development and implementation. Increasingly there is cross-fertilisation between teachers in the classroom and clinic; and, likewise in assessment of practical and attitudinal skills in the classroom and clinic, reinforcing learning and curriculum objectives. Staff induction, development and appraisal mechanisms together with peer observation combine to enhance osteopathic teachers’ attributes. Such opportunities appear to assist in developing osteopathic teaching skills by providing knowledge of different learning styles, and the ability to assess student performance and provide constructive feedback.
55
To conclude, it may well be that a teacher may take on several roles simultaneously. This can be seen in both the classroom situation and clinical setting, where there is a need to assess learner’s knowledge and provide information as well as facilitate learning. A good teacher will move instinctively from one role to another. Recognition of these roles should be part of the culture of good teaching practice. The teacher should demonstrate commitment to the subject being taught, an ability to integrate current and new knowledge critically and a keen awareness of the role of a teacher in higher education. Teachers will be encouraged to give their best performance and put more effort into their teaching if recognition of their contribution and skills are acknowledged and valued by the institution.
References 1. Woodhouse J. Introduction: from the twentieth century to the twenty-first century. In: Woodhouse J editor. Strategies for healthcare education. How to teach in the 21st century. Radcliffe Publishing; 2007. 2. Hays R. Teaching and learning in clinical settings. Radcliffe Publishing Ltd; 2006. 3. General Osteopathic Council. Standard 2000. Standard of Proficiency. March 1999. http://www.osteopathy.org.uk/about_gosc/ standard_2000.pdf > [Accessed 26 February 2008]. 4. Hays R. Teaching and learning in primary care. Radcliffe Publishing Ltd; 2006. 5. Conroy S. Professional craft knowledge and curricula: what are we really teaching. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 178–85. 6. Spencer J. ABC of learning and teaching in medicine: learning and teaching in the clinical environment. Br Med J 2003;326:591–4. 7. Best D, Edwards H. Learning together: fostering professional craft knowledge development in clinical placements. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 165–71. 8. Newble D, Cannon R. A handbook for medical teachers. 3rd ed. London: Kluwer Academic Publishers; 1994. 9. Butcher J. Mentoring in professional development: the English and Welsh experience. In: Moon B, Butcher J, Bird E editors. Leading professional development in education. The Open University; 2000, p. 97–106. 10. Busher H, Harris A. Leadership for learning: re-engineering ‘mindsets’. In: Moon B, Butcher J, Bird E editors. Leading professional development in education. The Open University; 2000, p. 68–82. 11. Smith D. Facilitating the development of professional craft knowledge. In: HiggsTitchen JA editor. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 172–7. 12. Cox K. Planning bedside teaching. Med J Aust 2003;158:280–2. 13. Higgs J, Bithell C. Professional expertise. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 59–68. 14. Mann K, Holmes D, Hayes V, Burge F, Viscount P. Community family medicine teachers preparation of their teaching role. Med Educ 2001;35:278–85. 15. Harden R, Crosby J. The good teacher is more than a lecturer e the twelve roles of the teacher. Med Teach 2000;22(4): 334–47.
International Journal of Osteopathic Medicine 11 (2008) 52e55 www.elsevier.com/locate/ijosm
Commentary
Criticality, research, scholarship and teaching: Osteopaths as educators e what makes a good teacher? Sarah S. Wallace a,b,c,* a
British School of Osteopathy, University of Bedfordshire, UK b College Etudes d’ Osteopathique, Montreal, Canada c University of Wales, UK
Received 13 February 2008; received in revised form 26 February 2008; accepted 26 February 2008
Abstract Current educational healthcare practice expresses curriculum content in conceptual themes which include attributes required by competent professionals. These together with the demands of statutory and voluntary osteopathic regulators provide a challenge to osteopathic teachers on account of the various models employed in the delivery of osteopathic education. There is an expectation that, in addition to being a competent osteopathic practitioner, the osteopathic teacher has to demonstrate professional and educational expertise, together with a self-awareness of their personal limitations. They have to be a role model and mentor to students, as well as being able to make professional judgements about students’ performance. Furthermore, the osteopathic teacher is expected to know what they should be teaching and what students are required to learn. Ó 2008 Elsevier Ltd. All rights reserved. Keywords: Osteopathic medicine; Education
1. Introduction In the last 20 years there has been an increase in the number of osteopathic educational programmes within the university sector, including the validation of already existing and mature independent programmes and the initiation of new programmes contained within the university itself. Similarly, courses within continental Europe have either established links with osteopathic educational institutions within the UK, or have acquired their own validated status either with a UK university or a local one within their community. This status of osteopathic education, together with the drive to achieve professional regulatory status and political recognition for the osteopathic profession, has * 59, Cornwall Road, Cheam, Surrey SM2 6DU, UK. E-mail address: [email protected] 1746-0689/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijosm.2008.02.001
led to further development and maturation of the structure of the osteopathic education providers, that in turn have increased the demands upon those who teach within these institutions. This paper is an overview of some of the teaching and learning strategies currently employed in the delivery of osteopathic education, and the capabilities that make a good osteopathic teacher.
2. What is currently happening in osteopathic education? Over this 20-year period, throughout healthcare education there has been a shift away from ‘old-style’ learning with didactic teaching methods (chalk and talk), limited learning resources and set textbooks with theory focussing on the ‘how’ of healthcare delivery rather than the ‘why’ of healthcare delivery. Furthermore, students enmeshed in
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
the old-style teaching methods are not typically encouraged to challenge or question practitioners or teachers. Concurrent to this ‘shift’ is the move away from a syllabus of training with detailed and concise statements in relation to learning, and a move toward a curriculum that emphasises learning. The teacher is now expected to be a facilitator of learning and to create a stimulating learning environment for the student experience.1 The current international structure of osteopathic education varies from full-time four- or five-year programmes, part-time courses, to that of four- to five-day seminars held several times a year. Each of these providers claims to provide a pathway that allows for the acquisition and development of professional attributes and skills sufficient to practice as an osteopath. As Hays2 identifies, it is current educational practice to express curriculum content in conceptual themes which include the attributes required by competent professionals. This is reflected in the standards of capabilities required for safe and competent practice as set by osteopathic regulatory bodies or professional associations.3 Curricula are therefore usually structured to allow for the application of knowledge skills in practice, and not just simply the acquisition of knowledge. Acquired skills include a wide range of communication, clinical examination, procedural and information management skills, along with those of treatment planning and patient management. Likewise, the acquisition of a wide range of personal and professional behaviours are now included in the attitudinal aspects of curricula, such as those related to legal issues and ethical considerations. These acquired and attitudinal skills, together with the practical know-how needed to practise osteopathy, are delivered in a number of different ways depending upon the curricula, the theoretical and practical content and cited learning objectives, the strategies of implementation, the structure and mode of the programme, and the learning resources available. Within the curricula of osteopathic programmes, there are usually a number of planned learning opportunities for the student to acquire the necessary knowledge and skills required. In the classroom situation there is variability in the teaching and learning strategies employed. This appears to range from the traditional didactic teaching to problem-based learning and further self-directed learning activities. The latter are seen to be most effective when a suitable resourced learning environment supports their implementation. Problembased learning and self-directed learning strategies integrate basic and clinical science curriculum strands and themes into clinical problems that demand constructive preparation by the teacher to encourage students to develop and refine the knowledge and skills that are relevant to the clinical setting. The onus is therefore on the teacher to be able to recognise and employ
53
a range of individual teaching methods depending upon the needs of the students and the subject matter.4 The acquisition of clinical and technical skills within the classroom environment is achieved by ‘coaching’4 where the teacher is expected to introduce, explain, contextualise and then demonstrate a particular technique. With tutorial support the student then practises the procedure, usually on colleagues, being expected to progressively acquire the necessary skill base prior to proceeding to its application and integration into clinical practice. This requires an awareness on the part of the teacher as to the knowledge and skill level of student novices, and the teacher must allow the ‘learner to be free’ to learn and recognise the parameters of safe practice while maintaining control over the clinical situation. Successful implementation of these strategies is dependent on the osteopathic provider in assisting their faculty to understand where their individual contribution fits within the curriculum structure. Likewise the onus is on the teachers to have detailed knowledge or expertise with what they are expected to help the students learn. This emphasises the need for both teachers and students to become familiar with curricula content and objectives, the depth and level of student learning required, and the ability to shift between various teaching and learning strategies. Failure to do so results in the delivery of a hidden or potential curriculum which could be dependent on the interests and understanding of individual teachers who may not observe the boundaries of the approved curriculum.5 The majority of current osteopathic education providers have established teaching clinics which are serviced by senior students under the guidance and supervision of osteopathic practitioners. Within these facilities, the students progressively acquire clinical responsibility for their patients. Institutions that do not provide clinical facilities may offer mentoring placements, supervisor placements or clinical placements to their students with osteopathic practitioners in the community setting. Osteopathic education providers that do not provide students an opportunity for clinic-based learning, should ensure that there are well planned, structured and quality assured opportunities for the student to integrate propositional and procedural knowledge with developing practical skills and professional attributes under the supervisory guidance of clinical teachers. Learning in the ‘clinical’ environment provides a focus on the real problems encountered in professional practice.6 The clinical teachers or staff members working therein provide a role model for professional thinking, behaviour and attitudes. Furthermore, it is the only setting within which the skills of case history taking, physical examination, clinical reasoning and decisionmaking, treatment and management planning and implementation, communication skills and professionalism can be taught and integrated as a whole. Central to this
54
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
process is the requirement that the teacher implements formal and informal assessment strategies that provide sensitive, contextual constructive feedback, and further learning opportunities that assist a student to progress through the programme.6 Such clinic-based learning is not so much about the acquisition of propositional knowledge but more about the development of clinical reasoning skills,4 the promotion of learning through active experience followed by reflection, and the integration of professional knowledge and basic sciences into the clinical learning environment. This appears to be undertaken in the majority of circumstances by employment of apprentice-style learning, emphasising the importance of the clinical tutor as a guide and role model.7 The student is seen to be an apprentice to a more experienced clinician, with an opportunity to learn to deal with the complexities of practice life. Initially, learning is achieved by watching, then performing tasks under supervision until sufficient competence is reached and then assuming an increasing degree of clinical responsibility for patients.2 Such exposure is considered to have a strong influence on student learning, as the role model that clinicians provide as teachers has a powerful effect on how students learn and the knowledge they gain in the clinical setting.7 It is not uncommon for osteopathic education providers to also provide clinic-based learning opportunities for junior students in the clinical setting. These range from observation of senior colleagues to participation in simple clinical tasks, such as shadow case history taking. As a consequence, the learning opportunities that arise as a student progresses through a programme are arguably more powerful than those demanded by an explicit curriculum and also provide an opportunity to shape the students’ values, assumptions and professional craft knowledge through implicit means.5 The effectiveness of clinical learning depends on the professional clinician acting in a supervisory role. The types of problems often encountered in the clinical setting include a lack of teacher awareness of the objectives of the clinical encounter, and the competence of the student, with teaching being incongruent or lacking in continuity with the remainder of the curriculum.8 There may also be a bias toward focusing on the recall of factual knowledge rather than the development of problem solving skills and attitudes. Other problems include inadequate supervision, failing to acknowledge the demands of the supervisory role, and the lack of constructive robust, but appropriately sensitive, feedback with little opportunity for reflection and discussion.6 The role of the clinical teacher as a mentor could be argued to underpin effective supervision and coaching in both the clinical, practical and classroom environments. Mentoring9 is considered to be a multifaceted concept providing personal support and rigorous professional development leading to the acquisition and
enhancement of competence. The process of such a mentoring framework is dynamic and should evolve over time as the relationship between the teacher and student matures and provides an opportunity for the student to become self-aware of their attitudes and beliefs as they acquire competence.7 Therefore the onus is on the teacher to engage with the student in co-enquiry, providing motivation and support together with target setting and problem solving ultimately encouraging reflection and therefore learning. In applying these personal and professional attributes of affirmation, inspiration and challenge, the teacher requires an ability to prioritise and acknowledge as to whether there is a need to counsel or to coach the student.10 In order to optimise the student learning experience, the onus is on the clinical teacher to make effective use of timetabling opportunities where implemented, to ensure that reflection and reflective practice are key dimensions in the development of student expertise. Both reflection on and about clinical activities is part of an overall approach to acquiring professional competence encompassing knowledge, technical ability, as well as interpersonal and cultural competence.11,12 Also central to the success of the student learning experience is the balance of tutorial e teacher support offered to the student. This appears to be more consistently effective where there is mixed composition of levels of proficiency and expertise within the clinical or tutorial teaching team providing a spectrum for the student learning experience. At one end is the practitioner who is able to inspire and motivate the student, but is unable to clearly articulate their reasoning processes as they are based on intuition and experience, and may not have had or are removed from theoretical understanding.2 At the other is the proficient practitioner who is able to explain from a more logical perspective the underpinning reasoning process. In between, is the practitioner who is able to shift from one dimension to the other depending on the clinical context and their recognition of the needs of the student.13 The experienced teacher therefore should be able to combine learner-centred approaches with sound educational practices, broad learning experiences, attention to student learning and concern for the development of professional expertise and judgement.14 Spencer6 reinforces this by considering that effective teaching depends on a teacher’s individual communication skills, and in particular those of questioning and providing explanations. Both, he argues, should be underpinned by attentive listening with sensitivity to the student’s verbal and non-verbal cues. In addition Spencer notes that effective sequenced questioning also provides an opportunity to promote student thinking at a higher cognitive level which may develop new understanding.
S.S. Wallace / International Journal of Osteopathic Medicine 11 (2008) 52e55
3. What are the attributes of a good teacher of osteopathy? Harden and Crosby15 consider that there are several different roles that a clinical teacher should be able to fulfil, demanding professional expertise and knowledge, and also educational expertise. Some teachers will only be required to fulfil one role, whilst others will be required to fulfil several. The first role is that of an information provider, both within the classroom and clinical setting. Others roles include being a role model as a reflective practitioner within all teaching settings, combined with that of a learning facilitator and mentor. The teacher also needs to become proficient in making accurate judgements about student performance, and be able to recognise that assessment is seen as part of a constructive relationship that reinforces student learning. A further requirement is that an osteopathic teacher should be a competent clinician, together with an awareness of their personal limitations and need to acquire or hone further knowledge and skills as required. They should be an effective facilitator of learning, and be able to reflect on the personal attributes and skills they bring into their teaching environment, and indeed the role they fulfil. In addition they are required to be more than familiar with what they are expected to teach and what they are expected to help students learn, as well as the various teaching and learning strategies that are required to be employed to ensure effective student learning. Hays2 considers that the correlation between clinical expertise and educational expertise is poor, as the academic roles of teaching, assessing and managing are not usually part of clinical training. He argues that, depending on the personal capabilities of the clinician, some can acquire these skills more easily than others. However, due to the maturation of management structures and quality assurance mechanisms in place within the current osteopathic educational institutions, it is now less common that osteopathic teachers may find themselves teaching without any preparation or professional educational development, and with little understanding of curriculum and assessment processes. Osteopathic teachers may find themselves involved either at committee level, or within a module or clinic tutorial team, contributing to curriculum and assessment development and implementation. Increasingly there is cross-fertilisation between teachers in the classroom and clinic; and, likewise in assessment of practical and attitudinal skills in the classroom and clinic, reinforcing learning and curriculum objectives. Staff induction, development and appraisal mechanisms together with peer observation combine to enhance osteopathic teachers’ attributes. Such opportunities appear to assist in developing osteopathic teaching skills by providing knowledge of different learning styles, and the ability to assess student performance and provide constructive feedback.
55
To conclude, it may well be that a teacher may take on several roles simultaneously. This can be seen in both the classroom situation and clinical setting, where there is a need to assess learner’s knowledge and provide information as well as facilitate learning. A good teacher will move instinctively from one role to another. Recognition of these roles should be part of the culture of good teaching practice. The teacher should demonstrate commitment to the subject being taught, an ability to integrate current and new knowledge critically and a keen awareness of the role of a teacher in higher education. Teachers will be encouraged to give their best performance and put more effort into their teaching if recognition of their contribution and skills are acknowledged and valued by the institution.
References 1. Woodhouse J. Introduction: from the twentieth century to the twenty-first century. In: Woodhouse J editor. Strategies for healthcare education. How to teach in the 21st century. Radcliffe Publishing; 2007. 2. Hays R. Teaching and learning in clinical settings. Radcliffe Publishing Ltd; 2006. 3. General Osteopathic Council. Standard 2000. Standard of Proficiency. March 1999. http://www.osteopathy.org.uk/about_gosc/ standard_2000.pdf > [Accessed 26 February 2008]. 4. Hays R. Teaching and learning in primary care. Radcliffe Publishing Ltd; 2006. 5. Conroy S. Professional craft knowledge and curricula: what are we really teaching. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 178–85. 6. Spencer J. ABC of learning and teaching in medicine: learning and teaching in the clinical environment. Br Med J 2003;326:591–4. 7. Best D, Edwards H. Learning together: fostering professional craft knowledge development in clinical placements. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 165–71. 8. Newble D, Cannon R. A handbook for medical teachers. 3rd ed. London: Kluwer Academic Publishers; 1994. 9. Butcher J. Mentoring in professional development: the English and Welsh experience. In: Moon B, Butcher J, Bird E editors. Leading professional development in education. The Open University; 2000, p. 97–106. 10. Busher H, Harris A. Leadership for learning: re-engineering ‘mindsets’. In: Moon B, Butcher J, Bird E editors. Leading professional development in education. The Open University; 2000, p. 68–82. 11. Smith D. Facilitating the development of professional craft knowledge. In: HiggsTitchen JA editor. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 172–7. 12. Cox K. Planning bedside teaching. Med J Aust 2003;158:280–2. 13. Higgs J, Bithell C. Professional expertise. In: Higgs J, Titchen A editors. Practice knowledge and expertise in the health professions. Butterworth Heinemann; 2001, p. 59–68. 14. Mann K, Holmes D, Hayes V, Burge F, Viscount P. Community family medicine teachers preparation of their teaching role. Med Educ 2001;35:278–85. 15. Harden R, Crosby J. The good teacher is more than a lecturer e the twelve roles of the teacher. Med Teach 2000;22(4): 334–47.