Clinical Teaching: Submitted By: Pandangan, Ibn-Kathier P. Panotolan, Ashim C

CLINICAL
TEACHING
Submitted By:
Pandangan, Ibn-Kathier P.
Panotolan, Ashim C.
Clinical teaching
is a form of interpersonal communication between two people - a
teacher and a learner. "The teaching-learning process is a human
transaction involving the teacher, learner and learning group in a set of
dynamic interrelationships.
“Teaching is a human relational problem" (Bradford 1958, p. 135). As a
"relational problem," successful teaching and learning requires that the
teacher understand and make constructive use of four factors:
1. The role of the teacher and the knowledge, attitudes and skills that the
teacher brings to the relationship,
2. The role of the learners and the experiences and knowledge that the
learners bring to the relationship,
3. The conditions or external influences which enhance the teaching-
learning process, and,
4. The types of interactions which occur between teacher and learner.
The Role of the Teacher
Many medical educators think that the only role of the teacher is to be a
reservoir of knowledge and skills that occasionally, and unpredictably,
spills over its dam, letting information flow randomly down a canyon of
learning. However, W. J. McKeachie, U-M Professor of Psychology and
former Director of CRLT, has often emphasized that expertise alone is
not enough for good teaching. In mathematical parlance, knowledge and
expertise are necessary, but not sufficient, conditions to guarantee good
teaching.
Clinical teachers should realize that they assume multiple roles in their
interactions with their students. Ullian (1986) has reviewed 16 of the
most significant studies of perceptions of excellent clinical teaching. He
found that factor analysis groups most behaviors and characteristics of
excellent clinical teachers into four roles: Physician, Teacher,
Supervisor, and Person.
The Physician is the expert and the source of all knowledge. There is
considerable discrepancy between the Physician's level of experience
and wisdom and that of the students. This discrepancy is the reason the
medical teacher and students are together. The physician is also
responsible to school administrators, specialty boards and hospital
credentials committees for evaluating and certifying the competency of
students. The physician is the upholder of professional standards and is a
socializing agent, a member of a professional discipline.
As a Teacher, the medical educator is acutely aware of the needs and

aspirations of students but does not automatically assume it will be
possible to provide them everything they need. The Teacher can listen,
question, paraphrase, encourage or doubt students but cannot always
provide for them.
As a Supervisor, the medical educator demonstrates procedures,

provides practice, observes and assesses performance and provides
feedback.
Finally, as a Person, the educator develops an atmosphere of sufficient
trust that the students are comfortable sharing ideas, feelings and
thoughts. The physician-educator does not necessarily have to like the
students but does need to accept their needs and imperfections. The
Person may provide significant personal help and support outside the
formal teaching setting.
The Role of the Learner
What do learners bring to the relationship? Bradford (1958) notes that

learners are usually loaded with all sorts of anxieties, needs, problems
and screens that interfere with learning. How secure is the learner in the
situation and group? "Does he perceive the teacher as capable of
understanding and helping him? To what extent does he even recognize
the kinds of help he would most appreciate as well as most need?" (p.
136). How motivated is the learner to learn, to risk old ideas and
knowledge for the sake of new? To what extent is self-esteem or self-
image threatened by the learning process?
Mann et al. (1970) have described eight general types of students. The
five types most applicable to medical students and residents are:
1. The Compliant Students - These are the typical "good" learners who
work hard, are task-oriented, show little emotional turmoil, and are
primarily concerned with understanding the material and complying
with teacher requests.
2. The Anxious Dependent Students - This is often a predominant type
in medical school, dependent on the teacher for knowledge and support
and anxious about evaluation. The feelings of anxiety and incompetence
block these students from actively learning and make them more
concerned about grades. They are difficult to engage in discussion, and
prefer lectures.
3. The Independent Students - These learners are often older than

counterparts and seem confident and unthreatened by the teacher. They
favor peer relationships with the teacher and approach the material in
calm, objective, and often creative ways. Medical students with previous
graduate work and chief residents often fall into this category.
4. The Sniper Students - These learners are uninvolved due to a low

level of self-esteem and pessimism about being able to form productive
relationships with authority figures. They can be hostile, but are often
elusive when confronted with a particular issue.
5. The Silent Students - These learners are characterized by what they

do not do. They feel helpless and vulnerable, but without the anxiety
characterizing the anxious-dependent learners.
Learners bring startlingly different needs and agendas to their interaction

with teachers, just as do patients to their medical encounters. Teachers
cannot be all things to all learners, just as physicians cannot care
effectively for patients of all personality types. However, awareness of
different types of learners, and adjustment of the teacher's style insofar
as is possible, will be helpful.
Conditions for Effective Learning

Medical students and residents are adult learners, and medical education
should follow the principles of adult learning. Unfortunately, this does
not always happen. Medical learners are certainly adults
chronologically, and they are pursuing a very difficult field of study
requiring
discipline and maturity. Unfortunately, many of the basic assumptions
underlying current medical education would be recognizable to an
elementary school teacher. In any case, medical education is, or should
be, an adult learning process. What are the principles that enhance the
teacher-learner relationship? There are four:
1. Adults usually want to apply what they learn soon after they
learn it.
This rule is broken somewhat less in clinical teaching than in other

areas of medical education. However, clinical teachers should
always feel compelled to justify any clinical teaching that cannot
be shown to have some, albeit small or indirect, application to a
relevant patient problem or clinical situation.
2. Adults are interested in learning concepts and principles; they
like to solve problems rather than just learn facts.
This issue has been recently addressed in the Report of the Panel
on the General Professional Education of the Physician (the GPEP
Report, 1984). Medical education suffers terribly under the weight
of unrelated, and often relatively useless, facts. As medical
knowledge expands, so does the density of the medical education
process, often to the detriment of the problem-solving and clinical
reasoning skills of future physicians. Clinical teachers, by
emphasizing use, rather than mere retention, of facts will not
contribute to what is already recognized as a major problem by
national authorities.
3. Adults like to participate actively in the learning process by

helping to set appropriate learning objectives.
How can students and residents possibly know what they need to
know? The teacher, of course, possesses considerable knowledge
and experience that learners do not. However, the teacher should
negotiate with learners regarding appropriate educational
objectives, given certain needs, resources, and overall goals. This
has a remarkably positive effect on learner motivation!
4. Adults like to know how well they are doing, feedback should
help them evaluate their own progress.
Feedback for the sake of improving performance is called

formative evaluation. Medical education offers numerous
opportunities for making decisions about competence, promotion
or advancement, called summative evaluation (Scriven, 1967).
However, clinical teachers have a critical role to play in making
comments, particularly negative ones, that will help a learner
change a professional behavior, make a better decision or perform
a skill more precisely. These pieces of personal, well intentioned
feedback are the critical elements for cementing a teacher-learner
relationship and bringing closure to the learning process.
Conclusion
Clinical teaching is an intense personal and interpersonal

experience. Certain rules and principles govern the roles that
teachers and learners assume and the ways that they play out these
roles together. This educational "drama" is complex and requires
considerable enthusiasm and commitment on the part of both
teacher and learner.

Clinical Teaching: Submitted By: Pandangan, Ibn-Kathier P. Panotolan, Ashim C

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CLINICAL

The Role of the Teacher

As a Teacher, the medical educator is acutely aware of the needs and

As a Supervisor, the medical educator demonstrates procedures,

The Role of the Learner

What do learners bring to the relationship? Bradford (1958) notes that

3. The Independent Students - These learners are often older than

4. The Sniper Students - These learners are uninvolved due to a low

5. The Silent Students - These learners are characterized by what they

Learners bring startlingly different needs and agendas to their interaction

Conditions for Effective Learning

This rule is broken somewhat less in clinical teaching than in other

3. Adults like to participate actively in the learning process by

Feedback for the sake of improving performance is called

Clinical teaching is an intense personal and interpersonal

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