As a new registrar, one of the biggest challenges I have had to overcome is teaching others. I don’t think I fully appreciated the additional skills that would be required when teaching at a higher level. For example, it’s a lot more difficult to teach a more complex procedure than a simple one, especially when you’re only just starting to feel competent at the procedure yourself! Knowledge thirsty SHO’s fresh from their clinical exams can really test you with questions on a morning ward round and additional time pressures on reaching registrar level can make teaching medical students more of a chore than anything else.

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Recently I was teaching a group of medical students when I noticed one of them was continuously looking at Facebook on his phone throughout the session. Initially I was a little annoyed at him for wasting my time. On reflection, I had just worked a long day weekend and didn’t want to be there myself. I was droning on about the various causes of anaemia in children via a wordy power point presentation. I probably wouldn’t have wanted to listen to me either!

The word doctor was originally derived from the latin verb ‘to teach’ and teaching others is integral to our training and continuing professional development. It is an important component of our paediatric curriculum and an expected competency that we must achieve.

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However it is not a skill that comes naturally to everyone and I do not recall at any time receiving any formal training in teaching, either at medical school or during my paediatric training. I have tried to go on a “Teaching Techniques’ course within my deanery but they are inevitably oversubscribed, or don’t fit in with my rota commitments.

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A study from the West Midlands in 2008 identified that paediatric registrars play an important role in teaching junior trainees and medical students and that registrar enthusiasm for teaching was prevalent. However many factors were felt to be inhibitory to teaching including ‘being too busy’, ‘difficult shift patterns’, inexperience’ and ‘lack of confidence. Formal training in teaching was identified as a particular need in this population, whether through increasing study budgets or teaching-orientated regional SPR study days.

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After several below par medical student teaching sessions, I began to think about what makes a good teacher and started to do a little research.  The first point that really hit me was that one of the most important characteristics of being a great teacher is enthusiasm.

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When I think about the various teachers I have had throughout my career, it’s the overly animated, arm waving, energetic ones who I remember. They clearly wanted to be there and enjoyed teaching me and therefore I felt valued and enjoyed listening to them.

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Another theme that emerged was that of ‘respect’ for the student and the concept of a two-way teacher-student relationship. Nobody want’s to be preached at continuously and there’s a lot we can learn from those we teach. Learning needs to be a two way process where students are encouraged to ask questions and voice their opinions in a supportive environment. Positive achievements should be recognised and celebrated. Feedback from our students is also essential in helping us learn from each teaching experience and should be actively sought.

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Sir William Osler, a Canadian doctor and the father of bedside teaching famously quoted;

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“No man can teach successfully who is not at the same time a student”.

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This quote reflects the need for good teachers to show a passion for life long learning themselves. When that clever SHO asks you a question you don’t know the answer to, why don’t you say “I don’t know but let’s find out” and look it up together?

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In clinical environments, students and junior colleagues are often present throughout the day and not just at teaching sessions and therefore are constant witness to our behaviour. Most of the doctors who I recognise as excellent clinical teachers are actually excellent clinicians and help others learn solely through their own example of good practice.

Below are a few useful techniques I’ve learnt. Feel free to try them out and let me know what you think, or share your own tried and tested methods.

1. Try not using powerpoint…or at least not putting words in your powerpoint (unconventional I know!) I’ve done a few presentations where I’ve used only pictures as prompts for what I wanted to say. These went really well as people were actually listening to every word I said rather than reading the slides.

2. When teaching practical procedures, don’t forget the detail and take it step by step. Don’t take for granted that the person you are teaching knows how to set up the trolley or attach a three way tap for example. It helps to run through the procedure verbally prior to starting and to ask the person to repeat what they’re going to do back to you.

3. Off the cuff teaching can be fantastic if you know the topic well. If you’re not too sure, arrange a time to teach the following day and prepare your key teaching points, maybe doing a bit of back ground reading to ensure you’re teaching the relevant and right stuff.

4. Get the medical students to teach each other and everyone else. Ask them to put together a presentation on a paediatric topic. It’ll help them learn and also to acquire those valuable teaching skills that they will need throughout their career.

5. Remember, you’re also learning as you’re teaching. To be a good teacher takes time, practice and a great deal of patience.

 

Further Reading
What Makes A Great Clinical Teacher in Pediatrics? Lessons Learned From The Literature- Susan L. Bannister, William V. Raszka, Jr and Christopher G Maloney. Pediatrics 2010: 125;863

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It’s Not Just What You Know: The Non-Cognitive Attributes of Great Clinical Teachers- Robert A Dudas, MD and Susan L.Bannister MD. Pediatrics 2014: 134;852

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Specialist Registrars’ Views On Their Teaching Role- T Bindal, D Wall and H M Goodyear. Arch Dis Child 2009- 94: 311-313

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