APPRAISING MY ‘IMPROMPTU WARD-BASED TEACHING’

Dr Colin MitchellMSc Geriatric MedicineJune 2009

Choosing a Topic

I know some of my strengths as a teacher: Can explain complex concepts Keen to teach

And I’m aware of my weaknesses Prone to long-windedness Can over-elaborate

I already know to concentrate on the known weaknesses But are there any issues that I’m not fully aware of?

Is this right?

Previous 360o feedback ‘Can be intimidating’

Really? Jars with my self-image Could interfere with a conducive learning

environment

The MSF - Keeping it simple

Aim to focus on the learning environment Is the environment conducive to learning?

Relaxed / Intimidating Is some pressure a good thing?

Further focus on one skill: ward-based teaching (WBT) Multiple exposures, multiple sources of feedback

Just F1s

Assessing Educational Environment

DREEM - Dundee Ready Educational Environment Measure*

50 Questions – agree / disagree

Based on instruments in use for 40 years Designed by 80+ experts using the Delphi process Statistically validated to focus on reliable / discriminatory

elements

Used worldwide to assess medical school teaching (PHEEM)

*Roff et al, 1997. “Development and validation of the DREEM. Medical Teacher 19:4, 205-209

Refining the Quantitative

Principles of choosing the items*: Relevant Clear, concise, focused and simple Some balance of +ve and –ve (DREEM 82% +ve)

Chose 7 from DREEM (slightly adapted) Added 4 of my own Some concordance, not repetition 8 +ve, 3 -ve

*Adapted from Berk (2006), 13 Strategies to Measure College Teaching. Stylus: Virginia

Choosing the scale

DREEM uses 5-point bipolar ‘intensity’ anchors: Strongly Agree Agree Uncertain Disagree Strongly disagree

Simple but allows a breadth of response Still sufficiently granular & simple Balanced (✔) and has a midpoint (?✔)

Defining the Qualitative

Opportunity to explore particular issues more fully

Correlate with quantitative themes

Concepts:

Questions:

Strengths

Weaknesses

Context

Suggestions

Defining the Qualitative

Opportunity to explore particular issues more fully

Correlate with quantitative themes

Concepts:

Questions:

Strengths What are the strengths of my WBT?

Weaknesses

What do you like LEAST about my WBT?

Context How does the pressure of on-the-spot quizzing affect you?

Suggestions

Every teacher can improve his skills – how would you suggest I improve my WBT?

Making it anonymous - online

MSF in UK training – anonymous. In industry – 97% anonymous “Maintaining the anonymity of the rater’s feedback is key to the

process. Just as a tie to compensation can lead raters to soften their ratings, so can a lack of anonymity”*

“…when peer assessment is used in a high stakes setting, it results in inflated estimates of performance... There is no way to completely avoid this issue but it may help to ensure the anonymity of evaluators”**

Online forms preserve anonymity - This can be made clear in the MSF

Rogers E et al, 2002. “Improving the Payoff from 360-Degree Feedback”. Human Resource Development. 25: 44-54**Norcini J, 2003. “Peer assessment of competence”. Medical Education. 37(6): 539-543

Validation

Cannot empirically validate without significant resources Using 7 items from the DREEM – pre-validated

My own questions must be logically validated Representative pilot Sent to 5 SHOs. 4 replied with comments

(unstructured) Minor adjustments made to wording, stressing

anonymity

RESULTS

Question Scores (Fractions of 100%)

Stimul

atin

g

Teac

her Cen

tred

Probl

em S

olving

Good

Feed

back

Knowle

dge

Expl

ains

Con

cept

s

Appro

acha

ble

Ridicul

e

Relax

ed a

tmos

pher

e

Respe

cts

Intim

idat

ing

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1234

Scoring

For negative aspects the score is reversed Therefore: Higher score is a good thing

Response Positive

Negative

Strongly agree 4 0

Agree 3 1

Uncertain 2 2

Disagree 1 3

Strongly Disagree 0 4

Free Responses (1)

What are the strengths of my ward-based teaching? When a situation arises you take time to discuss the

case (23/44*)

Enthusiastic and approachable… make[s] the learner think the problem through in a logical manner (30/40)

…instead of just giving an answer, you get us to think through the problem and help us work out the solution ourselves (24/44)

*Commenter’s overall score for quantitative elements shown in parentheses

Free Responses (2)

What do you like LEAST about my style of ward-based teaching? (Only 5/11 replied) Sometimes assume too much which can be

uncomfortable (20/40)

Sometimes can go into a lot of depth for too long (26/44)

… on some occasions it would be easier to get an answer, especially when it gets busy, but I would not learn as well… (24/44)

Sometimes it becomes a little didactic (25/44)

Free Responses (3)

How does the pressure of on-the-spot quizzing affect your learning (+vely or –vely)? (In the US, “Pimping” generally viewed positively*)

8/11 were generally positive, 2 didn’t answer Only negative response:

Too pressurizing and can be intimidating and lead to not wanting to ask for teaching (29/44)

*Wear D et al, 2005. “Pimping: perspectives of 4th year medical students”. Teaching and Learning in Medicine. 17(2) 184-191

Free Responses (4)

Every teacher can improve his skills – how would you suggest I improve my ward-based teaching? Be a bit more aware of when people have got lost in your

explanations (20/40)

You are a good teacher and have a lot of knowledge, but could improve by talking more succinctly and not rambling (26/44)

There is very little to improve on, your teaching is excellent (25/44)

I think sometimes you loose [sic] the balance and focus too much on teaching rather than seeing the patients… and thus even though your teaching is good, you are not setting a good example for juniors (28/40)

ANALYSIS

Robust?

Some basic statistical analysis of average total score: Median = average (59%, around a 2.5) 95% CI: ±19%

Some observations can be made: Lower scorers more likely to give a critique in the

weaknesses question Poor correlation between ridicule / intimidating / relaxed

questions.

The lowest scorer commented: “the relaxed manner of teaching is definitely a good approach” He/she also disagreed with the ‘relaxed atmosphere’

item (?)

Findings – My Teaching

Quantitative results Overall positive (59% compares with DREEM results) I can be intimidating

Yet the atmosphere is generally relaxed (=3rd highest scoring item)

3 comments specifically mentioned friendly / approachable

Themes emerging from qualitative results Rambling / long-windedness

Correlates with ‘teacher-centred’ Few negative comments about atmosphere

Only one comment directly mentioned ‘intimidating’ or synonyms.

Also note comment about assuming too much = ‘uncomfortable’ This rater also agreed with both the intimidate and ridicule questions

Findings – The Process

Getting good feedback is more difficult than it seems

Despite: Limiting scope Using validated questions Piloting Anonymous data entry

The results didn’t tell me much I didn’t already know Partially corroborated ‘intimidating’ problem Confirmed ‘long-winded’ problem

ASSIMILATION

Borg Cube by Martin Teufel - http://www.infosun.fim.uni-passau.de/br/lehrstuhl/Sommercamp/virtualworld/2005/galerie/

How I see myself

Image from http://www.theinsider.com/photos/1079058_TOM_CRUISE_FOR_TOP_GUN_2. Top Gun - Paramount Pictures.

How I see myself

YOU BOY!

What I need to avoid:

Val-de-ree! Val-de ha ha ha ha ha ha!

Further Actions

I may not be intimidating to most… But clearly a few may find me so How do I know who they are? What do I do about it?

Design my own feedback forms for my teaching sessions Add demographics Push for free-text responses

Don’t be afraid of constructive criticism Criticism is worst when I don’t know how to fix the

problem

Links:

Email: drcolinmitchell@gmail.com

http://colinsmededblog.blogspot.com

Twitter: @drcolinmitchell

Questions?

http://obamicon.pastemagazine.com