Teaching

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

PHTLS Instructor CoursePHTLS Instructor Course

The Teaching–Learning Transaction

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2

PurposePurpose

To prepare entry-level PHTLS instructors To prepare entry-level PHTLS instructors to teach and evaluate cognitive and to teach and evaluate cognitive and

psychomotor skills in PHTLS coursespsychomotor skills in PHTLS courses


ObjectivesObjectives

As a result of active participation in this As a result of active participation in this lesson you should be able to:lesson you should be able to: Discuss classroom and skill station activities that Discuss classroom and skill station activities that

enhance the teachingenhance the teaching––learning transaction in learning transaction in PHTLSPHTLS

Apply principles of adult learning to PHTLSApply principles of adult learning to PHTLS


ObjectivesObjectives

As a result of active participation in this As a result of active participation in this lesson you should be able to:lesson you should be able to: Correlate PHTLS course objectives with different Correlate PHTLS course objectives with different

methods of teachingmethods of teaching Discuss considerations in evaluating and providing Discuss considerations in evaluating and providing

feedback to course participantsfeedback to course participants


OverviewOverview

Learning, teaching, and the relationship Learning, teaching, and the relationship between thembetween them

LectureLecture––discussion and interactive discussion and interactive presentation of PHTLS lecturespresentation of PHTLS lectures

Teaching skills and effective presentation of Teaching skills and effective presentation of PHTLS skills stationsPHTLS skills stations

Evaluation: written and practicalEvaluation: written and practical


LearningLearning

The reconstruction and reorganization of The reconstruction and reorganization of experience, which increases our ability to experience, which increases our ability to

direct further experiencedirect further experience

Construction of meaning from experienceConstruction of meaning from experience


TeachingTeaching

Instruction or contribution to the development Instruction or contribution to the development of othersof others

Skillfully arranging the learning experienceSkillfully arranging the learning experience Identifying and using “teachable moments”Identifying and using “teachable moments”


Teaching and LearningTeaching and Learning

PHTLS courses involve a teachingPHTLS courses involve a teaching––learning learning transaction between the instructor and the transaction between the instructor and the course participantscourse participants


Three Domains of LearningThree Domains of Learning

CognitiveCognitive Knowing Knowing whatwhat

PsychomotorPsychomotor Knowing Knowing howhow

AffectiveAffective Attitude toward contentAttitude toward content


Cognitive Domain LevelsCognitive Domain Levels

At what level should participants operate?At what level should participants operate? KnowledgeKnowledge ComprehensionComprehension ApplicationApplication AnalysisAnalysis SynthesisSynthesis EvaluationEvaluation


Psychomotor Domain LevelsPsychomotor Domain Levels

Practice and experience are needed to Practice and experience are needed to progress from level to levelprogress from level to level ImitationImitation ManipulationManipulation PrecisionPrecision ArticulationArticulation NaturalizationNaturalization


Affective Domain LevelsAffective Domain Levels

Best way to teach is through role modelingBest way to teach is through role modeling ReceivingReceiving RespondingResponding ValuingValuing OrganizationOrganization CharacterizationCharacterization


Readiness to LearnReadiness to Learn

Must value the role of EMS in the care of the Must value the role of EMS in the care of the trauma patienttrauma patient

Must recognize the gap between actual Must recognize the gap between actual performance and what is expectedperformance and what is expected Role of baseline evaluations and pretestingRole of baseline evaluations and pretesting


Appealing to Learning StylesAppealing to Learning Styles

Preferred method of receiving and processing Preferred method of receiving and processing informationinformation

Many theories and models of learning stylesMany theories and models of learning styles


Appealing to Learning StylesAppealing to Learning Styles

Perceptual modalitiesPerceptual modalities AuditoryAuditory VisualVisual KinestheticKinesthetic


Hemispheric DominanceHemispheric Dominance

Left BrainLeft Brain VerbalVerbal AbstractAbstract

• Conceptual; uses Conceptual; uses symbolssymbols

LinearLinear• Sequential/cause and Sequential/cause and

effecteffect

RationalRational• Uses logicUses logic

Right BrainRight Brain NonverbalNonverbal ConcreteConcrete

• ExperienceExperience

• ““Big picture”Big picture”

NonlinearNonlinear• Thinks metaphoricallyThinks metaphorically

NonrationalNonrational• IntuitiveIntuitive


Adult LearnersAdult Learners

Motivated by the need to knowMotivated by the need to know Need to be self-directingNeed to be self-directing Adults have experiencesAdults have experiences

Foundation or barrier?Foundation or barrier?


TeachingTeaching

Instruction or contribution to the Instruction or contribution to the development of othersdevelopment of others

Skillfully arranging the learning experienceSkillfully arranging the learning experience Methods:Methods:

Lecture-discussionLecture-discussion QuestioningQuestioning DemonstrationDemonstration Guided practiceGuided practice


The goal of teaching is to design The goal of teaching is to design and deliver instruction that will fill and deliver instruction that will fill

the gap.the gap.

Less Knowledge

Teaching–Learning Transaction

More Knowledge


Lecture/DiscussionLecture/Discussion

Efficient way to deliver information to a large Efficient way to deliver information to a large group group

Lecture alone is less effective than Lecture alone is less effective than lecture/discussionlecture/discussion Learners must be engagedLearners must be engaged

Discussion is facilitated by questioningDiscussion is facilitated by questioning


The LecturerThe Lecturer

Educate or edutain?Educate or edutain? Knowledge alone does not make a good Knowledge alone does not make a good

lecturerlecturer Charisma alone does not educateCharisma alone does not educate Lecturer needs to be dynamic Lecturer needs to be dynamic and and

informationalinformational


Lecture KeysLecture Keys

Know your audienceKnow your audience Know where change needs to occurKnow where change needs to occur Direct your lecture toward meeting audience Direct your lecture toward meeting audience

needsneeds Stay focused on the objectivesStay focused on the objectives Reinforce important pointsReinforce important points


Lecture Preparation

Read the chapterRead the chapter Review the content outline and slidesReview the content outline and slides Practice, practice, practicePractice, practice, practice

Timing and deliveryTiming and delivery Avoid reinforcing mistakes by practicing to Avoid reinforcing mistakes by practicing to

correct themcorrect them


Preparing YOUR Lecture

Add your notes to the teaching outlineAdd your notes to the teaching outline Include possible questions to askInclude possible questions to ask

Integrate the lecture material with the Integrate the lecture material with the slidesslides Don’t read from the slides Don’t read from the slides

Being unprepared showsBeing unprepared shows


Successful Lecture

Keep key points to a minimumKeep key points to a minimum Summarize often for emphasisSummarize often for emphasis It’s okay not to know it It’s okay not to know it allall

Be prepared at a level higher than you will be Be prepared at a level higher than you will be presentingpresenting

Know what resources exist that could answer Know what resources exist that could answer participants’ questionsparticipants’ questions


Interactive PresentationInteractive Presentation

LessonsLessons Case-based Case-based Facilitate participant interactionFacilitate participant interaction

Lesson plansLesson plans PowerPoint speaker notesPowerPoint speaker notes Printed lessons in the Instructor’s ManualPrinted lessons in the Instructor’s Manual


Interactive PresentationInteractive Presentation

Using the lesson plansUsing the lesson plans Critical in delivering content sequentially and Critical in delivering content sequentially and

interactivelyinteractively Take advantage of built-in featuresTake advantage of built-in features Solicit answers to built-in questionsSolicit answers to built-in questions Be prepared with follow-up questionsBe prepared with follow-up questions Allow opportunity to answerAllow opportunity to answer


Use of FeaturesUse of Features

PowerPoint notes (with some Windows XP™ PowerPoint notes (with some Windows XP™ operating systems)operating systems) ““Slide show”Slide show” ““Set up show”Set up show” ““Show presenter view”Show presenter view”


Lecture TechniquesLecture Techniques

RelaxRelax——find a few friendly faces to focus onfind a few friendly faces to focus on Involve the studentsInvolve the students Be comfortable with not knowing everythingBe comfortable with not knowing everything Vary the pace and pitch of your deliveryVary the pace and pitch of your delivery Maintain eye contactMaintain eye contact Avoid distractionsAvoid distractions


Why Use Questions?Why Use Questions?

Stimulate interest in the topicStimulate interest in the topic Determine knowledge and experienceDetermine knowledge and experience Stress key pointsStress key points Generate discussionGenerate discussion Stimulate reflectionStimulate reflection Stimulate critical thinkingStimulate critical thinking


Successful Questioning

Give the participant time to answerGive the participant time to answer Don’t allow one participant to dominateDon’t allow one participant to dominate Reinforce correct answersReinforce correct answers

Ask the participant to repeat what was said for Ask the participant to repeat what was said for emphasis, oremphasis, or

Rephrase the participant’s answerRephrase the participant’s answer


Guidelines for QuestioningGuidelines for Questioning

Provide a frame of referenceProvide a frame of reference Prompt the answer if necessaryPrompt the answer if necessary Anticipate possible responses and be able to Anticipate possible responses and be able to

redirect in a positive mannerredirect in a positive manner Be specificBe specific Use both closed-ended and open-ended Use both closed-ended and open-ended

questionsquestions


Open-Ended QuestionsOpen-Ended Questions

Can you give me an example?Can you give me an example? What do you mean by . . . ?What do you mean by . . . ? Where would that lead? What would be the Where would that lead? What would be the

consequences?consequences? What would we have to assume for things to What would we have to assume for things to

work out that way?work out that way? What are some other possibilities?What are some other possibilities?


Open-Ended QuestionsOpen-Ended Questions

How do you know that’s right?How do you know that’s right? Would you do the same thing the next time? Would you do the same thing the next time?

Why/Why not?Why/Why not? Why do you say that?Why do you say that?


Managing the Lecture EnvironmentManaging the Lecture Environment

LightingLighting MicrophonesMicrophones AV equipment and materialsAV equipment and materials NotesNotes TemperatureTemperature


Matching Instructors with LessonsMatching Instructors with Lessons

Choose lectures and skills for which you are Choose lectures and skills for which you are well-prepared and that match your abilitieswell-prepared and that match your abilities


Teaching and Learning SkillsTeaching and Learning Skills

Transfer of skills is enhanced by a realistic Transfer of skills is enhanced by a realistic context for demonstration and practicecontext for demonstration and practice

Before demonstration participants should Before demonstration participants should know:know:

What is to be doneWhat is to be done Why it is to be doneWhy it is to be done When it is to be doneWhen it is to be done



Whole-part-whole presentation facilitates Whole-part-whole presentation facilitates learninglearning Demonstrate the skill in real time Demonstrate the skill in real time Demonstrate and discuss the skill step-by-step Demonstrate and discuss the skill step-by-step Demonstrate the skill in real timeDemonstrate the skill in real time



Stages of psychomotor learningStages of psychomotor learning Acquisition of prerequisite knowledgeAcquisition of prerequisite knowledge Learning each step of the skillLearning each step of the skill Transferring control of task from the eyes to Transferring control of task from the eyes to

kinesthetic movementskinesthetic movements Automatization of the skillAutomatization of the skill Generalization of the skillGeneralization of the skill


Giving FeedbackGiving Feedback

Except in final and baseline stations, correct Except in final and baseline stations, correct errors immediatelyerrors immediately

Focus on the performance, not the personFocus on the performance, not the person Provide a rationale and state how the Provide a rationale and state how the

performance was different than the desired performance was different than the desired performanceperformance

Make suggestions for approaching the skillMake suggestions for approaching the skill


Skills StationsSkills Stations

Stay on task (do not lecture)Stay on task (do not lecture) Adhere to rotation schedule Adhere to rotation schedule Recognize importance of principles over Recognize importance of principles over

preferencespreferences Emphasis: Emphasis:

Every participant has hands-on skills practiceEvery participant has hands-on skills practice


Skill StationsSkill Stations

Know station goalKnow station goal Have equipment present; in working orderHave equipment present; in working order Have enough equipment for all groupsHave enough equipment for all groups Ensure presence of a “patient”: coached in Ensure presence of a “patient”: coached in

advanceadvance Address safety concernsAddress safety concerns


Skill Stations

DeliveryDelivery Orient participants to the skill stationOrient participants to the skill station Participants demonstrate the skillParticipants demonstrate the skill Correct errors immediatelyCorrect errors immediately

• We learn what we doWe learn what we do

Give feedback and positive reinforcementGive feedback and positive reinforcement Practice, practice, practicePractice, practice, practice


Final Evaluations: PurposeFinal Evaluations: Purpose

What does the PHTLS card mean?What does the PHTLS card mean?


Written ExaminationWritten Examination

Examination is prepared from a table of Examination is prepared from a table of specifications based on PHTLS core measurable specifications based on PHTLS core measurable itemsitems

ConsiderationsConsiderations Representative sample of knowledgeRepresentative sample of knowledge Difficulty of itemsDifficulty of items Relationship of items to critical trauma management Relationship of items to critical trauma management

knowledgeknowledge Multiple item-writers and reviewersMultiple item-writers and reviewers


Written ExaminationWritten Examination

What is considered “passing” on the written What is considered “passing” on the written exam?exam?

Remediation/retestingRemediation/retesting Annotated exam copyAnnotated exam copy


Final Evaluation StationsFinal Evaluation Stations

Give clear directionsGive clear directions Observe carefully but unobtrusivelyObserve carefully but unobtrusively Recognize importance of principles over Recognize importance of principles over

preferencespreferences Emphases:Emphases:

Allowing participants to demonstrate what they Allowing participants to demonstrate what they have learned in the coursehave learned in the course

Assessing participants’ strengths and areas Assessing participants’ strengths and areas needing further developmentneeding further development


Final Station ScenariosFinal Station Scenarios

PreparationPreparation Know the station flowKnow the station flow Have equipment present; in working orderHave equipment present; in working order Have enough equipment for all groupsHave enough equipment for all groups ““Patient”: present, moulaged, coachedPatient”: present, moulaged, coached Know the critical errorsKnow the critical errors Address safety concernsAddress safety concerns


Final Practical EvaluationFinal Practical Evaluation

Inter-rater reliabilityInter-rater reliability Will two examiners watching the same Will two examiners watching the same

performance give the same score?performance give the same score? Intra-rater reliabilityIntra-rater reliability

Will a single examiner score identical Will a single examiner score identical performances the same way every time?performances the same way every time?

BiasBias



Intra-rater reliabilityIntra-rater reliability We all have biases that affect our decisionsWe all have biases that affect our decisions Consciously or unconsciouslyConsciously or unconsciously Evaluate the performance, not the personEvaluate the performance, not the person Always ask:Always ask:

• Would I evaluate every other participant the same as I am Would I evaluate every other participant the same as I am evaluating this participant for this performance?evaluating this participant for this performance?



Inter-rater reliabilityInter-rater reliability Valuing principles over preferencesValuing principles over preferences Scoring instrumentScoring instrument

• Can the written criteria be interpreted too broadly or too Can the written criteria be interpreted too broadly or too narrowly?narrowly?

Increasing inter-rater reliabilityIncreasing inter-rater reliability• Examiners have common understanding of principles Examiners have common understanding of principles

and the instrumentand the instrument



Inter-rater reliabilityInter-rater reliability Video exerciseVideo exercise



DeliveryDelivery Know the scenarioKnow the scenario Stay where you can seeStay where you can see If participants don’t do it, it isn’t doneIf participants don’t do it, it isn’t done Real time is keyReal time is key Be consistent with all groupsBe consistent with all groups Have extra equipment availableHave extra equipment available



KeysKeys Let the patient give as much information as Let the patient give as much information as

possiblepossible——the patient the patient makesmakes the station the station



Know what is passingKnow what is passing Encourage participants to evaluate themselvesEncourage participants to evaluate themselves Give feedback according to timeGive feedback according to time Give feedback based on critical error criteria; both Give feedback based on critical error criteria; both

positive and negativepositive and negative Don’t be afraid to re-evaluate someoneDon’t be afraid to re-evaluate someone


Learning SummaryLearning Summary

We learn when we recognize and value the We learn when we recognize and value the need to knowneed to know

We have different preferred methods for We have different preferred methods for receiving and processing informationreceiving and processing information

We learn in three different domainsWe learn in three different domains


Learning SummaryLearning Summary

Learning occurs as a result of reflection on Learning occurs as a result of reflection on experiencesexperiences

We must have an experience that can be We must have an experience that can be connected to prior experiences connected to prior experiences


Teaching SummaryTeaching Summary

Teaching is skillfully arranging the learning Teaching is skillfully arranging the learning experienceexperience

Focus on gapsFocus on gaps Lecture should be enhanced by questions Lecture should be enhanced by questions

and discussionand discussion Be prepared and organizedBe prepared and organized



Engage participants in the teaching-learning Engage participants in the teaching-learning transactiontransaction

Skills are learned best in contextSkills are learned best in context Correct errors immediatelyCorrect errors immediately Give feedback to improve performanceGive feedback to improve performance



Match instructors’ strengths to the lessonsMatch instructors’ strengths to the lessons Use lesson plan features for interactivity Use lesson plan features for interactivity Later versions of PowerPoint™ and Later versions of PowerPoint™ and

Windows™ allow presenter to view notes on Windows™ allow presenter to view notes on computer screen while projecting slidescomputer screen while projecting slides


Evaluation SummaryEvaluation Summary

Final evaluations serve to allow participants Final evaluations serve to allow participants to demonstrate increased knowledge of to demonstrate increased knowledge of trauma managementtrauma management

Annotated written evaluationsAnnotated written evaluations Increasing validity of practical evaluationsIncreasing validity of practical evaluations


Teaching TechniquesTeaching Techniques

Questions?Questions?


Prepared, enthusiastic Prepared, enthusiastic instructors create a positive, enjoyable instructors create a positive, enjoyable environment for the teachingenvironment for the teaching––learning learning

transaction.transaction.

Education

Teaching