careers
Essential
teaching skills
Once doctors were simply expected to “see one, do
one, teach one,” but teaching doesn’t come naturally to
everyone. Catherine Gray and Patsy Stark explain how
to do it better
We all know that a good teacher can inform and inspire
even the most unenthusiastic of learners, just as a bad one
can put you off the subject for life. Given that the word
“doctor” comes from the Latin docere, meaning “to teach,” a
doctor equipped with the skills to be a good teacher is often
a surprisingly rare find.
Medical students learning skills for teaching is not a new
concept to medical education in the United Kingdom. It
is specified repeatedly in the General Medical Council’s
Tomorrow’s Doctors, first released in 1993, that all medical
undergraduates should possess the skills required to
teach medical students and colleagues by the time they
graduate.w1 This requirement continues throughout your
career. But the GMC’s The Doctor as Teacher acknowledges
that for many people teaching skills are “not necessarily
innate.” w2 The latest Good Medical Practice document
reiterates that you should be “willing to contribute
to [teaching] activities” and that students involved in
teaching “must develop the skills, attitudes, and practices
of a competent teacher.”w3
Despite the huge value of the skills of teaching to
the future of medicine there is still little opportunity to
develop vital skills within the curricular constraints at
many medical schools. However, without basic training
in teaching skills at undergraduate level, it cannot realis-
tically be expected that, come graduation day, students
without a natural flair will spontaneously be able to show
the necessary skills, attitudes, and practices required of a
competent teacher.
Because of these restrictions, medical students often turn
to their extracurricular activities to show particular skills to
future employers—not only teaching ability but also other
generic skills, such as communication, leadership, and
teamwork. For example, Sexpression UK is a nationwide
initiative led by medical students that provides sex education
to high school and college students.w4 Members are given
basic training in teaching skills at an interactive workshop
and through use of a training manual before having their
teaching performance assessed by peers in a school. Acting
as a Sexpression facilitator will be extremely useful for
students in their future careers.
Although the ability to teach is not something that comes
naturally to everyone, the skills required to plan, facilitate,
and evaluate a teaching session are potentially attainable by
all. The following tips will help you on your way to truly
earning the title doctor.
Box 1: Before a teaching session
v What is to be the topic of the session?
v What do the students already know about the topic?
v What are the aims and objectives?
v Which teaching methods will I use to ensure the
objectives are met?
v How will I determine if the session has worked?
student.bmj.com
Plan a teaching session
As a student, running tutorials or revision sessions for
students in the lower years can be a valuable learning experi-
ence for everyone, with opportunities for you to impart your
ever growing knowledge that is increasing over time.w5 w6
As a doctor, you may not always have time to prepare
formally for your teaching, but consider the questions in box
1 before delivering a session.
Setting aims and objectives
A useful way of gauging students’ understanding is to set
aims and objectives before or at the start of a session, which
the students can then approve or amend, ensuring that
you are all on the same wavelength and heading towards
achieving the same learning goals.w6 w7
An aim is the term used to describe the overall purpose
of a session or course. This statement should be general in
nature and put the associated objectives in context, giving
a sense of direction. The aim may cover a broad range of
subjects or topics and involve long term learning outcomes.
For example, “The aim of this lesson is to provide informa-
tion about contraception and contraceptive services in
Sheffield and to encourage changes in behaviour with regard
to contraceptive use.”
An objective is what the students will have achieved by
the end of the session. These take the form of specific action
statements, each containing only one learning outcome.
Unlike an aim, objectives should be SMART—that is,
specific, measurable, achievable, relevant, and time limited.
For example, “By the end of this lesson, the student will be
able to list the various types of contraception; have a basic
understanding of how each contraceptive works; identify
their local family planning service; and show how to use a
condom safely using a model.”
Choose a teaching method
Once everyone is clear as to the purpose and goals of the
session, then it is up to you to decide how you want to
run the session and what teaching methods you will make
use of to allow for the best learning experience for your
students w6 w8 w9 There are two main roles to choose from,
teacher or facilitator, each with benefits and restrictions.
Didactic teaching
Didactic teaching involves spoken instruction and is often
used to convey a substantial volume of information to
a large audience at one time. Teachers are central to this
method of teaching because they control the content
and layout of the entire session. Learning is generally
passive, by watching and listening during the lecture, but
students also have the opportunity to make notes for use
in future learning.
Didactic teaching can be complemented by the use
of teaching aids—for example, handouts, worksheets, or
audiovisual material. The ABC of Learning and Teaching
in Medicine gives a useful overview of how to produce
effective teaching materials. w10 If done well, didactic
teaching can allow the teacher to communicate a large
amount of information in a clear, concise, and systematic
manner. But because an audience’s attention is difficult to
hold for more than 20 minutes at a time without a change
in activity, didactic teaching is best used to introduce a
topic that will be explored further using other methods or
self directed study.
Teaching in small groups
Teaching in small groups is often similar to didactic
teaching. But the advantage of learning in a small group
is that a predominantly passive style of learning can be
avoided because fewer students means more interaction
between teachers and students. This form of teaching is
the essence of a ward or clinic based tutorial, at which the
teacher can impart knowledge that is also consolidated by
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careers the student by asking and answering questions.
The teacher’s role within a small group need not always
be that of “teacher.” “Facilitating” a small group involves
encouraging individuals within the group to partici-
pate in discussion on a particular topic. Students learn
actively through their interaction, exploring the topic and
developing ideas within the group as well as challenging
any preconceived beliefs.
The role of the teacher is as facilitator to the discus-
sion, guiding the group through difficulties, as opposed
to contributing to the group or providing formal teaching.
This form of learning, with or without a designated facili-
tator, is becoming increasingly popular with medical
schools worldwide, often using problem based scenarios.
Many techniques can be used to facilitate learning in a
small group (box 2).
Small group teaching is best used to consolidate
learning after didactic teaching or to exchange thoughts
and ideas on a subject of which all group members have
some degree of prior knowledge. If well facilitated, it
allows students to develop skills in interaction, collabora-
tion, and leadership, as well as allowing them to actively
participate in their learning. However, it is vital that facili-
tators are aware of group dynamics and their role within
the group.
Teaching practical skills
Teaching a practical skill requires a different approach from
that involving purely knowledge and attitudes. For teaching
manual skills in simulation, the Royal College of Surgeons
recommends the “silent run through”w7:
v The teacher demonstrates the task at normal speed,
without commentary
v The teacher demonstrates the task slowly, talking
through each step
v The student talks through each step while the teacher
carries out the task
v The student carries out the task, talking through
each step.
It is important to give students the opportunity to ask
questions and to observe them throughout the procedure,
so that you can feed back on what they are doing correctly
or incorrectly.
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Box 2: Small group techniques
• Rounds—The facilitator asks each member of the
group in turn to respond to a particular prompt or
question. This is a useful icebreaker, particularly to
learn names in a new group, as well as allowing the
teacher to assess the knowledge of a group
• Buzz groups—The facilitator gives pairs, threes, fours,
or larger subdivisions of the group small timed tasks
to complete together. Each group can share their
outcomes with the class using feedback, a flip chart
poster, or an overhead, etc
• Fishbowls—This involves splitting into two groups,
an inner and an outer circle. Students in the inner
circle are given a task—for example, a role play or
skill demonstration—and the outer circle observes.
After a time, the outer circle replaces the inner circle.
Members of the outer circle can also feed back to the
inner circle
• Brainstorming—The facilitator introduces a question
or task to the group to stimulate ideas and then
records all the suggestions on a board. This method
is useful for starting a topic or for giving feedback.
Evaluation
Feedback is important to students and teachers because it
can confirm and consolidate knowledge, good practice, and
attitudes, and it can provide points for improvement and
prevent the development of bad habits.w6 w8 w9
Despite being such a useful tool, it is something that is
often forgotten or not used to its full potential. As well as
giving feedback to your students on their performance and
knowledge, it is useful for the teacher to receive feedback to
gauge whether their session has been successful.
There are many ways of structuring feedback; however,
these rules are useful to structure formal feedback after
performance of a skill or delivery of a teaching session.w8
v The learner performs the activity
v Questions are allowed to clarify points of fact only
v The learner says what he or she thought was done well
v The teacher-observer says what he or she thought was
done well
v The learner says what was not done so well and could
be improved
v The teacher-observer says what was not done so well
and suggests ways for improvement with discussion in
a supportive manner.
This framework supports the principles of construc-
tive feedback, a concept that is vital for the advance-
ment of learning. Constructive feedback should focus
on describing behaviour rather than interpreting it; give
specific examples; aim to be non-judgmental rather than
evaluative.
Structuring feedback constructively allows for praise of
what was done well and positive indications for improve-
ment rather than concentrating on what was done badly.
Feedback can also take place more informally, using
rounds, quizzes, and other methods, to find out what each
student learned or thought could be improved for the
next session.
Patsy Stark senior lecturer in medical education, Academic Unit of Medical,
Education, University of Sheffield Medical School
Catherine Gray fourth year medical student, University of Sheffield Medical
School, UK Mda03c1g@sheffield.ac.uk
Competing interests: None declared.
See Reviews p 380 (doi: 10.1136/sbmj.39333.567407.79).
STUDENTBMJ | VOLUME 15 | OCTOBER 2007