Teaching methods

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Abstract

Bernice McCarthy notes that trainees ask the following questions [1]. Why am I learning? What will I learn? How will I learn it? What if I don't agree, can't learn, and don't like it? Educators must help find the answers to these questions. A registrar-teaching programme should provide the means to learn the knowledge, skills and attitudes necessary for trainees to pass their exams and become successful anaesthetists. Many believe the best way to organise a programme is through dialogue between trainers and trainees [2, 3]. The resulting synthesis provides an environment for adult learning that is both enjoyable and achieves its stated goals as well as constructing a `built in' improvement cycle. Many institutions have implemented teaching programmes developed through dialogue but few or no data exist in the United Kingdom on how changes from a caring but one-sided registrar training programme to a programme synthesised from the input of trainees and trainers affects outcome. We were presented with an opportunity to measure attitudinal changes between groups of our registrars during a reorganisation of the teaching programme for Specialist Registrars in anaesthesia, which was undertaken over the course of two successive 3month modules with different groups of trainees in paediatric anaesthesia in the Northwest Region. The first module followed the pattern that had been used for many years. The second module included changes in design based on criticism from registrars. Records were kept of tutorial attendance during the two modules and an identical questionnaire was given to trainees at the end of each module. The Mann±Whitney test (p , 0.05) was used to test statistical significance. The new programme was based on the assumption that increased motivation would be the key to improved learning [3]. This would come from trainees having a larger part to play in the content and presentation of tutorials and teaching. The following changes were added: mutually agreed objectives, registrar presentation at each tutorial, practice exams to be marked by postFellowship registrars, contribution of papers to a departmental file, 6-week review of trainees' progress by trainer and completion of feed-back forms by both trainers and trainees at the end of the module. Questionnaire response rates were similar for the two groups. Module 1: 12/17 (70%), Module 2: 13/16 (81%). Changes in the organisation of the teaching coincided with statistically significant improvements in attendance at tutorials and improved perception of the usefulness of tutorials, handouts, presentations and exam practice. Selfassessment of clinical skills, confidence and enjoyment of the module were not affected significantly. Overall, no assessed categories were graded as worse in the second module. Improvements came in categories most affected by tutorials. Tutorials are more easily controlled environments and were targeted for change. These improvements are likely due to the increased input from trainees and more enthusiastic teaching that arises from a motivated energised atmosphere. Although continued subjective evaluation and objective testing of knowledge retention would be desirable to substantiate the claimed improvements, these results provide support to those programmes that have instituted similar changes and stimulus to those considering them. A programme based on mutually agreed objectives, explicit content and defined process with built in assessment and flexibility answers McCarthy's questions and provides potential for improvement too dramatic to allow a return to the previous organisation.