Community family medicine teachers' perceptions of their teaching role.

OBJECTIVES: Our study explored community preceptors' perceptions of their teaching role, to better understand effective ambulatory and community-based teaching. METHODS: Bandura's social cognitive theory and Schön's notion of reflective practice guided conceptual development of an interview exploring preceptors' views of their role, teaching goals, teaching techniques, student assessment practices, factors affecting teaching and learning, and balance of patient and student needs. Preceptors reflected also on a significant personal teaching experience. A total of 17 highly student-rated preceptors participated. A trained interviewer conducted each interview; all were transcribed and subjected to content analysis. RESULTS: Preceptors (male, 14; female, 3) described learner-centred approaches, setting goals jointly with the student. Demonstration, guided practice, observation and feedback were integral to the experience. Preceptors saw student comfort in the environment as key to effective learning; they attempted to maximize students' learning and breadth of experience. They wanted students to understand content, "know-how" and "being a family physician". Patients remained the primary responsibility, but learners' needs were viewed as compatible with that responsibility. Many preceptors perceived a professional responsibility as "role models". CONCLUSIONS: Preceptors recognized the dynamic environment in which they taught students, and they described strategies which demonstrated how they adapted their teaching to meet the needs of the learner in that environment. These teachers combined learner-centred approaches with sound educational practices, broad learning experiences, attention to student learning and concern for development of professional expertise and judgement. These findings may assist faculty development in family medicine, and other disciplines, in providing effective ambulatory care teaching.

Using problem-based learning in neurosciences education for medical students.

BACKGROUND: A Curriculum Task Force proposed problem-based learning as one important educational strategy and recommended changes to a traditional medical curriculum. METHODS: This paper describes how a problem-based learning course in neurosciences was developed and has evolved since its inception in the Dalhousie University Faculty of Medicine. The curriculum planning and design phases are outlined, followed by a description of how the course has been implemented and evaluated. RESULTS: Program evaluation results are presented, describing student performance on examinations and their feedback about the course. CONCLUSION: The authors summarize lessons learned and identify future issues to continue the ongoing development of the course.

The relationship of tutors' content expertise to interventions and perceptions in a PBL medical curriculum.

This study addressed three questions: (1) Do content-expert tutors differ from non-expert tutors in the extent to which they present/explain case content? (2) Do tutors who present/explain case content differ from those who almost never do in their ratings of various outcomes of a PBL curriculum? (3) Are tutors who present/explain case content rated differently by students from tutors who almost never do? Data were gathered from 88 tutors and 168 students in the first 2 years of a PBL medical curriculum. Students assessed their tutor after each unit, and tutors completed a questionnaire near the end of the academic year. In this study, 'content expertise' was defined operationally as tutors' self-ratings on the question 'To what extent could you teach (at the Med I level) the material covered in the cases?' Less than half of the tutors reported that they almost never presented/explained case content. As tutors' content expertise increased, they tended to present/explain case content more frequently. Tutors who almost never presented/explained case content rated PBL more highly than traditional methods. No differences were found in student ratings of tutors who almost never presented/explained case content, compared to tutors who did. The results suggest that tutors who are content experts find it difficult to maintain the 'facilitator' role, but that those who maintain this role are more satisfied with PBL. It appears that other tutor behaviours may have a greater influence on students' ratings of their tutors.

Tutoring in problem-based learning: perceptions of teachers and students.

This study examined teacher and student perceptions during the first 2 years of a complete transition from a conventional to a problem-based learning (PBL) curriculum at Dalhousie University. Teaching staff who had tutored in the two pre-clinical years (n = 88) completed a questionnaire at the end of the 1993-94 academic year, and student assessments of their tutors were collated for all nine units (n = 597). Seven research questions were addressed in the study which examined the faculty, student and administrative aspects of tutoring. The results showed that faculty tutors rated PBL more highly than traditional medical school methods on eight of the nine items. Teaching staff were very satisfied with their tutoring experience, but expressed a need for further training in group facilitation, questioning, handling 'difficult' situations and evaluating students. They reported that their workload outside tutorials was cut almost in half in their second year of tutoring. Students expected a tutor to be a skilled group facilitator who would guide them in their learning, while helping to maintain a positive group climate. They did not want the tutor to teach the content as they perceived the task of learning to be their responsibility. Several major administrative factors affected tutors' and students' perceptions of tutorials, including: changing tutorial group composition and tutor every 8-10 weeks; team tutoring; end-of-unit exam; conflicting demands of basic science 'vertical' units and ongoing 'horizontal' units; departmental budgetary requirements for basic medical education; recognition of tutoring in promotion and tenure decisions; and recruitment of tutors.

Tutoring in problem-based learning: a teacher development process.

Undergraduate medical curricula have become increasingly innovative in order to better prepare their graduates to enter practice, with the most notable innovation being the introduction of problem-based learning (PBL). This paper describes Dalhousie University's transition to PBL, from a teacher development perspective. The paper reinforces the need for a well-designed teacher development process that is carefully implemented and evaluated in order to ensure a successful curriculum change. A seven-stage process for teacher development of tutors at Dalhousie is described, and programme evaluation data are reported from both students' and teachers' points of view. The results from the evaluation are very positive and suggest ways of improving the teacher development process. These improvements are described, as well as future plans in this area.

Defining fitness and aptitude to practice medicine.

This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as 'fitness and aptitude', that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Defining fitness and aptitude to practice medicine.

The results of a study to determine the qualities and characteristics necessary for physicians to demonstrate in their practice reinforce the need for a medical school to emphasize the non-cognitive domain in its curriculum. The behaviors described in this study were written as educational objectives so that they could be evaluated with less subjectivity.

Techniques for the chronic cannulation of the jugular vein in mice.

The use of chronic intravenous cannulae implanted in the jugular vein of mice utilizing techniques previously developed for larger rodents is discussed. Two cannula designs and a chronic infusion chamber are illustrated. Cannula insertion depths for mice of three strains and various body weights, and estimates of operative mortality and cannula durability are given.