Web Resource 3.1: Pre-Test Questions
Before starting this chapter, it is recommended that you visit the accompanying website and complete the pre-test questions. This will help you to identify any gaps in your knowledge and reinforce the elements that you already know.
Learning outcomes
On completion of this chapter, the reader will be able to:
- Outline the four aspects of knowledge
- Differentiate between the concepts of teaching and facilitating learning
- Discuss the attributes of constructivism and objectivism
- Analyse the difference between the andragogy and pedagogy approaches to learning
- Identify the characteristics of an effective and an ineffective teacher
- Reflect upon own teaching/facilitating style
- Describe evidence-based practice
Defining Teaching
Teaching suggests, among other things, imparting knowledge. For a long time philosophers have debated the nature of knowledge, but it was not seriously considered within healthcare practice until the early 1960s. Since this time four aspects of knowledge have been pursued and promoted within the healthcare field. Carper (1978) identified these four aspects of knowledge as:
Empirical: this is the scientific knowledge based on research evidence.
Aesthetics: this aspect of knowledge is referred to as the art of healthcare practice and is demonstrated in the creative aspect of caring and the intuitive elements of practice.
Personal: this involves knowing oneself (Joharia’s window) and developing therapeutic relationships with patients and clients.
Ethical: this has become a very challenging aspect of healthcare as technological and genetic advances open up philosophical debates around issues such as euthanasia. Moral principles, values, judgements, what is right and what is wrong are now, more then ever, hotly contested issues. A statutory body known as the Council for Healthcare Regulatory Excellence governs all nine regulatory bodies to promote best ethical practice and consistency across all healthcare professionals.
Knowledge is also referred to in terms of know-how and know-that.
Know-how relates to the aesthetics of knowledge. It is the unwritten way to do things that may be related to personal experience, and may have been verbally passed on. This hands-on experience provides a rich source of knowledge that informs clinical practice. Reflection on and in practice can bridge the link between scientific knowledge and aesthetic knowledge (see Chapter 4 for more details).
Know-that is connected to scientific knowledge that is written down and formally taught. The art and science of knowledge are sometimes expressed as competing aspects of care and references are made to the practice-and-theory gap. The term ‘practice–theory gap’ is sometimes used to argue that the empirical knowledge is not relevant to practice and that skills are all that is required in practice. However, nothing could be further from the truth.
Leonardo Da Vinci summed this up perfectly when he stated that ‘Practice without theory is like a man who goes to sea without a map in a boat without a rudder’.
Teaching is also a fairly new concept. Until fairly recently it was taken for granted that, if someone was competent in his or her chosen subject, then he or she would make an ideal teacher. It has since been recognised that this is not the case. Teaching/facilitating requires many attributes including patience, understanding, good interpersonal communication skills and knowledge.
One of the many roles required of a mentor, is to be a teacher/facilitator. The term ‘teacher’ has been defined in several ways:
To help to learn; to give instructions or lessons; to cause to learn or understand.
Collins Dictionary (2006, p 592)
A system of activities intended to induce learning, comprising deliberate and methodical creation and control of those conditions in which learning take[s] place.
Curzon (1990, p 56)
Coach and student convey messages to each other not only, or even primarily, in words but also in the medium of performance.
Schön (1991, p 80)
Teaching is linked to learning and, although it is possible to learn without having been taught, it is not possible to teach without learning having first taken place. Therefore, if a student failed to learn, then no teaching has taken place (possibly a didactic approach of telling did take place).
Activity 3.1
As a teacher, the mentor imparts personal knowledge and experiences to the student, recognises the student’s individual learning style and needs, and ensures that the environment is conducive to their learning.
Consider how you teach, note down the behaviours that identify that teaching has taken place?
What ideals or values do you hold about teaching?
How do these ideals and values manifest themselves in your teaching practice?
Do you learn from students?
Gagne (1983) suggests that, similar to nursing, teaching is both an art and a science. The theories that underpin teaching could be viewed as the scientific approach – using a style of teaching that matches the learner’s style (see Chapter 5 for more details). The art could refer to the way in which the teacher relates to the students, sensing intuitively when someone is confused. The teacher is seen as someone who enriches the life of a student across a wide range of worthwhile experiences. The term ‘teaching’ therefore covers a wide range of activities, including:
- Information giver, enabler, thought provoker, challenger
- Counsellor, advice giver, helper, advocate, effective communicator
- Role model, leader and motivator, to name just a few.
According to Peters (1973) these activities take place in a structured way: they are planned in a logical order so that, if a spontaneous teaching session arises, the mentor will still consider the teaching environment, the needs and motivation of the student and the resources that will help in the facilitation of learning. Written teaching plans are not always required, but a mental checklist is needed because it provides clarity of thinking and a framework for the teaching process. It should include the following key elements:
- Environment preparation (hospital wards can be a challenge for privacy, relaxed atmosphere and peace)
- Description of the student – level, competencies, strengths and weaknesses, their preferred learning styles and past learning experiences
- Aim of the teaching session and the intended learning outcomes
- Outline of the content and sequence of the teaching session
- Break down of time to be spent on teaching and demonstrating knowledge and skills
- Description of teaching methods to be used (cognitive objectives can be met by a didactic approach, but affective objectives require exploration of beliefs and the challenging of values)
- List of teaching aids (rehearsal is useful before teaching demonstration to ensure that everything works as planned)
- Feedback and evaluation methodology.
Web Resource 3.2: Lesson Plan
A template of a lesson plan is available on the accompanying web page and can be adapted for future use.
The education of healthcare students is underpinned by a set of professional standards of proficiency (Box 3.1). These standards serve to supply a workforce that is fit for practice and fit for purpose.
Box 3.1 Professional standards
- Evidence should inform practice
- Students should undertake supervised clinical practice
- The appropriate codes for professional conduct, standards, performance and ethics should be applied to all healthcare interventions
- The skills and knowledge gained should be transferable
- Research should underpin practice
- Life-long learning and continuous professional development (CPD) are an essential part of professional practice
For more in-depth information view Quality Standards for Practice Placements (NHS Education for Scotland or NES 2008); the link to this document is www.rcn.org.uk/development/practice/clinical_governance/staff_focus/other_support/guidance_and_tools (accessed 24 October 2011).
The mentor is one of many who will teach the student during their journey to become a healthcare professional. The learning objectives are the building blocks that are set at the appropriate stage for the student’s learning. One of the most effective ways to establish whether teaching is set at the right level and in the right delivery style is to ask for feedback. The student is the essential partner in the teaching and learning process, and the student’s views are therefore the most important. Provision for evaluation must be well thought through and built into the lesson plan.
Clinical practice provides many opportunities to link the theoretical knowledge to its practical application. Rogers (1983) states that the teacher’s first task is to allow students to feed their own curiosity which will in turn evoke a desire to learn. Helping students to learn depends on the mentor being an effective communicator, with good verbal and interactive skills, as well as physical energy and drive. Strong et al (1995) provided the acronym SCORE to represent the key attributes required to nourish and enthuse students:
- Successful teaching requires the mentor to have an in-depth knowledge of the subject matter.
- Curiosity is vital for bringing passion to the subject.
- Originality in delivering information challenges and engages students.
- Relationships have to be nurtured in order to stimulate life-long learning.
- Energy and time are required to allow the mentor to (reflect, re-energise and regenerate) focus on the process of learning and not just the outcomes.
Good teachers bring passion that is infectious, they freely share their knowledge, and they challenge students to develop greater understanding and engage with them fully. A good teacher inspires students, creates an effective learning environment and shares the responsibility with the student in achieving the learning outcomes.
Glickman et al (2007) suggest that teachers should endeavour to have a high level of abstract thinking:
- Teachers with a low level of abstract thinking tend to blame students for the lack of learning, typically referring to them as ‘lazy’ or ‘thick students’.
- Teachers with a moderate level of abstract thinking will have some insight into the problems, but will lack the ability to rectify the issues. This will result in a continual imbalance between the student’s learning needs and the teacher’s learning style.
- Teachers who have a high level of abstract thinking will be insightful, solution focused, highly adaptable and resourceful, and will meet the needs of the students and successful teaching will take place.
Howard (2004) reinforces the idea that the teacher is central to student learning, and claims that self-awareness predicts successful teaching and leads to a confident and assured manner. He suggests that self-awareness occurs on three levels:
1. Superficial – aware of age and gender
2. Selective – important on an individualistic level (outward appearance and attitude), but does not seek to think widely of others
3. In-depth awareness (holistic) – for more details see Johari’s window in Chapter 5.
Self-awareness is a never-ending journey; the more self-knowledge a mentor has, the easier it will be for him or her to relate to others in both the work and the home setting.
A good teacher develops an intuitive feeling for students’ emotional needs, social background and cognitive development. An interest in students’ welfare promotes learning (Wragg 1984). This is particularly important in the health care settings, where students come from a variety of backgrounds, cultures and age groups (Thomson 2004). The relationship between the teacher and the student should be based on mutual respect and partnership; in this way the student’s learning will be enhanced. The teacher also needs to be personable and able to remember details about the student, including names (Howard 2004). The successful teacher will be patient, considerate, emotionally stable and able to make sound judgements. Wragg (1984) describes a successful teacher as an unconventional, flexible character willing to experiment and states that he or she should have a personal curiosity – working with students to discover facts, experiences and relationships between events rather than just telling students what they need to know. Some of these attributes will come naturally to some teachers whereas others will have to work at developing them.
Activity 3.2
Bev is a highly motivated mentor who loves teaching and helping students to become divergent practitioners. She wishes to extend knowledge beyond basic comprehension and recall to application of information and synthesis.
Janet, a third year student, is a surface learner who just wants to get through the course and be allowed to practise her chosen career. When Bev begins to discuss information about the United Nation, World Bank, sustainable food production, climate change and how these issues will affect the population’s health in the future, Janet asks ‘Why do I need to learn this stuff, is this information going to be on the test papers?’ and says ‘Just tell me what I need to know’.
Reflect on the Following Questions
- Have you come across students who are surface learners? How did you motivate them to learn more deeply?
- Identify the aspects of teaching that are easy/difficult when teaching a surface learner (see Chapter 5 for details on surface learning)
- How would you engage and motivate a student to learn beyond what they need to know to pass a course?
- Why is it important to move students beyond comprehension and recall?
Feedback from Activity 3.2
It is important that Janet sees the relevance of what she is learning and how it relates to the wider context of her course. Bev should not be surprised at Janet’s reaction, if she has failed to draw the connections of new materials to past experiences. A concept map would help to demonstrate the links of the previous knowledge to new information and demonstrate its practical application.
Janet will have accumulated knowledge (personal, cultural or academic) that will influence her views and attitudes about how she perceives these global issues. Bev will need to investigate what Janet feels and thinks about the information so that she can get Janet to make links and integrate this new knowledge.
Teaching subjects as compartmental elements (health improvement, anatomy and physiology, research and skills) creates artificial divisions. In the real world all of these subjects are integrated and part of providing holistic care. It may be that the links between the subjects have to be clearly made and reinforced.
Bev needs to convince Janet of the relevance of the information to its practical application. This will enable Janet to become more of a questioning individual, who moves beyond the narrow confines of being instructed, or just doing as she is told.
De-motivation occurs when students become bored, their needs are not being met, they are frustrated and anxious, or when they feel overwhelmed by studies. In these sorts of instances it is useful to get students to reflect on past successes, help them to break down studies into manageable chunks and set short-term goals. Once they have achieved success, raise the expected standards and support them in gaining competence and confidence. According to Mitchell (1982) motivation is a complex issue that is influenced by intrinsic and extrinsic factors, and an array of changing and often conflicting needs and expectation (Box 3.2).
Box 3.2 Intrinsic and extrinsic factors related to motivation
| Intrinsic factors | Extrinsic factors |
| These tend to be the psychological and attitudinal factors, such as the sense of challenge and achievement, feeling appreciated and receiving positive feedback. These psychological factors are strongly influenced by the actions and behaviour of the mentor | These tend to be tangible factors that are largely outside the control of the individual, such as conditions of work, financial rewards and the working environment. Such tangible factors are largely outside the individual’s or the mentor’s control |
A student’s behaviour is determined by what motivates him or her, the performance is a product of his or her ability plus motivation. Motivation is not the behaviour itself, or the performance; it is influenced by the internal and external factors that affect a student’s choice. Many models and theories have been purported about motivation (Maslow’s, Alderfer’s, Herzberg’s and McClelland’s) but it is not a static entity and changes over time according to circumstances; therefore, there is no single explanation or answer as to what motivates students.
Activity 3.3
- List, in order of priority, the specific needs and expectation that are important to you. (Do not include basic physiological needs – thirst, hunger or shelter)
- Briefly explain to what extent these needs and expectation are met within your current role as a mentor
- What aspects of your role as mentor motivates you (intrinsic and extrinsic factors)?
- What aspects of your role as a mentor de-motivate you (intrinsic and extrinsic factors)?
The mentor needs to help students to identify areas in which they have the potential to develop further and correct aspects of negativity. This will enable the student to maximise strengths and minimise weaknesses. Humour is a great way to establish a relationship and a lively approach helps to motivate students (Schonell 1961) (Box 3.3). An enthusiastic mentor, who demonstrates an interest in his or her subject, has a sound knowledge base and the ability to create an effective teaching and learning environment, will leave a positive and lasting impact (Wragg 1984) (Box 3.4).
Box 3.3 Helpful teaching behaviour
1. Shows a willingness to answer questions and provide explanations
2. Treats students with interest and respect
3. Uses encouragement and praise
4. Informs students of their progress
5. Uses humour
6. Has a pleasant voice
7. Is accessible to students
8. Supervises effectively
9. Expresses confidence in self and in students
Wong (1978) cited in Thomson (2004)
Box 3.4 Features of an effective and an ineffective teacher
| Effective | Ineffective |
| Good role model | Poor role model |
| Classroom management | Lacks structure |
| Good interactive skills | Poor relationship skills |
| Good communicator | Poor communicator |
| Enthusiastic | Lack of commitment |
| Energetic | Plodding |
| Self-aware | Self-conscious |
| Sensitive | Insensitive |
| Emotionally stable | Outspoken |
| Considerate | Disruptive |
| Curious | Disinterested |
| Accessible | Distant |
| Fair | Threatening |
| Appropriate | Superior |
| Encouraging | Belittling |
(Thomson 2004)
Ineffective teaching occurs when: mentors and other qualified members of staff distance themselves from students. This detachment results in mentors being perceived as a threat when teaching. Consequently, students are unable to relax sufficiently to interact and learning cannot then take place (Thomson 2004). Therefore, the mentor should inform the student of his or her availability and expectations in order to reduce the student’s anxiety and enhance the student’s ability to learn.
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