A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

434 ❘
Teaching in the disciplines
does not encroach into ward routines. Locations and times may suddenly need to be
changed, but the onus is firmly on the teacher to try to be punctual and prepared, or at
least to inform students and patients of unavoidable changes. (Medical students often
quote lack of information and disregard by the clinical staff as reasons for recurrent nonattendance.)
Whatever the setting, the teacher should not use the patient session to lecture, or use
the patient as a ‘chalkboard’ or living text. The guiding principle in medicine should be
one of demonstration and observation, with opportunities for practice as far as it is safe
and ethical. Feedback on practice (from tutor, peers, self and patient where appropriate)
is key but often neglected. In dentistry the chairside role is primarily that of advice and
supervision. For the teacher, student–patient interactions may appear routine but for the
other parties they are often complex and require a great deal of guidance, particularly in
the early stages of training. Opportunistic teaching may present itself in both contexts and
should never be overlooked; indeed in medicine detailed and advanced planning of
much patient-based teaching is often impossible. In the medical setting clinicians need
to be aware of the overall goals (learning outcomes) of the rotation of the student and
have thought about how patient encounters may contribute to their being achieved.
Questioning, from teacher to students and students to teacher, is an important skill in
clinical teaching (see the section ‘Questioning’, pp. 81–82 in Chapter 6), but again respect
for the patient needs to be considered. Good preparation and time for student reflection
and feedback should be built into sessions.
Clinical teaching and learning is exciting and rewarding, but in the NHS of the twentyfirst
century it has become increasingly challenging. Points to consider when teaching in
a patient-centred environment include:
• patient, student and teacher safety and anxieties;
• introduction of students to the clinical environment;
• skills acquisition, practice, feedback and assessment;
• observation, modelling and practice of professional behaviours;
• teaching versus treatment.
Clinical settings are having ever-increasing teaching demands placed upon them. This is
one reason why simulation is growing as a context for learning. While it has many
advantages and benefits, simulation should be used to augment and not replace the real
clinical experience.
SKILLS AND SIMULATION IN TEACHING AND LEARNING
For many years clinical medicine and dentistry were taught by the principle of ‘See one,
do one, teach one’. The inception and use of simulation within clinical teaching and
learning has allowed students to confront their anxieties within a safe environment, while