Teaching One To One Dr Alastair McGowan Sept. 2003

TONTO Role model for clinical practice Role model for life long learning Assessment in the workplace Applicable to many settings

Components of the curriculum Purpose wise judgements in uncertainty Content Teaching strategy role modelling Assessment primacy of practice Evaluation feedback built in

Curriculum design What educational purposes should we seek to attain? What educational experiences are likely to attain that purpose? How can these be organised effectively? How can we determine whether these purpose are being attained? Tyler,R. 1949

What are we trying to assess ? “Competence” (shows he/she can do it) “Performance” (actually does it )

Competence Vs Performance Is it reasonable to assume that competence is a good indicator of performance? Review of 18 studies assessing the relationship of competence and performance –Most use loose definitions –Unable to support concept of a direct relationship Rethans JJ, van Leeuwen Y, Drop R, van der Vleuten C, Sturmans F. Competence and performance: two different concepts in the assessment of quality of medical care. Family Practice 1990;7(3):168-74

Competence Vs Performance Study of GP’s –Standardised patients seen in normal surgeries –Repeated in controlled practice environment Mean score for performance 49% lower than competency score Scores directly related to consultation time

Principles of assessment Valid - measures what it purports to measure Reliable - measures performance consistently Feasible - is practical, deliverable, affordable Educational - trainee learns from process Acceptable - those involved have confidence in it

Observed Clinical Practice Hawthorne effect: under observation, performance may differ from normal behaviour

If not by magic then… Directly observe it

TONTO One to one teaching Role reversal –Ensuring competence –Demonstrating excellence Record of training

TONTO direct observation of practice working environment real patients uses structured recording sheets measures performance

TONTO Trainer and trainee work together reduction in clinical service provided by the team but some service is provided likely positive effect on efficiency overall

TONTO Training : One day course –Demonstration of process –Mainly hands on with SpRs –Some educational theory

Principles of assessment Valid - measures what it purports to measure assessor dependent Reliable - measures performance consistently assessor dependent Feasible - is practical, deliverable, affordable no sorting hat available Educational - trainee learns from process assessor dependent Acceptable - those involved have confidence in it initial experience positive