Residents-as-teachers : needs assessment of residents teaching skills in a clinical setting using direct observation of teaching

Ayodele, Olugbenga Edward (2020-03)

Thesis (MMed)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY : Background: Residents teach undergraduate medical students and other health care workers in clinical settings. Despite this pivotal teaching role, the majority of residents have not received formal training in education, and may be adopting ineffective teaching strategies. Some institutions have established residents-as-teachers (RaT) programmes with the aim of improving the teaching competency of residents. However, many of these programmes were put in place without a context-specific needs assessment to identify the existing strengths and deficiencies in the residents’ teaching skills. RaT programmes are rare in sub-Saharan Africa, and do not appear to exist in Nigeria. Successful planning and implementation of such a program will involve judicious commitment of scarce human and material resources, which makes a needs assessment imperative. Aim and Objectives: The aim of the study was to do a needs assessment of residents’ skills in teaching in the clinical setting. The specific objectives were to determine: residents’ self-perceived and true learning needs for facilitating learning in the clinical setting; residents’ self-perceived important topics that could be included in a RaT curriculum; and residents’ preferred methods of instruction for a RaT programme. Methodology: This cross-sectional observational, quantitative inquiry was conducted at Ladoke Akintola University of Technology (LTH), Ogbomoso, Nigeria. Thirty nine (78%) out of a total population of 50 residents voluntarily agreed to participate in the study. The 39 residents were subsequently divided into two groups on the basis of their willingness to have their clinical teaching sessions observed – those who were willing to be observed (Group A, n=20) and those not willing to be observed (Group B, n=19). Sixty two (85%) out of a total population of 73 medical students in Years 5 and 6 rotating through Internal Medicine, Surgery, Paediatrics and Obstetrics & Gynaecology at the hospital agreed to participate in the study. The study instruments consisted of a self-administered questionnaire completed by all residents, and the 24-item, 7-domain Maastricht Clinical Teaching Questionnaire (MCTQ) [rated on a 5-point Likert scale] completed by the residents, the medical students (recipients of the clinical teaching), and the researcher (who acted as an unobtrusive observer) after the teaching sessions. The residents’ self-perceived learning needs were determined by the teaching actions the fewest residents agreed or strongly agreed that they used during the course of their teaching. The residents’ true learning needs from the students’ and researcher’s perspective were the teaching actions least experienced by the students, and the teaching actions least observed by the researcher respectively during the course of teaching. Discrete data were summarized as percentages, and quantitative data as means (standard deviation [SD]). Differences in discrete and continuous variables were analysed using chi square and student’s t test respectively. All p values ≤ 0.05 were considered to be statistically significant. Results: Most residents had never had formal training in teaching, the vast majority indicated that skill development in teaching is very important, and all expressed the desire to be trained in developing their teaching skills. The residents’ self-perceived learning needs based on a self-administered questionnaire were formulation of learning goals (‘exploration’), and guidance given to students to bolster students’ independence (domain of ‘scaffolding’). The residents’ true learning needs based on MCTQ items least observed were demonstration of different tasks (‘modelling’), providing guidance and feedback (‘coaching’), encouraging students to think through their performance, voicing out their strengths and weaknesses (‘reflection’), and formulation of learning goals (‘exploration’). The leading topics perceived by residents to be important for a RaT course were communication skills, leadership, teaching of procedural skills, and bedside teaching; and their preferred methods of instruction were interactive sessions with teachers, and working in small groups with a facilitator. Conclusion: Findings from this study therefore provide important baseline information on the strengths and weaknesses of our residents in facilitating learning in the clinical setting. This needs assessment of residents’ teaching skills will serve to inform the design of a tailor-made RaT course for LAUTECH residents.

AFRIKAANSE OPSOMMING : Agtergrond: Kliniese assistente onderrig voorgraadse mediese student en ander gesondheidsorgwerkers in kliniese instellings. Ondanks hierdie belangrike rol in die onderwys, het die meerderheid kliniese assistente nog nie formele opleiding in die onderwys ontvang nie en neem hulle moontlik ondoeltreffende onderrigstrategieë aan. Sommige instellings het kliniese assistente-as-onderwysers (RaT)-programme opgerig met die doel om die onderrigvaardigheid van die kliniese assistente te verbeter. Verskeie programme is egter sonder konteks-spesifieke behoeftebepaling in werking gestel wat sterkpunte en swakpunte in kliniese assistente se onderrigvaardighede identifiseer. RaT-programme is skaars in Sub-Sahara Afrika en nog nie opgeteken in Nigerië nie. Suksesvolle beplanning en implementering van die program behels ‘n oordeelkundige toewyding van menslike en materiële hulpbronne wat skaars is en dus noukeurige behoeftebepaling noodsaaklik maak. Doel en Doelstellings: Die doel van die studie was om 'n behoeftebepaling te doen van kliniese assistente se vaardighede in die kliniese omgewing. Die spesifieke doelstellings was om die volgende te bepaal: kliniese assistente se self-waargenome en ware leerbehoeftes om leer in die kliniese omgewing te vergemaklik; kliniese assistente se self-waargenome belangrike onderwerpe wat in 'n RaT-kurrikulum opgeneem kan word; en klinese assistente se voorkeurmetodes vir onderrig vir 'n RaT-program. Metode: Hierdie waarnemende kwantitatiewe dwarssnitstudie is by Ladoke Akintola Universiteit van Tegnologie (LTH) in Ogbomoso, Nigerië gedoen. Nege-en-dertig (78%) van die totale bevolking van 50 kliniese assistente het vrywillig ingestem om aan die studie deel te neem. Die 39 kliniese assistente is in twee groepe verdeel op grond van hul bereidwilligheid om hul kliniese opleidingsessies waar te neem – diegene wat bereid was om waargeneem te word (Groep A, n = 20) en diegene wat nie bereid was om waargeneem te word nie (Groep B, n = 19). Twee-en-sestig (85%) uit die totale bevolking van 73 mediese studente in hul vyfde en sesde jaar wat deur Interne Geneeskunde, Chirurgie, Pediatrie en Verloskunde en Ginekologie in die hospital geroteer het, het ingestem om aan die studie deel te neem. Die studieinstrumente het bestaan uit 'n self-geadministreerde vraelys wat deur alle inwoners voltooi is, en die 24-item, 7-domein Maastricht Kliniese Onderwys Vraelys (MCTQ) [beoordeel op 'n 5-punt Likert-skaal], voltooi deur die kliniese assistente, die mediese studente (ontvangers van die kliniese onderrig), en die navorser (wat as 'n onopvallende waarnemer opgetree het) na die lesingsessies. Die kliniese assistente se self-waargenome leerbehoeftes is bepaal deur die onderrigaksies waaroor die minste kliniese assistente saamgestem het of die meeste saamgestem het dat hulle dit gebruik in hul onderrig. Die kliniese assistente se ware leerbehoeftes vanuit die perspektief van studente en navorsers was die onderrigaksies wat die studente die minste ondervind het, en die onderrigaksies wat die navorser onderskeidelik tydens die onderrigperiode waargeneem het. Diskrete data is opgesom as persentasies, en kwantitatiewe data as gemiddelde (standaardafwyking [SD]). Verskille in diskrete en kontinue veranderlikes is geanaliseer met die chi-kwadraattoets en die student se t-toets onderskeidelik. Al die p-waardes ≤ 0.05 is as statisties betekenisvol beskou. Resultate: Meeste kliniese assistente het geen formele opleiding in onderrig gehad nie en die oorgrote meerderheid het aangedui dat vaardigheidsontwikkeling in onderrig baie belangrik is, en almal het die behoefte betuig om opgelei te word om sodoende hul onderrigvaardighede te ontwikkel. Die kliniese assistente se self-waargenome leerbehoeftes gebaseer op ‘n self-geadministreerde vraelys, was die formulering van leerdoelwitte (‘verkenning’), en leiding wat aan student gegee is om hul onafhanklkheid te versterk (domein van ‘steierwerk’). Die kliniese assistente se ware leerbehoeftes gebaseer op MCTQ-items wat die minste waargeneem is, was die demonstrasie van verskillende take (‘modellering’), leiding en terugvoering (‘afrigting’), aanmoediging van student om na te dink oor hul prestasies, hul sterk- en swakpunte uit te spreek (‘besinning’) en formulering van leerdoelwitte (‘verkenning’). Die onderwerpe wat kliniese assistente as belangrik beskou het vir ‘n RaT-kursus, was kommunikasievaardighede, leierskap, onderrig van prosedurele vaardighede en praktiese onderrig; en hul voorkeurmetodes van onderrig was interaktiewe sessies met onderwysers, en om te werk in klein groepe met ‘n fasiliteerder. Gevolgtrekking: Bevindinge van hierdie studie bied dus belangrike basislyn vir inligting oor die sterk- en swakpunte van kliniese assistente om leer in kliniese omgewings te vergemaklik. Hierdie behoeftebepaling van kliniese assistente se onderrigvaardighede sal bydra tot die ontwerp van ‘n pasgemaakte RaT-kursus vir LAUTECH-kliniese assistente.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107787
This item appears in the following collections: