The GMC expects GP trainees to teach and assess healthcare professionals and students. Trainees are expected to be honest and objective when assessing the performance, conduct and competence of colleagues.
The GMC also expects all doctors to be willing to take on a mentoring role for more junior doctors and other healthcare professionals and to support those who have problems with their performance or health.
Evidence of teaching
In terms of the eportfolio, five key concepts from adult education theory are highlighted under the domain ‘Maintaining performance, learning and teaching’.
GP trainees require evidence of:
- Contribution to the education of students and colleagues
- Identification of learning objectives
- Use of appropriate teaching methods
- Evaluation of outcomes of teaching
- Reflection on learner feedback
Education of students and colleagues
A trainee may contribute to the education of students and colleagues formally and informally. Formal education would, for example, include presenting at journal club or at an audit meeting. This activity is then written up as a ‘lecture/seminar’ reflective log in the eportfolio.
Most trainees also contribute informally, on-the-hoof, without the teaching having been planned, for example when teaching medical students in the emergency department how to read an ECG. In these cases it is more difficult, but not impossible, to discuss how you evaluated the outcomes of teaching and reflected on learner feedback.
It is rare for a 'teaching’ learning log to contain evidence of all five of the requirements listed above, so it may be prudent to record several activities.
In that way, the journal club presentation with its formal feedback may provide evidence of ‘evaluation of outcomes of teaching’ and ‘reflection on learner feedback’. The on-the-hoof ECG teaching on the other hand is evidence of 'contribution to the education of students and colleagues' and 'use of appropriate teaching methods'.
Identifying learning objectives
Learning objectives are often expressed as the aim, objectives and intended learning outcomes (ILOs). For example, with regard to ECGs, the trainee's teaching aim, objectives and ILOs could be written as:
Aim: To increase the skill and confidence of medical students with ECG interpretation.
Objective: The medical students should know what normal ECGs look like; be able to identify common ECG abnormalities; and be able to describe rate, rhythm, PR interval, QRS complexes, ST segments and T waves.
Intended learning outcome (ILOs): By the end of this teaching session, medical students should have a systematic approach to interpreting the ECG and be able to identify common ECG abnormalities.
Trainees are not expected to write their teaching aims, objectives and ILOs in such detail. I provide the above example to illustrate an impressive record. When an educational supervisor reads the above detail, they have evidence that this trainee has a deep understanding of some key educational concepts.
Most educational supervisors expect the trainee to write a sentence about what their audience should be able to do or demonstrate, in terms of particular knowledge, skills and attitudes, by the end of the presentation.
For example, a trainee could write: ‘By the end of this audit presentation, I would like the practice to be aware that we are not meeting standards (new knowledge), to propose recommendations (develop some new skills), and to agree a plan for improving practice (change our attitude).’ Or the trainee could ask a specific question, such as: ‘At the end of this audit presentation, what changes do we as practice agree on?'
Appropriate teaching methods
The GP trainee, based on their topic and audience, can choose to deliver their teaching by lecture, one-to-one tutorial, presentation, assigned group work, workshops or by written assignment.
Whatever the method selected, it should stimulate the learners to question their preconceptions and motivate them to learn. The 'teacher' should facilitate learning; the work and learning should come from the learners.
In other words, the good teacher uses learning activities to increase the learner's motivation to learn; builds confidence in solving problems; helps with the planning of learning activities; helps with self assessment and gives individual feedback.
This again illustrates the usefulness of several entries. The audit presentation will showcase presentation, public speaking and perhaps Powerpoint skills. The one-to-one medical student ECG teaching has elements of didactic teaching (imparting knowledge) and facilitation skills ('how does that PR interval look to you?’; ‘what bits of history would you want from the nurse who handed you this ECG?’).
Evaluation of outcomes of teaching
Did the learning experience deliver what it set out to do? Did the GP trainee help the learners to achieve their learning objectives and was the teaching-learning process effective?
If learners fed-back that the learning was useful; pitched at the right level; delivered in an interesting way that held their attention; and actively engaged them, then the presentation/seminar/teaching session went well.
But how do trainees collect this feedback? If a questionnaire (either paper or electronic) is used, how well is it designed? As a rule of thumb, the questionnaire should contain 10 questions or less, have a simple (even numbered) rating scale and allow for free text to capture subtle and possibly new issues.
Reflection on learner feedback
The reflection should start with setting the scene and discussing how the feedback was obtained. The trainee should include what new knowledge and skills they gained from undertaking the feedback. Or, if they used a standard departmental form, they could comment on what was good about it and what could be amended.
The important bit for the educational supervisor reading the reflective log entry is ‘what would I do differently the next time I present or teach?’. To answer this question, it may be useful to ask:
- How well did I identify my audience's learning objectives?
- Would a different teaching method or presentation style been better? For example, should I have used Powerpoint or handouts that encouraged small group work?
- Did the feedback questionnaire I used give me all the information I wanted?
- Should I reflect on my feedback alone, or with a colleague or should I ask for a debrief with the specialist registrar or my clinical supervisor?
- Dr Naidoo is a GP trainer in Oxford. She has written three books on how to pass the CSA. The latest book CSA Practice Cases for the MRCGP Paperback was published in January 2016.
- GMC information on teaching, training, supporting and assessing
- Bradford VTS information on ‘naturally occurring evidence’ and quality improvement activity
- Useful tips on presentation skills