Principles of Teaching and
Learning in Clinical
Settings
Professor Hossam Hamdy
University of Sharjah
Aim
 What is Clinical Teaching
 Barriers to effective Clinical Teaching
 Strategies to improve Clinical Teaching
 Teaching and learning in different clinical
settings
Clinical Teaching
There should be no teaching without
the patient for a text and the best
teaching is often that taught by the
patient himself
(William Osler)
Triad Interactive Learning in
the Clinical Context
Context
Teacher
Student
Content
Patient
Teaching with Patient
 Bedside “Different from ward rounds”
 Outpatient clinic
 Emergency ward
 Day Care Surgery
 O.R
Barriers to Effective Clinical
Teaching – A global Concern
 Time lack for clinicians.
 Insufficient space to teach.
 Crowded outpatients.
 Increasing number of ‘super-specialist’
clinics.
Barriers to Effective Clinical
Teaching (cont/-)
 Lack of patients and inpatient beds.
 Lack of consistency in what is taught.
 Lack of organization in what is taught
between teachers.
Barriers to Effective Clinical
Teaching (cont/-)
 Teaching is not considered part of
service commitment.
 Lack of knowledge and skills about
teaching methods.
The Clinical Context
 More shift from Hospital setting to
Ambulatory settings.
 Diminish the significance of bedside
teaching “short length of stay”.
The Clinical Context
(cont/-)
 Hospital populated with critically ill and early
post-operative patients.
 Early diagnosis – no or little physical signs.
Key Clinical Competencies
 What are the key clinical competencies you
as a clinical teacher want to ensure that the
students have accomplished
 Good communication and data gathering
(history and physical examination
 Clinical reasoning
 Decision Making, investigation and
treatment
Clinical Teaching
Planning “set”
 Be available (on time) and approachable.
 Introduce yourself and know their names.
 Pre select patients/ Ask permission
 Ensure respect for patients comfort and
dignity
Clinical Teaching
Planning “set”
(cont/-)
 Clarify expectations and goals appropriate
to the setting, patient problems and student
level “prior knowledge”
Clinical Teaching
Teaching “Dialogue”
 Teach from clinical cases.
 Go to the bedside or exam room
 Use questions to diagnose patient & learners.
Clinical Teaching
Teaching “Dialogue”
(cont/-)
 Role model
 Focus the teaching on data gathering by or
about the patient “critical player”
 Promote student clinical reasoning skills..
Non-Analytical Reasoning
“Pattern
recognition”
 Context specificity.
 Prior knowledge & net-working.
 Schemata and script concordance.
Analytical Reasoning
 Cues form c/o – duration
 Early hypothesis generation
 Testing and re-testing hypothesis
 Ranking and re-ranking hypothesis
Clinical Reasoning
EBM Approach
Pre-test
Probability
TEST
Post-test
Probability
Each question in the history and each physical
examination is a diagnostic test.
Combined Model of Clinical
Reasoning
Patient
Presents
Non-analytic
Case
Representation
Interactive
Hypotheses
Tested
Analytic
Clinical Teaching Tips

Increase the student base of scenarios,
scripts and mental images.

Students should be guided to relate
novel experience with past experiences
‘Anchor proto-type in their memory’.
Clinical Teaching Tips (cont/-)
Model Professional Thinking and Decision Making
“Preceptor Thinking Out Loud”
 Implicit / Tacit 
Explicit
 Key features of disease
 Relevant information
“focused history & physical exam.”
Clinical Teaching Tips (cont/-)
Model Professional Thinking and Decision Making
“Preceptor Thinking Out Loud”

Priority in investigations and treatment.

Review diagnostic probabilities
and rationale for diagnosis and
treatment.
The One Minute Clinical Preceptor
Teaching Model
Diagnose Patient & Learner
Microskill 1:
Get a commitment
What do you think the
patient problem is?
Microskill 2:
Probe for supportive
evidence
Reasoning. Why do you
think this is the case?
The One Minute Clinical
Preceptor
Teach general rules & concepts
Microskill 3:


When this happens,
usually …
Take home message
The One Minute Clinical
Preceptor
Feedback “closure”
Provide regular, well timed
feedback.
 Should be descriptive rather than
judgmental.
 Reinforces positive behaviors and motivates
learner.
 Conveys an attitude of concern and interest
between instructor and learner.
Microskill 4:
The one Minute Clinical
Principle
Feedback “closure”
Microskill 5:
Correct mistakes and
promote self assessment
and self-directed learning.
 Focus on behavior, not individual.
 Ask learner for their opinion or perception.
 Be straightforward, but respectful.
The Effective Clinical Teacher (D. Newbie)
1.
Encourages active student participation rather
than passive observation
2.
Emphasis on teaching of applied problem solving
3.
Integrates clinical medicine with basic science
4.
Close observation of students during
interview/examination rather than side-room case
presentation
The Effective Clinical Teacher (D. Newbie)
5. Provides adequate opportunity for students to practice
skills
6. Provides good role-model for interpersonal
relationships with patients
7. Teaching patient-oriented rather than disease-orientated
8. Demonstrates a positive attitude towards teaching
The Effective Clinical Teacher
Most important being willing to teach
and be enthusiastic about it
Thank You