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 Contents

Section Title of section Page

i Autobiography 1

ii First lesson plan ± (observed session) 2

Second lesson plan 4

Third lesson plan 7

iii Tutors report 9

Critical reflective account of observed session 11

iv Methods of evaluating teaching 12

Examples from practice illustrating development in the use of 13

evaluation.

SMART plans for future development in the use of evaluation. 14

References 15

Appendix 16
i. Autobiography.

I have been a psychiatry trainee for six and a half years and entered this speciality
from my pre-registration house officer year. I am now a registrar in general adult psychiatry.
I am currently working in a liaison psychiatry post. I work into James Cook university
Hospital in Middlesbrough. As a multidisciplinary team we provide mental health care for
patients with physical health problems or episodes of harming themselves intentionally. A
key role of the liaison psychiatrist is the education of other health professionals about the
interface between physical and mental health. This involves regular teaching of junior
doctors, medical students and nursing staff.

I have always been interested in medical education and have developed other opportunities to
teach. I have been involved in the production of training videos for examiners of the Royal
College of Psychiatrists practical examinations, I teach on a revision course for physicians
preparing for the first part of their professional examinations, I facilitate a seminar for dental
students about mental health once a year and I am currently developing a training package for
the voluntary sector in conjunction with a mental health charity. I also teach junior doctors
and medical students as part of the local medical development programme when required.

I plan to develop my role in medical education and eventually be in a position to plan and
deliver a programme of education to undergraduate and postgraduate students.

(Word count ± 233)

ii. Lesson Plans

The use of antidepressants in palliative care ± Observed session.

Aims:

÷ To familiarise Macmillan nurses with the medical treatment of depression in palliative care.

Learning outcomes:

÷ ·y the end of the session the learner will be able to discuss the appropriate options for the pharmacological treatment of depression in
palliative care.
÷ ·y the end of the session the learner will be able to state what augmentation strategies are available.
÷ ·y the end of the session the learner will be able to name where to find information about the doses of the various antidepressants.

Time Topic Teacher activity Learner activity Resources

14:30- Introduction -Introduce self, title of session, aims and objectives. -Listen to introduction. Flipchart and pens. Have
-Outline structure of session. written on flipchart the title,
-Ask student to introduce themselves (round robin). -Introduce themselves. aims and objectives.
14:35 -Groundrules ± All questions welcome etc...
14:35- Activating / Start interaction by asking learners to tell me what they Recall prior knowledge about Flipchart and pens.
assessing already know about antidepressants. Write this on the antidepressants and recount
prior flipchart. (If it appears the group is particularly quiet in this to the group.
14:45 knowledge the introductions I might split them into smaller groups
for this task).
14:45- Mini- Mini-lecture introducing principles of choosing -Listen to lecture. Partial handout
lecture antidepressants, the characteristics of the groups of -Complete partial handout.
antidepressants, a small formulary of antidepressants and
14:55 the strategies for augmentation.
14:55- Group Split group into groups of about 3 and give them Use information from mini- Handouts of scenarios.
exercise scenarios to consider treatment options (syndicate lecture to choose treatment
15:05 groups) options.
15:05- Group Ask each group to explain their chosen treatment. In turn each group to explain
discussion Encourage the other groups to constructively comment on their choice briefly and then
the chosen treatment. Correct any areas of to discuss their choice with
misunderstanding, (This directly relates to the first the larger group.
learning outcome). Ask about strategies if this doesn¶t
15:20 work, (Tests second learning outcome).
15:20- Summary Recount key principles. Point out sources of further Listen to summary. Flipchart and pens.
information (on partial handout, e.g. NICE guidance and
·NF). Go back to learning outcomes and state how these
15:25 have been covered.
15:25- Evaluation Ask learners to fill out evaluation forms. Fill out evaluation forms. Evaluation forms.
15:30 of teaching

Teaching methods: Teaching was run as a small group interactive session, using a mini lecture and case based discussion. This reflected the need
to both acquire information and then be able to apply this in order to meet the outcomes.

Assessment of learning: Learning was assessed informally through learners¶ comments in the group discussion.

Rationale for teaching methods: Learning here was in the cognitive domain. Two outcomes concerned the acquisition of new information and
recalling this. The first outcome listed concerned the assimilation of this knowledge with prior learning and applying this information to a new
context. The teaching methods were therefore varied to include the delivery of new information and providing clinical scenarios in which to
apply this. The group of nurses had some prior knowledge of antidepressants so in order for the session to be relevant to their practice I used an
interactive approach. This activated their prior knowledge and enabled the learners to ask questions and discuss issues relevant to them. There
was a large amount of information to be delivered however I wanted to spend most of the time in discussion of example cases and applying
knowledge and principles gained to their practice. I therefore included a mini-lecture near the beginning of the session and provided a partial
handout to guide note taking to provide material for the later tasks of formulating their own management plan.
 What¶s it all about?´ - Why do psychiatrists ask the questions they do?

Aims: To increase the level of understanding about the aims of the psychiatrist in psychiatric consultation and the questions asked.

Learning outcomes: ·y the end of the session the learner will be able to describe and discuss some of the influences shaping the questions and
style of the psychiatric consultation.

Entry behaviour: To have had some experience of the psychiatric interview, either as a medical student, service user or carer. (Up to 15 learners).

Time Topic Teacher activity Learner activity Resources

10:45 Introduction The facilitators introduce themselves. Outline structure of Listen to introduction and put ·adges, flipchart paper and
and session (Discussion, watch video, lunch at 12:00) on name badges. pens, pins/tape/bluetack.
brainstorm
Ask learners to put on name badges.
Split into 3 groups and write
Ask the group to split into three and write down what on flipchart paper what they
they want from the session on flipchart paper. Put these want to achieve.
11:00 sheets on wall when completed.
11:00 State Use the group¶s comments to identify and discuss what Discuss with facilitators what Flipchart paper with group¶s
objectives will be covered, why and what is for another session. will be achieved in the comments on pinned on wall.
11:10 session.
11:10 Group Ask group to introduce themselves in a round robin and Each learner to state their
introduction give one guideline for the session each, e.g. µWe only name and a guideline.
and give constructive comments¶.
guidelines
State guidelines will be up during lunch break and can be
11:25 added to then.
11:25 Groupwork. Split group into 2 (one µdo¶ and one µshould¶). Ask Think of the questions. Then Pens and paper. Flipchart paper
µQuestions¶ groups to think about µWhat questions should / do discuss in groups and think of and pens.
psychiatrists ask?¶ on their own for a minute. Then ask 5 questions for each µdo¶ and
the groups to discuss this between themselves and write µshould¶ group.
11:40 the questions down on flipchart paper.
11:40 Groupwork. Ask the groups to swap their questions with the other Swap flipchart paper with Flipchart pens and paper.
µReasons¶ group. Then ask each group to write the reasons why questions on. Consider these
these questions are / should be asked. questions and write down
why they think they
12:00 are/should be asked.
12:00 LUNCH Remind learners that guidelines can be added to on board Eat lunch and discuss LUNCH
Revisit during lunch. questions they have come up
12:30 guidelines Mix with group. And talk about questions. with.
12:30 Group In large group look at the questions and use these as a Talk about the reasons for the ·oard/flipchart and markers.
discussion basis for discussion. Cover topics of: questions and discuss as a
-Multiple aims of the psychiatrist group.
-Structure of psychiatric history
-Language used
-Rapport
-Diagnosis
-Understanding the patients experience
-Different personalities
-Common aims with the patient
13:00 -µmanagement¶
13:00 Observe Show short video and ask group to consider what the Note down thoughts during Pen and paper.
role play psychiatrist is doing. Emphasise the doctor and patient video, show twice if
are ACTING! It is not meant to reflect real symptoms or necessary.
13:20 real practice.
13:20 Discussion Ask group to discuss their thoughts. Sit with group and Discuss their thoughts about
13:40 of role play encourage them to answer queries between themselves. the way the interview took
place within the group.
13:40 Summary / Ask for points in a µhat¶ of one thing each person has Write down learning points µhat¶, paper, pens.
13:50 assessment learned. Pick out the points and read aloud. Write the and put them in the µhat¶.
of learning points on the board.
13:50 Evaluation Circulate evaluation forms. Must fill out to improve Complete the evaluation of Evaluation forms.
14:00 of teaching session and receive certificate. teaching.
Teaching methods: This was a longer session allowing time for a greater range of techniques. After the initial introduction the session started
with some group discussion work in smaller sub-groups. This led on to a short period of individual work to activate prior knowledge and then
forming larger syndicate groups to consider opposing aspects of the question. This informed the interactive discussion within the group. A video
of a psychiatric interview was then shown and discussed as a group.

Assessment of learning: This was done in three ways. Initially learning from the smaller group discussions was assessed in the large group
discussion informally through people¶s comments. The application of this learning to a practical experience was then assessed in the discussion
about the observed psychiatric interview. Finally learning from the whole session was assessed by using a µround robin¶ to allow learners to
identify and re-enforce their learning points.

Rationale for teaching methods: This session involved a lot of interactive discussion so initially small groups were used to allow the quieter
learners to engage in the process. This also allowed for a period of activation and assessment of prior knowledge as I moved around to facilitate
each groups work. As the group sizes increased it allowed a snowballing effect for the discussion points. A syndicate group was used to allow
two opposing views to be considered and allow a greater appreciation of the competing aims of the psychiatrist in the interview. This then gave
two viewpoints which facilitated an interactive discussion. To reinforce the learning, make it more applicable to the learners¶ future experience
and provide a visual format a video of a psychiatric interview was shown and then discussed using points from the previous discussions.
 Assessment of self harm.

Aims: To increase the confidence and competence of junior doctors working in medicine in assessing people who have harmed themselves.

Learning outcomes:

÷ ·y the end of the session the student will be able to list the risk factors for repetition of self harm.
÷ ·y the end of the session the student will be able to discuss the limitations of actuarial scales for risk assessment.
÷ ·y the end of the session the student will be able to list the essential questions they must ask the patient.
÷ ·y the end of the session the student will be able to name the physical investigations that should be performed and the rationale for these.
÷ ·y the end of the session the student will be able to discuss the variety of factors that contribute to people harming themselves.

Entry behaviour: Foundation doctors in their first year as part of the µFoundations of Clinical Practice¶ programme.

Time Topic Teacher activity Learner activity Resources

10:00 Introduction Introduce myself, the topic of the session and its format. Listen and then move chairs to Large room with chairs
10:05 Ask the group to form into three groups of four. form three groups. that can be moved easily.
10:05 Small group Ask groups to discuss patients they have seen who have Discuss cases, the issues raised Chairs in three groups.
work harmed themselves. They should identify the issues and summarise one case to
these patients raised for them and one case to discuss present to the larger group.
with the larger group. While the groups are discussing
cases the teacher will move round the groups assessing
10:20 prior knowledge and identifying areas of need.
10:20 Whole group Ask a group to present case and the issues raised. Ask -Present the case. Chairs arranged in a
discussion, (to the groups to then answer these issues using their own -Reflect on the issues. large circle.
be performed in experience. Clarify any misunderstandings and facilitate -Analyse the issues, (e.g. why
three cycles of the discussion to cover the learning outcomes. did the patient refuse treatment?)
ten minutes). -Plan for what could be done in
10:50 future (e.g. mental capacity act)
10:50 Summarise Recap of the learning objectives then a µround robin¶ of State their key learning points in
11:00 learning the key learning points for individuals in the group. turn.
11:00 End session Highlight evaluation forms and further reading. (e-mail) Complete evaluation forms. Evaluation forms.
Teaching methods: This session used small group discussion and interactive case discussion based on learner¶s previous experience in a larger
group. A µround robin¶ at the end of the session summarised the main points and further reading was provided for them to refer to in the future.

Assessment of learning: Learning was assessed informally during the discussion and using the µround robin¶ format at the end of the session.

Rationale for teaching methods: The session aims were to increase the learners¶ confidence and competence. This required an approach based on
experience so an interactive session based on the experiential learning cycle was used. The small group work activated prior knowledge and
analysed the issues. The larger group work then allowed further analysis of the issues and planning for the future using the experience of others
in the group, (consistent with the social constructivist theory).
iiia. Tutors report.

a
   

:

÷ Lesson plan prepared and well structured. You reviewed the learning outcomes of the
session and discussed them in general terms.
÷ You were in an unfamiliar environment and with unfamiliar learners. You did a quick
ice-breaker and moved into your presentation seamlessly.
÷ Good identification of background of learners. Your questions (concerning what anti-
depressants they were familiar with) were general enough to stimulate safe responses
and gave you some idea as to their experience.
÷ It was helpful to investigate that they wanted to learn in the beginning. The more
relevant information is to adult learners, often the more successful the learning
experience is.
÷ Session organised and structured logically. You had an introduction to principles of
anti-depressants, reviewed different meds and then moved into interactive activities.
÷ You demonstrated a confident and relaxed manner in your session.
÷ You used lots of positive feedback when students responded (µgreat, very good¶)
÷ You did a lot of work prior to this session. Your plan, handouts and case studies were
a lot of preparation. Ideally, you can keep these resources in a teaching portfolio and
use them again.
÷ It was pitched at an appropriate level. They obviously had some (probably varied!)
background in this area. Your questions pushed their understanding and required
them to apply this in a clinical setting.
÷ Lecture style teaching can be a very appropriate teaching strategy in certain
conditions. You chose to use a mini lecture to review principles and characteristics of
anti-depressants in the beginning. This was entirely appropriate.
÷ It was a well controlled pace and you certainly kept to time. The structure of the
lesson was clear and the time allotted was well planned. You had to be flexible in
your plan as you were not sure how many students there would be or their exact
background. You did this flawlessly and created fantastic learning opportunities for
them.
÷ Your obvious interest and background in the area was a valuable asset for the
students.
÷ You used varied teaching methods in appropriate ways-lecture, brainstorm, small
group work, case studies
÷ Good activation of prior knowledge and cued learning (µwhat are the side effects of
lorazepam?¶) This cued the students to recall the material that you knew they had (or
should have!) covered previously and put it in a clinical context.
÷ You were approachable and  
 
. According to Rogers and Maslow, this
basic requirement is imperative to facilitate an environment conducive to learning.
The students felt comfortable answering out loud and asking questions (One girl
asked µCan I ask about 20mg dose of citalopram in an elderly woman¶?). I doubt you
would get this involvement if the students were threatened or intimidated by the
environment.
—
   



I hope you find the following comments helpful.

÷ You may have asked the students to share examples of cases concerning depression in
palliative care they have seen have seen. It could have generated some interesting
discussion if you had asked for examples they had seen- either a present client or in the
past. Remember, one of Knowles (1980) basic assumptions of adult learners is that they
have real life experience to draw from. You might have attempted to facilitate this.
÷ You explained the topic, outlined what you wanted to cover and gave an overall
introduction. However, a brief explanation to the structure might have helped. You might
have explained there would be a mini lecture, group work, then a brief summary. In doing
this, the students knew what to expect and what was expected of them
÷ It was a well controlled pace, however, there could have been more time for questions
during the lecture at the beginning. Asking questions can change timings, and I am aware
you were time constrained in this session! However, think about what you have to teach
them and what they could do on their own, or should already know. As we discussed, the
students had some background knowledge on this subject. Instead of just transmitting
information, you could have increased interaction and activated prior learning by asking
questions i.e.
Ô  What are the side effect of amitriptyline?- instead of listing them
Ô  Why have you seen patients stopping anti-depressants?

÷ Learners often value and can learn a lot from ÷
experience. It may have been
worthwhile sharing more of your personal 



  that were learning points
for you. It might have been helpful to include, for example, a case you remember in
which someone at risk was identified and treated, or someone at risk who was missed and
the consequences.
÷ The session was well planned and organized. However, there seemed to be a bit of
confusion at the end of the group work. It was a little unclear who would be commenting
on the group¶s treatment choice. After the first group went, you commented, but I think it
would have been more helpful, interactive and informative to you if the groups
commented on each others. In your lesson plan, you suggested that would be happening.
I think ÷ were quite clear what ÷ wanted and expected. However, the students
seemed to falter a bit. Plus, you were unfamiliar with the room and the number of
students- very difficult! Make sure you plan the activity and give clear instruction (or put
on flip chart or handouts) what you want the learners to do. Just keep this in mind next
time you are planning a group activity. That way everyone is doing what you want and
(hopefully) working cooperatively. Plus, it may make it easier for you and your time!

Overall, it was well taught. Your flexibility and preparation led to a successful experience.
I hope this feedback is helpful. Hopefully, you will learn from this experience!! Have you
have started reading for you learning module? If so, you may remember back to your
experiential learning cycle «. Identify the things that you need to learn from and plan what
you are going to do if the situation happens again.

Laura Delgaty
iiib. Critical reflective account.

Using my reflective diary and the tutor report I have identified areas for improvement.
When I started the session I stood at the front of the room with a flipchart. Instead I could
have used another member of the group as a scribe while I sat with the group. This would
have made the activation and assessment of prior knowledge more interactive. As suggested
in the tutor report this may also have been achieved by encouraging the learners to answer
questions during the mini-lecture. This would take longer but would build on prior
knowledge. Asking learners to share their experiences would also have helped.

The room was rectangular with a lot of furniture. I moved the desks to the side and put the
chairs in a circle, but removing the flipchart and using the board on the wall or removing
other furniture may have made the environment more comfortable. A more full explanation
of both the session structure and my expectations of the learners in the group exercise would
have made the session flow more easily as the learners would have known what was expected
of them.

To make delivery of information more accessible to the learners I could have used personal
clinical anecdotes to put facts into context and make the principles easier to remember.

In future sessions I will involve the group more by asking someone to be the scribe and using
the prior knowledge of the learners to answer each other¶s questions. I will look closely at
how the room can be arranged before the learners arrive. I will use examples from my own
practice to illustrate points made. I will specifically examine the level of interaction when
reflecting on my teaching. I will also read resource material provided by the course on
promoting interaction. ·y doing this I will identify and be able to discuss ways of facilitating
interaction within a group.

(Word count ± 316)

?
iv. Extended essay

a. Methods of evaluation of teaching.

A search of the literature on evaluation of medical teaching reveals a number of sources

commenting on the characteristics of an effective evaluation tool, for example Morrison
(2003), Mohanna, Wall and Chambers (2004) and Snell et al (2000). With the aid of these
criteria the advantages and disadvantages of different methods of evaluating clinical teaching
can be identified.

The two methods that will be discussed here are the use of a standard questionnaire produced
by the Royal College of Psychiatrists and keeping a reflective diary of teaching sessions.

Introduced in 2008 the µAssessment of Teaching¶ (AoT) is part of the Royal College of
Psychiatrists¶ range of work-place based assessment (WP·A) tools designed to assess
competence. These are used as evidence in annual reviews to show competency progression.
The competency based curriculum of the Royal College of Psychiatrists has a number of
objectives specifically on teaching others and the AoT is mentioned as appropriate evidence
to show these have been achieved. It is therefore an important and widely used tool for
evaluating teaching among psychiatry trainees. A copy is provided in Appendix 1.

The AoT can be completed by anyone. It has ten items rated on a Likert scale linked to the
teachers µstage of training¶. These are weighted towards using teaching aids, (three of the ten
items). There are no items rating content or learning outcomes. There is an area for
qualitative information which includes µagreed action¶.

The advantages of this tool are that it is short with tick box ratings which means it is feasible
to complete at the end of a session and not overly burdensome. It collects both quantitative
and qualitative information. This allows data to be grouped for comparison and analysis, and
also elicits information in greater detail that is useful for the teacher to consider how to
improve sessions. ·eing paired with feedback increases the teacher¶s motivation to use the
tool as the comments are directly relevant to him. The questionnaire applies to any psychiatry
trainee at any stage of their training at any site and is therefore able to be used widely. It is
specifically mentioned in the Royal College of Psychiatrists guidance on collecting evidence
to prove competency and is therefore directly linked to professional development. It can be
completed by anyone and therefore allows information from a range of sources to be
collected.

Disadvantages are that it has not been shown to be valid or reliable. Threats to the validity are
the narrow range of questions, distributed by the teacher allowing them to influence the
results and it is not completed anonymously. The reliability is adversely affected by the large
range of people who could complete the questionnaire, its reliance on assessing people
against their µstage of training¶ and the ratings are highly subjective using the completer¶s
idea of what is µacceptable¶ as a standard. People are unlikely to know how teachers should
be performing or what their µstage of training¶ is. These factors mean cross comparison
between trainees is unreliable. There is no evaluation of how well the learning objectives
were achieved or if they were appropriate. This potentially allows a teacher to be scored
highly even though he did not cover the stated outcomes or the outcomes were unrelated to
learning needs.

This tool highlights some of the advantages of using questionnaires to evaluate teaching. A
questionnaire format is flexible and can be redesigned to fit its purpose and, as shown later,
many of the disadvantages of this tool can be addressed. Questionnaires can be used by a
range of interested parties, (teachers, course organisers, curriculum designers etc... [Snell et al
2002]), and tailored to their needs.

The use of a reflective diary fits with Kolb¶s theory of experiential learning and has the goal
of improving practice through learning from experience. It is relatively unstructured
compared to other methods of evaluation and, while this limits how conclusions can be
generalised to others, this makes it highly relevant to the individual. It can be tailored to the
learning objectives of the reflector and used as evidence for meeting goals of professional
development. It is flexible and can be used by all teachers in any situation. Reflective diaries
can be confidential and are directly relevant to the practice of the individual teacher. This
provides a high level of motivation for the teacher to µbuy-in¶ to the process. One can also
include information from other sources, such as informal comments from students, as
material for reflection which increases its validity.

The individual nature of the reflective diary means it is of limited use to other interested
parties such as course providers. The burden of the time it takes to complete the process can
mean it is unfeasible in situations when time is limited. The reliance on qualitative data in
this method limits comparison to other teachers. There are no objective items for assessing
individual points, such as whether the teacher is addressing the learning needs of the student,
which results in a subjective account where significant areas for development can be missed.

b. Examples from practice illustrating development in the use of evaluation.

There were many disadvantages of the µAssessment of Teaching¶ tool from the Royal College
of Psychiatrists. When this was used it was found that some items were seen not to be
relevant and therefore not completed, the boxes for qualitative information were not
completed, (possibly because they were at the end and had confusing titles, for example
µagreed action¶), and people were confused by the request for their registration number. An
alternative tool was therefore devised to address these issues and is shown in the appendix.
This new shorter tool directly assessed the learner¶s perceptions of meeting the learning
objectives. It prioritised the qualitative data collection to maximise the completion rate and
used a Likert scale related to the learner¶s agreement to assess factors related to the delivery
of the session. It included the statement µI would recommend this session to a friend¶ to
assess overall satisfaction with the session.
c. SMART plans for future development in the use of evaluation.

÷ Continue to use the newly developed tool to evaluate teaching after each session.
÷ Refine the tool to reflect the situation it is used in and the development of my
knowledge and experience in using evaluation tools.
÷ Use validated tools when appropriate, such as the L-PAST, to evaluate teaching
sessions.
÷ Use multiple sources of information when evaluating teaching sessions.
÷ Request a copy of the evaluation conducted by course organisers on sessions I have
been involved with.

(Word count ± 1068)

References.

Morrison, J. (2003). A·C of learning and teaching in medicine: Evaluation. ·ritish Medical
Journal. 326:p385-p387.

Mohanna, Wall and Chambers (2004). Teaching made easy: a manual for health
professionals. Radcliffe medical press. Abingdon

Snell J, Tallett S, Haist S, Hays R, Norcini J, Prince K, Rothman A and Rowe R. (2000).
Medical Education. 34:p862-870
Appendix

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