Career Focus

Effective Teaching

BMJ 1998; 317 doi: (Published 18 July 1998) Cite this as: BMJ 1998;317:S2-7152

Doctors are often required to teach - but few are trained in teaching. Anna Donald describes the basic principles.

  1. Anna Donald, Lecturer in epidemiology
  1. University College London, London WC1E 9JP

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    Good teaching sessions are a bit like parties. It is good to strike a balance between soundly preparing for who's coming and what people should learn, while allowing people enough time and freedom to ask questions and to take in new knowledge. Basic planning is also essential for timekeeping.

    Providing the logistical information necessary to complete the session or course saves everyone time and frustration. It is helpful to provide a handout that includes the course outline, dates and times of teaching sessions, due dates for exams and assignments, how you can be contacted and any dates you will be away, office hours, reading lists, useful websites, and where reading materials can be found. People usually do not mind buying books that will be used often, and appreciate details of their cost and availability. Local booksellers are usually happy to supply enough books for the class. Packaging other printed materials into a reading pack also saves students a great deal of time. A librarian can help to obtain copyright permission from the relevant body.

    Summary points

    Almost everyone has someone who took an interest in their welfare and development. You may not have thought of that person as a mentor, but you know that it was an important relationship and a valuable influence

    • Be well (but not overly) prepared: administrative details, content, structure

    • Inform students about what is planned for the course and examinations

    • Treat students well: timing, refreshments, names

    • It's good not to know all the answers

    • Provide mechanisms to ensure regular attendance

    • Adjust the course with mid-way anonymous feedback

    • Give students feedback: homework, quizzes, evaluations

    • Be creative: props, parks and cafés!

    Conceptual content

    Which problem(s) would you like learners to be able to solve after each session? Disordered concepts are extremely difficult to learn, so it is a good idea to prepare for teaching sessions by identifying key questions that you want to address and organising the main points in a logical structure beneath them. Ensure that visual aids, such as slides and overheads, make sense conceptually when viewed in sequence. It is also helpful to begin a course by asking people to write down one to three objectives they have for attending it. This exercise helps students to focus on why they've come and informs you of what they're hoping for and of potential strengths and weaknesses.

    Structuring sessions

    Given the time and facilities available, which teaching format is likely to be most effective at conveying content? Possibilities include a 15-minute mini-lecture followed by small-group problem solving (this works well with up to about ten groups of six) with feedback at the end;tutorials; and lectures with short breaks for interaction (see above). It is always a good idea to provide a short break during sessions much longer than one hour, which can be achieved by asking people to turn to their partner and to solve a short problem. If going overtime is a danger, it is helpful to consider which material is not essential for grasping the main concepts and whether it might be possible to convey it in another way, for example as a hand-out.

    Content reinforcement

    Otherwise known as learning-by-doing, content reinforcement is a technique that recognises that information is best learned by using it; hence the development of “problem-based learning” in which students learn new knowledge by solving problems. The key to good problem-based learning is a well structured “problem” so that the learner is led to address relevant questions. Opportunities for this approach exist both within and outside the classroom. A typical problem-based approach involves providing students with structured problems to solve in small groups that force them to address key points. Although this requires initial preparation, it means that during most of the learning session you simply have to facilitate groups' learning and take feedback, which is less exhausting than standing up the front teaching.

    Even in lectures, students can turn to their partners for a minute or two each, and solve a short problem that you might otherwise have demonstrated to them. You can obtain feedback quickly from a large group by asking people to “vote” on the right answer. The timed, “turn to your partner” approach has many advantages and can be used in almost any context: it gives people a short break, enables shy people to express themselves, and stops others speaking for too long. Longer assignments, short (1-2 hour) homework, and 10-minute quizzes, with or without small rewards, reinforce previous learning, and can be followed by worked answer sheets. Bribery, thinly disguised as food, can work well. To the horror of my dental colleagues, I often give mini Kit Kats to students who score the top marks in short multiple choice questionnaire quizzes, partly to egg them on, and partly to convey the idea that epidemiology needn't be scary.

    Planning gains

    There is no rule that students should be kept in the dark about what's coming, so let them know what you're planning. Students usually learn better if they know the structure of the session or course in advance and can prepare for it, consciously and subconsciously. This can be achieved with course hand-outs that describe which skills and subjects will be addressed on each date, as well as what will be expected in exams. Mock exam papers 2-4 weeks before examinations are greatly appreciated. It is usually a good idea to outline briefly the order of events for each session at the start, and it is also possible to ask students what they want to learn from the session at the outset, which helps to focus their learning.

    Treat students as human beings

    Treating students as one would any other respected group is a good way to enjoy being in the class room, and gives them the emotional space needed to take in new knowledge. Learning students' names makes it possible to cold call them and improves attendance, as people know they'll be missed. Learning contracts (for example, to attend a minimum of classes and to participate in group work), and asking students for feedback (see below) gives students responsibility for their own learning. Starting on time and being rigid about keeping to time is considerate and discourages people from coming late. People greatly appreciate refreshments of some kind; you can charge people a small sum at the start of the course for provision of tea and coffee, or allow people to bring beverages into the room with them. Finally, while poorly rated teachers often report that “the students aren't interested,” it is good to bear in mind that it is the teacher's job to make students interested, not the other way around.

    Treat yourself as a human being

    It is easy to panic under the misguided idea that good teaching involves having the right answer for every possible question. In fact, this approach tends to have the opposite effect, making teaching terrifying for the teacher and stultifying for the student. Students respect teachers if they know that their questions will be answered within a reasonable time period and that their challenging questions will not be fobbed off. It is always possible to ask the class if anyone else can answer a question that you do not know the answer to, or to ask students to work out difficult questions and present them in the following session. It is also possible to bring in colleagues to address specialised topics.

    Ensure regular attendance

    It can be very disconcerting to have few regular attenders to seminars, but attendance can be improved by asking students to sign an attendance contract that allows them to miss 10% of classes, or by providing unpredictable revision sessions or short tests in class. It is also worth explaining to students that it's hard to teach &emdash; or to pass! &emdash; without regular attendance.

    Obtain feedback

    Long courses are invariably improved by feedback. Students appreciate teachers who bother to adjust their teaching style, albeit modestly, in response to honest criticism. Feedback should usually be anonymous and collected half-way through the course or earlier, as well as at the end, as then it is possible to make (usually minor) adjustments to the course in time to be of use to students. A questionnaire of key questions can be less than one page and take about 5-10 minutes to complete before or after a class.

    Preserve anonymity by leaving the room and giving students an envelope in which to place their responses.

    Give students feedback

    Students too need feedback in order to learn effectively. This can be provided with homework and in-class quizzes with worked answer sheets, and a midway presentation of their collective evaluation of the course, with a proposal of how you will address their main points.

    Have a good time!

    Have fun with yourself and your students. Teaching can be enormously creative. There is no “right” formula for teaching: as with parties, the best results come from combining good principles with your own style. It is usually possible to use props and games to reinforce skills (the “53” series cited on the opposite page suggests plenty of these), or to meet occasionally for seminars in an unconventional place, such as a park or café.

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