Department of Anaesthesia
Montreal Children's Hospital, McGill University, Montreal
Objectives
Introduction
One of the major responsibilities we have as anesthetists is teaching yet very few of us have received formal
training or had the opportunity to evaluate our teaching practice. Most of us learn how to teach through apprenticeship
by watching both good and bad teachers. I had a very positive experience with many wonderful teachers to emulate
during my anesthesia residency at the University of Ottawa. I was left with an enthusiasm and desire to teach residents
myself and learn as much as I can about the process.
Since I am a specialist in pediatric anesthesia that is what I teach, hence the title of this presentation, although
the same educational principles apply to all aspects of anesthesia. During the presentation we will use a case
in pediatric anesthesia to illustrate how best to teach its various components.
1. What are various methods we use to teach anesthesia?
Lectures
A survey of anesthesia residency programs in the US in 1988 revealed that all programs had lectures at least 1 day per week. The lecture is an efficient use of resources with a low teacher to student ratio. Unfortunately, it appears that students recall 70% of the material covered in the first 10 minutes of a lecture, 20% of that in the last 10 minutes and little else. There is a trend in education to move to more learner centered approaches such as small-group discussions.
Small group
Small-group sessions, usually 8 to 15 students, arc also very commonly used in medical education. Many medical schools now base their curriculum on this model. In anesthesia we use small groups to discuss cases, i.e., problem-based learning. (Remember those 0645h rounds?) The small-group format is particularly suited for adult learners who prefer to learn concepts rather than facts and apply learned principles immediately. Small-group work is superior to the lecture in achieving the goals of active learning, critical thinking, problem-solving and application of the knowledge to new situations. Small-group learning requires specific objectives, active participation from all present and should allow time for reflection. Drawbacks include increased cost due to higher teacher-student ratio, slower communication of information and the inability of some teachers to lead small groups effectively.
One on one
The nature of anesthesia practice necessitates the supervision by a staff of every act performed by a resident, therefore one on one teaching in the operating room occurs almost daily. It is likely that more time is spent using this method to teach anesthesia than any other. Despite this, there is little research on the use of this teaching method.
Computer-aided instruction
Despite the presence of computers in our lives for a number of years the role of computer-aided instruction has yet to be fully realized. Computers will not completely replace books and lectures and cannot substitute for a good teacher, but with improved and cheaper technology and increasing expertise on the part of the students, computer-based educational programs are now becoming an integral part of the medical curriculum. Use of the computer allows access to medical literature searches, electronic mail and computer-based simulations.
2. Are these teaching methods different from those used in other medical specialties?
Probably the largest difference occurs in the amount of one on one teaching done in anesthesia. Very few other areas of medicine spend so much time teaching in this situation. In anesthesia, compared to medicine and surgery, little or no teaching is done during ward rounds and in ambulatory care settings.
3. Which is the most appropriate teaching method for a particular educational objective?
Lecture
The lecture is best used when the material is not available in printed form or must be gathered from many different sources. When instructional objectives are considered, lectures are most appropriate for teaching knowledge and comprehension. Lecturing also allows the teacher to share some of his personal expertise and enthusiasm on the subject. In studies measuring students' problem-solving ability, attitude changes, application of knowledge to different situations and motivation for further learning, other teaching methods such as small group discussions had more favourable outcomes than lecturing.
Small group
Once factual information has been gathered from lectures or reading. the small group setting is very useful for teaching problem solving and allowing students to analyze and evaluate the information in different contexts. Case-presentation is the best example of the use of small-group discussion in anesthesia. Prior knowledge is utilized to discuss and understand the approach to a case, thereby promoting deep-learning.
One on one
One on one clinical teaching is particularly suited to a highly technical. specialty such as anesthesia. Motor skills are best learned in this hands on patient-based teaching situation. The teacher is able to demonstrate, supervise and provide immediate feedback. This is apprenticeship experience in the true sense of the meaning One critical aspect of one on one teaching is the opportunity for role-modeling attitudes and behavior. The nature of our relationship with patients and other members of the medical team is critical and cannot be taught in a classroom,
Computer-aided instruction
Computer-based learning may be useful in achieving more than one educational objective. It offers great scope for data acquisition with on-line literature searches and the increasing availability of textbooks and journals on CD-ROM. Interactive educational programs allow students the flexibility to learn at their own pace and receive immediate feedback on their performance. Finally, it is computer-based simulations that will likely have the biggest impact on medical education. Simulations can mimic a variety of clinical scenarios allowing the student to gather information and then attempt different treatment plans. The obvious advantage is that many attempts can be made without harm to a patient. Anesthesia is at the forefront of simulation technology with the development of realistic operating room scenarios including patients, anesthesia equipment and staff. Despite the rapid evolution of this technology we need well designed studies to demonstrate the educational effects.