Personal Philosophy of Teaching - Essay Example

?Personal Philosophy of Teaching Introduction Medical knowledge and information has been rapidly evolving. It is said to multiply to double its ratesevery five years. In effect, information being taught in medical school usually diminishes in relevance in a matter of years. In the current context, the focus of medical learning has now shifted to the student or the learner-centred approach in response to this fast-paced transition of knowledge. The learner-centred approach includes problem-based learning, case-based learning, and peer-assisted learning (Srinivasan, et.al., 2007). Such learner-centred approach is based on active and reflective learning which is also founded on the learner’s motivation to learn. This type of learning however, needs the participation and assistance of clinician-educators working with the learners as facilitators. This paper shall discuss my personal philosophy of teaching psychiatry to junior doctors in the psychiatric work place. It will also demonstrate knowledge and understanding of the principles underpinning the structure of learning and supervision in the medical workplace. This essay will also articulate and justify my personal philosophy of teaching and identify potential future needs and opportunities for engagement with continuing professional development. Body In teaching psychiatry to junior doctors, I applied the student-centred approach, more specifically, the case-based learning approach. Case-based learning is a valuable tool in medicine because it involves the application of theories and skills which are eventually meant to secure important tools for the learner (Kolodner, Hmelo, and Narayanan, 2003). Case-based learning is founded on the principle of clinical cognition which, in general, seeks to assess cases and establish applicable processes for their resolution (Elstein and Schwarz, 2002). John Dewey describes the theory of clinical cognition by explaining that experiences are often critical elements which impact on the overall quality of learning and that teachers have a responsibility to ensure optimal experiences in its applications (Kassirer, 2010). In effect, he further posits that teaching experiences “should arouse curiosity, enhance personal initiative, and allow free expression of learners’ ideas” (Kassirer, 2010, p. 1118). The knowledge which a student has learned through experience in any situation therefore becomes the tool in understanding and managing other situations which may follow. I used this case-based learning because through this method, I was able to guide the junior doctors into establishing a vivid picture of their patient, to have a more tactile experience of the patient’s case, and to enable comparisons of abnormal and normal psychiatric processes. A discussion by Halbreich (1994) established that part of the processes involved in teaching psychiatry to general practitioners is based on the establishment of a curriculum which is built on the needs of the GPs. The case-based and the problem-based techniques help designate the personal skills which need to be evaluated, the knowledge of symptoms, the differential diagnosis, as well as the management tools which they can apply (Halbreich, 1994). In effect, the learning process founded on the case-based approach involves the process of teaching GPs about the essential symptoms involving psychiatric affectations (Coderre, et.al., 2003). As the learners would have a more personal evaluation of various patient cases, they are also able to establish appropriate management interventions for these cases. I found that the process of teaching junior doctors about the medical management of psychosis in wards can be adequately carried out with the application of the case-based learning. Policy and practice protocols in medical management among psychiatric patients, involves the usual elements including, history-taking, reasons for consult, prioritisation of patient needs, assessment, identification of need for specialist consult, health plan/interventions (Bowen, 2006). Case-based approach individualizes the teaching and learning process, allowing the learner to evaluate the preceding elements which relate to case management (Eva, 2004). For which reason, the case-based approach is often used in medical teaching as it supports the notion that the role of the teacher is not solely to transmit information and knowledge, but it is also to facilitate the learning process and participate in mutual inquiry (Kassirer, 2010). In order to gain maximum efficacy, this approach requires me to be comfortable in situations where the learners are involved in challenging situations. In the course of my teaching and in applying the case-based approach, I noted that the junior doctors were soon able to gain expertise in psychiatric management. “Gaining expertise is not easy, and it cannot be achieved passively” (Kassirer, 2010, p. 1119). In applying the case-based approach, I was able to see the junior doctors endure various processes and sacrifices, and sometimes go through challenging moments of self-assessment (Norman, 2006). These learners soon realized that there were no shortcuts to learning and that they needed to participate in strong and deliberate practice which would highlight their level of competence and comfort. Case-based approach allows learners to mindfully evaluate and to assemble theories and concepts into more complicated concepts, helping learners eventually gain some form of expertise in their knowledge and skills (Mamede, et.al., 2007). The case-based approach usually includes the analysis of transcripts of psychiatrists and practitioners thinking aloud. I chose this practice because it allowed the junior doctors to assess the elements of reasoning and to assess the clinical concepts involved in the case (Mann, Gordon, and MacLeod, 2007). These transcripts indicate that sometimes diagnostic details can be easily and quickly established even where the medical data about the patient is very minimal. Even where such potential diagnosis may not be definitive, they still establish a framework for continued and more specific data gathering processes with the patient (Kaufman and Mann, 2007). I allowed the junior doctors to listen to these transcripts because it allowed them to understand how symptoms detected may lead a psychiatrist to a potential diagnosis. It also helped the learners understand how follow-up queries can lead psychiatrists to a more accurate diagnosis. Junior doctors already have the necessary background in medicine, and the case-based approach is a familiar method of teaching in their medical education (Kendall, Hesketh, and Macpherson, 2005). In emphasizing on this approach in teaching psychiatry, I wanted the learners to gain the clinical knowledge which was essential in the effective management of patient’s symptoms. The clinical reasoning often applied in case-based approach is an ideal means of absorbing knowledge and then storing it in one’s memory (Mamede, et.al., 2008). Once it is stored in one’s memory, the mind automatically breaks down the knowledge, allowing for the brain to process and establish ‘if-then’ scenarios for disease management (Kassirer, 2010). Even as uncertainty is sometimes attached to the establishment of knowledge based on memory, a significant amount of data has already been established on how individuals evaluate and apply their learning (Woods, 2007). Clinical reasoning is based on a visualized process which is both intuitive and analytical (Hall, 2002). It is intuitive as it is based on previous theories and information long accepted and proven true. This means that clinical reasoning is instinctive and often reflexive, requiring no element of analytical thought (Hall, 2002). It would therefore include first impressions and rapid responses to data. Among learners, their knowledge as junior doctors is usually based on their intuitive knowledge, and such easy knowledge often allows them to resolve the easier cases based on the patterns that they recognize. The analytical elements of clinical reasoning have been highlighted more in my teaching methods using the case-based approach. These analytical elements are more deliberate and more focused, and are more consciously and mindfully evaluated based on a variety of options (Crosskerry, 2003). I was also aware that the analytical process was more cognitive in approach and in applying the case-based method to the junior doctors, I discovered that with each case they worked with, they were able to make a more deliberate and discerning assessment of patient’s symptoms, allowing for a more effective evaluation of interventions (Atherton, 2009). Evaluating psychiatric illnesses is an individualized process. This was one of the elements of psychiatry which I emphasized to the junior doctors (Tampi, Muralee, and Weder, 2008). Inasmuch as the junior doctors may be used to the process of considering a set of symptoms to definitively determine the existence of a specific disease, such process may not be as easy to apply to the field of psychiatry where there are elements of subjectivity involved in the assessment of symptoms (Tampi, et.al., 2008). The analytical component in clinical reasoning is often activated in cases where the pattern seen in the case scenario is not clear (Redelmeier, 2005). For example, a patient’s sadness and loneliness may be viewed as depression, but other laboratory tools may not provide sufficient support for such a diagnosis. Junior doctors are therefore taught to discern each patient case as unique, assessing patient history, tolerance, and general state of mind in order to definitively establish an accurate diagnosis (Nolan and Badger, 2002). Even the use of psychiatric drugs has to be individualized to each patient based on a critical and analytical evaluation of elements (Bhugra, 2011). With clinical reasoning, the junior doctors are therefore able to fashion the elements of reality, thereby facilitating diagnostic reasoning. There are fewer errors in the clinical practice when the analytical methods of clinical reasoning are applied because these analytical components can even override and invalidate the initial impressions seen in intuitive practices (Newman-Toker, 2009). I wanted the junior doctors to supplement their knowledge about psychiatry and psychiatric illnesses and in the process enrich their clinical reasoning skills. Clinical reasoning is an important element of the psychiatric practice as it would likely help them establish accurate diagnosis and interventions for future patients (Fischhoff, 2003). I also wanted the junior doctors to improve on their causal reasoning, especially in relation to inferences on cause and effect relations between clinical components and incidents (Norman, 2006). Through the causal reasoning of the junior doctors, I believe that they can also detect discrepancies involving some diagnoses. Causal reasoning would also be useful in understanding multiple diagnoses, especially where the symptoms of a patient’s psychosis may not match the usual symptoms as explained by theories and standards of the practice (Kassirer, 2010). The approach I applied is mostly case-based, specifically using conferences with small groups of 10 junior doctors. The small number for each group was preferred because it was more manageable and it helped ensure a more learner-centred approach to learning (Newble and Cannon, 2001). With the small number of learners, I was able to devote more attention to all the junior doctors under my tutelage. The learner-centred approach allowed them to be exposed to the elements of clinical reasoning, guiding them towards understanding the specific applications of reasoning to particular cases (Fry, Ketteridge, and Marshall, 2003). Reasoning strategies in medical learning are already expected to be adequately developed for junior doctors (Misch, 2002). In effect, I can more or less expect to work with more flexible minds, minds which have strong powers of observation, and a willingness to question and learn from others. While the process may be learner-centred, the case-based approach also allows for collaborative learning, with the learners bouncing ideas off of each other as a means of establishing more dynamic learning processes (Ramani and Leinster, 2008). In this process of learning, I played the role of coach – a guide – who functioned best as a support system, allowing the learners to direct their pace and determine direction of learning (Harden and Crosby, 2000). As a coach and guide, I carried out various functions, including monitoring and providing comments and answers where necessary. As a result, I was able to fashion effective relations with the junior doctors. Specific elements involving the medical issues of patients as well as the clinical reasoning in the diagnosis and treatment of the illness can be managed simultaneously (Thomas, et.al., 2001). I believe that the interactive process with the junior doctors can be established well under the teaching approach which I adopted. Through the case-based method, the doctors could effectively interact with each other and with me (Narayan and Corcoran-Perry, 1997). Interactions brought about instant feedback with data being collected and diagnosis established based on data gathered. At times where data and discussions are withheld, the clinical reasoning can sometimes be lost; moreover, the learners may fail to discuss the critical elements which are relevant to the case scenario they are faced with (Mohanna, Chambers, and Wall, 2007). Conclusion The discussion above explains and critically analyses the case-based approach which I have applied as a clinician-educator to junior doctors in the psychiatric workplace. This approach has long been common in medical education, especially during the higher years of medical education. Among junior doctors, this approach is a useful tool as it has contributed in the doctor’s evaluation of information through clinical reasoning. Clinical reasoning is based on the generation of knowledge and data with the end goal of developing diagnosis and appropriate management interventions. The reasoning process is based on logical and theoretical foundations of medical education. Medical education transitions from theory to practice. Through the case-based clinical reasoning approach, doctors are able to relate the theoretical applications and symptoms of psychiatric illnesses, and consider how they may relate to specific diseases. 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