Tim Wilkinson - Tertiary Teaching Excellence Teaching Profile
Teaching profile from Tim Wilkinson (Associate Professor, Christchurch School of Medicine and Health Sciences, Otago University) - a Sustained Excellence Award winner 2002
Associate Professor, Christchurch School of Medicine and Health Sciences, Otago University
The Teacher's Role
Tim Wilkinson teaches Health Care of the Elderly courses for fourth-year medical students. He believes that ‘... learning occurs best within a safe and supportive environment with clear expectations and good support.' Tim's philosophy is to provide a flexible, rich and encouraging learning environment where teaching methods are designed to meet the needs of students and offer opportunities for interaction. Tim is now a leader in medical education in New Zealand as chair of the Faculty of Medicine Undergraduate Curriculum Committee and as chair of the continuing education committee for the Royal Australasian College of Physicians. A past student states, ‘Tim inspired me with enthusiasm, professionalism and close attendance to the requirements of the students, both as a group and as individuals.'
Memorable teachers are often effective information providers, role models and facilitators. Equally important, however, is to create a learning environment where the ‘teacher' and information provider almost becomes unnecessary but the subject remains memorable. In the absence of distractions, most students are motivated, capable and willing to do their own learning. My role is to create the environment that best promotes this independence in learning. To do this requires attention to creating clear goals, appropriate incentives and provision of the right amount of time and space.
Ron Harden, a prominent medical educator, has crystallised this by identifying 12 roles that a teacher may take: mentor, learning facilitator, on-the-job role model, teaching role model, lecturer, clinical or practical teacher, resource material creator, study guide producer, course organiser, curriculum planner, curriculum evaluator and student assessor. In 1994, when I first started teaching medical students, my role was only that of information provider. Although I had been involved in teaching during my training, I soon realised that content expertise in my field of interest was not enough to equip me as an effective teacher. I therefore studied to obtain a Certificate in Clinical Teaching and, more latterly, a Master of Clinical Education.
The changing practice of medicine means our medical teaching programme needs to emphasise life-long ‘future-proofed' skills, communication skills and attitudes. Our graduates need to be able to assimilate new knowledge and to continue in lifelong learning, self monitoring and adapting to changing practice. These factors have driven my teaching direction towards leadership in curriculum development because many of the problems require systemic solutions.
I continue to practise as a geriatrician as patient care still gives me as much pleasure as teaching. There are some parallels between my work as a physician and my work as a teacher. The effective practice of geriatric medicine is contingent on collaboration, teamwork and collegiality. Any illness needs to be considered within a person's social and environmental context. Promoting independence for an older person is a prime goal. I bring a similar philosophy to my teaching. Good teaching and achieving major education changes require collaboration, teamwork and collegiality. Effective learning must also consider the social and environmental context. Promoting independence in learning is critical.
Another role of a teacher is not only to develop new teaching and learning methods but also to evaluate and disseminate this work. I am committed to documenting and sharing good practice by publishing in peer-reviewed journals.
Medical Student Health Care of the Elderly Course
The main focus of my face-to-face teaching is the five-week course for medical students in the fourth year of their six-year curriculum. The course has 12 students at a time and runs six times per year. Students have opportunities to see patients in hospital, in outpatient settings and in the community. Inter-professional teamwork is an important life-long skill so we provide specific teaching on teamwork and provide formal opportunities for students to learn and understand the roles of other health professionals. Geriatric medicine is not widely perceived as a ‘glamour specialty'. Yet I see it as a triumph that this is not only a popular course with students but also results in improved and sustained positive effects on student attitudes to older people. This is also due to the enormous contributions from my colleague, Dick Sainsbury.
My face-to-face teaching is almost entirely in small groups, interactive and related to students' experiences and clinical scenarios. I try to provide a structure for students' learning and to make links between areas so that experiences make sense and can be used effectively. I believe learning occurs best by facilitated discovery rather than by listening to ‘answers'.
Teaching with a patient is enormously pleasurable. There are considerable challenges arising from the need to attend to the welfare of the patient, the welfare of the students, the acquisition of knowledge and skills by students and appropriate role modelling. In teaching psychomotor skills around a patient, I explain the rationale, demonstrate the technique, break it down into components and then allow each student to practise. I found that some students' attention might lapse while others are ‘having their turn'. I have therefore introduced ‘peer assessment' - after a student has tried the new techniques, I encourage self-assessment by asking the student to comment on what went well and what they found difficult. I then ask the student's colleagues to comment before offering my opinions. I like this method as it means all students are learning, not just the one who is practising at the time, and it reinforces the necessary lifelong practice skills of self and peer assessment.
In teaching diagnosis and interviewing skills, it is important for students to develop hypothetic deductive thinking. I therefore model this by interrupting the student-patient interview and asking all students to generate a list of possible diagnoses. I then ask each student to suggest a single question that might differentiate these diagnoses. Following a facilitated discussion between the students, they decide which question is likely to be best. They ask this, consider the answer and form new hypotheses. This is repeated several times. I will guide this by offering suggestions of other diagnoses, by encouraging them to apply basic scientific principles and by suggesting interview skills that I find useful in practice. At the same time, I attend to any concerns of the patient.
One of my roles, as Associate Dean (undergraduate education), was to monitor student achievement and ensure that struggling students were picked up. I therefore implemented a process of student progress review built around formative feedback and longitudinal following of student learning.
The process is characterised by systematic collection and collation of feedback from all teachers across all years in our school, including information on knowledge, skills and attitudes. Because I could take a longitudinal view, I could identify any students in difficulty but could also choose to wait to see if some problems resolved by themselves or if they needed intervention. To help borderline students, I spoke with the relevant course convenor, and helped each student develop his or her own plan of remediation. During the meeting with the student I deliberately encouraged self-assessment, followed by outlining their tutor's assessment before I offered my opinion or solutions. Any documentation was always in the form of a letter addressed to the student. By facilitating this approach I found nearly all students took ownership of any problems and were able to remedy them before the end of the course. As a result, the numbers of failing students have declined. In addition, any students who do fail are now being detected earlier. This system reliably detects problems even in the difficult areas of attitudes and skills.
The hidden curriculum, institutional factors and student welfare can all impact on learning. To explore this area further, I helped a final year student develop a questionnaire-based survey of medical student experiences during time at medical school. We are particularly interested in the effect of staff attitudes, positive and negative learning experiences, and the effect of student debt on learning. This work is an example of facilitating student-led research and part of it has already received widespread national interest.
Distance Learning Packages
For a number of years I have provided educational talks to rest home workers on matters relating to care of older people. Because this mode of education could only reach a limited audience within Christchurch, because my talks needed to be supplemented with written material and because I could not continue providing these talks, I joined a multidisciplinary group to produce a series of educational videos targeted at care workers of older people in institutional care. We supplemented these videos with a written workbook. The programme used a combination of identified learner needs based on the face-to-face sessions, evidence based written material and piloting of the material on the target audience. The courses are now registered at levels 3 and 4 on the National Qualifications Framework and contribute to the National Certificate in Support of the Older Person.
Assessment in the Undergraduate Medical Curriculum
Valid and reliable assessment of clinical skills is a critical component to ensure our graduates are ready to practise. In organising our high-stakes clinical skills assessment, I have developed and documented methods to ensure it is of high quality and that standards are robust. Leading a review of assessment practices across the undergraduate medical curriculum was the first major project I undertook as chair of the Faculty of Medicine Curriculum Evaluation and Assessment Committee, when appointed in 1999. Once again, I was keen for the study environment to provide the right learning incentives. There were a number of assessments that were not clearly or systematically related to Faculty objectives. Furthermore, many assessments were testing superficial knowledge without adequate emphasis on deep learning, skills or attitudes. We felt there were insufficient opportunities for students to be assessed formatively. Following an extensive consultation exercise within the Faculty and exploration of systems used in other medical schools, we were able to develop a clear blueprint that matched all our objectives to efficient assessments and to a criterion referenced pass / fail / distinction system. I have also been working on creating clear links between undergraduate education and professional practice. Our undergraduate assessment blueprint identified an absence of assessments that reinforced reflection, self-directed learning or learning based on individual learning needs. We are, therefore, developing a learning portfolio for students, which link with my work on portfolio development for practising physicians. Evaluation of these changes is the subject of my ongoing PhD studies.