General teaching tips
BASIC TEACHING SKILLS
Setting the scene
The importance of starting off on the right foot cannot be overestimated. The students are most
likely to learn in a relaxed and friendly environment. GPs have a reputation for being friendly and
approachable teachers. While part of this is no doubt related to the way in which we approach our
clinical work, some of it is consciously developed to put students at their ease. In the same way
that we arrange the seating for patients to help communication, we can help teaching by arranging
the students’ chairs in a circle and putting any visual aids (flip charts etc) so that they can be easily
seen. A friendly greeting and the offer of a cup of tea relaxes students, and if asked they will wash
their mugs up afterwards!
Students tell us that their GP is often the only person who enquires what they have seen that
week. They find this valuable, and feel they can discuss things openly with us as we are out of the
hospital setting.
Once the group is together it is worth informally discussing some ground rules. These are the rules
by which the group will function over the next few weeks, covering things like attendance and
confidentiality. We will deal with setting ground rules more fully in the section on managing groups.
Being student centred
The phrase student centred has a similar meaning to being patient centred. Essentially it is about
moving away from an authoritarian form of teaching where you, as the teacher, knows exactly what
the students need to know and are going to teach it whether they like it or not. Within CMT an
authoritarian approach is not sensible, never mind the philosophical objections, because the
students are the ones who know what they have done already, what they are doing in the hospital
over the next few weeks and thus what the gaps in their knowledge are. Being student centred
means focussing on what the students want to know and involving them in the learning as much as
possible

“We were always asked what we felt that we didn’t know enough about so we weren’t going
over the things we already knew well – so we managed to fit in most of the things in the log
book that we hadn’t done before” (3rd Year student)

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You will automatically start being student-centred on the first session when you and the students
sit down together and look at the aims for the next sessions. Keep checking with the students that
you are covering what they want to know. That way you will avoid a lot of duplication and waste of
time.
Assessing prior knowledge
Finding out what students know already is very important. Remember that even if they know it
already, time spent rehearsing the information is not wasted – by calling it up, they will be
preparing themselves for learning. Try to think creatively – they may not have already seen
someone with fibrosing alveolitis, but they are likely to have seen other causes of shortness of
breath – can they describe one of these cases? How was the patient affected? What was the
underlying problem?
You will find that students often have relevant knowledge in another field entirely which is
nonetheless useful. For example when talking about anxiety ask the students about their exams.
How did they feel? How does this relate to the feelings that people experience in anxiety? Once
the students prior knowledge has been explored you can then start to build new knowledge on to it,
with no risk of teaching students something they already know.

A couple of problems often arise. Students may say they know nothing about a subject when in
fact they do. There are several reasons for this: they don’t see how experience A could be related
to experience B; they fear that their knowledge is too superficial and they will be made to feel
stupid; or they fancy a non-challenging session. Creative exploration of prior knowledge should get
round this. Another common situation is that one member of the group is either very
knowledgeable or rather behind their peers

A teacher started to discuss nutrition in patients with inflammatory bowel disease when she
noticed the group looking uneasily at one of the students. It turned out that he had a BSc in
nutrition. He was delighted to go over the subject with the group, at the end of which both
the group and the GP teacher felt they had learned a lot.

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We will deal with mixed ability teaching in the section on teaching groups, but as a quick guide, use
the knowledge of the able students to fill in the gaps of their peers rather than didactically going
over it all.
Getting students to participate
Students are most likely to learn when they are actively involved with the learning. This seems
particularly obvious when you are learning a skill – watching me perform a cardiovascular system
examination a thousand times is not going to teach a student how to hear heart sounds unless they
have a go. It is equally important for students to use new bits of knowledge they have learned. This
will help them ‘fit them in’ to their memories and use them when needed. You will have to devise
situations in which students can actively discuss what they have learned and test that they
understand new concepts. Students are likely to learn when you use a variety of teaching methods
in the session. This keeps students interested. Thus you could have a discussion, some practical
work, get the students to think through a case and look at a model all in one session. Useful
techniques include questioning, brainstorming, interaction with patients and role-play. We will deal
with the art of asking questions below, and some of the techniques to use with a group in the
section on teaching groups
Asking questions and dealing with answers
Questions are the simplest way of getting students to interact with a teacher. However, asking
questions is not as simple as it appears. Firstly you need to consider why you are asking the
question. Ideally you want to get the students involved in a discussion that will keep them involved
with the teaching and helps them learn. With this in mind you need to consider the type of question
you ask. A closed question – e.g. “what is the main cause of heart failure” invites a short factual
answer. Either the student knows the answer or they don’t. If they do they will get a brief glow of
success, and if they don’t they are likely to fell rather stupid. Open questions permit a more
discursive response and invite the student to think their way through a problem. Questions can
also probe at different levels of knowledge. The most common questions asked by teachers look at
recall of facts. However, it may be more useful to see whether the student can use those facts, and
whether they can solve new problems with those facts. Thus you could ask “using what you know
about the way the heart works, how do you think a heart attack would affect function? Can you
think what symptoms a patient might have?”
The most common problem we see with asking questions is that teachers don’t allow students long
enough to think of an answer. Remember that complex questions need more thinking time. Rather
than answering the question yourself when the student can’t, ask yourself why. There are several
possibilities:
· the student doesn’t understand - try putting the question another way
· the question had more than one part and the student cannot remember the first point – try to
keep it simple
· the question was too difficult – reframe the question at an easier level (this may make several
smaller questions) as working through the answer to the question with you in small stages will
help students understand the underlying concept