Clinical Teaching in

Physiotherapy

Subhash Khatri

Goal of Clinical Physiotherapy education is to produce the PT we would like to see if we were sick!

PTs of tomorrow are taught by teachers

of today using curricula of yesterday!

It has simply been assumed that

PTs who have graduated from PT

schools/colleges and undergone

postgraduate training can

automatically start teaching the

day after they graduate.

Overview

Clinical environment Focused on patient Problems, Diagnosis & Management Real life situations Decision making on time Apply theoretical & practical

knowledge Acquire clinical skills

A teacher is a performer like an

actor; the only difference is that

teacher expects learners to

perform!

Challenges of Clinical Teaching

1. Time constraints2. Work demands : clinical, research or

administrative 3. Often unpredictable and difficult to prepare for4. Engaging multiple levels of

learners(PG/Interns/IV/III/II/I)

5. Patient related challenges: short hospital stays; patients too sick or unwilling to participate in a teaching encounter

6. Lack of incentives and rewards for teaching7. Physical clinical environment not comfortable for

teaching

Class room

• Large group

• No patient

• Knowledge

• Theoretical framework

• Teacher student ratio

large

• Passive students

• Less interactive

• Less class room hours

Clinical

• Small group

• Focus on patient

• Application of

knowledge

• Clinical reasoning

• Teacher student ratio

small

• Active students

• More interactive

• More clinical hours

Skills that make a excellent clinical teacher

1. Share a passion for teaching2. Are clear, organized, accessible, supportive and

compassionate;3. Are able to establish rapport; provide direction and

feedback; exhibit4. Integrity and respect for others5. Demonstrate clinical competence6. Utilize planning and orienting strategies7. Possess a broad repertoire of teaching methods and

scripts8. Engage in self-evaluation and reflection9. Draw upon multiple forms of knowledge, they target

their teaching to the learners’ level of knowledge.

Challenges in outpatient teaching

1. Busy clinical setting2. Teaching time often short, no time for elaborate teaching3. No control over distribution and organization of time4. Attending to several patients at the same time with multiple

learners5. Brief teacher-trainee interactions6. Patient care demands usually take priority and must be addressed7. Multiple patient problems must be addressed simultaneously, so8. teachers cannot focus on one problem to teach9. Learning and service take place concurrently10. Organic and psychosocial problems are intertwined11. Diagnostic questions often settled by follow up of empiric treatment12. Teacher should be a guide and facilitator than information provider

Challenges of inpatient teaching

Difficult to set teaching goals, unanticipated events occur frequently

Ward team usually composed of varying levels of learners Patients too sick or unwilling to participate in the teaching

encounter Patient stays are too short to follow natural history of disease Teachers could compromise trainee-patient relationship if they

dominate the encounter Trainees and teachers feel insecure about admitting errors in

front of the patient and the rest of the medical team Tendency by many clinical teachers to lecture rather than

practice interactive teaching Engaging all learners simultaneously can be difficult Teachers need to pay close attention to learner fatigue, boredom

and workload

Education is not teaching what learners doesn’t know but making

them to behave as they don’t behave!

Teaching of clinical

Physiotherapy should be

carried out on real

patients with real

problems!

Teachers should be

encouraged to seek

feedback on their teaching

from peers and

learners!

Learning styles

Cognitive approach 1. Pragmatists2. Reflectors3. Theorists 4. Activists

Learning styles

VAK model1. Visual2. Auditory 3. Kinesthetic

Learning styles

Outcomes of learning1. Superficial learning 2. Deep learning

Clinical Teaching Models

1. Stanford Faculty Development:- Promoting positive climateControl of sessionCommunication of goalsPromoting understanding and retentionEvalutionFeedbackPromoting self directed learning

2. Micro skills of Teaching(One-minute preceptor)

Five-step approachGetting commitmentProbing for supportive evidenceTeaching general rulesReinforcementCorrecting mistakes

3. Dundees model

Problems with Clinical Teaching

Lack of clear objectives and expectations

Teaching pitched at the wrong level Focus on recall of facts rather than

problem solving Lack of active participation by

learners

What you say is not important, how

you say is important!

Don’ts

1. Leave the student alone until asked to supervise2. Correct the student's mistakes in front of patient 3. Fails to set time limit for clinical teaching activities

4. Give general answers to a specific question5. Not approachable6. Difficult person to summon for consultation/help7. Fail to adhere to teaching schedule 8. Ask questions in threatening manner9. Put down them(you don’t know this?)10.Insecurity about up to date knowledge

Do’s (Practical Tips for clinical teacher)

1. Preparation2. Planning 3. Orientation4. Introduction5. Observation6. Interaction 7. Summarize8. Debrief9. Feedback10.Plan for next interaction

We will wrap up here!