Appraising my Teaching Skills using MSF

Appraising my ‘IMPROMPTU WARD-BASED Teaching’
Dr Colin Mitchell
MSc Geriatric Medicine
June 2009

Choosing a Topic
I know some of my strengths as a teacher:
Can explain complex concepts
Keen to teach
And I’m aware of my weaknesses
Prone to long-windedness
Can over-elaborate
I already know to concentrate on the known weaknesses
But are there any issues that I’m not fully aware of?

Is this right?
Previous 360o feedback
‘Can be intimidating’
Really?
Jars with my self-image
Could interfere with a conducive learning environment

The MSF - Keeping it simple
Aim to focus on the learning environment
Is the environment conducive to learning?
Relaxed / Intimidating
Is some pressure a good thing?
Further focus on one skill: ward-based teaching (WBT)
Multiple exposures, multiple sources of feedback
Just F1s

Assessing Educational Environment
DREEM - Dundee Ready Educational Environment Measure*
50 Questions – agree / disagree
Based on instruments in use for 40 years
Designed by 80+ experts using the Delphi process
Statistically validated to focus on reliable / discriminatory elements
Used worldwide to assess medical school teaching
(PHEEM)
*Roff et al, 1997. “Development and validation of the DREEM. Medical Teacher 19:4, 205-209

Refining the Quantitative
Principles of choosing the items*:
Relevant
Clear, concise, focused and simple
Some balance of +ve and –ve (DREEM 82% +ve)
Chose 7 from DREEM (slightly adapted)
Added 4 of my own
Some concordance, not repetition
8 +ve, 3 -ve
*Adapted from Berk (2006), 13 Strategies to Measure College Teaching. Stylus: Virginia

Choosing the scale
DREEM uses 5-point bipolar ‘intensity’ anchors:
Strongly Agree
Agree
Uncertain
Disagree
Strongly disagree
Simple but allows a breadth of response
Still sufficiently granular & simple
Balanced (✔) and has a midpoint (?✔)

Defining the Qualitative
Opportunity to explore particular issues more fully
Correlate with quantitative themes

Making it anonymous - online
MSF in UK training – anonymous. In industry – 97% anonymous
“Maintaining the anonymity of the rater’s feedback is key to the process. Just as a tie to compensation can lead raters to soften their ratings, so can a lack of anonymity”*
“…when peer assessment is used in a high stakes setting, it results in inflated estimates of performance... There is no way to completely avoid this issue but it may help to ensure the anonymity of evaluators”**
Online forms preserve anonymity - This can be made clear in the MSF
Rogers E et al, 2002. “Improving the Payoff from 360-Degree Feedback”. Human Resource Development. 25: 44-54
**Norcini J, 2003. “Peer assessment of competence”. Medical Education. 37(6): 539-543

Validation
Cannot empirically validate without significant resources
Using 7 items from the DREEM – pre-validated
My own questions must be logically validated
Representative pilot
Sent to 5 SHOs. 4 replied with comments (unstructured)
Minor adjustments made to wording, stressing anonymity

Results

Rater Scores (% of Maximum)

Question Scores (Fractions of 100%)

Scoring
For negative aspects the score is reversed
Therefore: Higher score is a good thing

Academic Perceptions

Perception of the Teacher

Teaching Atmosphere

Free Responses (1)
What are the strengths of my ward-based teaching?
When a situation arises you take time to discuss the case (23/44*)
Enthusiastic and approachable… make[s] the learner think the problem through in a logical manner (30/40)
…instead of just giving an answer, you get us to think through the problem and help us work out the solution ourselves (24/44)
*Commenter’s overall score for quantitative elements shown in parentheses

Free Responses (2)
What do you like LEAST about my style of ward-based teaching? (Only 5/11 replied)
Sometimes assume too much which can be uncomfortable (20/40)
Sometimes can go into a lot of depth for too long (26/44)
… on some occasions it would be easier to get an answer, especially when it gets busy, but I would not learn as well… (24/44)
Sometimes it becomes a little didactic (25/44)

Free Responses (3)
How does the pressure of on-the-spot quizzing affect your learning (+vely or –vely)?
(In the US, “Pimping”generally viewed positively*)
8/11 were generally positive, 2 didn’t answer
Only negative response:
Too pressurizing and can be intimidating and lead to not wanting to ask for teaching (29/44)
*Wear D et al, 2005. “Pimping: perspectives of 4th year medical students”. Teaching and Learning in Medicine. 17(2) 184-191

Free Responses (4)
Every teacher can improve his skills – how would you suggest I improve my ward-based teaching?
Be a bit more aware of when people have got lost in your explanations (20/40)
You are a good teacher and have a lot of knowledge, but could improve by talking more succinctly and not rambling (26/44)
There is very little to improve on, your teaching is excellent (25/44)
I think sometimes you loose [sic] the balance and focus too much on teaching rather than seeing the patients… and thus even though your teaching is good, you are not setting a good example for juniors (28/40)

Analysis

Robust?
Some basic statistical analysis of average total score:
Median = average (59%, around a 2.5)
95% CI: ±19%
Some observations can be made:
Lower scorers more likely to give a critique in the weaknesses question
Poor correlation between ridicule / intimidating / relaxed questions.
The lowest scorer commented: “the relaxed manner of teaching is definitely a good approach”
He/she also disagreed with the ‘relaxed atmosphere’ item (?)

Findings – My Teaching
Quantitative results
Overall positive (59% compares with DREEM results)
I can be intimidating
Yet the atmosphere is generally relaxed (=3rd highest scoring item)
3 comments specifically mentioned friendly / approachable
Themes emerging from qualitative results
Rambling / long-windedness
Correlates with ‘teacher-centred’
Few negative comments about atmosphere
Only one comment directly mentioned ‘intimidating’ or synonyms.
Also note comment about assuming too much = ‘uncomfortable’
This rater also agreed with both the intimidate and ridicule questions

Findings – The Process
Getting good feedback is more difficult than it seems
Despite:
Limiting scope
Using validated questions
Piloting
Anonymous data entry
The results didn’t tell me much I didn’t already know
Partially corroborated ‘intimidating’ problem
Confirmed ‘long-winded’ problem

assimilation
Borg Cube by Martin Teufel - http://www.infosun.fim.uni-passau.de/br/lehrstuhl/Sommercamp/virtualworld/2005/galerie/

How I see myself
Image from http://www.theinsider.com/photos/1079058_TOM_CRUISE_FOR_TOP_GUN_2. Top Gun - Paramount Pictures.

How I see myself

YOU BOY!
What I need to avoid:
Val-de-ree!
Val-de ha ha ha ha ha ha!

Further Actions
I may not be intimidating to most…
But clearly a few may find me so
How do I know who they are?
What do I do about it?
Design my own feedback forms for my teaching sessions
Add demographics
Push for free-text responses
Don’t be afraid of constructive criticism
Criticism is worst when I don’t know how to fix the problem

Questions?
Links:
Email: drcolinmitchell@gmail.com
http://colinsmededblog.blogspot.com
Twitter: @drcolinmitchell
http://obamicon.pastemagazine.com

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Appraising my Teaching Skills using MSF

by Colin Mitchell on Jul 01, 2009

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