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  • Instructor Notes: Introduce yourself if not previously done.
  • Key Points: Lesson presents basic, but important, information
  • Key Points: All learning occurs through experience Reflection on experience allows us to associate meaning with the experience Understanding learning is essential to good instruction
  • Key Points: Teaching is about the participants’ learning Definitions provide a framework for the instructor’s role
  • Key Points: Teaching only occurs in the interest of learning Learning and teaching are intertwined Teaching-learning transaction requires active participation by instructor and course participants
  • Key Points: An activity may include learning in all three domains There are levels, from simple to complex, within each domain Successful learning and teaching proceed from simpler levels to complex levels
  • Key Points: Knowledge : basic recall of facts, such as defining shock Comprehension : attaching meaning to knowledge, such as understanding that shock is a life threatening condition, as opposed to just being able to define it Application : using information to solve problems, such as initiating rapid transport as a result of knowing that uncontrolled hemorrhage quickly leads to death Analysis: Taking a whole and breaking it down into its component parts, such as starting with the concept of shock, and then explaining how hypoperfusion and anabolic metabolism lead to cell, tissue, organ, and organism death Synthesis : Putting together a big picture from individual parts, such as using the physical exam findings to arrive at a conclusion about a patient’s condition Evaluation : The ability to judge something according to principles, such as determining the necessity and feasibility of air medical transport, or evaluating one’s own performance on a call
  • Key Points: Imitation : performing a skill as it was demonstrated, e.g., rapid extrication Manipulation : adapting the skill to one’s own style Precision : the skill has been practiced until it is “second nature” Articulation : the skill is combined in sequence with other skills; e.g., auscultation of breath sounds becomes part of patient assessment Naturalization: the skill is used in different settings or contexts; using a realistic context for teaching enhances naturalization; e.g., using actual crashed vehicles for teaching rapid extrication rather than simulating a vehicle
  • Key Points: The best way to teach is through role modeling Receiving, responding, valuing, organization, characterization Affective components are taught along with cognitive and psychomotor knowledge, largely by the way of perceptions of the instructor’s attitude toward the knowledge and skills being presented Receiving : willingness to attend to stimuli; e.g., a participant demonstrates receiving by coming to class Responding: interacting with the situation; e.g., a participant begins to ask questions about PHTLS Valuing: believing in the importance or worth of a concept; e.g., a participant tells someone else that PHTLS is an important course for improving prehospital care of the trauma patient Organization: the value is integrated into the person’s system of values and is prioritized among them; e.g., the participant believes in saving both life and limb, but makes the appropriate choice when necessary Characterization: the attitude is pervasive and demonstrated consistently; e.g., the EMT-B who never fails to check his equipment at the beginning of a shift Slide 10: Affective Domain Levels Content: The best way to teach is through role modeling Receiving, responding, valuing, organization, characterization Supporting Points: Affective components are taught along with cognitive & psychomotor knowledge, largely by the way of perceptions of the instructor’s attitude toward the knowledge and skills being presented Receiving: willingness to attend to stimuli, e.g., a participant demonstrates receiving by coming to class Responding: interacting with the situation, e.g., a participant begins to ask questions about PHTLS Valuing: believing in the importance or worth of a concept, e.g., a participant tells someone else that PHTLS is an important course for improving prehospital care of the trauma patient Organization: the value is integrated into the person’s system of values & is prioritized among them, e.g., the participant believes in saving both life and limb, but makes the appropriate choice when necessary Characterization: the attitude is pervasive and demonstrated consistently, e.g., the EMT-B who never fails to check his equipment at the beginning of a shift Notes:
  • Key Points: An individual cannot learn until he/she believes what is to be learned has an important purpose — to himself or herself — and until he/she recognizes what it is he/she doesn’t know
  • Key Points: Everyone can learn using a variety of approaches but prefers to learn one way more than others and probably learns better that way.
  • Key Points: One way to categorize learning styles is through sensory or perceptual modalities, or “AVK” The auditory learner prefers to listen to lecture and engage in discussion The visual learner prefers to read, study diagrams, and watch presentations The kinesthetic learner prefers to learn by touching and manipulating equipment
  • Key Points The left and right hemispheres function differently, but in a complimentary manner to each other Differences are more pronounced in youth, but become less prominent as we age and gain experiences in activities that require the skills of the nondominant hemisphere
  • Key Points: Adults and children learn in the same ways, but adults have different needs and characteristics that must be appealed to in order to create a learning environment Adults are motivated to learn when they understand why the information or skill is important to them Adults need to be self-directing, e.g., need an opportunity to ask questions that are of interest to them Adults have experiences, which can act as a foundation for further learning, or if what is being taught conflicts with previous experience, such experience may become a barrier to learning
  • Key Points: The teaching-learning transaction is directed at filling the participant’s gap in knowledge
  • Key Points: Everyone has or will develop their own style of presenting information
  • Key Points: The PHTLS case-based lessons have been carefully created to bring out specific discussion points The lesson plans provide key questions to ask participants, allowing assessment of participant knowledge and providing an engaging learning experience The lesson plans appear both in the PowerPoint speaker notes and the printed Instructor’s Manual
  • Key Points: Instructors can write notes on the printed lesson plans, including other questions that will stimulate discussion
  • Key Points: PowerPoint notes can be printed out or, if your computer allows, viewed on the computer screen as the presentation is projected to the audience
  • Key Points: If possible, meet and talk to a few people in the course before your lecture; it will give you a few friendly faces to focus on in the audience Ask questions; generate discussion No one knows everything Eye contact shows confidence in yourself and your knowledge of the topic Be aware of mannerisms, habits, extraneous noise
  • Key Points: Give about 8 seconds to answer “ I’d like to hear what someone else has to say on the topic.” Ask the participant to repeat what was said for emphasis: “Did everyone hear that? Mark, could you please repeat what you just said?” Or, rephrase the response for emphasis
  • Key Points: The participants must have enough information to answer and must know in what context you are asking the question Try rephrasing the question
  • Key Points: Examples for each stem Can you give me an example of a situation that would call for rapid extrication? What do you mean by “going down the tube”? Could you be more specific? What would be the consequences for the patient with on-going hemorrhage if we stayed on the scene to start IVs? What would we have to assume in order to rely on air transportation for this patient? What are some other possible causes of absent breath sounds on one side of the chest?
  • Key Points: Examples for each stem How do you know that auscultating the chest prior to rapid extrication is right? If you had the situation to do over, would you make the same decisions? Why/why not? Why do you say that splinting extremities is not a priority for this patient?
  • Key Points: Sufficient lighting allows you to see your notes; most lecterns have a reading lamp Don’t read from your notes, but do use them to keep on track and make important points
  • Key Points:
  • Key Points: The more realistic the setting of practice, the more likely the skills will be transferred to the real world Participants must know the rationale and context of the skill to understand its importance and application
  • Key Points: Seeing the big picture allows the learner to place the steps in context and to understand the importance of the steps to the final result Demonstrating the skill in real time gives an overview Demonstrating and discussing each step provides analysis Putting the steps together in a real-time demonstration provides synthesis Videos allow for consistency from instructor to instructor
  • Key Points: Learning occurs in stages from simple to complex Automatization : the knowledge of the steps of the skill become tacit (can perform the task without thinking about how to do it) Generalization: the skill is adapted for use in various situations
  • Key Points: Skills instructors sometimes stray from the purpose of the skills station; individuals who are able to stay on task and heed the rotation schedule will do well with these stations Participants will have seen a video skills demonstration prior to the rotation; instructors must be familiar with these videos The emphasis is on participants doing the skills, not talking through them
  • Key Points: Having to improvise when equipment doesn’t work or is missing takes the focus away from learning If resources allow, acting or talent agencies in your area often have “starving actors” who will work inexpensively and usually do a great job of acting out the parts Provide a safe environment
  • Key Points: Demonstrate the skill: whole-part-whole Correct errors immediately so they are not reinforced through practice
  • Key Points: The PHTLS card indicates successful completion of the PHTLS program Successful performance on written and practical evaluations
  • Key Points: Process increases validity of exam as an instrument to measure course learning Instructor Notes: Many instructors call the table of exam specifications a “test blueprint “
  • 74%
  • Key Points: Additional information on final assessments is presented separately
  • Key Points: A major obstacle to practical exam validity, and thus the meaning we can attribute to practical evaluations, is reliability — both inter-rater reliability and intra-rater reliability
  • Key Points:
  • Key Points: We are interested in principles of trauma care above preferences for employing the principles in specific ways. For example, there are principles of securing patients to a long backboard. As long as the principles are applied, the exact configuration of the straps does not matter — it is a preference If you believe participants are doing something wrong, ask yourself, “Is this a problem with principles or preferences?”
  • Instructor Notes: Distribute final evaluation forms Instruct participants to view the video as if they were viewing an actual final evaluation performance and to use the evaluation form to rate the performance Play the video Discuss how the participants rated on each criterion and what their rationales were; promote critical discussion of principles and preferences
  • Key Points: Cognitive — knowing what Psychomotor — knowing how Affective — valuing learning
  • Key Points: Instructors must ask questions to stimulate reflection Simple to complex organization of material, “natural” sequence Drawing on and using the experiences of participants

Teaching Teaching Presentation Transcript

  • PHTLS Instructor Course The Teaching–Learning Transaction
  • Purpose
    • To prepare entry-level PHTLS instructors to teach and evaluate cognitive and psychomotor skills in PHTLS courses
  • Objectives
    • As a result of active participation in this lesson you should be able to:
      • Discuss classroom and skill station activities that enhance the teaching – learning transaction in PHTLS
      • Apply principles of adult learning to PHTLS
  • Objectives
    • As a result of active participation in this lesson you should be able to:
      • Correlate PHTLS course objectives with different methods of teaching
      • Discuss considerations in evaluating and providing feedback to course participants
  • Overview
    • Learning, teaching, and the relationship between them
    • Lecture – discussion and interactive presentation of PHTLS lectures
    • Teaching skills and effective presentation of PHTLS skills stations
    • Evaluation: written and practical
  • Learning
    • The reconstruction and reorganization of experience, which increases our ability to direct further experience
    • Construction of meaning from experience
  • Teaching
    • Instruction or contribution to the development of others
    • Skillfully arranging the learning experience
    • Identifying and using “teachable moments”
  • Teaching and Learning
    • PHTLS courses involve a teaching – learning transaction between the instructor and the course participants
  • Three Domains of Learning
    • Cognitive
      • Knowing what
    • Psychomotor
      • Knowing how
    • Affective
      • Attitude toward content
  • Cognitive Domain Levels
    • At what level should participants operate?
      • Knowledge
      • Comprehension
      • Application
      • Analysis
      • Synthesis
      • Evaluation
  • Psychomotor Domain Levels
    • Practice and experience are needed to progress from level to level
      • Imitation
      • Manipulation
      • Precision
      • Articulation
      • Naturalization
  • Affective Domain Levels
    • Best way to teach is through role modeling
      • Receiving
      • Responding
      • Valuing
      • Organization
      • Characterization
  • Readiness to Learn
    • Must value the role of EMS in the care of the trauma patient
    • Must recognize the gap between actual performance and what is expected
      • Role of baseline evaluations and pretesting
  • Appealing to Learning Styles
    • Preferred method of receiving and processing information
    • Many theories and models of learning styles
  • Appealing to Learning Styles
    • Perceptual modalities
      • Auditory
      • Visual
      • Kinesthetic
  • Hemispheric Dominance
    • Left Brain
      • Verbal
      • Abstract
        • Conceptual; uses symbols
      • Linear
        • Sequential/cause and effect
      • Rational
        • Uses logic
    • Right Brain
      • Nonverbal
      • Concrete
        • Experience
        • “ Big picture”
      • Nonlinear
        • Thinks metaphorically
      • Nonrational
        • Intuitive
  • Adult Learners
    • Motivated by the need to know
    • Need to be self-directing
    • Adults have experiences
      • Foundation or barrier?
  • Teaching
    • Instruction or contribution to the development of others
    • Skillfully arranging the learning experience
    • Methods:
      • Lecture-discussion
      • Questioning
      • Demonstration
      • Guided practice
  • The goal of teaching is to design and deliver instruction that will fill the gap. Less Knowledge Teaching – Learning Transaction More Knowledge
  • Lecture/Discussion
    • Efficient way to deliver information to a large group
    • Lecture alone is less effective than lecture/discussion
      • Learners must be engaged
    • Discussion is facilitated by questioning
  • The Lecturer
    • Educate or edutain?
    • Knowledge alone does not make a good lecturer
    • Charisma alone does not educate
    • Lecturer needs to be dynamic and informational
  • Lecture Keys
    • Know your audience
    • Know where change needs to occur
    • Direct your lecture toward meeting audience needs
    • Stay focused on the objectives
    • Reinforce important points
    • Read the chapter
    • Review the content outline and slides
    • Practice, practice, practice
      • Timing and delivery
    • Avoid reinforcing mistakes by practicing to correct them
    Lecture Preparation
    • Add your notes to the teaching outline
      • Include possible questions to ask
    • Integrate the lecture material with the slides
      • Don’t read from the slides
    • Being unprepared shows
    Preparing YOUR Lecture
    • Keep key points to a minimum
    • Summarize often for emphasis
    • It’s okay not to know it all
      • Be prepared at a level higher than you will be presenting
      • Know what resources exist that could answer participants’ questions
    Successful Lecture
  • Interactive Presentation
    • Lessons
      • Case-based
      • Facilitate participant interaction
    • Lesson plans
      • PowerPoint speaker notes
      • Printed lessons in the Instructor’s Manual
  • Interactive Presentation
    • Using the lesson plans
      • Critical in delivering content sequentially and interactively
      • Take advantage of built-in features
      • Solicit answers to built-in questions
      • Be prepared with follow-up questions
      • Allow opportunity to answer
  • Use of Features
    • PowerPoint notes (with some Windows XP™ operating systems)
      • “Slide show”
      • “Set up show”
      • “Show presenter view”
  • Lecture Techniques
    • Relax — find a few friendly faces to focus on
    • Involve the students
    • Be comfortable with not knowing everything
    • Vary the pace and pitch of your delivery
    • Maintain eye contact
    • Avoid distractions
  • Why Use Questions?
    • Stimulate interest in the topic
    • Determine knowledge and experience
    • Stress key points
    • Generate discussion
    • Stimulate reflection
    • Stimulate critical thinking
    • Give the participant time to answer
    • Don’t allow one participant to dominate
    • Reinforce correct answers
      • Ask the participant to repeat what was said for emphasis, or
      • Rephrase the participant’s answer
    Successful Questioning
  • Guidelines for Questioning
    • Provide a frame of reference
    • Prompt the answer if necessary
    • Anticipate possible responses and be able to redirect in a positive manner
    • Be specific
    • Use both closed-ended and open-ended questions
  • Open-Ended Questions
    • Can you give me an example?
    • What do you mean by . . . ?
    • Where would that lead? What would be the consequences?
    • What would we have to assume for things to work out that way?
    • What are some other possibilities?
  • Open-Ended Questions
    • How do you know that’s right?
    • Would you do the same thing the next time?
      • Why/Why not?
    • Why do you say that?
  • Managing the Lecture Environment
    • Lighting
    • Microphones
    • AV equipment and materials
    • Notes
    • Temperature
  • Matching Instructors with Lessons
    • Choose lectures and skills for which you are well-prepared and that match your abilities
  • Teaching and Learning Skills
    • Transfer of skills is enhanced by a realistic context for demonstration and practice
    • Before demonstration participants should know:
      • What is to be done
      • Why it is to be done
      • When it is to be done
  • Teaching and Learning Skills
    • Whole-part-whole presentation facilitates learning
      • Demonstrate the skill in real time
      • Demonstrate and discuss the skill step-by-step
      • Demonstrate the skill in real time
  • Teaching and Learning Skills
    • Stages of psychomotor learning
      • Acquisition of prerequisite knowledge
      • Learning each step of the skill
      • Transferring control of task from the eyes to kinesthetic movements
      • Automatization of the skill
      • Generalization of the skill
  • Giving Feedback
    • Except in final and baseline stations, correct errors immediately
    • Focus on the performance, not the person
    • Provide a rationale and state how the performance was different than the desired performance
    • Make suggestions for approaching the skill
  • Skills Stations
    • Stay on task (do not lecture)
    • Adhere to rotation schedule
    • Recognize importance of principles over preferences
    • Emphasis:
      • Every participant has hands-on skills practice
  • Skill Stations
    • Know station goal
    • Have equipment present; in working order
    • Have enough equipment for all groups
    • Ensure presence of a “patient”: coached in advance
    • Address safety concerns
    • Delivery
      • Orient participants to the skill station
      • Participants demonstrate the skill
      • Correct errors immediately
        • We learn what we do
      • Give feedback and positive reinforcement
      • Practice, practice, practice
    Skill Stations
  • Final Evaluations: Purpose
    • What does the PHTLS card mean?
  • Written Examination
    • Examination is prepared from a table of specifications based on PHTLS core measurable items
    • Considerations
      • Representative sample of knowledge
      • Difficulty of items
      • Relationship of items to critical trauma management knowledge
      • Multiple item-writers and reviewers
  • Written Examination
    • What is considered “passing” on the written exam?
    • Remediation/retesting
    • Annotated exam copy
  • Final Evaluation Stations
    • Give clear directions
      • Observe carefully but unobtrusively
      • Recognize importance of principles over preferences
    • Emphases:
      • Allowing participants to demonstrate what they have learned in the course
      • Assessing participants’ strengths and areas needing further development
  • Final Station Scenarios
    • Preparation
      • Know the station flow
      • Have equipment present; in working order
      • Have enough equipment for all groups
      • “ Patient”: present, moulaged, coached
      • Know the critical errors
      • Address safety concerns
  • Final Practical Evaluation
    • Inter-rater reliability
      • Will two examiners watching the same performance give the same score?
    • Intra-rater reliability
      • Will a single examiner score identical performances the same way every time?
      • Bias
  • Final Practical Evaluation
    • Intra-rater reliability
      • We all have biases that affect our decisions
      • Consciously or unconsciously
      • Evaluate the performance, not the person
      • Always ask:
        • Would I evaluate every other participant the same as I am evaluating this participant for this performance?
  • Final Practical Evaluation
    • Inter-rater reliability
      • Valuing principles over preferences
      • Scoring instrument
        • Can the written criteria be interpreted too broadly or too narrowly?
      • Increasing inter-rater reliability
        • Examiners have common understanding of principles and the instrument
  • Final Practical Evaluation
    • Inter-rater reliability
      • Video exercise
  • Final Station Scenarios
    • Delivery
      • Know the scenario
      • Stay where you can see
      • If participants don’t do it, it isn’t done
      • Real time is key
      • Be consistent with all groups
      • Have extra equipment available
  • Final Station Scenarios
    • Keys
      • Let the patient give as much information as possible — the patient makes the station
  • Final Station Scenarios
    • Know what is passing
      • Encourage participants to evaluate themselves
      • Give feedback according to time
      • Give feedback based on critical error criteria; both positive and negative
      • Don’t be afraid to re-evaluate someone
  • Learning Summary
    • We learn when we recognize and value the need to know
    • We have different preferred methods for receiving and processing information
    • We learn in three different domains
  • Learning Summary
    • Learning occurs as a result of reflection on experiences
    • We must have an experience that can be connected to prior experiences
  • Teaching Summary
    • Teaching is skillfully arranging the learning experience
    • Focus on gaps
    • Lecture should be enhanced by questions and discussion
    • Be prepared and organized
  • Teaching Summary
    • Engage participants in the teaching-learning transaction
    • Skills are learned best in context
    • Correct errors immediately
    • Give feedback to improve performance
  • Teaching Summary
    • Match instructors’ strengths to the lessons
    • Use lesson plan features for interactivity
    • Later versions of PowerPoint™ and Windows™ allow presenter to view notes on computer screen while projecting slides
  • Evaluation Summary
    • Final evaluations serve to allow participants to demonstrate increased knowledge of trauma management
    • Annotated written evaluations
    • Increasing validity of practical evaluations
  • Teaching Techniques Questions?
  • Prepared, enthusiastic instructors create a positive, enjoyable environment for the teaching – learning transaction.