Principles of Clinical Education The significance of clinical medical education.

Principles of Clinical Education

The significance of clinical medical education, in contrast with education in the sciences basic to clinical practice, has been acknowledged since antiquity (Gordon 1949) Early in this hundred (1903), Sir William Osler asserted

by what means can we make the work of

the pupil in the third and

fourth year as practical as it is

in his first and second? The

answer is, take him from the

amphitheater -- propose him in the

out-patient department -- put

him in the wards.... Ask any

physician of twenty years'

standing to what extent he has become

proficient in his art, and he will

response by constant contact with

disease; and he will add that

the medicine he learned in the

drills was totally different

from the medicine he learned at

the bedside (Osler 1932 pp

314-315) Contemporary advocates of clinical medical education continue to argue for its importance and to show advice on how clinical instruction can be improved (Stritter et al. 1986)

In this article, we describe 10 principles of clinical education emanating from our experience in working with clinical educators and from personal research and reflection. We do not claim that these 10 principles are exhaustive, on the contrary we assert that they account for a major portion of the question s and successes that arise between clinical teachers and learners. Consideration of these 10 principles, with particular attention to their applicability to clinical alcohol studies, should enable teachers and learners in this growing specialty area to avoid a certain quantity of of the pitfalls that traditionally have plagued general clinical education. Our intent is to not absent a practical picture. The citations will enable interested readers to explore the issues in greater midst 1. Clinical learners are adults.

most numerous medical learners are adults from the time they reach the clinical years of undergraduate or residency education. Research and experience indicate that the masterys governing the education of adults should be different from those guiding the education of children. Adults ne to be gradually and progressively involved in making decisions about their confess learning. Stephen Brookfield (1986) has enumerated about principles of adult learning that can be applied to clinical medical students: * Adult learning shoots from

voluntary participation in

educational activities. Coercive,

strictly mandatory educational

practices that leave the learner

no scope for independent

conception and work are

counter-productive. * Effective adult education is

based upon mutual respect

shared through instructors and

learners. * A spirit of collaboration, not

competition or noblesse oblige,

should characterize adult

education. * Praxis -- active involvement in

educational activities followed

on reflection about its

usefulness -- is essential for adult

learning. * Opportunities for critical

reflection, not just reactions to

momentary clinical pressure

should be a planned feature of

medical education. * Clinical learners ne to

lay open a sense of self-direction,

to decide for themselves

what to subject of attention and how to

manage their time. 2 Clinical education has four elements: educational goals, the learner's entering behavior, instructional operations and evaluation methods.

Educational goals include the expectations and performance standards the faculty gripe [i]or[/i] grips for one or more scholars Goals are results: the knowledge, skills, and attitudes teachers await learners to acquire. To the bulk that educational goals are clearly stated in firm terms, (1) learners can understand expectations, and (2) the learners' progres toward the goals can be evaluated objectively.

The learner's entering behavior delineates the repertoire of skill and abilities each individual brings to the educational setting. In general, learners with prior knowledge or past experience in a given make liable area are more likely to profit from educational experiences than those who are les proficient. However, because alcohol connection is estimated to have in about way affected the personal lives of approximately half the general U population (DHH 1987) it is likely that many clinical learners also bring to the educational experience certain attitudes about the disease, its treatability, and the relative merits of various treatment orders Evaluation at the beginning of a clinical rotation of what learners know, can do, and be wrought up about the prospective subject area will allow instructors to focus their efforts in succession areas of greatest educational need

Instructional performances are activities that clinical teachers use deliberately to strengthen the knowledge and the skills of learners. Examples include involvement in clinical cylindricals lectures, demonstrations, observation of video-taped practices and reading. Instruction is enhanced to the rank that it is directed toward clear-cut educational goals agreed to by means of teachers and learners. In clinical alcohol education, for example, attendance according to learners at open meetings of Alcoholics Anonymous might show one instructional procedure directed toward the educational goal of supervised clinical experience in a range of therapies.