Faculty member on FAIMER Brazil (2014)


I’m spending a week in Fortaleza, Brazil as part of the FAIMER-Brazil programme for 2014. FAIMER is an international programme aimed at developing capacity in medical education and research, especially in developing countries. There are regional institutes in South Africa, Brazil, India and China, and the main organisation in Philadelphia. I was here in 2013 and found the experience both professionally and personally rewarding. I’m not by nature a very sociable person or emotionally expressive…so being in Brazil is definitely an “opportunity for growth” for me, because they are SOCIAL! and EXPRESSIVE!

As part of my time here in Fortaleza, I’ll be assisting with a session on distance and technology-mediated teaching and learning, as well as helping the programme participants with their research projects. During that session I’ll be sharing the results of the open online module on professional ethics that we ran last year, using that project as an example to illustrate some general principles of distance and online learning.

On a side note, a few days ago one of the other faculty members approached me and started chatting. I’d realised that he looked familiar but couldn’t place him until he introduced himself as Roberto Esteves. I immediately recognised him as a physician and teacher who I’d become aware of through his posts on Google+, and who blogs at Educação Médica.

We ended up having a great conversation about medical education in general, as well as the possibilities for collaborative research projects between our institutions. For me, this was a wonderful example of how connecting with people online can strengthen the interactions and relationships you experience in the “real world”. This hasn’t happened to me very often (I don’t travel enough) but when it does it’s really powerful.

Small group teaching

This is the first draft of an articles that published in my Clinical Teacher mobile app.


Small group learning is one of several educational strategies used to promote student learning, as it promotes a student-centred approach in the educational context (as opposed to a teacher-centred approach, in which the teacher determines the objectives, content to be covered and assessment tasks). There are a variety of benefits associated with learning in small groups, which is why they are often integrated into different learning approaches. For example, working in small group is usually an integral component of problem-based learning (Dent & Harden, 2005).

The learning objectives are what should determine the teaching strategy and as such, small group learning should not be seen as universally appropriate for all educational contexts. In addition, the success of small group learning will be influenced by the availability of resources, including physical space, facilitators and materials. In addition, the relative experience of the facilitators can play a major role in the outcomes of the learning experience.

There are four important group characteristics for small group learning to be effective:

  • There should be active participation and interaction among all group members
  • There should be a clearly defined, specific task or objective/s, that the group is working towards
  • The group should reflect on learning experiences and modify their behaviour accordingly
  • There is no defined number of students that should be in a small group, and in fact, the size is often dictated by the availability of facilitators and other resources

Advantages of small group teaching

Students have opportunities to develop important skills for working in multidisciplinary teams. They learn how to communicate effectively, as they are encouraged to discuss new concepts that arise. They learn how to prioritise tasks, which is usually a component of the PBL process (Kitchen, 2012; Dent & Harden, 2005; Crosby, 1997; Entwhistle, Thompson & Tait, 1992; Walton, 1997).

  1. Promotes ‘deep’ learning: Encourages deep learning and higher order cognitive activities, such as analysis, evaluation and synthesis. Engage by being active participants in the learning process, as opposed to passively “absorbing” information.
  2. Develops critical thinking skills: Allows students to develop critical thinking by exploring issues together and testing hypotheses that are difficult to do well in a lecture. This practice develops problem-solving skills.
  3. Promotes discussion and communication skills: Environment is conducive to discussion. Students do not feel exposed or hidden, but are comfortable. Each student is encouraged to actively participate.
  4. Active and adult learning: Help identify what a student does not understand, and discussion aids understanding by activating previously acquired knowledge. Students are encouraged to reflect on their experiences and develop self-regulatory skills.
  5. Self motivation: Encourages involvement in the learning process, increasing motivation and learning. By taking responsibility for their learning they become self-motivated rather than being motivated by external factors e.g. the lecturer (teacher-centred approaches usually do not facilitate self-directed learning).
  6. Develops transferable skills: Helps develop skills necessary for clinical practice, e.g. leadership, teamwork, organisation, prioritisation, providing support and encouragement for colleagues, problem solving and time management.
  7. Application and development of ideas: Yields opportunities to apply ideas and consider potential outcomes. Making connections during group discussion enhances student understanding.
  8. Tutor as a role model: A logical and systematic tutor approach demonstrating ‘transferable’ skills motivates student learning and development.
  9. Recognises prior learning: Students are encouraged to surface their own prior knowledge, including their own perceptions (and misconceptions) of material previously covered.
  10. Social aspects of learning: Participation and social aspects of small group learning means that learning is more enjoyable than solitary approaches.
  11. Encourages alternative viewpoints: Encourages an awareness of different perspectives on various topics and can therefore help develop an attitude of tolerance.

Small group processes

“Appropriate ground rules make students feel ‘safer’ in sharing and expressing their views” – Kitchen (2010)

Students often find that working in small groups is a greater challenge than expected, probably because they are used to situations in which they work as individuals within a group. However, when individual success is dependent on the group cohesion and collaboration, and the group struggles to perform effectively, students may resist the process. It is therefore important to make them aware of the normal progression of group development (Tuckman & Jensen, 1977).

  1. Forming – a collection of individuals attempting to establish their identity within the group
  2. Storming – characterised by conflict and dissatisfaction that may lead to the development of trust
  3. Norming – attempts to function effectively by developing a sense of group identity and norms
  4. Performing – group performs at an optimal level by being focused on the task, and manages disagreement appropriately

The role of the facilitator

“Small group productivity depends on good facilitation, rather than on topic knowledge” BUT “Less than one third (of clinicians) have received formal training in small group teaching” – Kitchen (2010)

The facilitator plays an essential role in small group, and traditionally would design the module. This would include the development or preparation of stimulus material, which can be in the form of questions, scenarios, images, video, research papers or case studies (Kitchen, 2012). In addition, the facilitator would present the objectives of the session, initiate the process, encourage participation, promote discussion and close the session. In these cases, the facilitator is very clearly leading the process and is in control. This approach is probably the one that most clinical educators are familiar with, and derives from a combination of ability, expertise, experience and enthusiasm. However, when the facilitator clearly dominates the process, self-directed learning and interaction between learners can be limited. Increasingly, small group learning is looking to students to provide more initiative, explore learning options, test hypotheses, develop solutions and review outcomes. In these situations the role of the tutor is less clear and will vary depending on the type of learners making up the groups.

The facilitator/s (often, small groups have multiple facilitators) must all be informed of the objectives of the session. If not, there is the possibility of different groups moving in different directions. This is not as much of a problem if exploration of a concept is the goal. However, if all groups are meant to achieve the same objective, consistency among facilitators is important. For this reason, staff training is vital whenever small groups are being considered as a teaching strategy. It is important to understand that, while content-specific expertise is useful, facilitation skills are essential.

“A fundamental feature of effective facilitation is to make participants feel that they are valued as separate, unique individuals deserving of respect” – Brookfield (1986)

One of the most important roles of the facilitator is to ensure that an atmosphere of trust and collaborative enquiry is created in the small group. This can be achieved by the group setting their own norms and objectives for the session, or if they are inexperienced in groupwork, for the facilitator to guide them through this process. It would also be useful to have the students express their own expectations for the session, especially of their role and responsibilities in the group. As the group members grow in experience, they should take over more and more of the facilitators role, until it may be difficult to tell them apart. As the learners take more control of the group session, more traditional teachers and facilitators may have a challenge adjusting to the new dynamic.

Finally, it is the responsibility of the facilitator to arrive early in order to check that the venue is appropriately prepared for the session. Arriving early is not only useful in order to ensure that the session runs smoothly, but also to set an example for students.

Assessment of small groups

“With undergraduate medical education currently carrying a health warning because of the stress and anxiety exhibited by students and young graduates, any educational process that promotes enjoyment of learning without loss of basic knowledge must be a good thing” – Bligh (1995)

As with all assessment, it is important for students to be aware of the assessment process and outcomes. Teachers and facilitators must decide beforehand on the nature of the assessment task, as well as whether it will be formative or summative, and who will be responsible for conducting it. If the person responsible for assessing the students is also involved with facilitating the groups, it is especially important for students to feel that the environment is a safe space. If not, they may be reluctant to fully participate in the process, as in doing so, they may reveal their ignorance and therefore be vulnerable. This may be addressed by the facilitator being open and discussing their role in assessment as part of the process. If students will be evaluating the facilitators, there may also be a sense of shared responsibility for assessment, thereby “equalising” the balance of power in the relationship.

Assessing the group outcomes is reasonably straightforward and can relate to either the achievement of objectives, or the process of working in a group. Determining the achievement of objectives can be be through student self-report, facilitator observations, or observation by an external assessor. While the assessment of individuals within the group is more challenging it is nonetheless possible, especially when students are able to assist in the process by evaluating their peers. Individual performance can be measured through attendance, contribution or participation, conducting research for the group, and by supporting or encouraging others.

Challenges when working in small groups

“The size of a small group is less important than the characteristics of the group” – Dent & Harden (2005)

When considering implementing small group learning in your course, bear in mind that a change in teaching approach should complement the overall programme strategy and objectives, as well as actually enhance the learning experience. Small group learning should be seen as an integrated component of the curriculum and should be related to other components. In other words, small group learning should be seen as a simple addition.

Often, busy clinical teachers struggle to find the time to implement small group learning strategies, especially when you take continuity of the teaching experience into account. However, this has an impact on scheduling of other teaching activities, which can be challenging to arrange. Careful planning is therefore an important aspect of integrating small groups into the curriculum.

There is a perception that students do not enjoy working in small groups. However, this is possibly based on situations in which students either were not able achieve the objectives, or their learning experience was poor. Careful planning and design are essential in order for the group to successfully achieve the outcomes that are set. Too often, teachers think that group work is about a group of individuals working in a team. It is essential for the groups’ success to be based on cooperative behaviour. In other words, the individuals must work together in order to achieve shared goals that are difficult to achieve as individuals.

Practice points

  • Working in small groups is characterised by student participation and interaction, in order to promote student learning.
  • The size of the group is dependent on the learning activity, although 3-6 students is usually recommended. The size of the group is less important than the group characteristics.
  • Facilitator training is an essential factor for small group success, although most small group facilitators have received no formal training.
  • Integrating small group learning into a curriculum should be carefully considered as part of an overall teaching and learning strategy, rather than as an addition.


Small group work can be an exciting and engaging approach to teaching and learning practice, especially if it is implemented with careful thought and consideration as part of an integrated curricular strategy. The reasons for making the choice should be pedagogical and as such, have educational advantages as the primary motivating factor for the move. Small group teaching has been shown to be beneficial in terms of developing self-directed approaches to learning, critical thinking and reasoning, tolerance of the views and perspectives of others, and the development of interpersonal skills. While there are challenges in its implementation, they can be addressed with thoughtful design and regular feedback from all stakeholders.

References and other sources

Interview: The use of technology-mediated teaching and learning in physiotherapy education

Selection_001I was recently asked to do a short interview by Physiospot, on the use of technology-mediated teaching and learning in physiotherapy education. As it turns out, the bulk of the interview relates more specifically to a Scholarship of Teaching and Learning, rather than the use of technology. However, I think that this makes it potentially more relevant for physiotherapy educators, especially those who may not be interested in the “technology” aspect. Thanks to Rachael Lowe at Physiospot for the invitation to chat.

Here is the link to the interview.

Effective lectures

This is the first draft of an article that was eventually published in the Clinical Teacher mobile app.


“The successful teacher is no longer on a height, pumping knowledge at high pressures into passive receptacles. He is a senior student anxious to help his juniors” (William Osler, 1849-1919)

In medical education, the word “lecture” is fast becoming a term of derision. Advances in our understanding of how people learn have demonstrated that passive approaches to teaching and learning is ineffective in developing advanced cognitive skills. However, traditional lectures where students are expected to sit and listen are still one of the most common methods of teaching in health sciences education (Graffam, 2007; Sandhu et al., 2012). When interactive lectures are used instead of didactic lectures, we know that student satisfaction, learning outcomes, and knowledge retention is better. However, rather than suggest that the lecture is dead, as many would have you believe, this article presents a range of methods that clinical teachers can use to enhance lectures by making them more interactive.

What is a lecture?

“…a great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other. One of the greatest pleasures of lecturing occurs when learners pose insightful questions that the lecturer did not — perhaps even could not — foresee..” (Gunderman, 2013)

A good lecture tells a story, as simple as that. It poses problems that are eventually resolved, and it keeps learners in suspense, waiting to see how the problem can be worked out. Great lecturers find ways to share the responsibility for solving these problems with learners, working with them to find a solution. In these kinds of classrooms, students are not merely sitting and listening. Instead, they are challenged and engaged, actively thinking and imagining along with the lecturer as both struggle toward new insights (Gunderman, 2013).

Lectures are often thought of as a mechanism for sharing facts, rather than for sharing personal experiences and insights. When thought of in this way, a lecture can be used to give a human face to a topic, or to paint a bigger picture for a course. They can stimulate interest, explain concepts, provide core knowledge and direct learning (Cantillon, 2003). Outlines of lectures can provide a structure where they can be seen in the context of the whole programme, with concepts shown in relation to each other. In this respect, it is clear that the purpose of a lecture need not be primarily to transmit information, since other techniques like assigning a reading or distributing an electronic copy of the notes, can be equally effective. Lectures should therefore not be used simply as a method of spoon feeding students with predigested facts (Harden & Dent, 2005).

“The real purpose of a lecture is to show the mind and heart of the lecturer at work, and to engage the minds and hearts of learners” (Gunderman, 2013)

It is important to note that lectures in themselves are not bad but that they, like any teaching method, can be used badly. A good lecturer tells a story that inspires and motivates students, so we should use caution when speaking poorly of lectures. When the lecture fails as a teaching medium, it is often the lecturer who is at fault.

Content vs Learning

One of the key challenges faced by lecturers is the tension between covering a range of discipline-specific content and ensuring that deep and meaningful learning happens. This tension is often exacerbated by the limited time in the curriculum allocated to each section of work. The movement of facts from lecturer to the class is pretty much how most people think of learning. However, knowing what to do with facts should rightfully be the centre of the learning process. That doesn’t mean that we shouldn’t stand in front of students and speak, but that our “speech should be to evangelise, to inspire, and to demonstrate”, rather than simply being a mechanism to impart knowledge (Chester, 2013).

“A great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other.” (Gunderman, 2013)

One of the enormous challenges with lectures is the attempt to incorporate students into the process, as part of an interactive exchange. The problem is that one-way lectures are difficult to make interactive because students are generally presented with answers rather than having to find answers for themselves (Dalsgaard & Godsk, 2007). However, a problem-based approach to teaching and learning that is supported by social constructivist principles (Vygotsky, 1978) is not feasible with a lecture. It requires a different approach to learning than what is available in the traditional lecture format, which is why lectures should not be thought of as an effective means of developing skills, higher order thinking, or changing attitudes (Cantillon, 2003). It is therefore worthwhile to consider that multiple teaching approaches have value, and that no single method can be used to cover the range of learning that much happen during clinical education.

“In the world of Google, facts can be accessed quickly and efficiently at any time, from any place, and with any device – so rote mastery of facts is no longer the core of learning” (Chester, 2013)

Types of lecture

Before you begin creating a lecture, it is useful to spend some time thinking about what kind of lecture you’re going to present. Or, to put it another way, what is the overall objective of the lecture? What will it be used for, in the context of the programme? Consider the following different types of lecture (Dent & Harden, 2005):

  • Overview – an overview of the module as an introduction to establish the context, before beginning with other teaching and learning methods.
  • Core – a series of lectures that presents the major concepts of a module.
  • Non-core – using lectures occasionally to elaborate on complex ideas, or to present aspects of the topic that are peripheral to the core curriculum.
  • Assessment material – demonstration of worked examples of assessment methods in the module.
  • Patient presentations – using a lecture to “walk students through” a case study, which can be more interactive than the one-way transmission of facts
  • Shared lectures – when several lecturers provide multiple points of view or perspectives on the same topic e.g. a physician and nurse provide different approaches to the management of the same patient (see also “Team teaching”).

Structuring a lecture

Most lectures are able to follow the simple outline of a beginning, a middle and an end. “Tell them what you are going to tell them, tell them, then tell them what you told them.”


The introduction to the lecture is used to attract the attention of the students and set the mood for the session. One was to “captivate” students from the start is to use an exciting or controversial proposition, question or statement (Sandhu et al., 2012). It can be used to inspire them to concentrate, or to establish pre-existing knowledge. During this early part of the session, make sure you establish context by explaining how this lecture fits into the broader picture. Identify the usefulness of the content, identifying it’s perceived value for the students and thereby giving them a sense of place and direction (Cantillon, 2003). The Introduction should also be used to set the aims and objectives for the lecture. If the lecture is part of a series, it is always useful to use the Introduction to briefly review what was presented during the previous lecture. If this is the first lecture with a new group, this would be a good time to go over the “ground rules” e.g turning off cell phones, late arrivals, questioning periods, etc.

Main body

The main part of the lecture can be structured in a variety of ways:

  • Sections: Lecture is divided into sections, which is easy to plan and for students to make notes, but can be perceived as boring. This approach may be more useful for topics that are naturally categorised in hierarchies e.g. health or body systems, or classifications of injuries or disease.
  • Problems: State a problem and then produce arguments and counterarguments for solutions to the problem. This approach can help students develop critical thinking around clinical problems.
  • Sequence: A series of linked statements, each leading logically from one to the other, towards a conclusion. This approach could be used to take students through a patient examination process.

In order to prevent students’ minds from wandering, the Body of the lecture should be broken up into shorter sections, either by alternating the presentation format or by having students engage in relevant activities (Sandhu et al., 2012). After presenting the content, lecturers can have students work individually, in pairs or in small groups. You could even ask them to present short summaries of the key points of the lecture, during the end of the session.


The lecture should finish with a review of the objectives and key points that were covered. The lecturer might highlight ways in which students could extend the lecture by presenting routes for self-study and further independent learning. The Conclusion should avoid the introduction of new ideas.


Keep the time that students are sitting passively to a minimum. Thirty to forty minutes can be considered a maximum period of time without a proper break, since this is about the longest that people can concentrate. This time period can be broken up into ten or twenty minute sections, during which lecturers can have students engage in activities. For example, present them with a new idea or high-level concept (10 minutes), have them engage with the idea by discussing with a neighbour (2-5 minutes), clarify the idea with further examples (10 minutes), before finally moving on to the next idea. After that, give the students a 5-10 minute break before continuing.

The lecturer as a performer

“There are good lectures and bad lectures, just as there are good lecturers and bad lecturers. Rather than disposing entirely of the lecture as a means of learning, we should attempt to understand better the features that distinguish effective, engaging lectures from those that leave learners limp. Good lecturing is an art, and like other arts such as painting, musicianship, and writing, it takes real dedication and many hours of practice to excel at. Some may be more gifted at lecturing than others, but through study and practice, nearly everyone can improve” (Gunderman, 2013).

While it can be useful to think of the lecturer as a performer, they are not entertainers. The lecturer should aim to inspire and captivate students, but not to entertain them. There are a range of verbal and nonverbal skills that can be employed to keep the students captivated and engaged. These include using direct eye contact, changes in body language, gesturing, changing volume and tone for emphasis and exaggeration, projecting a sense of enthusiasm and excitement, and having a sense of humour (Sandhu et al., 2012). Digressions in the form of a personal story or contemporary reference can alter the tone and style of the lecture and can recapture flagging student attention. Students are almost always excited to hear about clinical experiences, especially those that demonstrate that the lecturer is human and fallible.

Maintain eye contact with students, moving your attention around the room. Focus on individuals when making a relevant point, as if you are speaking directly to that person. While this is a good way of maintaining a connection with them, avoid focusing on the same person too often, as this may make them feel targeted. Speak clearly and fluently. You may need to practice enunciating your words if you’re not comfortable speaking to groups. Make sure that you adjust your pace of delivery if you expect students to take notes, and adjust your tone of voice to avoid a monotonous session. Whether you prefer to lecture while seated, standing still or walking around the room, make sure that wherever you are, you are visible and audible to everyone in the room.

The last lecture is a good example of the lecturer as a performer.

It is worth noting that the lecturer may need to change their personal perspective of their role in the classroom, moving from being a “fount of knowledge” towards becoming a more experienced peer, a guide who knows the terrain and who can help students learn how to navigate it independently. If the lecturer sees themselves as the source of the “correct” information, students will also have that perception, which gives them little incentive to actively work through the course (Dalsgaard & Godsk, 2007).

Slideshow presentations

Many lecturers use slideshow presentations as a way of highlighting the major points of the session but many more use presentations in ways that end up distracting students while adding little to the lecture. For example, fancy animated transitions between slides add nothing to what students should learn, and comes across as cheap and gimmicky. In the same way, multimedia integration as part of a slideshow can add significant value to what you want students to learn but can also distract from the main point of lecture. Therefore, avoid adding images and video simply for the sake of it. Try to decide how adding different media will add to the presentation, rather than simply take attention away from the main concepts you’re trying to convey.

When developing a slideshow presentation, lecturers often focus on the bullet points that convey the facts, and pay attention to little else. But slideshow design is important. There’s nothing worse than trying to make sense of too much cramped text forced onto a single slide, or to feel like you’ve been slapped in the face by an ugly presentation. Even if you don’t believe that you can design anything good looking, then a simple black font on a white background is perfectly adequate. Better that than cheap clip art and flashing animated transitions.

For those who are a bit more adventurous and would like to learn more, Presentation Zen is a great site for learning about good design principles for presentations. Here are some example posts from the site that I enjoyed:

Presentation tools

If you’re considering (or are already using) slideshows as part of your lectures, you should familiarise yourself with the following tools:

Using images in a slideshow

There’s nothing more boring than reading a long list of bullet points. Consider using pictures embedded in the slide that will help you to make a point more strongly, or that add the kind of detail that is difficult to illustrate with text. Presentation Zen is an amazing resource that has many examples of how images can make or break a presentation.

Always try to find high quality images, preferably from sources that use open licenses (see the section on “Copyright” later). The quality of a digital image is determined chiefly by its resolution. The higher the resolution, the better the quality of the image. However, note that as resolution increases so does the file size, which may be a problem if you need to keep your presentations small. The table below presents examples of an image at different resolutions.

Normal resolution

Low resolution

* *

Also, make sure that you maintain the correct aspect ratio when using images in your lecture slides. It’s jarring for the viewer to see images that are stretched or compressed into areas that they were not designed to fill.

Correct aspect ratio

Incorrect aspect ratio

* *

Another common problem is when lecturers take a small image and expand it to take up more screen space. When this happens, the image on display looks pixelated. You can avoid this by using images at their actual size, rather than enlarging them. Note that you can take a large image and make it smaller with no discernable problems. The issue arises when you try to make a small image larger.

Using video

Video can be a great way to appeal to students on an emotional level, since it often brings out the human element of a story. However, if you do include a video as part of your lecture, make sure that it’s short, since passively watching a video is no different to passively watching a lecturer. If you do include video, it should go beyond simply telling the students something that you could tell them yourself. If all it does is convey more facts, then it would be better to have them learn those facts in another way. Also, after watching the video, the lecturer should set aside time for the students to engage with the ideas that were presented. If you’d like for students to watch a long video because it’s an essential aspect of the module, rather have them watch it at home, make notes, create questions, and then bring those questions to class for discussion.

It is possible to record lectures in a way that the lecture can be made available for students to watch later. The benefits of this include being able to pause, rewind and re-listen more complex sections of work. In addition, some software programmes allow a slideshow presentation (if one was used) to be synchronised and shown alongside the video of the lecturer. Recorded lectures can be made available on the university intranet along with additional resources, copies of the presentation slides, handouts, etc. for students to access after the lecture. Note however, that watching videos of lectures is not a replacement for attending lectures, especially if the lecturer has created space and time in the lecture for interaction.


A lesson plan is always useful as a guide for students to situate themselves within the context of the lecture, and can be made available to them in print or online. The can be created in advance and given to students either before the lecture to help them prepare, or afterwards as a summary.

The point of a handout is to scaffold students’ independent exploration of a topic, not to provide them with the content of the lecture. Use the handout to identify the aims and objectives of the session, to make connections to other lectures or subjects, summarise the main concepts, provide self-assessment questions for independent study and direct them to additional reading and resources.

More comprehensive handouts avoid the need for students to take extensive notes but this may also encourage them to stop concentrating during the lecture. Notes that provide less detail may encourage students to pay more attention and to engage with the topic independently, since the handouts in themselves do not provide everything that is necessary to know. For this reason, handouts should provide a scaffold for students to build a better understanding of a topic by summarising the major themes of the lecture, while at the same time avoiding exhaustive coverage. They should aim to inform self-directed learning, and should therefore include exercises and questions with reading lists (Cantillon, 2003).

Let students know if they are expected to take notes during the lecture or if the handouts will provide everything they need. Note-taking is a form of engagement during the lecture but can also help students to structure their thoughts during follow up homework. You can teach them how to effectively take notes during class, for example by using the Cornell method (see below for a guide on using this method, from the Cornell Learning Strategies Center).

Facilitating interaction

While most students have had several years of experience attending lectures by the time they reach you, almost all of them view lectures as an opportunity to sit back and soak up the learning, or as one student told me, to “sit back and switch off”. It’s important for students to understand that actively engaging with the lecture will help them to derive maximum benefit from it.

One of the easiest ways to encourage interaction during a lecture is “Think. Pair. Share”. The lecturer presents an idea, then gives the students a short period of time to think about it individually, possibly giving them a question as a stimulus or asking them to write something down. Then, they pair up with the person sitting next to them and discuss the ideas and questions that each of them just came up with. Finally, some of the pairs are asked to share what they discussed with the larger group, with the lecturer providing input at various stages in the form of clarification, reinforcement and challenges.

Another useful option is to get the students to ask the lecturer questions during the session. However, instead of asking them to do it as individuals, try having them work on a question in small groups of two or three. This way they can avoid the perceived embarrassment of asking a “silly” question and will gain confidence to ask questions in public. Then, instead of the lecturer answering the question, give other groups the opportunity to try first. This will not only hold everyones attention but will also give the lecturer a few different ideas to work with during the discussion.

Having students work in small groups is an effective way for them to engage with the content of the lecture. By discussing the concept with others, they not only remain focused during the lecture, but they have an opportunity to reinforce it in their own minds. In this way misunderstanding can be identified early on, with students having the opportunity to ask clarifying questions. In addition, seeing different answers to the same question can demonstrate to students the different ways of understanding something.

Students can also be given short, formative assessments after a significant piece of work has been covered. They can be informed in advance that the assessment will happen at the end of the lecture, thereby prompting them to pay more attention than they would usually. By making it a formative assessment there is less pressure on them to worry about passing, and more attention can be paid to identifying areas of their misunderstanding. The timing of the assessment is important, since doing one at the beginning of the lecture would be more appropriate to determine prior learning, while one at the end would be better for evaluating the work just covered. Having students assess each other’s work using a rubric prepared in advance will not only relieve the lecturer from marking the work but will introduce students to evaluating the work of others. Completing the assessment before the end of the lecture period also allows time for students to ask questions to clarify their misunderstanding.

Questions of copyright

This is a common challenge that lecturers often face. What content you can use and what you can use it for is determined by copyright. How much text can you photocopy and give to students? What pictures can you include in my slides? Are YouTube videos off limits? These are just a few questions that arise when considering the issue of intellectual property and which pieces of content you can include. Note that even if you’re properly referencing the content, it doesn’t matter. This is a problem of how much content you can distribute without paying for it.

It’s always a good idea to try and find content that is licensed with Creative Commons licenses. This is a way of knowing exactly what the content creator will allow you to do. When someone creates a piece of content, even if there is no copyright notice, by default they own all rights to use that content exclusively. This has implications for when lecturers use content they did not create, and share it with students without paying the author. Most university libraries have intellectual property policies and agreements, and specify exactly how much content lecturers can share with students.

Getting feedback

It is always useful to get feedback after a lecture as this will allow you to make changes to future lectures based on the students’ experiences. The feedback should not only aim to identify areas that could be improved but should also provide constructive advice on how the lecturer can actually improve. Sources of feedback can include:

  • Students, whose opinions are possibly the most valuable
  • Colleagues, as part of a more formal peer review
  • Personal reflection, as part of developing a teaching portfolio

If mini-assessments are conducted at the end of the lecture they also be kept as part of an informal evaluation of teaching practice, since student performance is a useful indicator of teaching efficacy. In addition, students’ notes can also be reviewed (with their permission) in order for the lecturer to see if the session was clear to them (Cantillon, 2003).

A simple form can be used for either peer or student review of a lecture:

The lecturer was:

Strongly agree

Slightly agree

Slightly disagree

Strongly disagree




Clear and concise


Lecturers will often need to deal with several challenges that may arise during the lecture, including:

  • Students arriving late
  • Questions that aim to distract
  • Cell phones ringing
  • Students falling asleep
  • Students talking to each other
  • Technical failures

While these challenges are outside of the direct control of the lecturer, being well-prepared and engaging the students’ attention will help prevent many of these problems arising. In addition, ensuring that students know the rules of the classroom may also address some of these issues.


Lectures can be an incredible effective, powerful form of communicating important and difficult concepts and ideas to students. Lectures can be used to present core material and to provide an overview of the course. It should be structured, have clearly defined objectives and a lesson plan. Lecturers should pay attention to their own presentation skills and to the preparation of their handouts and other materials. Lectures can be made more effective by capturing and maintaining the attention of students, requiring them to be active participants in the session, leading them in questioning and discussion. In addition, formative assessment with immediate feedback can also be used to enhance traditional lectures.


Legal stuff

To the best of my knowledge, all sources used in the creation of this work are freely available and not encumbered by licensing issues. The image in the article header was taken from the Wikipedia page on Meerkats.

Clinical reasoning: Identifying errors and correcting

Yesterday I attended a presentation on clinical reasoning by Professors Vanessa Burch (University of Cape Town) and Juanita Bezuidenhout (University of Stellenbosch). Here are the notes I took during the presentation.

  1. How does CR work?
  2. How do errors occur?
  3. Do clinician educators contribute to errors?
  4. Can we identify students with CR difficulties?
  5. Can we improve CR skills?

How does CR work?
Graphical representation of the clinical reasoning process by Charlin et al. (2012).

Graphical representation of CR, from Charlin et al. (2012).
Click on image to enlarge.

High level CR appears to be intuitive but is really pattern recognition that happens as a result of lots of experience.

Students don’t have the illness scripts (i.e. patterns to recognise clinical presentations / clinical knowledge organised for action) and so they spend more time in System 2 reasoning, rather than system 1 reasoning (see Charlin et al, 2012). Side note: for additional detail on how pattern recognition actually works, see Stephen Pinker’s book, “How the mind works“.

Are we mindful of the complex thinking processes that make up CR, and do we expect students to be operating at the same level? Do we explicitly tell students about the CR process or expect them to “absorb it”?

We can act on illness scripts without acknowledging that they exist. This is why awareness of our behaviour (i.e. metacognition or mindfulness / reflection in action) is so important. System 2 processes act as a balance to prevent acting on patterns that are similar but not the same. This could be the basis for CR errors. See below the process from Lucchiari & Pravettoni’s cognitive balanced model that describes a conceptual scheme of diagnostic decision making.

Click on image to enlarge.
Click on image to enlarge.

It is also important to be aware that belief systems (i.e. cognitive biases and heuristics) exist, and that they can influence behaviour / decision making, which may lead to CR errors (Lucchiari & Pravettoni, 2012). See image below.


Novice practitioners tend to miss subtle differences in clinical presentations. Students must articulate their reasoning processes so that you can help them to link the facts (i.e. the clinical information) to the diagnosis. If the student missed the conceptual relationship between variables, they are prone to making mistakes.

Audétat et al (2012) use Fishbein’s integrative model of behaviour (and associated belief systems) to explain why managing clinical reasoning difficulties is so challenging (see below).

Click on the image to enlarge.
Click on the image to enlarge.

There is a tendency, in the clinical context, to emphasise service delivery above all else, with educational needs taking a distant second place. In other words, increase the students’ case load with little thought given to how this may impact on their learning (or the actual management of the patient). The clinical environment is therefore almost always not a very good educational environment that is conducive to learning.

Clues to identify students with CR difficulties:

  • Often not aware that we’re in System 2, while students are in System 1 → talking past each other because we’re in different spaces.

Clues at at the bedside:

  • Limited semantic transformation of patient interview. Student unable to do anything with the information at hand.
  • No logical clustering of complaints. The student can’t categorise like information in a clinically logical way.
  • No order of priority attributed to complaints. Students can’t decide what the most important problem is.
  • Key information not obtained during patient interview. Student doesn’t think to ask important questions → non-existent or faulty illness scripts (non-existent illness scripts are less dangerous than poorly configured ones because it’s easier to correct).
  • Physical examination excessively thorough or cursory. Student unable to make reasonable progress through the case.
  • Too many investigations ordered.
  • Inability to interpret results of investigations. Student unable to articulate a reasoning process, or they reason incorrectly, when confronted with a different set of variables e.g. X-ray, rather than a patient.

Strong beliefs in incorrect illness scripts can make novices see things that aren’t there e.g. seeing pneumonia on an X-ray that is clear. Belief systems are powerful drivers for behaviour.

CR errors are often left “unfixed” because trying to do it in the clinical context is too time consuming. These should be addressed later.

Other ways to see CR errors:

  • Discharge letters and case notes may be unstructured and lack clarity. Lack of illness scripts (or faulty ones) prevent students from linking concepts, which is evident in how they write narratives.
  • Too much / little time spent with the patient.
  • Emotional reaction to students: negative affect on the part of the patient (ask patients how they experienced the student’s management), or on the part of the clinician (there’s something about the student – that isn’t related to rudeness or some other inappropriate behaviour – that you find upsetting.

Can CR be taught?

Every clinician thinks differently.
There is no right or wrong way to think.
Diagnostic competence requires knowledge.

The challenge is to:

  • Organise accurate knowledge in a user-friendly way. This is about developing appropriate semantic networks / conceptual relationships.
  • Create rapid access routes to the knowledge. Create opportunities to access the semantic networks quickly.
  • Provide enough opportunities to use the pathways. Practice, practice, practice.

Avoid students thinking that they don’t know the diagnosis. Help them to move towards thinking or knowing the diagnosis.

The key to success is structured reflection. How do we get into their heads, and how do we show them what is in our heads?

Reflection must be structured because it doesn’t help for the student to keep thinking the wrong thing. It’s no good asking the student to “have another go” because they just gave it their best shot. When the student keeps guessing the wrong answer (or, even if they guess the right answer), it’s not useful.

How do we get students to “think again” (i.e. System 1 and 2 thinking) in a structured and explicit way?

  • Prioritise 3 possible diagnoses
  • Column 1: What fits the diagnosis (Yes)? This identifies if they have an illness script. Begin by removing the diagnoses that definitely don’t fit, so that they don’t continue with the faulty illness script.
  • Column 2: What doesn’t fit the diagnosis (No)?
  • Column 3: What do you still need to find out (Data needed)?

This process will  help students to articulate an illness script in a structured way. The steps require that you explicitly articulate your (i.e. the clinician’s) own thinking process. Students could also write a narrative explaining their reasoning process for the different columns.

Anxiety and loss of self-esteem will cause students to crash and be unable to take in anything that you say. You must first create an environment where they can take articulate their thinking process. It’s not about giving them the answers or the facts, it’s about taking them through a reasoning process.

We cannot help students think on a case by base basis. There are too many cases. We need to help them to work this out on their own.


  • Audétat, M.-C., Dory, V., Nendaz, M., Vanpee, D., Pestiaux, D., Junod Perron, N., & Charlin, B. (2012). What is so difficult about managing clinical reasoning difficulties? Medical education, 46(2), 216–27.
  • Lucchiari, C., & Pravettoni, G. (2012). Cognitive balanced model: a conceptual scheme of diagnostic decision making. Journal of evaluation in clinical practice, 18(1), 82–8.

Simon Barrie presentation on Graduate Attributes

“Curriculum renewal to achieve graduate learning outcomes: The challenge of assessment”
Prof Simon Barrie, Director of T&L, University of Sydney

Last week I had the opportunity to attend a presentation on graduate attributes and curriculum renewal by Prof Simon Barrie. The major point I took away from it was that we need to be thinking about how to change teaching and assessment practices to make sure that we’re graduating the kinds of students we say we want to. Here are the notes I took.


Assessment is often a challenge when it comes to curriculum renewal. The things that are important (e.g. critical thinking) are hard to measure. Which is why we often don’t even try.

Curriculum is more powerful than simply looking at T&L, although bringing in T&L is an essential aspect of curriculum development. Is curriculum renewal just “busy bureaucracy”? It may begin with noble aims but it can degenerate into managerial traps. Curriculum renewal and graduate attributes (GA) should be seen as part of a transformative opportunity.

GA are complex “things” and need to be engaged with in complex ways

GA should be focused on checking that higher education is fulfilling it’s social role. UNESCO World Declaration on Higher Education: “higher education has given ample proof of it’s viability over the centuries and of its ability to change and induce change and progress in society”.

GA should be a starting point for a conversation about higher education. If they exist simply as a list of outcomes, then they haven’t achieved their purpose.

How is an institution’s mission embodied in the learning experiences of students and teaching experiences of teachers?

What is the “good” of university?

  • Personal benefit – work and living a rich and rewarding life
  • Public benefit – economy and prosperity, social good
  • The mix of intended “goods” can influence our descriptions of the sorts of graduates that universities should be producing and how they should be taught and assessed. But, the process of higher education is a “good” in itself. The act of learning can itself be a social good e.g. when students engage in collaborative projects that benefit the community.

Universities need to teach people how to think and to question the world we live in.

If you only talk to people like you about GA, you develop a very narrow perspective about what they are. Speaking to more varied people, you are exposed to multiple set of perspectives, which makes curriculum renewal much more powerful. We bring our own assumptions to the conversation. Don’t trust your assumptions. Engage with different stakeholders. Don’t have the discussion around outcomes, have it around the purpose and meaning of higher education.

A framework for thinking about GA: it is complex and not “one size fits all”. Not all GA are at the same “level”, there are different types of “understand”, which means different types of assessment and teaching methods.

  • Precursor: approach it as a remedial function, “if only we got the right students”
  • Complementary: everybody needs “complementary” skills that are useful but not integral to domain-specific knowledge
  • Translation: applied knowledge in an intentional way, should be able to use knowledge, translating classroom knowledge into real world application, changing the way we think about the discipline
  • Enabling: need to be able to work in conditions of uncertainty, the world is unknowable, how to navigate uncertainty, develop a way of being in the world, about openness, going beyond the discipline to enable new ways of learning (difficult to pin down and difficult to teach, and assess, hard to measure)

The above ways of “understanding” are all radically different, yet many are put on the same level and taught and assessed in the same way. Policies and implementation needs to acknowledge that GA are different.

Gibbons: knowledge brought into the world and made real

The way we talk about knowledge can make it more or less powerful. Having a certain stance or attitude towards knowledge will affect how you teach and assess.

What is the link, if any, between the discipline specific lists and institutional / national higher education lists?

The National GAP – Graduate Attribute Project

What are the assessment tasks in a range of disciplines that generate convincing evidence of the achievement of graduate learning outcomes? What are the assurance processes trusted by disciplines in relation to those assessment tasks and judgments? Assessing and assuring graduate learning outcomes (AAGLO project). Here are the summary findings of the project.

Assessment for learning and not assessment of learning.

Coherent development and assessment of programme-level graduate learning outcomes requires an institutional and discipline statement of outcomes. Foundation skills? Translation attributes? Enabling attributes and dispositions? Traditional or contemporary conceptions of knowledge?

Assessment not only drives learning but also drives teaching.

  • Communication skills – Privileged
  • Information literacy – Privileged
  • Research and inquiry – Privileged
  • Ethical social professional understandings – Ignored (present in the lists, but not assessed)
  • Personal intellectual autonomy – Ignored (present in the lists, but not assessed)

Features of effective assessment practices:

  • Assessment for learning
  • Interconnected, multi-component, connected to other assessment, staged, not isolated
  • Authentic (about the real world), relevant (personally to the student), roles of students and assessors
  • Standards-based with effective communication of criteria, assessment for GA can’t be norm-referenced, must be standards-based
  • Involve multiple decision makers – including students
  • Programme level coherence, not just an isolated assessment but exists in relation to the programme

The above only works as evidence to support learning if it is coupled with quality assurance

  • Quality of task
  • Quality of judgment (calibration prior to assessment, and consensus afterwards)
  • Confidence

There is a need for programme-level assessment. Assessment is usually focused at a module level. There’s no need to assess on a module level if your programme level is effective. You can then do things like have assessments that cross modules and are carried through different year levels.

How does a university curriculum, teaching and learning effectively measure the achievement of learning outcomes? In order to achieve certain types of outcomes, we need to give them certain types of learning experiences.

Peter Knights “wicked competencies”: you can’t fake wickedness – it’s got to be the real thing, messy, challenging and consequential problems.

The outcomes can’t be used to differentiate programmes, so use teaching and learning methods and experiences to differentiate.

Stop teaching content. Use content as a framework to teach other things e.g. critical thinking, communication, social responsibility

5 lessons:

  1. Set the right (wicked) goals collaboratively
  2. Make a signature pedagogy for complex GA part of the 5 year plan
  3. Develop policies and procedures to encourage and reward staff
  4. Identify and provide sources of data that support curriculum renewal, rather than shut down conversations about curriculum
  5. Provide resources and change strategies to support curriculum renewal conversations

Teaching GA is “not someone else’s problem”, it needs to be integrated into discipline-specific teaching.

Be aware that this conversation is very much focused on “university” or “academic” learning, and ignores the many different ways of being and thinking that exist outside the university. How is Higher Education connecting with the outside world? Is there a conversation between us and everyone else?

We try to shape students into a mold of what we imagine they should be. We don’t really acknowledge their unique characteristics and embrace their potential contribution to the learning relationship?

We (academics) are also often removed from where we want our students to be. Think about critical thinking, inquiry-based learning, collaboration, embracing multiple perspectives. Is that how we learn? Our organisational culture drives us away from the GA we say we want our students to have.


If you can’t explain it simply…

Sometimes I get frustrated with colleagues who seem to think that the more complicated they can make an idea sound, the more intelligent they must be. I can’t think of another reason why they would obfuscate what they’re trying to say. I spend a lot of time trying to simplify what I’m talking about, although I don’t always manage to get this right. It’s not that I think my audience isn’t able to deal with complex ideas, I just think that I should be able to share complicated ideas simply.

Bertrand Russell’s 10 Commandments of Teaching

Honourable_Bertrand_RussellA great post from Brainpickings, on Bertrand Russell’s 10 Commandments of Teaching:

  1. Do not feel absolutely certain of anything.
  2. Do not think it worth while to proceed by concealing evidence, for the evidence is sure to come to light.
  3. Never try to discourage thinking for you are sure to succeed.
  4. When you meet with opposition, even if it should be from your husband or your children, endeavor to overcome it by argument and not by authority, for a victory dependent upon authority is unreal and illusory.
  5. Have no respect for the authority of others, for there are always contrary authorities to be found.
  6. Do not use power to suppress opinions you think pernicious, for if you do the opinions will suppress you.
  7. Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric.
  8. Find more pleasure in intelligent dissent than in passive agreement, for, if you value intelligence as you should, the former implies a deeper agreement than the latter.
  9. Be scrupulously truthful, even if the truth is inconvenient, for it is more inconvenient when you try to conceal it.
  10. Do not feel envious of the happiness of those who live in a fool’s paradise, for only a fool will think that it is happiness.

Note: This has been cross-posted at Unteaching.

Finding the time

People do not fail in life because they aim too high and miss… (The Principal of Change)

“People do not fail in life because they aim too high and miss. They fail in life, because they aim too low and hit.”

We often can’t imagine how we’ll ever find the time to make the changes we know are important to improve learning. But it’s not about finding the time. If you try finding the time in an already packed curriculum, you won’t. It’s about recognizing that if the change is important, then you must make the time to do it.

Note: This was originally posted at Unteaching.

Yet another T&L blog?

Yet another T&L blog (Unteaching)

We thought there was room for something a bit more…playful. Something less formal. Maybe even irreverent. We think that there’s space for a group of like-minded South African educators to get together and shoot the breeze without needing to worry about who is watching and who you represent. A place where you can cut loose and say what you think. Where you can challenge the status quo and where you don’t have to conform. We think that there is room for debate and discussion that is institution-independent and we think that this could be that space.

I recently began working on a project called Unteaching, with a few other people in South African higher education. We’re interested in trying to build a conversation around rethinking teaching and learning practices in a way that was oriented to the local context, with our unique facilitators and challenges. At the moment it’s just a WordPress blog but we’re kind of figuring it out as we go along, so things may change.

In thinking about a few guiding principles, I couldn’t help but keep coming back to this advertising campaign for the original Mac computers. We wanted this community to be different and to represent in some way the ideals and enthusiasm for change that could be reflected in thindividual stories and experiences of people who are doing for eat work in the classroom but who don’t have the opportunities to publish or present at conferences.

Click to enlarge.
Click to enlarge.