Comm Eye Health Vol. 13 No. 36 2000 pp 60 - 61. Published online 01 December 2000.

Teaching and learning

Detlef Prozesky MBChB MCommH PhD

Professor of Community Based Education, Faculty of Medicine, University of Pretoria, South Africa

Related content

Teaching methods

In the previous articles in this series we discussed the process of learning and teaching, and the importance of communication in this process. Now we take a look at the different teaching methods that people use. Most teachers use a limited number of methods – ones that they are used to, and feel comfortable with. Unfortunately these methods may not be the best that are available. This article aims to give some guidelines about the methods that teachers should use.

Jobs, tasks and the ‘domains of learning’

In the first article in this series we said that a teacher of eye care workers is guided by the job which they have to be able to perform after training. If you think carefully about it, you will see that a job is made up of a series of tasks – each of which has to be performed competently. What do we need to teach a person, to perform a task competently? According to Abbatt and McMahon, people need to be taught both skills and enabling factors (i.e. factors which a person needs to perform the skill properly). Let’s take an example:

Teaching eye care workers to manage trachoma

Teaching eye care workers to manage trachoma (1)

Skills Needed for the Task Enabling Factors
Diagnosing a case of trachoma Knowledge of symptoms, signs, stages
Applying eye ointment Knowledge of the organism, stages, treatment
Performing tarsorrhaphy Knowledge of the anatomy of the eyelid, surgical equipment/ materials to use. Educating people and communities to prevent trachoma. Knowledge of the spread of the disease and methods of preventing such spread
  An attitude of concern and caring

We see here that there are three kinds of skill, and two kinds of enabling factor:

  1. Decision making skills
  2. Manual skills
  3. Communication skills
  4. Knowledge
  5. Attitude

Educationalists call these five categories the domains of learning.

Teaching the different skills and enabling factors

Let’s return to our example – teaching eye care workers to manage trachoma. How would we normally teach the skills, knowledge and attitudes needed here?

Teaching eye care workers to manage trachoma (2)

Skills / enabling factor to be learnt Suitable teaching method
Diagnosing a case of trachoma Students see patients in an eye clinic, with an experienced clinician to check the diagnosis.
Applying eye ointment; performing tarsorrhaphy Demonstrate the skill, then let students perform it under supervision until they are competent.
Educating people and communities to prevent trachoma Let students practice educating people; give them feedback about the way they do it.
Knowledge of symptoms, signs, stages, the organism, medication, anatomy, spread, prevention etc. Give a lecture covering these facts. Refer students to pages in a textbook to study.
An attitude of concern and caring. Point out examples of good and bad attitudes to the students; discuss these together

It is clear from this example that we need to use different methods, to teach the different domains of learning. Very often teachers do not understand this. It is a common mistake for example to use lectures for everything. In stead of learning practically how to communicate, students are given a lecture about communication!

A feast of methods

The generations of teachers who have gone before us have developed a large number of methods. All of these methods are now available for us to use. Here are some of the most commonly used ones, in relation to the domains of learning:

Manual skills

There is really only one way to teach a manual skill, and that is to let the students perform the skill under supervision. It is best if the students first see a careful demonstration of the skill, and if both teachers and learners are guided by checklists. Students get feedback – which means that the teacher shows them where they have made mistakes. Sometimes students practise on a model first, before working with a real patient – for example, they can inject an orange, or they can practise examining each other.

About checklists

A checklist is a step-by-step, written description of a skill that is excellently performed.

Here is an example, for the skill ‘Applying eye ointment':

  • Position the patient comfortably (sitting or lying down).
  • Wash your hands.
  • Check that the ointment and the prescription agree.
  • Open the tube of ointment and hold it in your clever hand.
  • With the index finger of the other hand, gently pull down the lower eyelid of one eye, to expose the lower fornix.
  • Squeeze a ‘worm’ of ointment 2 cm long into the lower fornix, from left to right. and so on.

Checklists like this have several uses:

  • Teachers use them when they demonstrate a skill, and to give feedback to students.
  • Students use them as a guide when they practise the skill by themselves.
  • Teachers use them to assess skills in an examination.

Communication skills

Again, communication skills can only be taught be making students practise them, after a demonstration, and giving them feedback on their performance. We often use role plays to teach these skills – for example, one student gives a health education talk, while the others pretend to be a group of villagers. After the role play the teacher and the ‘villagers’ give feedback to the ‘educator’, again using a checklist of the skill.

Decision making or problem solving skills

The most common decisions that eye health care workers have to make is what the diagnosis is, and what treatment should be given. We teach these by giving the students problems to solve, and giving them feedback on the solutions they come up with. Such problems can be written ones: case studies or patient management problems. Here we give students the information they need (this can be done on paper or on a computer), and ask them to diagnose the case and solve the treatment problem. Then of course we should ask them to do the same thing with real patients.

Knowledge

Lecturing is the most common form of teaching knowledge (see box below). There are numerous other methods, all of which are probably better than lectures. Teachers may discuss important topics with small groups of students in tutorials. A group of teachers may present a seminar, where they discuss different aspects of the same topic. Teachers may discuss a topic with students, drawing on what they already know about it. Teachers may arrange educational visits, where students learn from what they see and experience. Teachers may give students projects to do, for which the students find the information they need themselves – and so on.

About lectures

A checklist is a step-by-step, written description of a skill that is excellently performed.

There is no doubt that lectures are very popular with teachers – but are they the method of choice for teaching knowledge? Consider the following:

  • Most students learn very little during lectures – they get the knowledge into their heads afterwards, by self-study.
  • It is surely a terrible waste of time to dictate notes to a hundred students, each of whom has to take the dictation down by hand.
  • Studies have shown that, without doubt, lecturing leads to less knowledge retention than any other way of teaching knowledge.
  • The average attention span of people who sit listening to someone talking is around 10 minutes. That is why students get bored and go to sleep during long lectures.

What do you think? Perhaps it is better to ‘teach’ routine knowledge by giving good handouts or pages from textbooks to students, for directed private study. Teachers should rather use precious classroom time to explain difficult concepts, or to solve problems together. In any case there should be interaction between teachers and learners during lectures – the method should stimulate and involve learners, rather than boring them to tears.

Attitudes

Attitudes are difficult to ‘teach’. All teachers can really do is to help students develop suitable attitudes. A very powerful way is by example, since students imitate the attitudes of their teachers. Another way is to point out examples of good and bad attitudes, and to discuss these with the students: why should a good eye care worker have this attitude, and not that one? Teachers can also give feedback to their students, on how their attitudes are developing. For those readers who would like to know more about these teaching methods, we recommend the following books:

  • Abbatt, F. and McMahon, R (1993, UK£7.00*), Teaching health care workers, second edition, London: Macmillan. The ideas in this book are more ‘formal’, in the sense that it emphasises the discipline of using the right method for the right domain.
  • Werner, D. and Bower, B. (1982, £11.50*), Helping health workers learn, Palo Alto, California: Hesperian Foundation. This book is a real encyclopaedia of ideas for less formal, interactive teaching.

* Editor’s Note: Both of these books are available at the above prices plus UK£2.75 postage each from TALC, PO Box 49, St Albans, Herts AL1 5TX, UK. Fax: 00 44 (0)1727 853 869; E-mail: talcuk@btinternet.com

At the start of this article we saw how important it is to make sure that eye care workers learn all they need to learn, to perform their work competently. In the next article we deal with this question in more detail: how do we develop a course curriculum? Watch this space!

CORRECTION: The Editor apologies that in the two tables on p.60 ‘tarsorrhaphy’ should have read ‘tarsal rotation’.