Teaching at the Student's Level

Although the concept of "teaching at the student's level" seems obvious at first glance, it actually poses many challenges within a clinical setting. Consider The Learning Vector in the following figure:

Exposure Acquisition Integration Integration Acquisition Exposure
Trace the red Learning Vector above to see approaches to teaching students at different levels.
If a student had little clinical exposure a more directive teaching style may be useful with an emphasis placed on:
  • Providing structure
  • Setting expectations
  • Giving directions
  • Planning experiences
  • Selecting patients
If the student has moderate clinical experience, a more facilitative teaching role may be useful with an emphasis placed on:
  • Asking the student questions
  • Listening to the student's ideas
  • Sharing your own reasoning
  • Thinking aloud
With the most advanced student, where their clinical experience is extensive, the teaching role can become more collaborative with emphasis placed on:
  • Helping the student set goals
  • Helping evaluate progress
  • Exchanging ideas
  • Serving as a resource

As the student moves forward in their professional development ("x" axis), the nature of the clinical instruction ("y" axis) is modified, with the student being given a more independent role. Correspondingly, as the student moves through this progression, they move along the vector from "exposure", to "acquisition", to "integration", similar to the "see one, do one, teach one" phrase of which we are all familiar.

The difficulty arises as one considers the context in which the learning is taking place. Most clinical education is centralized around patient encounters. This may range along a variety of dimensions. In your office there may be a wide variety of patients and patient problems. The patient population may range in age from newborn to the elderly. The nature of the clinical encounter may range from a diagnostic exam, to a specific procedure, to psychosocial counseling. The nature of the conditions may range from the common (ear infections, UTIs, URIs, etc.) to the more obscure or undefined presentation of symptoms. While this variety is one of the components that attract so many of us to primary care, it poses unique challenges when trying to teach a student in this setting.

Within any given cohort year of medical students, the individuals will have a variety of experiences and exposure and therefore ability. During any given day, we are all more or less familiar with the issues at hand during a given patient encounter. In other words, although the goal is to move along the learning vector as we progress in our professional development, the movement along the vector is not linear. For example a student may feel quite competent performing an ear exam and diagnosing an ear infection, but may not have a clue about how to remove a toenail.

As a result, the concept of "teaching at the student's level" is constantly changing throughout the day. As a preceptor, the challenge is to determine where the student falls on the vector for any given teaching encounter, with the goal of moving the student along the vector.

Odds are, most of the students you will be taking into your office will fall under the levels of "exposure" and/or "acquisition." As the student becomes more familiar with aspects of the clinical encounter, there may be times that he/she moves further along the learning vector. Your challenge as the preceptor will be to adjust your teaching style to the student, based on the situation at hand.

Asking questions will help you determine where your student falls on the Learning Vector for any given teaching encounter.

Module 3: Interacting with Your Medical Student