Developing a Structured Teaching Plan for Psychiatry Tutors at Oxford University
Author: Al-Taiar, Hasanen
Date: 2014-10-00
Type: Dissertations/Theses
Subjects: Foreign Countries,Psychiatry,Mental Disorders,Teaching Methods,Medical Students,Questionnaires,Transformative Learning,Adult Learning,Interviews,Tutors,College Faculty,Student Attitudes,Feedback (Response),Patients,Video Technology,Risk Assessment,Reflection

Purpose: The purpose of this thesis was to examine the teaching ways I undertook in teaching medical students and to examine the use of a structured teaching plan for the academic and clinical tutors in psychiatry. The teaching plan was developed for use, initially by Oxford University Academic tutors at the Department of Psychiatry. In addition, I wanted to see whether medical students learned in a transformative way (Mezirow, 1991). One of the aims of this project was to design an interview protocol questionnaire with a view of checking if the transformative learning process occurred in fifth year medical students at Oxford following their 8 week psychiatry placement i.e. if they learnt in a transformative way which is one form of adult learning. Psychiatry is so different from other branches of medicine, in that it is majorly seen as a &quot;crisis event.&quot; It is known that many professionals including medical students have some negative attitudes towards psychiatry as a specialty in general and towards people with mental health conditions. Improving the attitude towards psychiatry is something I would like to achieve via my teaching. Helping students to undergo the transformative learning process might result in improving such attitudes in the short term but will hopefully promote the habits of life-long learning in the future and create reflective clinicians. In addition, I found that I like the concept of transformative learning as it ties in well with my dominant &quot;nurturing&quot; teaching perspective. Methodology: I met with my tutorial group peers a few times to discuss and devise the interview protocol questionnaires to encompass Mezirow's phases of transformative learning. We shared the draft questions with our tutor who provided feedback on them to accommodate the main phases of Mezirow's theory. We produced an interview protocol leaflet for students (Appendix 3), explaining the purposes of the interview and thanking them for taking part (figure). We agreed to interview 5 students, each, and to share our interviews for feedback afterwards. I conducted and recorded five interviews with fifth year medical students at Oxford University who had finished their eight week psychiatry placements. Their placements involved attending clinical and academic tutorials with the specialist registrars as well as shadowing the consultant psychiatrists during their ward rounds and reviews, in addition to assessing patients on their own or shadowing other doctors. Results: Some students came to psychiatry not knowing how to interview psychiatric patients and others had different impressions about some disorders e.g. somatoform disorders (disorientating dilemmas). They started to critique their own assumptions and question the validity of their pre-existing beliefs about psychiatry and psychiatric patients. &quot;What I learnt in psychiatry has changed the way I perceive how I see people e.g. in Cowley Road where I live. I am more aware of the background now.&quot; Students learnt some valuable communication and other clinical skills that they think &quot;are transferrable&quot; to other specialties as they use them in dealing with patients in other specialties like emergency and obstetrics departments. Some students went to say that &quot;they will be disappointed if I lose these skills.&quot; There is evidence that case studies and simulations are classroom techniques associated with transformative learning (Parker, 2010). In our placements, students were able to watch video simulations of clinical cases as well as present and discuss a variety of clinical scenarios from real life, in addition to interacting with real patients on the wards and clinics. Examples of transformative learning were variable and included examples like conducting a good risk assessment, interviewing psychiatric patients which was challenging for some students and took them out of their &quot;comfort zone.&quot; It is relatively safe to say that students might start their psychiatry placements being in a state of &quot;disorientating dilemmas.&quot; These bright students will often question their pre-existing beliefs and concepts about a particular subject. Translating that to psychiatry, some medical students might presume that all psychiatric patients are homeless, aggressive or violent. Many of them are experiencing psychiatry and dealing with patients for the first time in their lives. With the course progression, they will &quot;critique their assumptions&quot; and ask themselves whether their pre-existing thoughts were valid or not. Here it comes, the &quot;Ah-ha&quot; moment or &quot;lights-on experience,&quot; as one can see in this student's reply: &quot;Hearing people stories is very powerful either in the context of being on the wards e.g. Littlemore, or by conversation with an acutely psychotic patient. I found myself enjoying my time in conversation and that's a real revelation.&quot; The students went on to reflect on their experiences in psychiatry to reach certain conclusions: &quot;I go home and think about what I saw and learnt. I realise that a particular patient could be a member of my family or a friend.&quot; &quot;I learnt to look at peoples' problems more holistically as there will be a story or more than one behind each patient we meet.&quot; These interviews have given us some insight that many students have been exploring the options for new roles and relationships as reflected in their clinical behaviour with colleagues and patients in the same rotation and the subsequent rotations (as with interviewee no.2). Cranton defined critical reflection as &quot;the means by which we work through beliefs and assumptions, assessing their validity in the light of new experiences or knowledge, considering their sources, and examining underlying premises.&quot; The literature highlights the central importance of cultivating a process of critical reflection with certain key elements. It is clear from the sample studied that students understood &quot;reflective practice&quot; and the majority of them used it for their learning in different ways, some of these experiences occurred by simply taking a step back, thinking and reflecting on what the student had done and how they can do better next time. Some students used it in a quite an informal &quot;or unconscious&quot; way. Some researches like Cranton suggested that the most promising transformative learning potential is long term work with others and Imel concurred with the significance of establishing a community amongst learners. We can see a pattern of good working relationships with members of the mental health team in three of these interviews (60%) and examples of the expressions used were &quot;you were very much welcome to the team.&quot; Conclusions and Discussion: Although the sample I studied was small, I interviewed five patients in preparation for the MTI whereas other PGDipLATHE [Postgraduate Diploma in Learning and Teaching in Higher Education] colleagues interviewed three each. From the results, we can see good evidence of transformative learning happening in medical students undertaking their psychiatry placements at Oxford. It is evident that some students went through some (but not all) phases of Mezirow's transformative theory. At this point and on further reflection, I would critique some aspects of my interviewing process which was done in December 2013. Probably, I should have gone into more depth with each of the students about the phases of Mezirow's theory. This is a good point for the future. Recommendations: I recommend that this teaching plan be used by all educators in psychiatry. The learners (students found them helpful). Empowering students to lead the tutorials themselves, with expert input when required. Appendixes include: (1) MTI Interview Questionnaire; (2) MTI results; (3) MTI Student Leaflet 2013; and (4) Examples of students' feedback.