Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Teaching Styles An Introduction to Situational Teaching

Do these situations seem familiar? You have been treating pneumonia for many years, and over these years have learned how to manage very complicated patients well. You feel competent and enjoy your work. A volunteer comes and tells you precisely how you should manage a simple case, detail after detail. You somehow feel frustrated... A new junior doctor joins your team. He is required to perform simple tasks but keeps getting things wrong. You feel you dont have unlimited time to spend managing every small task on your team and you feel upset that he cant perform simple jobs. He feels inadequate and unmotivated. What do you think the issue or problem is? How could things have been handled differently?

Teaching Actions Directive and Supportive Behavior

Directive actions: The teacher makes the decision on how things will be done Gives the junior doctor a specific treatment plan to carry out Makes clear which juniors are to see which patients Shows a junior doctor how to perform a specific skill Sets a time table for work to be completed Supportive actions: The leader gives the follower opportunity to make their own decisions Asks for a differential diagnosis Points out which laboratory findings are abnormal Praises the junior doctors accomplishments Reviews possible resources for clinical decision making Determine which cases below demonstrate more directive actions and which are supportive in nature. Case Study 1 Saree met with Bunly to review the patient with diabetic ketoacidosis in the ICU. She explained the importance of monitoring electrolytes as the patient was rehydrated and asked Bunly to notify her specifically of the patients potassium level every two hours. Bunly said he would do it. Case Study 2 On her way out of the ICU, Saree saw that Srei Neang was having problems starting an IV on a small, dehydrated infant. She was nervous and lacked confidence. Saree asked one of the more experienced nurses to come and help Srei Neang.

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Case Study 3 Saree reviewed a pneumonia case with Pheak before leaving the hospital. Pheak had started the patient on oral steroids. Saree commented that she wasnt sure if this measure would help, but left him to make the decision and praised Pheak on his overall management of the patient. Describe a situation where directive behavior would be appropriate but supportive behavior wouldnt be necessary. When would supportive behavior be better than directive actions?

Four Teaching Styles Director (caghVag), Coach (GkbgVwk), Supporter (GkKaMRT), Delegator (GkeprGMNac/Eckkarna)
How much supportive and directive behavior do these types of teachers have (high or low)? Director: The teacher provides specific instructions and closely supervises the performance of a task. Coach: The leader continues to direct and closely supervise the task but also explains decisions, asks for suggestions, and supports progress. Supporter: The teacher facilitates and supports students efforts towards accomplishing their tasks and shares the decision-making responsibility with them. Delegator: The teacher passes over responsibility for decision-making and problem-solving to the students.
---- SUPPORTIVE BEHAVIOR -----> (high)

Director

(low) ----------- DIRECTIVE BEHAVIOR -----------> (high)

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Identify which of the four teaching styles is in use in the following cases below. It may be helpful to first determine the level of directive and supportive behavior to help decide which style is in use. Case Study 1 Phal is supervising the ICU/ER. Hes heard that a Lao doctor who will be coming for one month is the also the supervisor of the ICU in his university hospital. Phal briefly reviews how the ICU/ER flows, where equipment is found, and introduces him to all the staff. Because Phal knows the Lao doctor has a lot of experience, he provides his phone number to the new doctor, assures him hell do a great job and tells him hell stop in to review his patients in the afternoon. Case Study 2 Piseth has learned a lot in his first year, but still lacks the confidence to perform even simple surgeries. Theavy asks Piseth to be primary surgeon for the next case. He encourages Piseth that he has the needed skills for the case, praises him for his good technique, tells him he will walk him through the case step by step, and assures him that if anything goes wrong, he will intervene. Case Study 3 Savry just started at the hospital. Mao reviews the new admission with her, writes out some initial orders, and gives her an outline of a treatment plan for the following few days. He then goes with her to speak with the patients mother to explain what is happening and what the mother can expect in the coming hospital stay. Case Study 4 A new branch of the hospital will be opening in Phum Tmei. Since Naroth helped set up the last new branch clinic, the hospital director has allowed him to chose his own staff, set up his protocols and decide how services will be offered in the new clinic.

Teaching Styles and You

What teaching style do you feel most comfortable using?

Which style do you need to develop?

What are three things you can do to help develop these styles?

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

These styles are skills that can be learned. A teacher who exercises only one style will burn out the students.

Determining Development Level

Two factors which a teacher needs to assess: Competence: Knowledge and skills gained from experience and training. Commitment: A combination of confidence and motivation. Enthusiastic beginners need directions about how to get started in a new activity. After a while, they become disillusioned learners, finding the task more difficult than they thought it would be. Then the leader needs to be a coach, offering both direction and support. Later, learners become reluctant contributors knowing what they are supposed to do but not feeling confident about their ability. Then the leaders task is to encourage them to act on what they know Every person has the potential to become a peak performer - someone to whom the task can be delegated and who can move with competence and commitment.
Ford, L. Transforming Leadership, IVP,1992. pg 286.

Think back to learning medicine can you relate to these stages? In the following table, Blanchard assigns levels of competence and commitment to difference levels of development. Think about different people you work with and specific tasks they are doing. Where would they fit into these developmental stages? (Remember its skills-specific ie someone can be at D1 for one skill but D4 for another.)
High competence - High commitment More competence - Variable commitment Some competence - Low commitment Low competence - High commitment

D2 D1 DEVELOPED <------------------------------------------------------------------------------------------------ DEVELOPING

D4

D3

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Matching Teaching Styles to Development Levels

Case Study 1 Phany is a new junior but has shown that she has good problem-solving skills and a good fund of knowledge. She has demonstrated a willingness to learn and work hard, but you know shell need quite a bit of direction on new or complex cases. Development Level: ____ Appropriate Teaching Style: ____ An appropriate action would be: o Allow her to manage complex cases, telling her she has great problem-solving skills and that she can call you if she has any problems. o Give her more complex cases but review closely with her how to manage their treatment. o Have her continue seeing simple cases so she is not treated differently than her peers. o Let her go without supervision to help on the lake. Case Study 2 Oudom just finished as one of the best doctors in his class. He is very well respected as a doctor and you hope to use him to teach junior doctors, a new role for him. Development Level: ____ Appropriate Teaching Style: ____ An appropriate action would be: o Assign him to the OPD to oversee the junior doctors. o Tell him he was an excellent doctor so will make an excellent teacher and put him into the lecture schedule. o Before you ask him to lead rounds, remind him hes a great doctor and you have confidence in his knowledge and skills and youll be there if something should go wrong. o Have him follow you in OPD as you supervise the junior residents for a couple days.

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Case Study 3 Maj is about to graduate and has proven himself an excellent physician. Development Level: ____ Appropriate Teaching Style: ____ An appropriate action would be: o Ask him to see patients the same way as the new juniors, presenting them to you and hearing how youd manage the case because theres always something he can learn. o Tell him hes very good at making complex diagnoses, asking him to review his thought processes in making those diagnoses with you. o Assign him to work in a branch clinic. o Compliment him on his good business sense and encourage him in his efforts to start a private practice.

Teaching Styles and You

Think of two tasks that youve asked someone else to do recently. Was there a match between the development level and your teaching style? If not, what could you have done better?
Resources:

Angkor Hospital for Children Faculty Development Course

The Intentional Teacher

Doughtery, D., Bacon, D., and Trebesch, S., The Organization: Project Timothy series. Singapore: OMF International, 2008. Blanchard, K. and Johnson, S. The One Minute Manager. New York: Morrow, 1982. as used in above.

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Teaching Styles An Introduction to Situational Teaching

Do these situations seem familiar? You have been treating pneumonia for many years, and over these years have learned how to manage very complicated patients well. You feel competent and enjoy your work. A volunteer comes and tells you precisely how you should manage a simple case, detail after detail. You somehow feel frustrated... A new junior doctor joins your team. He is required to perform simple tasks but keeps getting things wrong. You feel you dont have unlimited time to spend managing every small task on your team and you feel upset that he cant perform simple jobs. He feels inadequate and unmotivated. What do you think the issue or problem is? How could things have been handled differently?

Teaching Actions Directive and Supportive Behavior

Directive actions: The teacher makes the decision on how things will be done Gives the junior doctor a specific treatment plan to carry out Makes clear which juniors are to see which patients Shows a junior doctor how to perform a specific skill Sets a time table for work to be completed Supportive actions: The leader gives the follower opportunity to make their own decisions Asks for a differential diagnosis Points out which laboratory findings are abnormal Praises the junior doctors accomplishments Reviews possible resources for clinical decision making Determine which cases below demonstrate more directive actions and which are supportive in nature. Case Study 1 Saree met with Bunly to review the patient with diabetic ketoacidosis in the ICU. She explained the importance of monitoring electrolytes as the patient was rehydrated and asked Bunly to notify her specifically of the patients potassium level every two hours. Bunly said he would do it. directive Case Study 2 On her way out of the ICU, Saree saw that Srei Neang was having problems starting an IV on a small, dehydrated infant. She was nervous and lacked confidence. Saree asked one of the more experienced nurses to come and help Srei Neang. directive

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Case Study 3 Saree reviewed a pneumonia case with Pheak before leaving the hospital. Pheak had started the patient on oral steroids. Saree commented that she wasnt sure if this measure would help, but left him to make the decision and praised Pheak on his overall management of the patient. supportive Describe a situation where directive behavior would be appropriate but supportive behavior wouldnt be necessary. When would supportive behavior be better than directive actions?

Four Teaching Styles Director (caghVag), Coach (GkbgVwk), Supporter (GkKaMRT), Delegator (GkeprGMNac/Eckkarna)
How much supportive and directive behavior do these types of teachers have (high or low)? Director: The teacher provides specific instructions and closely supervises the performance of a task. Coach: The leader continues to direct and closely supervise the task but also explains decisions, asks for suggestions, and supports progress. Supporter: The teacher facilitates and supports students efforts towards accomplishing their tasks and shares the decision-making responsibility with them. Delegator: The teacher passes over responsibility for decision-making and problem-solving to the students.
---- SUPPORTIVE BEHAVIOR -----> (high)

Supporter

Coach Director

Delegator

(low) ----------- DIRECTIVE BEHAVIOR -----------> (high)

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Identify which of the four teaching styles is in use in the following cases below. It may be helpful to first determine the level of directive and supportive behavior to help decide which style is in use. Case Study 1 Phal is supervising the ICU/ER. Hes heard that a Lao doctor who will be coming for one month is the also the supervisor of the ICU in his university hospital. Phal briefly reviews how the ICU/ER flows, where equipment is found, and introduces him to all the staff. Because Phal knows the Lao doctor has a lot of experience, he provides his phone number to the new doctor, assures him hell do a great job and tells him hell stop in to review his patients in the afternoon. Case Study 2 Piseth has learned a lot in his first year, but still lacks the confidence to perform even simple surgeries. Theavy asks Piseth to be primary surgeon for the next case. He encourages Piseth that he has the needed skills for the case, praises him for his good technique, tells him he will walk him through the case step by step, and assures him that if anything goes wrong, he will intervene. Coach Case Study 3 Savry just started at the hospital. Mao reviews the new admission with her, writes out some initial orders, and gives her an outline of a treatment plan for the following few days. He then goes with her to speak with the patients mother to explain what is happening and what the mother can expect in the coming hospital stay. Director Case Study 4 A new branch of the hospital will be opening in Phum Tmei. Since Naroth helped set up the last new branch clinic, the hospital director has allowed him to chose his own staff, set up his protocols and decide how services will be offered in the new clinic. Supporter

Teaching Styles and You

Delegator

What teaching style do you feel most comfortable using?

Which style do you need to develop?

What are three things you can do to help develop these styles?

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

These styles are skills that can be learned. A teacher who exercises only one style will burn out the students.

Determining Development Level

Two factors which a teacher needs to assess: Competence: Knowledge and skills gained from experience and training. Commitment: A combination of confidence and motivation. Enthusiastic beginners need directions about how to get started in a new activity. After a while, they become disillusioned learners, finding the task more difficult than they thought it would be. Then the leader needs to be a coach, offering both direction and support. Later, learners become reluctant contributors knowing what they are supposed to do but not feeling confident about their ability. Then the leaders task is to encourage them to act on what they know Every person has the potential to become a peak performer - someone to whom the task can be delegated and who can move with competence and commitment.
Ford, L. Transforming Leadership, IVP,1992. pg 286.

Think back to learning medicine can you relate to these stages? In the following table, Blanchard assigns levels of competence and commitment to difference levels of development. Think about different people you work with and specific tasks they are doing. Where would they fit into these developmental stages? (Remember its skills-specific ie someone can be at D1 for one skill but D4 for another.)
High competence - High commitment More competence - Variable commitment Some competence - Low commitment Low competence - High commitment

D4

D3

D2

D1

DEVELOPED <------------------------------------------------------------------------------------------------ DEVELOPING

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Matching Teaching Styles to Development Levels

Case Study 1 Phany is a new junior but has shown that she has good problem-solving skills and a good fund of knowledge. She has demonstrated a willingness to learn and work hard, but you know shell need quite a bit of direction on new or complex cases. Development Level: D2 Appropriate Teaching Style: S2 An appropriate action would be: o Allow her to manage complex cases, telling her she has great problem-solving skills and that she can call you if she has any problems. S3 o Give her more complex cases but review closely with her how to manage their treatment. S2 o Have her continue seeing simple cases so she is not treated differently than her peers. S1 o Let her go without supervision to help on the lake. S4 Case Study 2 Oudom just finished as one of the best doctors in his class. He is very well respected as a doctor and you hope to use him to teach junior doctors, a new role for him. Development Level: D1 Appropriate Teaching Style: S1 An appropriate action would be: o Assign him to the OPD to oversee the junior doctors. S4 o Tell him he was an excellent doctor so will make an excellent teacher and put him into the lecture schedule. S3 o Before you ask him to lead rounds, remind him hes a great doctor and you have confidence in his knowledge and skills and youll be there if something should go wrong. S2 o Have him follow you in OPD as you supervise the junior residents for a couple days. S1

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Case Study 3 Maj is about to graduate and has proven himself an excellent physician. Development Level: D4 Appropriate Teaching Style: S4 An appropriate action would be: o Ask him to see patients the same way as the new juniors, presenting them to you and hearing how youd manage the case because theres always something he can learn. S1 o Tell him hes very good at making complex diagnoses, asking him to review his thought processes in making those diagnoses with you. S2 o Assign him to work in a branch clinic. S4 o Compliment him on his good business sense and encourage him in his efforts to start a private practice. S3

Teaching Styles and You

Think of two tasks that youve asked someone else to do recently. Was there a match between the development level and your teaching style? If not, what could you have done better?
Resources:

Angkor Hospital for Children Faculty Development Course

Facilitators Notes

The Intentional Teacher

Doughtery, D., Bacon, D., and Trebesch, S., The Organization: Project Timothy series. Singapore: OMF International, 2008. Blanchard, K. and Johnson, S. The One Minute Manager. New York: Morrow, 1982. as used in above.