For more than forty years, this learner centered system has helped focus teachers on student teacher interaction to improve learning. Student teacher interaction! Does that really, tangibly happen in pre-clinical medicine? Yes, more than it used to, but…
These are 15 well researched techniques to improve teacher performance in a classroom, and other environments. This is an interaction model for teachers.
Irrelevant do you say? You teach clinical medicine to adults, on the ward, not in a classroom? Enough of this little kiddie business?
Let me challenge you. You’re on the ward, and have a gaggle of medical students googling on their cell phones as you do rounds. You goggle at their rude behaviour, roughly ask them to put their pocket computers away and pay attention. You begin to posture like Socrates, and get a response, from one of your characteristically low achievers. You cut him off, gloss over it, glare at him, and ask your all star. You patiently wait for their answer, and go on to ask that person to delve deeper.
I know. I know all about it.
I hope when I get old, if I’m not there already, that I don’t get that first kid as a doctor…
Because you’ve shamed him, and not taught him anything.
What are the TESA behaviours (Rodriguez and Bellanca, 2007)?
These are 15 well researched techniques to improve teacher performance in a classroom. I’ll list them. They can be organized into 3 different types: response opportunities, feedback, and personal regard.
1) Equitable Distribution. Teachers tend to ask student questions in the front row, and down a middle corridor to the back, in essence, in an inverted “T”. Recognize this and ask questions into the back corners.
2) Individual Help. The squeaky wheel gets the grease. Usually a lot of it. Make sure you grease everybody! Identify 3 students in the class who receive the least amount of attention, and consciously give them individual help.
3) Latency. Wait for it. Don’t rescue your student. Ask the question, and bite your tongue.
4) Delving. Provide some additional information to allow the student to answer the question. Force the student to make some interconnections, come up with the answer, and succeed. How about some follow up questions?
5) Higher Level Questioning. Do only the brightest students get the tough questions? Are you giving simple recall questions to a certain kind of student? What does that say about your expectations? What kind of message does that give the students? Students rise up to your expectation.
1) Affirm/ Correct. Give appropriate, congruent feedback about performance. Let’s stop the, “Earth to Joe, Earth to Joe, are you there?” nonsense (see courtesy, below).
2) Praise. This helps learning.
3) Reasons for praise. Do it correctly, congruently. Remember Seligman.
4) Listening. Use active listening techniques. Do you talk to the person you’ve labelled subconsciously a dull student, and listen to the “bright” one? Allow students time to put things together, go more deeply, and verbalize.
5) Accepting Feelings. We physicians aren’t good at this, by and large. Don’t evaluate and castrate, just accept. If it won’t “mark out” your student, for example if in private, label the affect like you would do clinically.
1) Proximity. Students stay on task longer with the teacher at their elbow.
2) Courtesy. Self evident and not enough of it. Clearly. Do you use sarcasm? Do you talk to high status students with more courtesy? Have you noticed how high status students interrupt or talk down to low status students? Are they copying you?
3) Personal interest and compliments. Think of your student’s personal interests. Where have they come from? What have they experienced? Make some links. Do you give more smiles, more eye contact, more out of class time to the higher status students?
4) Touching. This has been proven to help. Be very very careful here. Stay appropriate and respectful.
5) Desist. Can you stop bad behaviour appropriately, with courtesy?
In my teaching environment, not all 15 teaching behaviours (Rodriguez and Bellanca, 2007) are possible, as I have only one student. However, the 3 most used behaviours would be higher level questions, wait time, and listening. The 3 least used would be equitable distribution, which is simply not applicable, desisting, which I have only rarely had the occasion to use in my teaching career (yes, I’m lucky), and touching. I have a female student. I don’t think I’ve done it. I don’t think I’d do it with a male, except in very odd circumstances.
My student is a physician in her second post -graduate year. She is approaching independent practice readiness. My job is to let her loose, and show her that I trust her judgement (that’s personal regard, courtesy). Questions, if I have them, are all higher level dealing with hidden agendas, physician patient relationship boundaries, morals/ ethics, etc. I don’t rescue her. Rescuing her and not allowing her to answer the question infers that I don’t believe her ready to practice. I must show her my confidence in her. I wait, and wait, and if she doesn’t have the answer, I tell her she can answer tomorrow. Listening is basically what I do. 99.9% of the time, I just show up in the exam room after the patient has left, and she starts, carries on, and finishes the whole conversation. (It sounds funny, but it’s accurate, and appropriate.)
Desisting. I’ve used that once or twice, and, strangely, it’s not been with my students, but with physicians that were choosing less than ideal behaviours. We’ll leave it at that.
Each and every one of these behaviours looks powerful. I imagine “desisting” would be seldom used with medical students, but I can remember during my training one or two circumstances when behaviours had to be stopped. It had something to do with a classmate running around with a leg. (Somebody else’s).
These behaviours can help bring in every student. In my traditional (didactic) medical training occurring 30 years ago, there were certainly hiding spots in the classroom. My lectures could have been made much more instructive: frankly, information was just dumped on us. It wasn’t taught at all. There were no questions at all in some lectures (either student or teacher directed).
It would be nice if a professor actually taught. Imagine, evolving a medical student’s experience from self- teaching to being taught.
Rodriguez, E and Bellanca, J. (2007). What is it about me you can’t teach. Thousand Oaks, CA: Corwin Press.