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What constitutes a good clinical teacher?

Al-Qahtani, Mona Faisal

The Journal Of The Egyptian Public Health Association: April 2011 - Volume 86 - Issue 1 and 2 - p 27–32
doi: 10.1097/01.EPX.0000395429.33802.5e
Original articles
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Background The practical part of medical studies occurs in clinical settings. The characteristics of a good clinical teacher have been reflected in a large number of medical educational studies, mainly within the western context.

Objectives To explore the views of medical students and staff with regard to the characteristics of a good clinical teacher, and to determine whether sex and type of department have any significant effect on this issue within the Saudi context.

Materials and methods A questionnaire was developed. It consists of 25 characteristics with four domains: professional, teaching skills, personal, and social. The study population included 85 fourth-year students and 36 faculty staff in the following three departments: respiratory technology, physical therapy, and medical laboratory technology, at the University of Dammam, Kingdom of Saudi Arabia.

Results The questionnaire had high reliability and satisfactory content validity. There were statistically significant sex differences regarding the importance of one domain (professional, P<0.001) and seven individual characteristics. Female participants accorded higher mean ranks compared with men (25.3 vs. 32.5 in social domain). Faculty significantly accorded higher mean ranks in all domains compared with students. No statistically significant differences among students' views based on the type of department were observed.

Conclusions and recommendations There was a general agreement on the importance of all characteristics, but the degree of importance significantly varies. Faculty in general and female participants in particular viewed such attributes as more important than their counterparts. These characteristics should be incorporated in the teacher evaluation format/questionnaire currently used by the college, which will ultimately have a positive impact on teaching and learning in Saudi Arabia.

Department of Health Information Management and Technology, University of Dammam, College of Applied Medical Sciences, Kingdom of Saudi Arabia

Correspondence to Mona Faisal Al-Qahtani, Department of Health Information Management and Technology, University of Dammam, College of Applied Medical Sciences, Kingdom of Saudi Arabia Tel: 00966-504981410; fax: 00966-38599265 e-mail: mfmq97@gmail.com

Received November 29, 2010

Accepted January 15, 2011

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Introduction

As the practical part of professional medical studies appears in clinical settings, clinical teaching is considered as one of the most important components of students' learning process. According to Finucane et al. [1], the quality of education in medical school is influenced by three factors: students, teacher, and the curriculum. To ensure the occurrence of learning in a clinical environment, students should be provided with a teacher, learning material, and an environment where the learning occurs [2]. It is hypothesized that effective teaching should translate into effective learning by the physician in training, which in turn should translate into effective care of patients [3].

There are no general consensuses among researchers on what exactly constitutes a good/effective clinical teacher [3]. For instance, a good teacher, in the general context, has been defined as instructors who seek to understand student's difficulties, are keen to provide help and advice on study methods, and make sure to present learning material at a proper level for their students [4]. For Khoo and Teoh [5], an effective teacher is ‘someone who can impart his or her knowledge and skills successfully and is able to bring about appropriate changes in knowledge, skills, attitudes, and behaviors in the learners’. Such definitions emphasize the importance of having a knowledgeable and skillful teacher [4,5]. Other studies [6,7] highlight the importance of having good ‘interpersonal relationships’ with students. For other studies [7,8], it is the good delivery of teaching that describes a good teacher. Such diverse definitions and descriptions of a good teacher might trace back to the different roles played by a teacher, the different background of an evaluator, and to the different needs of learners in different learning contexts.

Despite this, the most important ingredients for being effective teachers are as follows: having a wide knowledge and deep understanding of their disciplines; being good at planning and organizing [9,10]; being able to deliver and communicate effectively with students; having good interpersonal skills [7,9]; being able to provide reasonable evaluation and effective feedback; being enthusiastic; having clarity and a good rapport with students [9–12]; being inspiring, concerned, helpful, dedicated, humorous, and caring [10]; being a scholar, capable of advising students [7]; being an expert in their discipline; a motivator; a modifier of learner's goals; and being an exemplar [11].

The above discussion has highlighted the key characteristics of a good teacher in a general learning context. Within the clinical setting, what distinguished clinical teaching and learning environment from others is that it is focused mainly on the patients; where the patient problem is considered as a platform for both teaching and learning opportunities [13,14]. Moreover, the process of learning mainly involves observing/watching and doing/acting or in other words ‘experiential learning’ in such an environment [13,14]. In addition, clinical teaching emphasizes the blending of individual and team learning [13].

In such clinical environment, clinical teachers are expected to have many roles to play apart from being a mere information provider [15–17]. A study [13] on clinical setting suggests three main roles for clinical teachers, namely, role model, clinical supervisor, and instructional leader/scholar. Another research [16] expands the roles of clinical teachers to involve being a medical expert, a communicator, a collaborator, a manager, an advocate, a scholar, and a professional. Moreover, detailed roles of clinical teacher have been recognized. These are being a lecturer, a practical teacher, a role model in a job, a role model in teaching, a learning facilitator, a mentor, a student assessor, a curriculum assessor, a curriculum planner, a course planner, a resource creator, and a study guide producer [15].

With regard to the nature of clinical learning environment, and the different roles that should be played by a clinical teacher, it is expected that a student in this environment might have particular views regarding the characteristics of a good clinical teacher. In their review of literature, Sutkin et al. [18] identified 480 descriptions of a good clinical teacher. Such descriptions have been classified into 49 themes, which were further grouped into three categories: physician, teacher, and human characteristics. They found that noncognitive features, such as inspiring, supporting, actively involving, and communicating with students, dominated the description and themes [18]. Although ultimately it is important for the clinical teacher to be highly knowledgeable in his/her course, it is also very crucial to show enthusiasm and interest in teaching [13,17,19,20]. In addition, a good clinical teacher should focus on plan teaching around experiential learning and on active involvement of the learner [14,17,21,22], should possess clinical competencies [13,19] and professional competence [23], and should be able to deliver clear and well-organized presentation [13]. In the same vein, the finding of AlHaqwi et al. [24] indicates that good supervision has an influence on students' clinical learning.

Different backgrounds of participants/evaluators might not always end up with an agreement on the level of importance placed for a particular characteristic. For example, in a study conducted by Buchel and Edwards [3] they found that residents express their concern regarding the importance of being respectful for students' autonomy and independence as clinicians, whereas faculty rated this issue among the least essential one. In contrast, faculty viewed that acting as a role model was essential, unlike residents who rated this as the lowest attributes.

In contrast, some studies [21,25] show a similarity between the views of residents and their faculty on the attributes of an ideal clinical teacher. Both groups emphasize the importance of being stimulating, encouraging, competent, and communicative.

Clinical teaching effectiveness and the characteristics of an effective clinical teacher have been reflected in a large number of educational studies. Many of such studies have been conducted in Western countries. However, according to the investigator's knowledge, none of the studies have explored such issues in Saudi Arabia within the applied medical sciences discipline.

The main objective of this study is three-fold. First, to explore the perspective of students and faculty regarding the characteristics of a good clinical teacher. Second, to compare the students' and faculties' perspectives regarding this issue and find out the most valued characteristics. Third, to investigate whether sex and type of department have any significance on this issue.

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Materials and methods

Study setting

The study was carried out at the College of Applied Medical Sciences, University of Dammam, Saudi Arabia.

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Study design

Cross-sectional study.

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Target population and sample size

The questionnaires were distributed to all fourth-year students and their faculty in three departments of College of Applied Medical Sciences at the end of the academic year 2008. These were the departments of respiratory technology, physical therapy, and medical laboratory technology. A total of 85 out of the 99 questionnaires were completed by students yielding a response rate of 86%, and 36 out of 64 questionnaires were completed by faculty yielding a response rate of 56%.

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Data collection

On the basis of the relevant literature, a list of 25 characteristics of an effective teacher was identified. This list was reviewed and agreed upon by a brainstorming session during one of the Faculty Development Workshop at the College of Applied Medical Sciences. In this workshop, faculty were asked to think of one effective clinical teacher they had known in terms of what was the teacher like and what makes a good teacher?

A questionnaire was then developed to assess the respondent's views regarding the main characteristics of a good/effective clinical teacher. It consists of 25 statements; for each statement, a Likert Scale was used that ranged from 5 if the respondents indicated that the characteristic is ‘very important’, to 4 if ‘important’, to 3 if ‘neutral’, to 2 if ‘not important’, and to 1 if ‘not important at all’. Such statements covered four aspects/domains: professional domain (statements one, two, four, six, seven, eight, and 12), teaching domain (statements three, five, nine, 10, 11, and 13), social domain (statements 14, 15, 16, 17, 18, and 19), and personal domain (statements 20, 21, 22, 23, 24, and 25).

The data were collected using self-administered questionnaire during the period of April–May of the academic year 2008–2009. Approximately 15–20 min were required to fill out the questionnaires.

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Scoring

The questionnaire consisted of 25 statements. Each statement is scored in the range of 1–5. Each statement had a maximum score of 5, yielding a maximum overall total score of 125. The minimum overall total score possible was 25. The questionnaire was divided into four domains:

  • (1) Professional domain: seven statements, maximum score is 7×5=35;
  • (2) Personal domain: six statements, maximum score is 6×5=30;
  • (3) Social domain: six statements, maximum score is 6×5=30;
  • (4) Teaching skills: six statements, maximum score is 6×5=30.

For graphical presentation of data (Fig. 1), the mean scores for the domains were transformed into mean percentage scores using the formula: mean score of a domain/maximum score for that domain ×100.

Figure 1

Figure 1

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Statistical analysis

The Statistical Package for Social Sciences (SPSS, IBM, Chicago, Illinois, USA) version 16 was used to analyze the collected data. A nonparametric test was conducted. Cronbach-α coefficient was used to assess the internal consistency of the questionnaire. The Mann–Whitney U-test was used to find out the following: (i) whether there is any difference between students' and faculty views regarding this issue and (ii) sex differences. The Kruskal–Wallis test was conducted to test for any significant differences among students' perceptions based on the type of department. Furthermore, the Microsoft Office Excel version 2003 was used for graphical presentation of data.

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Results

Table 1 shows the internal consistency (Cronbach-α coefficient) and the mean correlation coefficient of the domains of the questionnaire. For each domain and the overall questionnaire, the Cronbach-α values were high-to-very high.

Table 1

Table 1

Richardson (1988) [26] suggested the following guidelines to assess the internal consistency

Richardson (1988) [26] suggested the following guidelines to assess the internal consistency

Table 2 summarizes both the students' and faculty's (N=121) perception to each statement. The most highly rated characteristics were number 2, 16, 25, 7, 24, and 4, where the means were greater than 4.2. The lowest rated characteristic was number 22, followed by number 3 (the means were 3.78 and 3.81, respectively).

Table 2

Table 2

With regard to the domains of the questionnaire, Fig. 1 shows that the highest mean scores were accorded to the ‘personal’ domain (24.80 of 30), followed by the ‘professional’ domain (28.90 of 35). The lowest mean score was accorded to the ‘teaching skills’ domain (24.08 of 30).

The Mann–Whitney test (Table 3) indicated that there were statistically significant differences between students' and faculty perceptions on the degree of the importance of all domains. Faculty accorded a higher mean rank for all domains than the students. The Mann–Whitney tests also indicated that there were significant statistical differences between the perceptions of male and female participants about the importance of overall domains and social domain. Female participants accorded a higher mean rank for overall and social domains compared with male participants.

Table 3

Table 3

The Kruskal–Wallis test showed that there were no statistically significant differences among students' views regarding the importance of teacher characteristics based on the type of departments (results not shown).

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Discussion

This study was conducted to find out the most important characteristics of a clinical teacher. It is essential to observe that these characteristics could be changed and/or developed as long as faculty have the interest and intention to do so. Thus, they could be described as behaviors rather than stable or static characteristics. In this respect, Khoo and Teoh [5] indicated that although some of the personal attributes are inherent, most can be acquired and learned.

Clinical teachers could be described as those who carry their duties as ‘doctors’ for their patients and as ‘teachers’ for their students. In an attempt to explore ‘what makes a good doctor?’ Koh et al. [27] summarized the answers in the word ‘ASK’. This indicates that it is important that a good doctor posseses a positive Attitude, have professional competent Skills, and is updated with professional Knowledge. The results showed that all participants shared consensus views regarding all characteristics mentioned in the questionnaire as being important for an effective/good clinical teacher. However, the most highly rated characteristics by all participants were being knowledgeable and updated with medical information, a finding similar to the study of Jahan et al. [19]. This is followed by building positive relationships with students, patients, and staff, a finding in harmony with the study of Rizo et al. [28] and Schonwetter et al. [29]. There is also an agreement that good clinical teachers are those who show respect for students' autonomy and independence, a finding in accordance with the studies of Buchel and Edwards [3] and Purcell et al. [30]. In addition, all participants believed that having clinical supervision skills is essential for a clinical teacher, a finding consistent with the earlier findings of AlHaqwi et al. [24].

All participants felt that it is important for a clinical teacher to show sincerity. They also felt that being well organized is one of the important characteristics in defining a good clinical teacher, a finding in harmony with the study of AlHaqwi et al. [24].

Participants considered providing a role model for good practice as essential for being a good clinical teacher, a finding consistent with the studies of Stark [21] and Robert [31]. However, faculty placed a higher importance on this attribute compared with students, a finding consistent with the study of Buchel and Edwards [3].

The least rated characteristics by all participants were showing a sense of humor and using a variety of assignments and assessments. The finding of placing lower score on the importance of using a variety of assessments is parallel to the study of Sutkin et al. [18]. Such result may suggest that the respondents prefer a typical type of assignment and assessment, regardless of learner differences. The lower score on the importance of being humorous, in defining a good clinical teacher, is in agreement with that of Metcalfe and Matharu [8].

In addition, there are also several areas where faculty and students verified a significant disagreement on the level of importance of some characteristics. Faculty valued all characteristics more than students did. The three most highly rated characteristics by faculty were having teaching skills, in terms of clarity and being well-prepared; followed by absolute commitment to their task; and being enthusiastic. Students, in contrast, felt that providing open communication with students, patient, and staff was the most important characteristic for a good clinical teacher. This is followed by building a positive relationship with students, and showing concern and care for students, patients, and their relatives.

The results showed the existence of some significant sex differences, a finding that contradicts with the studies of both Laurent and Weidner [32] and Metcalfe and Matharu [8]. Female participants, in this study, tend to appreciate a teacher who shows concern and care for others; who is available and easily accessible; who shows understanding for other's views; who encourages a cooperative, nonthreatening and nonjudgmental learning environment; who is knowledgeable and updated with medical information; who listens attentively with interest; and who shows enthusiasm, more than male participants do.

The result showed no statistically significant differences among the students in the three departments, a finding that contradicts with the study of Buchel and Edwards [3].

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Conclusion and recommendations

All the characteristics stated in the questionnaire were accepted by both the faculty and students. However, the scores of the mean ranks given by faculty were higher than that given by the students for all domains and for most individual characteristics. In addition, female participants gave higher mean ranks for the social domain and some individual characteristics compared with male participants' ranking. Female participants considered being approachable, understandable, and enthusiastic, possessing listening skills, and being knowledgeable as the most important characteristics for a good clinical teacher.

For faculty, it is recommended that they devote more consideration to these characteristics. For decision makers, the following is recommended: (i) these characteristics should be incorporated in the teacher evaluation format/questionnaire currently used by the college and (ii) the Faculty Development Unit at the college of Applied Medical Sciences should allocate some workshops/seminars to address the importance of such characteristics in defining a ‘good teacher’. Finally, it is expected that making use of the information acquired in this study will enhance the learning environment and consequently have a positive impact on students' learning. These recommendations should take into consideration the study limitations presented next.

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Limitations of the study

This study was conducted at only one college in the University of Dammam; accordingly, making generalizations to other colleges with similar features can be carried out but with a limited degree of certainty. In addition, this study was limited to fourth-year students, who are exposed to the clinical environment for a relatively short period.

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    Keywords:

    characteristics; good teacher; medical sciences department

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