Using observations of clinicians' teaching practices to build a model of clinical instruction

To discover, define, and describe the teaching behaviors of a set of clinical instructors and then, on the basis of those findings, to build a model of clinical instruction so that clinical faculty could find support through self-reflection.

More than 100 hours of direct observation of 16 clinical instructors were conducted at a state university physicians' clinic and a teaching hospital. Medical students, residents, and clinical faculty were interviewed. Clinical teaching practices were observed, identified, and juxtaposed with education research and theory.

The observed clinicians' teaching practices were made up of seven interrelated behaviors, labeled as engage, model, converse, measure, structure, conceptualize, and empower. Some physicians exhibited developed use of these behaviors, whereas others struggled to assimilate them into their teaching. The degree to which clinicians talk about teaching philosophy generally correlates with the quality of their teaching. The authors then created a model of clinical instruction positing five core and two ancillary behaviors.

The model provides guidelines for professional and critical reflection on the teaching practices of clinicians. The model offers a framework from which clinical faculty can regard their own teaching practices. Within this self-reflective process, clinicians can find ways to guide their own professional development.