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doi:10.1136/bmj.326.7393.810

2003;326;810-812BMJLinda HutchinsonenvironmentABC of learning and teaching: Educational

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worst the learners will want to emulate that behaviour, at bestthey will have been given tacit permission to do so.

Maximising educational environmentClassroom, tutorials, seminars, lectures

Room temperature, comfort of seating, background noise, andvisual distractions are all factors of the environment that canaffect concentration and motivation. Some are within theteachers control, others not.

Respect for the learners and their needs, praise,encouragement of participation can all lead to a positivelearning experience. Lack of threat to personal integrity andself esteem is essential, although challenges can be rewardingand enjoyable.

Small group teaching facilitates individual feedback, but theseating arrangement used will have an important effect onstudent participation. If, for example, students sit in traditionalclassroom rows, those on the edges will feel excluded. A circularformat encourages interaction. It allows the teacher to sit

alongside a talkative person, thus keeping them out of eyecontact and reducing their input. A quiet student can be placedopposite to encourage participation through non-verbal means.Students can also work in unfacilitated groups on a topic,enabling them to work in teams and share the learning tasks.

Clinical settingsIn real life settings, the dual role of teacher and clinician can becomplicated. The students will be closely observing theclinician, picking up hidden messages about clinical practice.

They need to feel that there is no danger that they willunnecessarily distress or harm patients or their families. Theyalso need to feel safe from humiliation. Making them feel

welcomed and of value when they arrive at a new placement orpost will aid their learning throughout.

Course and curriculum designThe designers of short and long courses should consider therelevance of the learning environment to the potential learners.Student representation on curriculum committees is one meansof ensuring a more student centred course.

The aims, objectives, and assessments should be signpostedwell in advance of a course and should be demonstrably fair.The teaching methods should build on learners experience,creating a collaborative environment. Disseminating thefindings of course evaluations, followed by staff training, helpsto identify and correct undesirable behaviour among facultymembers. Evaluations should also include a means forreviewing the courses aims and objectives with the students.

In longer courses, student support systems and informalactivities that build collective identity must be considered.Students who are having difficulties need to be identified earlyand given additional support.

It is easy to learn attitudesincluding poor attitudes.Attitudes are learnt through observation of those inrelative power or seniority. Teachers must therefore beaware of providing good role modelling in the presenceof students

Checklist to ensure good physical environment

x Is the room the right size?x Is the temperature comfortable?x Are there distractions (noise, visual distractions inside or outside)?x Is the seating adequate, and how should it be arranged?x Does the audiovisual equipment work?

Checklist for teaching in clinical settings

x Have patients and families given consent for students to be present?x Do the staff know that teaching is planned and understand what

their roles will be?x Is there adequate space for all participants?

x How much time is available for teaching?x How may the students be made to feel useful (for example,

pre-clerking and presenting)?

Further reading

x Newble D, Cannon R. A handbook for medical teachers. 3rd ed.London: Kluwer Academic, 1994.

x Eraut M. Developing professional knowledge and competence. London:Falmer, 1994.

x Welsh I, Swann C. Partners in learning: a guide to support andassessment in nurse education. Abingdon: Radcliffe, 2002.

x Norman GR, Schmidt HG. The psychological basis ofproblem-based learning: a review of the evidence. Acad Med1992;67:557-65.

x Dent JA, Harden RM. A practical guide for medical teachers. London:Churchill Livingstone, 2001.

Teacher

Traditional tea ching canleave some studentsexcluded (that is, outsidethe triangle ofinfluence)

The ABC of learning and teaching in medicine is edited by Peter Cantillon, senior lecturer in medical informatics and medical education,National University of Ireland, Galway, Republic of Ireland; Linda Hutchinson, director of education and workforce development andconsultant paediatrician, University Hospital Lewisham; and Diana F Wood, deputy dean for education and consultant endocrinologist, Bartsand the London, Queen Marys School of Medicine and Dentistry, Queen Mary, University of London. The series will be published as a bookin late spring.

BMJ2003;326:8102

Clinical review

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