Peer Observation of Practice and Reflection

This essay discusses the experience of peer observation of practice and reflection in teaching. The author shares their experience of delivering a tutorial session on mental state examination for medical students. They discuss the importance of creating an effective learning environment, engaging students, and receiving feedback. The essay also explores the benefits of Pendleton's rule for teaching feedback.

Assessment Front Cover
Assessment Details
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Module Unit Title
Teaching and Learning in the medical
workplace.
Module Unit Number Due Date of Submission
16th December 2019
Assessment Title
Peer observationof practice and
reflection
Submission Attempt
 First 
Date of Submission
26.11.2019
Student Details
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Student Name
Ashokkumar Shishodia
Student Number
24055140
Programme Title
PGC workplace-based
postgraduate medical
education.
Student Contact Address
72 Godolphin Close, Eccles M30 9EW
Student University e-mail Start Date
10th September 2019
Academic Support
Please complete all details
Programme Lead
Helen McNeill
Personal Tutor Module Lea
Student Declaration
I declare that this piece of work is completed and requires marking and I am
aware of the content of the Originality Report generated through Turnitin.
I certify that this assessment is the result of my own work and quotations
and sources of information have been duly acknowledged in the text. This
work has not been submitted for any previous award. I am aware of Edge
Hill University’s rules on confidentiality, plagiarism and collusion, as set out
in the Programme Handbook
Student Signature : Date: 26.11.2019
INTRODUCTION:
I am in my final year of specialty training in neuropsychiatry and general adult
psychiatry with North West Deanery. I have medical students and junior doctors,
both foundation years and core trainees attached to my placement on 6 monthly
(core trainees), 4 monthly (foundation doctors) and 3 weekly (medical students)
cycle. As a senior trainee in psychiatry, I have been associated with teaching the

core psychiatry trainee at the local MRCPsych Programme (membership of the
royal college of psychiatry training) for years 1 and 2. I have also been associated
with teaching at the local GP training programme and at the local community
mental health team.
SELF-REFLECTION:
For my current essay assignment, a 30-minute tutorial session on mental state
examination for two fourth year medical students was completed at the
Wythenshawe Hospital. This was part of their intended learning outcome to
review patients, history taking and mental state examination and present cases.
The learning environment was focused to be trainee based; to maintain quality
and degree of enthusiasm for learning. The trainee based learning environment
has be analysed with the help of evaluating overall organising concept of training
program that are based on the actual need of trainees. It is observed that
trainees were asked for their suggestions in regards to conducting training
sessions for supporting them to overcome with the ability threats by improving
their skills. However, it will provide help to trainees to get appropriate benefits
from learning sessions. It has been highlighted that negative learning
environment can have both direct and detrimental effect on career progression,
psychological and physical health. (Quine 2003). It has also been noticed about
the negative and detrimental effect of suboptimal learning environment on
trainee’s enthusiasm and learning. (Gan and Snell, 2014). I used training
curriculum with purpose to direct the content for my section. With the help of
training curriculum I can easily identify specific learning needs of individual
students that result in higher skills and knowledge about the specific area of
study.
The session was organised by my observer peer as the hospital has medical
student placement for their psychiatry curriculum. It was decided that I will
deliver session on the mental state examination for the case that was presented
by the medical students. It has been analysed that effective strategies are
required to be identify actual needs and desires related to training & learning
sessions. It is necessary to involve trainees to make decision about organising
appropriate training programs by taking their opinions and suggestions.
However, it can be done through adopting various ways such as direct
observation, questionnaires, consultations with person on key positions, review
of related literature, interview, focus groups, assessment or surveys and studies
of records & reports. Mental state examination is fascinating, as it forms the
fulcrum on which rest the psychiatry history. I made conscious effort to take on
role of a competent trainer; keeping into account that the learners need to guide
their own learning progress by consciously moving away from an expert.
(Allergy 2009)
Though being fairly confident, there was still feeling of nervousness and I was
also was aware of being observed. It is necessary to establish more effective s
well as efficient plan of learning session to address learning outcomes by
followed steps that are given here. Initially, it is required define number of

learning outcomes including important concepts ad skills related to needs of
trainees. Secondly, it is necessary to clarify key topics and relevant concept to be
taught in training programs. Thirdly, it has been analysed that next step is all
about to organise material which is required to organise learning sessions like
study material, tutor, session hall etc. I used active learning as an effective
approach. This approach helps me in increasing of students learning regarding
the particular field of study. This approach also helps me by enhancing my
understanding about the needs of students. For this approach, I used visual tools
that results in improvement of students knowledge about the subject in less
period of time. In addition to this, it is significant to plan about technique used
for presenting the knowledge by using effective digital tool which is more
efficient to make people learn about different concepts. It includes various kinds
of activities of training sessions such as lectures, demonstration, discussions,
online learning, role play, small group teaching and case studies. However, it is
essential to carry out evaluation regarding effectiveness of learning sessions and
analyse that student easily get about key concepts or not. Meanwhile, it is
required to focus on timing by recording it to ensure that duration spent for
teaching every concept it similar to allocated period of time for them. Though the
session was for thirty minutes only, I had to remind myself that most pertinent
part of the mental state examination in relation to the history was to be
discussed. There was pressure to deliver that in the allocated time slot. Mental
state examination teaching that I have delivered previously has been for half a
day session.
I paused after having talked for eight minutes to ask the trainee for feedback on
the learning and asked them for specific questions. I repeated this cycle for 3
times, taking break at eight minutes each, responding to their queries over 2
minutes. My teaching strategy is much effective to gain feedbacks from students
through which their problems and issues related to studies get explored that are
required to be solved immediately. According yo the CANER, TERTEMIZ, 2015, it
has been determined that teaching strategy more effective for an individual. This
is because, they can easily collect feedback from the students about the quires
that results in attainment of better outcomes within less period of time. It is
favourable to identify the difficulties for trainees regarding learning which is
helpful for tutor to adopt new strategies for solving their problem. It will provide
support to make teaching more effective and build confidence level of individuals
to clarify their queries which make their concepts clear. However, just providing
learning is not sufficient and student participation is must for effective training
which can be done through conducting feedback or query sessions between
teaching periods. The topic was of interest for the medical students for preparing
towards the observed structured clinical skills examination. (OSCE). Discussions
were stimulated, questions were asked relevant to the topics and usefulness and
applicability for clinical practice. It was an exercise towards building self-
confidence (Srinivasan et al., 2011). I think so because when tutor clarify queries
of students which facilitate to encourage them for communicating more that
builds their confidence regarding studies.
I follow a directing style of teaching with the belief that it is optimal for the
learners and the learning environment. This style helps me in providence of

appropriate guidance to the students towards attainment of their career goals.
However, I understand that adult learning is diversified, and every learner has an
individual or different style of learning (Taylor and Hamdy, 2013). It has been
analysed that, every person has their own mind set and way of understanding
about concepts for which queries are must to be clarified which make them clear
about different literature concepts. It is necessary to make an individual more
confident and ask for more queries which improve their active participation in
teaching activity that helps to enhance learning respectively. Every individual
learner may have a different learning style; for some this may include factual
knowledge and for others deep understanding. (Newble and Entwistle, 1986).
Learning can be delivered in various format such as audio-visual approach,
lectures, case-based discussion, practice-based learning, multiple choice
questions (MCQ), case scenarios, feedbacks from work based placed assessments
(WBPA) and mock observed structure clinical skills examination. (OSCE). For
optimal learning to happen, I as a clinician-teacher must ensure that learning
preferences are well understood, and learning directed and facilitated to achieve
desired learning goals. Being more attentive and involved in the learning session
will support and contribute learners towards their individual learning goal. My
observer commented on how I allowed learners for time to ask question and
reflect. There are number of aspects which are required to be focussed in terms
of making learning environment optimising by selecting appropriate lighting
carefully which is favourable to study easily. It is necessary to pay attention to
body temperature and focus to match the learning atmosphere with respective
learning. It is needs to address actual needs of trainees and develop sense of
order which make them involve immediately in activities of learning. Basically, it
is required to analyse the actual need of learning according to which specific
concepts should be more focussed which are beneficial to enhance their clinical
abilities. However, query and feedback session can be used to assess the actual
need and learning styles of trainees according to which effective education will
be delivered.
REFLECTION ON BEING OBSERVED:
Effective tool for self-reflection on teaching and developing further skill sets as a
clinician-teacher is through peer observation and constructive feedback; though
they may be difficult at times to be obtained. Saika and I corresponded over the
telephone and email to arrive at a common goal for peer observation
assignment: mainly towards what is wanted from the session and her
observation on the teaching session to be delivered. Teaching sessions can easily
provoke anxiety and nervousness, given I have a very casual and informal
approach. This inner need to delivered session well can easily translated into
creating a rigid environment for both the teacher and the leaner, causing the
learner to lose interest and enthusiasm. Though Saika and I are part of the same
training scheme, we have not had the opportunity to get to know each other and
it was very heartening to see her relaxed and kind manner.
I have noticed that when nervous, I tend to speak fast and this can easily
translate into me being very unclear, and at times difficult for the learners to

understand. This intrinsic need to know everything can easily translate into me
being rattled and nervous when asked a relevant query regarding question that I
do not have response to straightaway. I thought this occurred when I was asked
a question regarding the difference between involuntary movement disorder and
movement disorder secondary to side-effects of prescribed medication such as
long-term depot anti-psychotics. Saika commented that she thought I engaged
the students well when responding to their query and asked appropriate follow
up questions. She also commented on how my relaxed approach and appropriate
speech modulation engaged the students. Considering positive views of Saika on
my performance for engaging well with students, I am really very grateful for
their opinion which is favourable for me in terms of improving my confidence
level. I can use the similar technique in future more effectively by utilising my
previous experiences in regards to the similar situation. It is helpful to deal with
students really well to make them learning properly.
Self-reflection is an excellent tool on this as how it is so easy to be critical of one
self, and easily creating feeling of being inept as a teacher. With the help of this
tool I easily teach my students that supported me in attainment of long term
goals and objectives within less period of time. Being alert to non-verbal cues
during the teaching session, gave me an insight into how learners have different
intrinsic personalities and how the teaching session can be modulated to take
that into account. I have used several cues like “you need to know about patient
psychology, share your complicated experience etc.” As clinician-teacher will
resonate effective management of learning behaviour associated with learner’s
involvement is a nonheritable talent that maintains an appurtenant and
contributes towards learning environment (Caner and Tertemiz, 2015).
Pendleton’s rule was used for teaching feedback. Though the approach behind
Pendleton rule is systematic, I do find it usefulness in the structured
conversations between clinician-teacher and the student marking on areas
performed well; with scope for improving areas performed less well. (Pendleton
et al., 1984). Effective feedback practice has principles such as providing chances
for closing the gap between present and desired performance. Secondly, it
consists to help students to clarify about goals and objectives of good
performance and put efforts to deliver high quality knowledge to learners
regarding their education. Thirdly, it includes the criterion of facilitating the
development of self-assessment in training and motivate tutor & peer dialogue
around teaching. However, it involves encouraging positive motivational beliefs
and self-esteem along with providing information to tutors which can be utilised
for supporting shape the teaching. With the effective use of Pendleton’s I become
able in collecting of feedbacks from the students about their knowledge
regarding the topic. One of the main strength of this approach as it supported me
in increasing of students understanding about the subject in effective as well as
efficient manner.
REFLECTION ON BEING AN OBSERVER:
The second part of the session was history taking and Saika’s teaching session
was observed. The session was roughly for thirty minutes in the same room at

Wythenshawe Hospital. Prior to the peer-observation session we had the
meeting discussing what Saika was hoping to get out of the session and my
observations.
Pendleton’s rule was used for providing structured feedback to Saika. Stimulated
discussion was completed on areas performed really well and areas for further
improvements. We also discussed ideas around more use of audio-visual
material, reflective learning and being receptive that learners have different
learning styles and they can be met with different and individualised learning
style (Pendleton et al., 1984). The utilisation of constructive feedback is
favourable because it helps to reinforce positive behaviour in order to correct
negative performance along with ensuring maintenance of strong culture of
working. It includes the use of critical feedback through which an instruction is
provided to improve negative performance along with making an individual
ware about their mistakes or problems at work place.
Saika provided structured learning environment for the medical students by
identify the appropriate room and marking the room for teaching only. She
prompted the students on how to structure the psychiatry history and
encouraged them throughout the session on effective use of psychiatry
terminology. She brought clarity for difficult to understand concept in the
psychiatry history, and it was heartening to see the learners engaged. This
strategy is effective to develop an effective environment for learning which
encourage trainees to show their active participation. It will facilitate to make
learners understand every concept of psychiatry in proper manner.
Saika discussed the outcome of the session at the end for period of few minutes.
One of the outcomes was for the students to be involved in more case reviews, to
keep themselves abreast with classification of the disease manual. Saika also
discussed the importance of learning about mental disorder categories that they
may be asked on during the clinical examinations. The learning session was also
important for them to consolidate their skills and knowledge for preparation
towards their clinical exams. This was discussed at the start. This seemed to be a
strong motivator! Saika was able to meet their intended learning outcome (ILO).
On reflection, I consider that the exercise was very informative, constructive
educational activity, it has given me an opportunity to understand different
teaching skills and its usefulness. By reflecting my experience, it is important for
me in my professional growth and success. I observed that collecting feedback
from students about their course helped me in fulfilling of their educational
needs.
I am mostly lost for words when asked to reflect on what I have done well during
consultant or senior doctor guided work-based assessments. It is not easy to
provide negative evaluation on my core trainees, medical students assessments
as it is in not my nature to do so. On reflection this is something that I have
started to work on and will get better at.
CONCLUSION:

The experiences of reviewing my teaching and writing this reflection essay was
both educational and inspiring. I did wonder if the learning outcome would have
been different if the current assignment was with doctor from a different medical
speciality. I have acknowledged how the constructive feedback and work place-
based assessment has important role within the training curriculum. The
constructive feedback from my observer and the student was reflective of my
improving competency as a teacher and hopes this continues to guide me in my
role both as a clinician and a teacher.
The educational field is evolving on a continuum basis and with continual and
exponential improvement in field of information exchange learning, we are
entering an exciting field of innovative teaching methods. It is required to use
more effective as well as efficient technique to understand about individual
learning styles to deliver appropriate education for them. It is necessary to
utilise feedback session for trainees which helps to evaluate their learning
problems to solve them. However, active participation is required which can be
acquired by increasing their confidence level and motivate them ask about their
queries without any hesitation. We are also been made aware of the restriction
on just using one particular type of teaching methods as the learners teaching is
very much individualistic and therefore it is imperative that one considers
different modules of teaching styles to prepare the students by creating a
conducive environment. Ongoing stimulus for learning environment and
learners with continual modification of knowledge is paramount for their career
progression (Neal and et. al., 2020).
Both the reflective writing assignment and peer observation exercise has
stimulated the need for continuous encouragement and support for learning
environment along with individualised teaching plans and skills. As a trainer, I
like to create a conductive environment for learner with individualised teaching
methods and plans. Importantly leadership skills at implementing positive
environment are imperative for supporting learners and to discourage creation
of negative environment. It is required ask suggestions for training sessions and
their needs through which effective learning atmosphere can be developed for
appropriate education of trainees. This will only go on to support learner’s
enthusiasm and career progression (Quine 2003).
I will strive on continuum basis to provide an enthusiastic learning environment.
This will be achieved by reflective learning, feedback guiding professional and
career development and developing appropriate skills at work-based
assessments. This is well supported under guidance from the general medical
council. (General Medical Council 2013).
In conclusion, skills set developed as part of my own learning as part of the
training journey in medical school and psychiatry, it will continue to guide me
towards becoming an enthusiastic teacher, trainer, mentor and inspiring role-
model for my colleagues, junior trainees and medical student.

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