Reflection Report: Peer Observation of Practice in Medical Setting

This report details a peer observation of a medical teaching session conducted at Wythenshawe Hospital, focusing on a mental state examination tutorial for fourth-year medical students. The author, a senior trainee in neuropsychiatry and general adult psychiatry, reflects on their teaching strategies, including the importance of trainee-based learning and the use of feedback to enhance the learning environment. The report analyzes the author's approach to the session, considering both the content delivery and the impact of being observed by a peer. It discusses the importance of self-reflection, effective teaching techniques, and adapting to different learning styles. The author also incorporates feedback received from the observer and explores strategies for improving teaching skills and building learner confidence. The report highlights the use of Pendleton's rule for feedback and emphasizes the significance of creating an optimal learning environment.

Assessment Front Cover
Assessment Details
Please complete all details
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
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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).
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. 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. 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 certain style of teaching with the belief that it is optimal for the
learners and the learning environment. 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. 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.
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.
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.
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.
References
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Jan;20(1):58-60.
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Management: A Study on Prospective Teachers. Procedia - Social and
Behavioral Sciences 186 (2015) 155-160.
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General Medical Council.
4. NEWBLE, DI., ENTWISTLE, NJ., 1986. Learning styles and approaches:
implications for medical education. Med Educ. 1986 May;20(3):162-75.
5. PENDLETON, D., SCHOFIELD, T., TATE, P., HAVELOCK, P., 1984. The
consultation: an approach to learning and teaching. Oxford: Oxford University
Press.

6. QUINE, L., 2003. Workplace bullying, psychological distress, and job
satisfaction in junior doctors.Camb Q Healthc Ethics. 2003 Winter;12(1):91-
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