8-12
ROLE OF THE INSTRUCTOR IN THE CLINICAL SITUATION
The role of the clinical instructor—whether an experienced health worker, a
doctor, or someone else—is of key importance. The instructor needs to do far
more than question, examine, and treat the patient while the students watch. It
is up to her to balance consultation with education. She needs to look for every
opportunity to help the students learn, yet be sensitive to the needs and feelings
of the sick person and her family.
Teaching assistants: In the early stages of clinical learning, it is especially
helpful if, apart from the instructor who conducts the consultation, a second
instructor or experienced health worker is present. This teaching assistant quietly
guides the observing students in where to look in their books and how to record
information in the ‘patient report’ forms. This way, the consultation proceeds with
little interruption, yet the students receive individual help and answers to their
questions. The teaching assistant can also quietly ask the students questions that
lead them to asking the right questions themselves.
Involving the sick person and her family as helpers: Sick persons
sometimes feel angry about having students observe or take part in their clinical
consultation. They may feel they are being used, without having any choice in the
matter. Unfortunately, this is often true.
You can often transform this situation by looking at the sick person as a person,
not as a patient. To do this:
• Explain to the sick person and her family about the training course, and
the need for health workers to gain experience in order to serve their
communities better. Then ask if they are willing to help teach the student
health workers about the problem.
• Respect the decision of those who say no. Do not try to pressure or shame
them into saying yes.
• Keep the student group small—usually not more than 3 or 4.
• Include the sick person and any family members in the discussion of the
problem. Make sure that details of the physical examination, diagnosis,
treatment, and prevention are discussed clearly and simply.
If the sick person is involved in this way, you will be surprised how often she will
end up feeling good about the consultation and the presence of the students. Several
times we have seen persons thank
the group warmly and say:
If the person’s illness is an especially
common one, and not embarrassing to
her, she may not mind if other people
waiting for consultation also hear
about its signs, causes, prevention,
and treatment. They may even have
helpful ideas or experiences to
contribute.