HOW TO...
Improve Handouts GEORGE BROWN and DAVID TOMLINSON
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
George Brown, B.SC, D.PHIL, is Senior Lecturer in University Teaching Methods, University of Nottingham; David Tomlinson, B.SC, PH. D, is Senior Lecturer in Physiology and Pharmacology, University Hospital and Medical School, Nottingham N67 2AD. This article examines the conditions under which handouts should be used for instruction, reviews their various uses and suggests some guidelines for their construction. We have based o u r evaluation on our own varied experiences, together with the published findings of investigations into the efficacy of handouts as aids to instruction. We hope that this article will be of interest to inexperienced medical teachers who are experimenting with different approaches to instruction, as well as to more experienced teachers, who may find it valuable to compare such experiences. I n addition, a structured evaluation of any teaching aids which draw on medical school funds is particularly useful in the face of financial cut backs, as at present. T h e Nature of Handouts Used literally, the term ‘handout’ covers any written information distributed to students as an adjunct to their classes. However, we will not concern ourselves with administrative information or laboratory manuals. For our purposes the term ‘handout’ refers to written material designed to facilitate learning in a course of instruction, a lecture or small-group class. Clearly, this definition includes material for formative self-assessment, but the exacting procedures involved in the design of tests and questionnaires are outside the scope of this article. It follows from our definition that the teacher must decide what the students are intended to learn as a result of instruction before he or she can consider whether or not handouts are needed. The teacher who elects to present some of hidher discourse in the form of a handout rather than, or as well as, the spoken word, has decided that the student must receive this information in an exact and unequivocal form. It follows, then, that the student should view the handout in the same light. Handouts which are badly constructed, contain errors and which can be interpreted only with difficulty by students are unlikely to facilitate learning. They may have the opposite effect, by reducing the credibility of the teacher in the minds of the students. Such handouts will certainly be a waste of the teacher’s
Medical Teacher Vol2 N o 5 1980
time, the students’ time, and the funds of the school. Thus handouts require care in preparation and are unlikely to succeed if their construction is left to an assistant who is unfamiliar with their purpose or if they are prepared hurriedly. T h e Uses of Handouts The major potential uses of handouts may be summarized as follows:
Handouts w e d by students in private study may State the prerequisites for a course or class (orientation). State the learning objectives for a course or class (direction of work). Indicate alternative sources of information (reinforcement of learning). Provide supplementary information (expansion of learning).
Handouts w e d by students during classes may Provide an infrastructure for the topic. Emphasize crucial points and generate perspective. Provide a framework for interaction between teacher and students. Help students to receive detailed information. Guarantee the accuracy of transferred information. Handouts Designed for Private Study
Orientation- Statement of Prerequisites or Provision of Prerequisite Information The intensive nature of undergraduate medical courses does not permit teachers to demand a great deal of extra-curricular preparative work of medical students. Most undergraduate medical teachers prefer to lay their own foundations. However, the acceptance of significant numbers of students without A-level biology for entrance to medical school does generate a need for some guidance on the biological background to courses early in the 215
curriculum. Anatomists may therefore offer handouts which are designed to enable students to familiarize themselves with morphological organization and termin-
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
ology. A handout which gives a n outline of a prospective course and a brief, highly selective set of readings can function as a valuable ‘road map’ enabling the assiduous student to plan some preparatory reading and the less assiduous student to take remedial measures if he or she misses a class. Courses which are timetabled at later points in the curriculum will usually need to build upon a foundation of information presented earlier. In such instances students will often work better if supplied with a handout which reminds them of the salient features of the foundation material. This may be illustrated by the following example. A lecture on thyrotoxicosis is to be given to medical students in their sixth term. This will require the students to use information learned earlier in the curriculum concerning the factors regulating basal metabolic rate, physiological correlates of altered basal metabolic rate and the physiology and pharmacolocgy of the sympathetic nervous system. T h e handout sets down the information gathered (si,gns and symptoms) for a ‘classical’ thyrotoxic patient and the questions generated are related to the above mentioned areas in an attempt to interpret scientifically the clinical findings. Thus, the handout is designed to encompass the basic medical sciences in a clinical problem-solving format and to structure the students’ preparation for the topic by presenting them with cogent and relevant questions.
Provision of Learning Objectiues Teaching is more effective if we know what essential points we wish to convey. Similarly, learning is improved if students know what is expected of them. So, one purpose of a handout for a course or a lecture is to provide a checklist of objectives for both ourselves and the students. These will help students to organize their private study and to prepare for formal assessment. For the teacher, most would probably agree, learning objectives are just as useful in planning classes and compiling assessments. However, the presentation of learning objectives to students can raise problems which can frustrate the altruistic teacher. For objectives to be helpful the verbs used in their construction must be unambiguous (Mager 1977). Students must also be given some guidance on how to use objectives. T h e use of learning objectives cannot be discussed in detail here but, having advocated this in the form of handouts, we should highlight two potential areas of difficulty. With practice and guidance (see for instance Mager 1977) most teachers readily master the minimal skills of providing instructional objectives in the cognitive domain. However, the aspirations we have for our medical students go way beyond the requirements that they ‘know’ and ‘understand’ their work- we also demand that they acquire appropriate attitudes towards people under their care. This calls for the more difficult formulation of objectives in the affective domain and for 216
procedural skills. A second set of problems arises from t h e relationship (or lack of i t ) between learning objectives and formal assessment. if a student is presented at each lecture with a handout which lists the teacher’s objectives, then the student will assume that, if he masters all the objectives and can ‘deliver the goods’ in the examination. he will receive an ‘A ,grade'. However, given a prescription for perfect outcome of learning, embodied in let us say 250 well-constructed lrarning objectives, the student will realize that he cannot reasonably aspire to prrfection and without guidance may well order his learning by simply disregarding thosr objectives which are difficult to attain. The tracher could help by indicating which objectives are genuinely essential in thc long term, which are extremely useful and which are includcd for the able student. l’his hierarchy of importancc must, of coursc. be bornr in mind during compilation of thc cxamination paprr(s).
Indication of Alternatiue Sources of Inforniution Handouts are most commonly uscd to provide a reading list associated with a course. There is probably an inverse square law at work here. T h e longer tht. reading list, the less likely a student is to read any of t h r texts and articles. A handout to guide a medical student’s reading should not be a random walk through the litvraturr, even if it is signposted alphabetically. Essential chapters of texts and articles could be cited with a brief comment on the contcnts. 1.ess essrntial reading should be indicated as well as some examples of relevant advanced work for thc more assiduous student. Reading lists should be brirf. pertinent and take into a(:couiit thc mcdical studcnts’ opportunity and time to rcad. Thirty hours of lectures and practicals pvr week d o not leave much time for mediral students to rcad. so one should ensure that the reading t h a t they do is cffirirnt and useful.
Prouzsion ?f Supplementary Information Most teachers who provide handouts are --ell-incentioncd. Often, thc most well-intentioned of 2 : : are thosc specialists who see little of junior medical s t ~ 5 r except s for the instances when they are asked to :\.t srudents a feel for the specialties’ by presenting a OT.C.XL: tour dr force on their topic. Their problem is prc:z< rkc Tass of genuinely fascinating information dot\: I: 1 ?:I xhich can be presented and absorbed in the ti-.: : - . E : : E ~ : ? The solution is sometimes to provide a hand-ri: ---z:L rx5ents thc information which cannot be fitret ::.:: XT ~ 2 sThc . handout is prefaced by the suggestic:. ::A: :ze Kgdent will find the information useful on :ke ---- 3 IC tkctive _ . or as house officers. Students usuail: z z - z -5clent filing systems, and handouts c o n i z : T : x =:-ze3n of prospective use may often go astrz: TY :TX== i3suld ~=LTb u l d be certain that such handouts are ....L-L:-go to some lengths to emphasize r k r zi z t and to advise them on appropriate ~:~:-_LZ’:T_ c i i y and retrieval. Provision of this form of f z z ~ ILZT : ~ ~w .xtter
--
Medica: T x - b - T a Z -%i 3 1980
appreciatcd by postgraduatr students. T h e lattcr usually receive only a small amount of didactic. instruction a n d , with their more mature approach to information hand ling, can make effcctive USC ofsupplementarv matcrial. Handouts Designed for Use D u r i n g Classes
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
Promiion of Structure and Perspectizie f o r a Topzc A handout can be used to guide students through a lecture. I t should be given o u t in advance of the lecture or the students should be given time t o read it at the beginning of the lecture. Otherwise. they will read i t , evcn if the lecturer bcgins to speak immediately. Such a guide will function in a manner analagous to the use of a road map, containing both 'signposts' and 'landmarks'. T h e handout can be constructed so that spaccs are left bctween 'land-marks' to permit the students to a d d to i t their own version of the interim stages. Our students attach more value to those handouts which arr presented as skeletons and which they complete themselvcs. than those which arrive complete and self-contained. This approach can be takcn a stagc further by framing the 'land-marks' as a serics of related and salient questions. T h e lecturer can then run the session interactively, rrquiring students to answer questions during thc lecture.
Provision of a FramPwork f o r Interactkv Classcg, IIandouts which reiterate the lecturer's spoken discoursr are sometimcs used in the hope that the students will not expend thcir efforts on slavish note -taking. but will instead listcn attentivcly. A completc substitute for notctaking is a recipe for passivity, and the experimental evidence indicates that the activity of note-taking leads to more effective rerall and understanding (Hartley and Davies 1978). Eigurc 1 illustrates a different and potentially more successful approach. Obviously, not d11 topics lend themselves to such treatment but, in o u r experience, i t has proved successful when appropriate. Teachers vary in the ways in which they confront students with the questions. Some ask for volunteers to answer, others select individuals at random, whilst a third possibility is to generate brief discussions by groups of three or four students in the lecture class. T h e most profitable approach will depend upon the personality of the teacher and h i d h e r rapport with the groups, as well as upon the number of students involved.
Sauzng T i m e and Ensuring Accuracy in the Transfer of Detaded Informatzon
Figure 1. A n example of a handout which provides the framework for a n interactive class.
It is a salutary expericnce for a teacher to present even a relatively straightforward dia
Improve Handouts GEORGE BROWN and DAVID TOMLINSON
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
George Brown, B.SC, D.PHIL, is Senior Lecturer in University Teaching Methods, University of Nottingham; David Tomlinson, B.SC, PH. D, is Senior Lecturer in Physiology and Pharmacology, University Hospital and Medical School, Nottingham N67 2AD. This article examines the conditions under which handouts should be used for instruction, reviews their various uses and suggests some guidelines for their construction. We have based o u r evaluation on our own varied experiences, together with the published findings of investigations into the efficacy of handouts as aids to instruction. We hope that this article will be of interest to inexperienced medical teachers who are experimenting with different approaches to instruction, as well as to more experienced teachers, who may find it valuable to compare such experiences. I n addition, a structured evaluation of any teaching aids which draw on medical school funds is particularly useful in the face of financial cut backs, as at present. T h e Nature of Handouts Used literally, the term ‘handout’ covers any written information distributed to students as an adjunct to their classes. However, we will not concern ourselves with administrative information or laboratory manuals. For our purposes the term ‘handout’ refers to written material designed to facilitate learning in a course of instruction, a lecture or small-group class. Clearly, this definition includes material for formative self-assessment, but the exacting procedures involved in the design of tests and questionnaires are outside the scope of this article. It follows from our definition that the teacher must decide what the students are intended to learn as a result of instruction before he or she can consider whether or not handouts are needed. The teacher who elects to present some of hidher discourse in the form of a handout rather than, or as well as, the spoken word, has decided that the student must receive this information in an exact and unequivocal form. It follows, then, that the student should view the handout in the same light. Handouts which are badly constructed, contain errors and which can be interpreted only with difficulty by students are unlikely to facilitate learning. They may have the opposite effect, by reducing the credibility of the teacher in the minds of the students. Such handouts will certainly be a waste of the teacher’s
Medical Teacher Vol2 N o 5 1980
time, the students’ time, and the funds of the school. Thus handouts require care in preparation and are unlikely to succeed if their construction is left to an assistant who is unfamiliar with their purpose or if they are prepared hurriedly. T h e Uses of Handouts The major potential uses of handouts may be summarized as follows:
Handouts w e d by students in private study may State the prerequisites for a course or class (orientation). State the learning objectives for a course or class (direction of work). Indicate alternative sources of information (reinforcement of learning). Provide supplementary information (expansion of learning).
Handouts w e d by students during classes may Provide an infrastructure for the topic. Emphasize crucial points and generate perspective. Provide a framework for interaction between teacher and students. Help students to receive detailed information. Guarantee the accuracy of transferred information. Handouts Designed for Private Study
Orientation- Statement of Prerequisites or Provision of Prerequisite Information The intensive nature of undergraduate medical courses does not permit teachers to demand a great deal of extra-curricular preparative work of medical students. Most undergraduate medical teachers prefer to lay their own foundations. However, the acceptance of significant numbers of students without A-level biology for entrance to medical school does generate a need for some guidance on the biological background to courses early in the 215
curriculum. Anatomists may therefore offer handouts which are designed to enable students to familiarize themselves with morphological organization and termin-
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
ology. A handout which gives a n outline of a prospective course and a brief, highly selective set of readings can function as a valuable ‘road map’ enabling the assiduous student to plan some preparatory reading and the less assiduous student to take remedial measures if he or she misses a class. Courses which are timetabled at later points in the curriculum will usually need to build upon a foundation of information presented earlier. In such instances students will often work better if supplied with a handout which reminds them of the salient features of the foundation material. This may be illustrated by the following example. A lecture on thyrotoxicosis is to be given to medical students in their sixth term. This will require the students to use information learned earlier in the curriculum concerning the factors regulating basal metabolic rate, physiological correlates of altered basal metabolic rate and the physiology and pharmacolocgy of the sympathetic nervous system. T h e handout sets down the information gathered (si,gns and symptoms) for a ‘classical’ thyrotoxic patient and the questions generated are related to the above mentioned areas in an attempt to interpret scientifically the clinical findings. Thus, the handout is designed to encompass the basic medical sciences in a clinical problem-solving format and to structure the students’ preparation for the topic by presenting them with cogent and relevant questions.
Provision of Learning Objectiues Teaching is more effective if we know what essential points we wish to convey. Similarly, learning is improved if students know what is expected of them. So, one purpose of a handout for a course or a lecture is to provide a checklist of objectives for both ourselves and the students. These will help students to organize their private study and to prepare for formal assessment. For the teacher, most would probably agree, learning objectives are just as useful in planning classes and compiling assessments. However, the presentation of learning objectives to students can raise problems which can frustrate the altruistic teacher. For objectives to be helpful the verbs used in their construction must be unambiguous (Mager 1977). Students must also be given some guidance on how to use objectives. T h e use of learning objectives cannot be discussed in detail here but, having advocated this in the form of handouts, we should highlight two potential areas of difficulty. With practice and guidance (see for instance Mager 1977) most teachers readily master the minimal skills of providing instructional objectives in the cognitive domain. However, the aspirations we have for our medical students go way beyond the requirements that they ‘know’ and ‘understand’ their work- we also demand that they acquire appropriate attitudes towards people under their care. This calls for the more difficult formulation of objectives in the affective domain and for 216
procedural skills. A second set of problems arises from t h e relationship (or lack of i t ) between learning objectives and formal assessment. if a student is presented at each lecture with a handout which lists the teacher’s objectives, then the student will assume that, if he masters all the objectives and can ‘deliver the goods’ in the examination. he will receive an ‘A ,grade'. However, given a prescription for perfect outcome of learning, embodied in let us say 250 well-constructed lrarning objectives, the student will realize that he cannot reasonably aspire to prrfection and without guidance may well order his learning by simply disregarding thosr objectives which are difficult to attain. The tracher could help by indicating which objectives are genuinely essential in thc long term, which are extremely useful and which are includcd for the able student. l’his hierarchy of importancc must, of coursc. be bornr in mind during compilation of thc cxamination paprr(s).
Indication of Alternatiue Sources of Inforniution Handouts are most commonly uscd to provide a reading list associated with a course. There is probably an inverse square law at work here. T h e longer tht. reading list, the less likely a student is to read any of t h r texts and articles. A handout to guide a medical student’s reading should not be a random walk through the litvraturr, even if it is signposted alphabetically. Essential chapters of texts and articles could be cited with a brief comment on the contcnts. 1.ess essrntial reading should be indicated as well as some examples of relevant advanced work for thc more assiduous student. Reading lists should be brirf. pertinent and take into a(:couiit thc mcdical studcnts’ opportunity and time to rcad. Thirty hours of lectures and practicals pvr week d o not leave much time for mediral students to rcad. so one should ensure that the reading t h a t they do is cffirirnt and useful.
Prouzsion ?f Supplementary Information Most teachers who provide handouts are --ell-incentioncd. Often, thc most well-intentioned of 2 : : are thosc specialists who see little of junior medical s t ~ 5 r except s for the instances when they are asked to :\.t srudents a feel for the specialties’ by presenting a OT.C.XL: tour dr force on their topic. Their problem is prc:z< rkc Tass of genuinely fascinating information dot\: I: 1 ?:I xhich can be presented and absorbed in the ti-.: : - . E : : E ~ : ? The solution is sometimes to provide a hand-ri: ---z:L rx5ents thc information which cannot be fitret ::.:: XT ~ 2 sThc . handout is prefaced by the suggestic:. ::A: :ze Kgdent will find the information useful on :ke ---- 3 IC tkctive _ . or as house officers. Students usuail: z z - z -5clent filing systems, and handouts c o n i z : T : x =:-ze3n of prospective use may often go astrz: TY :TX== i3suld ~=LTb u l d be certain that such handouts are ....L-L:-go to some lengths to emphasize r k r zi z t and to advise them on appropriate ~:~:-_LZ’:T_ c i i y and retrieval. Provision of this form of f z z ~ ILZT : ~ ~w .xtter
--
Medica: T x - b - T a Z -%i 3 1980
appreciatcd by postgraduatr students. T h e lattcr usually receive only a small amount of didactic. instruction a n d , with their more mature approach to information hand ling, can make effcctive USC ofsupplementarv matcrial. Handouts Designed for Use D u r i n g Classes
Med Teach Downloaded from informahealthcare.com by University of Oxford on 11/13/14 For personal use only.
Promiion of Structure and Perspectizie f o r a Topzc A handout can be used to guide students through a lecture. I t should be given o u t in advance of the lecture or the students should be given time t o read it at the beginning of the lecture. Otherwise. they will read i t , evcn if the lecturer bcgins to speak immediately. Such a guide will function in a manner analagous to the use of a road map, containing both 'signposts' and 'landmarks'. T h e handout can be constructed so that spaccs are left bctween 'land-marks' to permit the students to a d d to i t their own version of the interim stages. Our students attach more value to those handouts which arr presented as skeletons and which they complete themselvcs. than those which arrive complete and self-contained. This approach can be takcn a stagc further by framing the 'land-marks' as a serics of related and salient questions. T h e lecturer can then run the session interactively, rrquiring students to answer questions during thc lecture.
Provision of a FramPwork f o r Interactkv Classcg, IIandouts which reiterate the lecturer's spoken discoursr are sometimcs used in the hope that the students will not expend thcir efforts on slavish note -taking. but will instead listcn attentivcly. A completc substitute for notctaking is a recipe for passivity, and the experimental evidence indicates that the activity of note-taking leads to more effective rerall and understanding (Hartley and Davies 1978). Eigurc 1 illustrates a different and potentially more successful approach. Obviously, not d11 topics lend themselves to such treatment but, in o u r experience, i t has proved successful when appropriate. Teachers vary in the ways in which they confront students with the questions. Some ask for volunteers to answer, others select individuals at random, whilst a third possibility is to generate brief discussions by groups of three or four students in the lecture class. T h e most profitable approach will depend upon the personality of the teacher and h i d h e r rapport with the groups, as well as upon the number of students involved.
Sauzng T i m e and Ensuring Accuracy in the Transfer of Detaded Informatzon
Figure 1. A n example of a handout which provides the framework for a n interactive class.
It is a salutary expericnce for a teacher to present even a relatively straightforward dia
