title: Pedagogical strategies used in clinical medical education: an observational study.
abstract: BACKGROUND
  Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.
  
  
  METHODS
  Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.
  
  
  RESULTS
  Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.
  
  
  CONCLUSIONS
  This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.
authors.affiliation: University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden. maria.skyvell-nilsson@fhs.gu.se
authors.forename: Maria Skyvell
authors.initials: MS
authors.lastname: Nilsson
authors.forename: Sandra
authors.initials: S
authors.lastname: Pennbrant
authors.forename: Ewa
authors.initials: E
authors.lastname: Pilhammar
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Wenestam
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D015510:Clinical Medicine / Q000193:education*; D004504:Education, Medical, Undergraduate; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D019370:Observation; D013503:Surgery Department, Hospital; D013548:Sweden; D013663:Teaching / Q000379:methods*; D055815:Young Adult