Various instructional strategies are used to teach the content and procedural skills of a medical specialty. Two common instructional strategies have been described as the “bucket technique” and the “SOCO” method.

Bucket Model: The “bucket technique” is still commonly used in medical education and comes with the assumption that medical school faculty are “all knowing” and that medical student or resident minds are like empty buckets.

The goal of the instructional session is to fill the empty learner “buckets” with knowledge or “pearls of wisdom” from the faculty.

Major Set-back of Bucket Model: The problem with this method is that it is teacher-focused, not learner-focused and most often it is associated with the lecture format without clearly defined,  learner-centered instructional objectives. The learner then is expected to regurgitate all the knowledge in some useful order. Since the knowledge is rarely learned around patient presentations, recall is difficult when needed in the clinical setting as it has been memorized as a list of facts.

SOCO Model: The Single Overriding Communicating Objective  method more effectively promotes learning, Retention, and application of information to new situations. A brief teaching session, such as at the bedside,  might have only one single overriding communication objective (SOCO). A longer session, such as a Grand Rounds presentation, may have three or four SOCO’s. Such objectives should be learner-centered, measurable, and appropriate for the level of the medical student or resident. There may also be “enabling objectives” that must be met before the learner will be able to successfully meet each single overriding communicating objective.

Adult Learning

Adults learn best in a supportive environment where they are encouraged and have the opportunity to support one another. Joining together around a table or bedside with close interaction among all members of the group facilitates adult learning. Adults especially appreciate teachers who provide learning significance, ie. the “need to know,” and who share the responsibility of learning with the students. By providing clear goals and objectives, adult learners can “prepare mentally” for the instructional session without hidden expectations that promote unnecessary anxiety. Adults have a wealth of prior experience that can also be harnessed and built upon as new information and skills are taught. Adult learners remember best when they are actively experiencing learning in a problem-based or case-based format, during active, student-centered instruction with plenty of positive verbal and written feedback. Perhaps these principles of adult learning are said best in the triplet: “Tell me…I forget; Show me…I remember; Involve me…I understand.”

Studies of learning have demonstrated that only about 7% of information recall is dependent upon the actual content, and 93% of recall relates to how the content was presented. Accordingly, instructional strategies are most effective when they involve the learner. Since so much of what is effectively acquired and retained by the learner depends upon how it was presented, principles of oral communication should be followed closely, especially when using the lecture and small group discussion formats. The mood for learning can be set by:

1) approaching the class with real excitement and enthusiasm,
2) adding vocal variety for interest and clarity,
3) including purposeful pauses,
4) maintaining effective eye contact with each learner throughout the presentation,
5) showing a desire to communicate without over-dependence on notes,
6) actively involving the learner and,
7) ending using a strong conclusion with vitality.

Compared to written communication, oral speech has more personal references, more first and second person pronouns, shorter length of thought units, greater repetition, more mono syllabic words and more familiar words.

Instructional Strategy and Teaching Steps 

Utilizing the “events of instruction” or teaching steps gives the mentor or teacher an organized instructional strategy for optimally transmitting knowledge and assessing competency.

Recall Gagne’s Nine Events of Instruction

Healthcare Instructional Strategy

Learner-centered teachers humble themselves before their students and unpretentiously perform the highest form of teaching. They use instructional strategies to serve and uplift, not to control or manipulate.  They engage the learner in a mutual obligation to learn and they worry less about being seen as “experts” or “authorities.” Learner-centered teachers place learners in control of their own learning, serving as facilitators of the instructional session. As academic pride is stripped away, such teachers humbly influence students’ lives for good and become master teachers.


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