The contemporary thinking in medical education, tends to lay emphasis on "teaching - learning", as opposed to the greater importance previously attached to "teaching" alone. Presently the educationist is more interested in understanding what and how students learn, why some of them do not learn and when they learn better. Whatever they learn, is it relevant to the health needs of the community ? What should they learn in this reference and how ? Hence, the attention is more focused on learning and the learner.

Teaching

The purpose of teaching is to facilitate learning and encourage the learners to learn more effectively. The purpose of teaching is not mere dispensing of information, but to develop life long learning habits.
It is wrong to presume that all the information transmitted to the students is always learnt or since that does not happen, a lot more information should be transmitted so that something will be learnt ! It is also wrong to presume that our students are immature and irresponsible. The students tend to behave in a manner similar to what they are considered to be. If they are considered to be responsible, they will behave in a responsible manner.
Presently the educationists feel that the role of a teacher is not of bossing around and being authoritarian. The major role of a teacher is to be a considerate and friendly person, to create an appropriate atmposphere for effective learning, so that the learning is an enjoyable process and is a plesaure.
Are we, as teachers and students together, able to create such an atmosphere in our institutions ? We need to think more and more about such matters. We need to undertake a continuous objective analysis of the teaching - learning process. To do the same, we need to be aware about the different factors and forces involved in the process.
Let us consider in this context, learning in more detail.
What is learning ? Learning is a process resulting in some change or modification in the learners' way of thinking, feeling and doing. The change may be temporary or permanent.

Learning

The more effective the learning experience, better is the learning. Provision of more effective learning experiences depends on the teacher. Therefor, depending on the ability of teacher to deliver an effective lecture or conduct a clinic or demonstrate an experiment, the consequent learning would be satisfactory or unsatisfactory.
The new experience is just a beginning step in the process of learning. Further processes involved are : new experience - registration and analysis - reflection - action and analysis another experience or exposure and repetition of the process, till a demonstrable change occurs in the learner.
Learning is thus a cyclical process ; however, it can be considered as an uprising spiral motion, where with time, there is a change in the level of attainment. It is this sequence which can be referred to as learning spiral and makes learning a dynamic process.

Process of Learning

When and where one gets the new experiences and how often these are repeated, is referred to as learning opportunities. A new experience, a new piece of information may be first heard and seen during a lecture and may be accepted and analysed as something relevant and important. On reflection, it may seem to be significant for some purpose. On recall it may be spoken aloud or written / drawn on a paper, analysed to be incompletely recalled, may be library or may be discussed with a friend and ultimately may become a part of the permanent memory. This is how learning occurs. Learning is to progress from one step to another.
Learning is individual : We all learn, different things at different rates and hypothetically anybody can learn anything given sufficient time and resources. However, at a practical, hard ground level, our learning is limited. We all learn different matters attaining different levels of achievement.
The scope and magnitude of learning depends to a large extent on the personality types of the individuals e. g. those who prefer sensing would learn better about those things which they can see, hear, touch and experience by five senses, whereas those who prefer intuition would like subjects that allow to create theories. Ideas and hypotheses would fascinate them.
Now let us consider some basic principles of learning.

Principles of learning

1. Relevance : Learning is better with subject matters of immediate relevance. When the relevance is remote or obscure and the students has to learn with a belief that the knowledge perhaps might be of use some day, the learning is difficult. However, a student can be motivated to learn effectively by explaining the importance of subject matter with reference to his ultimate goal e. g. the future clinical practice in the community. This could mean that  some of the basic principles are relevant and important to be learnt now and some finer details may be learnt later in actual practice.
2. Sequential learning : We learn by adding to what we already know. We learn by progressing from simple matters to complex and more complex matters. A suitable example or interesting anecdote may attract the learner's attention and through it some facts and principles can be communicated.
Learning is better , when it progresses from an observation to reasoning, from a particular point to a generalisation, from a particular experience to an abstract concept. However, sequence is a matter of commonsense and it is not essential to adhere to any rigid rational order or logical sequence while teaching a subject matter. Depending on the topic to be explained or taught and depending on the learning atmosphere and opportunity, the learning sequence can be altered and adjusted accordingly.

Process of Learning

3. Active involvement : Learning is more effective with an active involvement of the learner in the process, e. g. a small group discussion is more effective than a lecture.
4. Formative assessment and feedback : Learning being a process of acquiring new knowledge and skills which enable the students to do something that they could not do before, providing feedback on their performance helps the students to learn better. You will learn more about it in the chapter on Evaluation.
5. Rebound effect of evaluation : The system and process of evaluation has a definite effect on learning and learners. Students are generally blamed to be examination oriented.  However, the very fact that students learn for the sake of examinations can be utilised for better learning.  For example, if more questions are asked regarding the health problems faced by the community, automatically students would work more for those topics and would learn more about them .
6. Social and cultural ethos : The degradation of social and cultural values is affecting education also. Medical education is no exception. An observation that non - deserving candidates may score better does affect the learning behaviour in a negative manner. To  maintain a positive atmosphere in the educational institutions is a joint responsibility of all those who can afford to preserve and practice high moral principles on the basis of their spiritual strength.

Having considered different aspects of learning, let us how consider teaching.

Teaching :

Some teachers have an inborn gift of the art and skill of teaching, but most of us learn and develop the skills as we progress in our career.
Most teachers are interested in teaching effectively and some may work for an improvement. The technique of Microteaching should be useful for such interested teachers. Later in the book, you will find a discussion on this simple technique of teacher training.
Under the present situation, teachers find themselves confronted with a large number of students, a vast body of knowledge to be comprehended, a rapidly changing field of information in many areas and a limited time available for teaching, in which students are expected to achieve a maximum level of understanding.
Therefore, the teacher may have to consider, what experiences will motivate the students and enable them to learn ; how the information can be structured for a given group ; which sequence and form of presentation would be most effective and how the individual differences amongst the students can be taken care of.
Considering all the above aspects, it seems that a teaching - learning programme based on community oriented learning by objectives should be most suitable in present circumstances. Properly developed learning objectives based on health needs of the cummunity and current academic needs should be helpful both to the students as well as to the teachers.

Attempts are being made to develop learning objectives of different levels for different disciplines. However, for the time being, you may also consider to develop and document learning objectives for whatever topic the students would learn under your supervision. Similar exercise undertaken by a group of teachers working in a particular discipline or department would be even more effective and helpful to the learners.
Traditionally teaching is an interaction between the teacher and student under the former's responsibility, in order to bring about expected changes in the latter's behaviour.
What is the purpose of teaching ?
The purpose of teaching is to facilitate learning. Meaningful and effective teaching should help the student to :
- create an interest in learning for the topic in particular and more knowledge in general.
- develop proper life - long learning habits and attitudes.
- acquire, retain and utilize the knowledge.
- achieve appropriate skills and use them with confidence.
What to teach ?
To learn everything in the field of medicine is impossible even in a life time. Some from of selection is therefore essential. Some form of stratification is also necessary. The accepted recommendation is to divide the subject matter into -
Prioritisation

Since the time is limited, the major aim of your teaching should be to cover the vital and most of the essential. The desirable could only be mentioned or suggested for self study.
How to teach ?
We  usually teach the way we were taught, unless there are reasons for change.
How we teach also depends upon how much we care for the students, for the subject and for our reputation as a teacher ; how much we respect ourselves, our students, our subject ; and our institution ; and how much concern we have for the welfare of the students, community and the institution. If we do care, respect and have reasonable concern, it does not matter how we teach - it would automatically be effective and interesting. Perhaps there is nothing like the way for teaching.
Teaching - learning process is therefore a complex phenomenon. It appears to be an open ended spiral movement as compared to the linear model of conventional teaching. Considering the dynamic status of medical knowledge today, a medical teacher has to be a life long learner himself to keep uptodate and be well informed about recent advances in different fields.
The present manual is a humble attempt to induct medical teachers into the teaching - learning process. On the basis of what has been discussed in the preceding pages, it is possible to identify three distinct components of this process. These include :

• Learning objectives

• Subject matter and teaching methodology

• Evaluation

In the chapters that follow, we have tried to retain this basic format for our discussion. Let us emphasise here that all these components are inter - dependent and one can not be sustained without adequate support from the others.