The second discursive teaching method is the tutorial—a term that we employ to encompass an interaction between a teacher and student over a student's presentation of material (as in ward rounds, psychotherapy supervision, seminars, or journal clubs). The tutorial differs fundamentally from the lecture in that the student brings his or her thinking about a subject to the teacher, who then criticizes and develops the ideas and points of view presented by the student.
In this form of teaching most of the work and the talking is done by the student and rests upon his or her prior preparation for the meeting. The teacher's role is that of a constructive critic who questions the student's work in a fashion that intends to correct mistakes, to provoke the student to defend his or her opinion, and to deepen the student's understanding of the matters at hand. Interaction is the essence of tutorials where student and teacher can compare what the student could do alone with what is accomplished together in the tutorial. A real appreciation by the student of how greater understanding can be achieved derives from this contrast between his or her initial efforts and the eventual opinion and knowledge arrived at after a teacher's consideration and criticism.
Tutorials, in such forms as bedside rounds, are so much a part of day-to-day running of clinical units that their structure and aims may be misaligned. They should not degenerate into mini-lectures by the leader but should rise to a meeting of the minds between an effortful prepared student and an experienced knowledgeable teacher. Thus in all forms of tutorial the student brings some work that he or she has prepared previously. That work is then the focus of constructive criticism and discussion between the student and the faculty member. The tutor is the critic, not the producer of the work, even though he or she may add to the product in the discussion that follows.
The tutorial is the best forum for a consideration of subtle details and individual variations within the themes of psychiatric presentations and treatments. It can provide a sense of thorough dealing with some subject exemplified by a patient or by a research paper and ultimately can enhance the student's confidence in the subject matter.
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