Transcript Teaching Residents and Students: Tricks of the Trade and

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Clinical Session II
Becoming an Effective Medical
Educator
John T. Benjamin MD
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UNC School of Medicine
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Objectives of Talk
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Describe adult learning theory
Review what should happen on day 1
Review 1 minute preceptor
Discuss various “tricks of the trade”
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Anecdote: Recent Grand
Rounds
• Retired academic pediatrician stated publicly
that “If we are expert at what we do, then we
should be able to teach it.”
• Reasons to Disagree:
» We each learn differently,
» We need to identify the needs of our
learners,
» Teaching is much more than “Telling”
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Schon’s Learning Theory
• Based on Shon’s 1987 publication, his
theory became the underlying foundation for
the conceptual model of Pedialink.
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Clinical
Problem
Reflection
in Action
Enhanced
Care
Learning
Resources
Reflection
on Action
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Definitions
• Reflection in Action: results when a question
stimulates thinking about how to answer or
resolve an issue. These are brief reflective
moments.
• Reflection on action: The “I don’t knows”
prompt looking into answers more
completely, and those answers can influence
our practices.
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Key Quotes: John Parboosingh
• “Teachers need to be and teach learners how
to be stewards for self-directedness”
• “Learning ultimately is a social phenomenon;
this is why we need a ‘community of learners’
either in real time or web-based”
» “Learning is dependent on the company
we keep”
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Cone of Learning
Doing the real thing
Simulating the real thing
Doing
Giving a talk
Discussion Receiving and
Participating
Exhibit
Pictures Visual receiving
Listening
Reading Verbal receiving
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Underlying Belief about Learning
and Teaching
• Self-directed learning is the most effective
method of adult learning
• Therefore, teaching needs to focus on having
the learner teach him or herself.
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On Becoming a Clinical Teacher
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Day 1: Critical to set expectations
Ask questions properly
Have a “bag of tricks” you can use
Utilize the “1 minute preceptor”
Understand that feedback is more important
than evaluation if teaching is to be effective.
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On Dealing with the Learner
Day 1 Key!!
• Expectations need to be clear from day 1.
• Goals and Objectives should be shared either
in written or verbal form on day 1.
• Schedules should be reviewed and any
expected absences be identified on day 1.
• Times for teaching should be clarified.
• Times for feedback should be stated day 1.
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Example: 1 minute preceptor
1. Get a Commitment (What)
2. Probe for Supporting Evidence (Why)
3. Tell learner what did right (Warm Fuzzy)
4. Correct Mistakes (Whoops)
5. Teach General Rules (When)
6. Summarize
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1. Get a Commitment
• Allows you to gain an insight into the
learner’s reasoning.
• Case – 3 yo pulling on left ear. Complains of
pain and couldn’t sleep last night.
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2. Probe for Supporting
Evidence (Why)
• Give me information that supports your
diagnosis.
• Pertinent history and physical findings
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3. Tell Them What They
Did Right
• “Your diagnosis of otitis media seems to be
supported by history and physical.”
• Be very specific.
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4. Give Guidance About Errors
and Omissions
• “In your presentation, I would have liked to
have known about……”
• Again - be specific – eg include recent
history, medications used, allergies to meds,
etc.
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5. Teach a General Principle
• Can be anything related to the patient. Just
choose 1 topic.
• Example: if seeing otitis media, can talk
about speech, hearing, Prevnar, physical
findings…. Just choose one.
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6. Summary
• Let’s summarize: This is a 10 month old with
signs and symptoms of otitis media for whom
you would like to prescribe high dose
Amoxicillin.”
• Let’s go see the patient.
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The Art of Asking Questions
• Balance between determining level of learner
and “pimping”.
• Use both open ended and closed ended.
• What about incorrect answers? Must correct,
but as a group. Take votes, make it fun!
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Examples I Use in my Teaching:
• Visual Examination
• 3 minute reports by students (and myself)
• Students/Residents teach each other topics,
figure out what they don’t know, and then
report back.
• Physical findings: at end of rounds go back to
child to demonstrate finding.
• Unknown pictures
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Other Techniques
• Using auditory
senses (eg cough)
• Themes for the day
• Scavenger hunt for
physical findings.
• Demonstrations
• Notebook/flash
cards
• 1 minute preceptor
• Phone call roll plays
• Share 1 thing
learned that day
from patient
• Sign out exercise
• Repeat, repeat
• Summarize at the
end of rounds
(inpatient) or after
seeing each patient
(outpatient)
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Feedback vs. Evaluation
• These two terms are not equivalent.
• Evaluation is what is done at the end of the
experience with the learner. Feedback
should be happening as go along.
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Feedback – 5 Minutes a Week
• Organized in advance and predictable – not
just when things go wrong. Private setting.
• Start by saying: This is our feedback session.
• Then ask: “How do you think things are
going?” and then listen carefully.
• Sandwich not always necessary
• Be explicit and give examples
• Ask for it to be bidirectional
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Conclude Feedback
• By summarizing and giving a plan of action if
needed.
• If problem, identify specific time to meet
again in 3-4 days.
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Evaluation: Base on Levels of
Learning (Lewis First)
• Observer only (F)
• Reporter only (+/- P)
• Interpreter (HP)
• Manager (H)
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Documentation of Teaching
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Resident focus:
www.pedialink.org
• Resident’s Corner: use ILP
• Bright Futures: www.pediatricsinpractice.org
• Can correlate ACGME competencies with the
modules.
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Pediatricsinpractice.org
• Bright Futures website that specifies and
exemplifies different types of teaching:
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Role Play
Buzz Groups
Brainstorming
Case Presentation
Reflective Exercise
Mini-Presentation
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Assignment
• Write down 5 teaching techniques you have
heard about today, try them in your next
teaching activity and rank them for their
perceived effectiveness.