Transcript Teaching Residents and Students: Tricks of the Trade and

Clinical Session II
Becoming an Effective Medical
Educator
John T. Benjamin MD
The Teaching Center
UNC School of Medicine
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”
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”
Schon’s Learning Theory
• Based on Shon’s 1987 publication, his
theory became the underlying foundation
for the conceptual model of Pedialink.
Clinical
Problem
Reflection
in Action
Enhanced
Care
Learning
Resources
Reflection
on Action
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.
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”
Cone of Learning
Doing the real thing
Simulating the real thing
Doing
Giving a talk
Discussion
Receiving and
Participating
Exhibit
Pictures
Listening
Reading
Visual receiving
Verbal receiving
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.
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 feeedback is more
important than evaluation if teaching is to
be effective.
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
Example: 1 minute preceptor
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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
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.
2. Probe for Supporting Evidence
(Why)
• Give me information that supports your
diagnosis.
• Pertinent history and physical findings
3. Tell Them What They did Right
• “Your diagnosis of otitis media seems to be
supported by history and physical.”
Be very specific.
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.
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.
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.
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!
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
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)
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.
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
Conclude Feedback
• By summarizing and giving a plan of action
if needed.
• If problem, identify specific time to meet
again in 3-4 days.
Evaluation: Base on levels of
Learning (Lewis First)
• Observer only (F)
• Reporter only (+/- P)
• Interpreter (HP)
• Manager (H)
Documentation of Teaching
Resident focus: www.pedialink.org
• Resident’s Corner: use ILP
• Bright Futures:
www.pediatricsinpractice.org
• Can correlate ACGME competencies with
the modules.
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
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.