Clinical Session II Becoming an Effective Medical Educator John T. Benjamin MD The Teaching Center UNC School of Medicine

Objectives of Talk

• 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 Enhanced Care Learning Resources Reflection in Action 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 Exhibit Pictures Listening Reading

Receiving and Participating 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

• 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

• 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: – 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.