Small Group Teaching

Teaching Residents and Fellows to Teach… Deb Bynum, MD Division of Geriatric Medicine University of North Carolina

Introduction to the Series… Teaching to Teach  See one, do one, teach one…

Importance of Teaching

 Student perspective: validate importance of resident teaching in student curriculum -written curriculum unwritten curriculum…  Resident perspective: validate importance of teaching as something that should be taught in the curriculum

Importance of Teaching

 Informal (hidden, unwritten) curriculum  Professionalism  Teamwork  Role modeling  Culture of the institution  How to get things done at your site (nuts and bolts of every day)

Importance of residents as teachers        Informal curriculum Residents “closer” to student experience Amount of time residents/interns spend with students Recognition from School of Medicine accreditation councils Ability to “think aloud” Residents oversee the “team”, assign patients to students, dictate how/when rounds occur Residents feed in to student evaluations

What is Small Group Teaching?

 It is what we do in clinical education

Dr. Bates – The book is not enough… What do you Need?

-Teacher -Students -Patient/Case

Small Group Teaching – When?

 Work Rounds  “Down Time”  Admitting patients  Teaching rounds  Acute Care

What are the Benefits?

 Active participation and learning  Ultimate in Case based learning  Takes advantage of the “teachable moment”  Efficiency: combining care of patients with teaching

What are the Challenges?

 Different learners at different levels  Time restraints  Acuity of patients  Perceived lack of knowledge: What do I have to offer?

The Game Plan…

 PrePlan  Orient the group  Ask open ended questions  Summarize, summarize, summarize  Give individual feedback  Correct errors when needed  Receive feedback and evaluate your own skills

Switch it up…

Orientation

 Ask learners what they need/want  Goals and objectives  Determine needs  Determine levels of learners  Set expectations  Will they present?

 Will they look up questions?

 Plan for feedback sessions

General Principles

 Keep it fun  Keep it interactive  Keep it patient/case based  Ask questions

Techniques

 One Minute Preceptor Model  Canned Talks  Think out loud  Case based short presentations  Evidence based medicine: start with a clinical question

One Minute Preceptor…

      Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Well Give Guidance About Errors and Omissions Teach a General Principle Conclusion : Summarize, Review

One Minute Preceptor…

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Get a Commitment: What do you think is going on?

Probe For Supporting Evidence: Why?

Reinforce what was done well: You have a thorough differential… Give guidance/correct errors: It is also important to consider….

Teach a general principle: When you see this, you should always think of… Conclusion: Let’s go see…

One Minute Preceptor: Basics

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WHAT

 What do you think is going on?

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WHY

 Why do you think that?

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WHEN….

 When you see this, you need to think of ….

Other strategies

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Role playing Case discussions (resident report) Student/learner short presentations Scavenger hunt for physical findings Teach at bedside Check out: learners share one thing learned from the day Sign out exercises Unknown pictures Summarize at end of presentation, day, week…

Feedback

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Call it feedback

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Separate from evaluation

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Be explicit, give details

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Ask learners to self assess

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Do in private

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Correct errors immediately

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Have plan of action if needed Do not always need the “sandwich”

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Ask for feedback also

Tradition: Just Because You’ve Always Done it That Way Doesn’t Mean It’s Not Incredibly Stupid