Reflect on residents that have been memorable to your education. What did they do well? What did they not do well?

Residents as Teachers: Empowering Resident Educators Heather O’Mara, DO MAJ, MC Faculty Development Fellow

Disclaimer The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

Objectives Discussed the role residents play as teachers and educators Examined components of a Resident-As-Teachers (RAT) curriculum Practiced skills for residents to use when working with junior learners Reviewed opportunities for implementing a RAT curriculum

Residents as Educators Residents report: – 20% of time is spent teaching junior learners – Teaching is one of their primary responsibilities – Better grasp of content after being the teacher Medical students report: – 30% of education on clinical rotations is by residents – Residents are most important teachers on the ward

Residents as Educators Broad learning audience: – Junior residents – Inter-professional learners – Medical students – Patient care team – Patients

Activity 1: Reflection on Experiences 2 MINUTES

Role modeling Focus on teaching points Creating a safe learning environment Providing experiential learning opportunities Giving feedback Setting expectations Stimulating learning The Learner Perspective Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How medical students learn from residents in the workplace: a qualitative study. Acad Med Mar;89(3):490-6.

RAT Curriculum Understand learner RIME One minute preceptor Feedback Teaching in large groups Teaching in small groups Bedside teaching Teaching procedures Teaching physical exam skills

Understand Your Learner Introduction Training: what school, stage of training Prior experience Goals: – After school – For this experience Outline your expectations for them Feedback expectations What expectations does their school have?

RIME STAGEFOCUSEMPHASISSUMMARYLEVEL OF TRAINING ReporterReliable, accurate data-gathering and presentation S/O portion of encounter Answer “what” questions MS II/III InterpreterDiagnostic reasoningA/P portion of encounter How details fit together MS III/IV ManagerTreatment planning, diagnostic testing Plan of SOAPData and decision making individualized to patient; responsibility MS IV/PGY-1 EducatorAsking, answering, and teaching important questions Global responsibility Ownership for self- improvement & improvement of others PGY 1+ Pangaro, L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med Nov;74(11):

Activity 2: RIME Categorize the learner based on the presentation. What led to your choice? 5 MINUTES

One Minute Preceptor STEPOBJECTIVEEXAMPLE Get a commitmentLearner will state their own diagnosis/plan What do you think is going on? Probe for supporting evidence Evaluate learner’s knowledge and reasoning Why do you think that? Teach general rulesEmphasize common “take- home” points When you see A, it often means B Reinforce what was rightProvide feedbackTell what the learner did “right” and the effect it had Correct mistakesProvide recommendations for improvement Tell the learner what was not done right, give tips for improvement next time Neher, JO, Stevens NG. The one-minute preceptor: shaping the teaching conversation. Fam Med Jun;35(6):391-3.

One Minute Preceptor Video

Activity 3: One Minute Preceptor 1.Pair up with a partner. 2.One person will be the “learner” presenting, the other will “precept” 3.Use the one minute preceptor tenants 4.Switch roles if you have time 7 MINUTES

Feedback

Feedback vs Evaluation FeedbackEvaluation ImmediateScheduled InformalFormal Observation Objective Event specificGlobal performance ImprovementGrading DialogueMonologue

Feedback: What and How Specific Objective Modifiable behaviors Expected Timely Limited Constructive Ask Tell/Teach Ask Act Sanchack, K. Giving Effective Feedback Through Dialogue with SOME TLC. Uniformed Services Academy of Family Physicians. Edition 14: Winter

Feedback Example You observe a resident performing a colposcopic exam, and biopsies. The resident was excellent in the explanation and consent of the procedure to the patient. The patient jumps slightly during the placement of the speculum and states, “That’s uncomfortable!” The resident repositions the speculum slightly and states “ Sometimes it is going to hurt a little”. The resident follows the appropriate sequence of actions, identifying an appropriate area to biopsy. As the resident continues with the procedure, the patient intermittently makes sounds of slight discomfort when the speculum is bumped and particularly with the biopsy. When the resident has completed the procedure, the patient asks if she can have any medication for pain. The resident replies stating, “colposcopy is not that painful, and you should be fine with over- the-counter Motrin. Even Motrin is not needed for most people.” The resident concludes by stating he will call the patient with results, and he feels confident that she has only minor changes, that may not require further intervention.

Activity 4: Feedback 1.Pair up with a partner 2.One person will be the “learner”, the other will provide feedback 3.Use Ask, Tell/Teach, Ask, Act framework 4.Switch roles if you have time 7 MINUTES

Curriculum Options Longitudinal monthly/quarterly sessions Transitions conferences Faculty development conferences and sessions Faculty development rotations

Evaluating Your Curriculum Student evaluation of teacher Resident feedback of curriculum OSCE Clerkship evaluations

Activity 5: Putting it all together Work in groups of 2-3 Scenario provided Where in the RIME model is the learner performing? Where should they be performing based on their level of training? Practice one-minute-preceptor or feedback based on their current performance and desired performance. 7 MINUTES

Take Away... What three lessons or skills are you going promote for your residents to be successful teachers? How are you going to incorporate this into a Resident as Teachers curriculum?

Objectives Discussed the role residents play as teachers and educators Examined components of a resident-as- teachers (RAT) curriculum Practiced skills for residents to use when working with junior learners Reviewed opportunities for implementing a RAT curriculum

Questions?

References Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How medical students learn from residents in the workplace: a qualitative study. Acad Med Mar;89(3): Neher, JO, Stevens NG. The one-minute preceptor: shaping the teaching conversation. Fam Med Jun;35(6):391-3 Frank, et al. ED Stat! Strategies for teaching any time Schwenk T, Whitman N. Residents as teachers: a guide to educational practice. Pacific Grave, CA. Whitman Associates; BarrowMV. Medical student opinions of the house officer as a medical educator. J Med Educ. 1966;41: Pangaro, L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med Nov;74(11): Sanchack, K. Giving Effective Feedback Through Dialogue with SOME TLC. Uniformed Services Academy of Family Physicians. Edition 14: Winter 2011.