Things I Wish I’d Known: A Skills Workshop for Faculty New to Medical Student Education

Disclosures Mario DeMarco: None Suzanne Minor: None David Norris: None Christina St. Michel: None

Objectives Upon completion of this workshop, participants will be able to: 1.Describe the components of learning objectives and identify teaching techniques and assessment methods for course objectives. 2.Utilize a variety of teaching techniques including the One Minute Preceptor, Aunt Minnie and SNAPPS. 3.Identify the components of quality positive and constructive feedback for learners. 4.Describe the Millennial learner and identify strategies to optimize their education.

Objective Writing Christina St. Michel, MD Baylor College of Medicine

Goals vs Objectives Goal: purpose of curriculum –Larger and more general vision –Non-specific –Applied to entire curriculum of study Objective: –Specific –Observable –Measures learning outcomes –Applied to units of study (each unit)

Objective writing: benefits LCME compliance Focused educational activities Focused testing Focused studying

Objective writing: pieces A: Audience B:Behavior: Action/performance/observable verbs! C: Conditions: under what conditions must they perform task D: Degrees/standard: if important (speed, accuracy, quality) Who will do what how well by when By the end of this session, students will be able to define the 4 components of an objective without the use of their handouts. Given several EKGs, the students will correctly diagnose each abnormal or normal pattern

Thoughts? Objective of this session is to: Increase students’ ability to write objectives Where is the verb? Increase students’ ability to write objectives

What do you really want the student to do Knowledge (list, record) Comprehension (explain) Application (demonstrate) Analysis (diagram, differentiate) Synthesis (arrange, formulate) Evaluation (assess, value)

Now, how do you teach it? Knowledge (lecture, video) Comprehension (discussion, presentations) Application (exercises, projects, role play) Analysis (case studies, discussion) Synthesis (projects, case studies) Evaluation (simulations, critiques)

A word about powerpoint Don’t copy & paste slides from different sources. Keep the design very basic and simple. It shall not distract. Pick an easy to read font face. Carefully select font sizes for headers and text. Leave room for highlights, such as images or take home messages. Decorate scarcely but well. Restrict the room your design takes up and don’t ever let the design restrict your message. Black text on a white background will always be the best but also the most boring choice. If you want to play with colors, keep it easy on the eyes and always keep good contrast in mind so that your readers do not have to strain to guess what you’ve typed on your slide. Keep It Straight and Simple. Keywords only. No sentences! Never read your slides, talk freely. Have more images in your slides than text. But do not use images to decorate! Images can reinforce or complement your message. Use images to visualize and explain. A picture can say more than a thousand words. Use animations and media sparingly. Use animations to draw attention, for example to your Take Home Message. Use animations to clarify a model or emphasize an effect.

Team based learning A special form of collaborative learning using a specific sequence of individual work, group work and immediate feedback to create a motivational framework in which students increasingly hold each other accountable for coming to class prepared and contributing to discussion. --Michael Sweet

Other teaching options Case studies Micro-teach Standardized patients Role-play

Testing your objectives Written tests: – NBME item writing manual: manual.html manual.html –Essay: issues: time/clearly defined standards FM cases Standardized patients Evaluations

Teaching Techniques Mario DeMarco, MD, MPH University of Pennsylvania

Common Barriers in Office Based Precepting Time constraints Lack of financial or institutional support Inadequate educational space and resources Preceptor confidence or clinical experience

Office Based Precepting From Simon et al. JGIM 2003;18:730-5.

Models for Clinical Teaching “The One-Minute Preceptor” (OMP) SNAPPS Aunt Minnie

The One-Minute Preceptor 5 Microskills Step 1: Get a commitment Step 2: Probe for supporting evidence Step 3: Teach general rules Step 4: Reinforce what was done right Step 5: Correct mistakes

The One-Minute Preceptor 5 Microskills Step 1: Get a commitment “What do you want to do?” Encourage the learners processing and synthesis of information Step 2: Probe for supporting evidence “What factors did you consider in making that decision?” Helps preceptor understand learners fund of knowledge Step 3: Teach general rules When you see this, always consider….” Help the learner understand application of general medical reasoning to individual cases Step 4: Reinforce what was done right “You did a nice job with…” Offer positive reinforcement and feedback Step 5: Correct mistakes “Next time, you might consider….” Comment on mistakes or misunderstandings to correct errors.

SNAPPS Learner-centered model Learner “drives” the presentation and questions – Preceptor “facilitates” Encourages condensed reporting of facts and more expression of thinking and reasoning

SNAPPS S ummarize relevant H&P findings N arrow the differential: Likely? Relevant? A nalyze the differential P robe the preceptor P lan patient management S elect a case-related learning issue

Aunt Minnie Focus is on pattern recognition Contrasts the other approaches which focus on expoloring Dx or Management options More closely reflects the actual apporach applied by most clinicians

Aunt Minnie Step 1: Student presents the chief complaint and the presumptive diagnosis Step 2: Student begins a write-up and preceptor evaluates the patient Step 3: Preceptor discusses case with student Step 4: Preceptor reviews and signs medical record

Providing Feedback David Norris, MD University of Mississippi Medical Center

"Without feedback, mistakes go uncorrected, good performance is not reinforced, and competence is achieved empirically or not at all.” – Jack Ende, MD

Barriers to Effective Feedback “I don’t want to be the bad guy...” “I don’t want to upset him...” “I don’t want to make a big deal out of this... ” “I don’t want to ruin someone’s career... ” “I don’t want to be accused of mistreatment... ” “I’m not sure how she will react...” “I may have contributed to the problem...” “I know he realizes it and will not do it again...” “I think it’s too late in her training or the year...” “I don’t like confrontation...”

Positive vs Negative Feedback Positive Feedback Behavior

Positive vs Negative Feedback Negative Feedback Negative Feedback Behavior

Positive vs Negative Feedback

Constructive Positive vs Negative Feedback

General Techniques

Label It

Be Objective

Site Your Target

Confirm Understanding

Techniques

Feedback Sandwich Positive It is good that you took the time to let the patient tell her story. Constructive Next time a patient is tangential, you may want to try redirecting her more frequently. Positive Still, taking the extra time made her feel like she had really been heard.

Interactive Feedback Sandwich Ask How do you think that went? Tell I noted that, though you did obtain the info, you didn’t redirect when he was tangential. Next time you can try redirecting or close-ended questions to be more time-efficient. Ask Is there anything I can do to help? Perhaps demonstrate it with the next patient?

The Millennial Learner Suzanne Minor, MD Florida International University

Cultural Competence Approach Remember that diversity exists in every group. Generalizations: used to summarize cultural beliefs and practices and point to common trends, but more information is needed to determine whether a statement is appropriate to an individual. Stereotypes infer that a person or a group of people fits a particular generalization without regard for individual differences. Using stereotypes inhibits us from exploring whether a characteristic fits a particular individual or group of people. UNC Chapel Hill Cultural Competence Module 1

Cultural competence includes finding out about each individual in addition to understanding various cultural values/behaviors so we learn not to make assumptions, to be aware of cultural cues, and to ask questions in a culturally sensitive way. UNC Chapel Hill Cultural Competence Module 1

Generations World War II: born before 1946 Baby Boomers: Generation X: Millennial Generation: Moreno-Walton L, Brunett P, Akhtar S, DeBlieux PMC. Teaching across the generation gap: a consensus from the council of emergency medicine residency directors 2009 academic assembly. 2009;16:S19-S24.

1.Special 2.Sheltered 3.Confident 4.Team-Oriented 5.Achieving 6.Pressured 7.Conventional 7 Traits, by Strauss and Howe

Literacy Decreasing traditional academic literacy Increasing media literacy Implications – for communication, syllabus Considine D, Horton J, Moorman G. Teaching and reading the Millennial Generation through media literacy. 2009;52:

Communication? Clear rules, Expectations & Consequences Deadlines & Pace What is flexible? Summative assessment details When is team-work ok? Ethics and consequences Role model Moreno-Walton L, Brunett P, Akhtar S, DeBlieux PMC. Teaching across the generation gap: a consensus from the council of emergency medicine residency directors 2009 academic assembly. 2009;16:S19-S24. Boateng B. Should generational characteristics be considered in instructional methods? The instructional preferences of millennials and its implications for medical education. The Internet Journal of Medical Education. 2011;2. Accessed August 21, 2011.

Consistent Accountability

Written communication - concise, like a text message Reading Assignments – Smaller!?

Feedback Frequent Enthusiastic Think T-ball coach Moreno-Walton L, Brunett P, Akhtar S, DeBlieux PMC. Teaching across the generation gap: a consensus from the council of emergency medicine residency directors 2009 academic assembly. 2009;16:S19-S24. Chernoff A. The Millennials – ever optimistic about jobs. CNNMoney. Accessed August 21, money.cnn.com/2011/05/18/news/economy/millennial_generation_workers/index.htm

Responsibility A 2 way street!

Breakout #1 15 minutes

Breakout #2 15 minutes

Questions