Teaching at the bedside of the dying patient “teaching on the run” Assoc. Prof Mark Boughey Centre for Palliative Care University of Melbourne, Australia SECTION 1 - INTRODUCTION Welcome We are all involved in clinical teaching and look around at other teachers and wonder what they do that makes them good, and wonder if there is something out there we should know. Focus is on clinicians in the workplace who teach and supervise “on the run”. Point out they will learn as much from each other as the facilitators, therefore introductions – Who you are; where you teach and an icebreaker (something about yourself nobody else knows, best holiday, food you hate....)

Good and bad learning experiences What teaching techniques were (in)effective for you as a learner? Discussion: This activity is a period of open discussion about good and bad learning experiences. Start the activity strongly: “You have all been learners. What teaching techniques were effective or ineffective for you as a learner” Divide group in two and then get them to talk in pairs. Half should consider good experiences and half bad experiences. (allow ~3 mins) Seek input and paraphrase whiteboard responses in two columns (ie good, bad). Try and translate the experience into a general term rather than writing down verbatim.

Conceptualising the scaffolding of education & training activities The 70/20/10 learning concept 1 70% 20% 10% Learning from experience Learning from others Structured learning Workplace experience & integration Feedback & relationships Training How do you enhance the teaching & learning experience at the bedside? 70/20/10 learning concept was developed by Morgan McCall, Robert W. Eichinger and Michael M. Lombardo at the Center for Creative Leadership, Greensboro, N.C. USA 70% from real life and on-the-job experiences, tasks and problem solving. This is the most important aspect of any learning and development plan. 20% from feedback and from observing and working with role models. 10% from formal training. They believe that the key elements to a successful learning process include both the 70/20/10 formula and how individuals internalize and apply what they've learned.  Therefore education & training esp around EOLC we need to maximise the teaching/learning opportunities depending on your work, workplace & role Innovations can enhance many of the learning ineractions 1. Lombardo, Michael M; Eichinger, Robert W (1996). The Career Architect Development Planner (1st ed.). Minneapolis: Lominger. Center for Creative Leadership . www.ccl.org

Adults learn best when ... Motivated Clear outcomes Information is relevant Appropriate level Active involvement Regular feedback Time for reflection Refer to the adult learning principles from the slide and relate it to the previous activity (good and bad experiences). Points on the whiteboard will usually match the list reasonably well. Emphasise that we are teaching adults and should employ appropriate strategies: Motivation plus enthusiasm of teachers Clear outcomes are set, be sure that they are aware of what you are teaching Information is relevant so emphasise the importance to their practice Appropriate level refers to the importance of a teacher to ‘pitch’ information so that it is most useful Active involvement involves interaction with learners (eg use questions and discussion) Regular feedback should be provided as part of formative assessment Time for reflection enables learners to process information, actions and experiences The BUT refers to the idea that people have different learning preferences, so the teaching methods used with learners who are motivated and self-directed will need to be different then those for unmotivated or dependent learners etc. Therefore, it is important that the teaching style employed is flexible enough to engage the range of adults being taught. Note: The adult learning principles have face validity, but there is limited empirical evidence.

The needs of education & training. 1. Purpose To improve (challenge & change) knowledge, skills, attitudes Curricula Specific to professional group Specific to level generalist to specialist Specific to palliative care Competencies Educational practices Teaching Supervision Mentorship 1. www.meddent.uwa.edu.au/teaching/on-the-run

The role of the Teaching on the Run program is to provide, at the bedside, simple techniques to change the clinical exchange to an active rather than passive learning & supervising experience 70% 20% 10% Learning from experience Learning from others Structured learning Workplace experience & integration Feedback & relationships Training You as the learner You as the teacher/supervisor mentor 70/20/10 learning concept was developed by Morgan McCall, Robert W. Eichinger and Michael M. Lombardo at the Center for Creative Leadership, Greensboro, N.C. USA 70% from real life and on-the-job experiences, tasks and problem solving. This is the most important aspect of any learning and development plan. 20% from feedback and from observing and working with role models. 10% from formal training. They believe that the key elements to a successful learning process include both the 70/20/10 formula and how individuals internalize and apply what they've learned.  Therefore education & training esp around EOLC we need to maximise the teaching/learning opportunities depending on your work, workplace & role Innovations can enhance many of the learning ineractions 2. www.meddent.uwa.edu.au/teaching/on-the-run/tips

The role of the Teaching on the Run to enhance the training & teaching experience Introduces the concept that “teaching is a planned learning activity” It is a learning activity at the bedside, on ward rounds, in clinics ….& nearby…at the team meeting Meets the challenges of busy rounds & clinical work It is a planned activity from either the senior or junior clinician Can be spontaneous as situations arise in a teaching environment, or maybe thought through to reflect an outcome of a rotation/placement over days or weeks PRESENT State the definition, emphasise the ‘planned”. Learning has been defined as: “a relatively permanent change in understanding or behaviour brought about by a planned learning experience”. The challenge is that we are busy, and do much of our teaching on the run. The PLANNING however may be having a set of planned sessions to draw on (teaching scripts on common, or important topics which we can quickly draw on), having thought about an attachment so we know how the 10 weeks can unfold and who is responsible for what or have some quick checks to apply to our teaching. © 2009 Faculty of Medicine, Dentistry and Health Sciences UWA

Objectives of TOTR Improve teaching & skills training by recognising opportunities in your clinical setting Incorporate simple teaching aids into your clinical teaching /skills training & supervision/feedback Increase confidence in teaching ability Enables the learner to become a teacher earlier At the end of this workshop participants will be able to…

The Teaching on the Run Program www.meddent.uwa.edu.au/teaching/on-the-run/tips

In practice Teaching - you recognise a moment ( prior or during) state this is an opportunity & what trying to achieve. Skill acquisition – 4 steps Teacher demonstrates, usual speed, no commentary Teacher demonstrates while describing steps Teacher demonstrates as learner describes steps Learner demonstrates and describes steps Question & investigate what trying to achieve Reflect & feedback on what happened

www.meddent.uwa.edu.au/teaching/on-the-run www.meddent.uwa.edu.au/teaching/on-the-run/tips