Workshop Never too busy to teach

Learning outcomes Summarise the SNAPPS teaching model and be able to apply it to teaching interactions in the clinical environment. Indicate the barriers to teaching in the clinical environment and implement strategies to minimise these. Distinguish the different levels of questioning used to target learning using bloom's taxonomy Describe feedback models and employ these in clinical teaching.

A possible example to consider through the session: Think of August 2019… A possible example to consider through the session: You are the FY1 on the gastro ward. You have just finished the morning ward round with your consultant and have been asked to put in an ascitic drain with the registrar in addition to several TTOs, a discussion with radiology, bloods to take and some prescriptions to update. The Consultant has asked if you could kindly teach the 3rd Year Medical Students in 1 hour as a consultant is needed for an endoscopy on the emergency list. The consultant informs you there should be 4 students who are on their gastro placement currently but are unsure of their level of knowledge and what they want teaching on. You suspect you may have 15-20 minutes spare and have been recommended to teach them about signs of liver disease.

What do you need to know before you start this teaching session on the ward?

Examples include: Number of students and what year group Pre existing knowledge/levels of learners. How could we find this out? Learning needs – what are they motivated to learn? What do they need to learn? Any suitable patients? If not how will you conduct the session? Key learning objectives – what do you want the students to be able to do or have improved by the end of the session. Be realistic in the time frame available. Are you going to be interrupted? How could this be avoided/minimised? How are you going to collate feedback to improve your teaching?

What skills make an excellent bedside teacher?

Examples include: A passion for teaching Motivates students and inspires to learn Respect their level of knowledge and demonstrates clinical competence Admire their clinical practice and doctor-patient relationships Clear, organised, accessible, supportive and compassionate Establish rapport, direction and feedback, respectful of others Possess a range of methods and modalities Engage in self-evaluation Target level of teaching to the learner’s level of knowledge Good listener Act as role models

Bedside Teaching Dos Don’ts Brief the patients and gain their consent, tell them what will be involved, and check their physical signs. Meet the students and introduce yourself. Ask if there's anything in particular they would like to concentrate on. Give the teaching a clear purpose. For example, “Today we are going to learn how to tell the difference between mitral regurgitation and aortic stenosis.” Keep all students involved, for example, break up the examination into sections and let them take turns. Give immediate and constructive feedback. You can also ask the non-examining students to give feedback to the examining students—what did they do well, and did they forget anything? If the patient doesn't mind, let all the students experience the physical signs, for example, a heart murmur. Remember, you are role modelling a doctor-patient relationship. Explain what the physical signs meant, and how they fit together. Summarise the main points Embarrass the patient by leaving them undressed while you discuss the causes of leuconychia. Students also hate this. Upset a patient by discussing possible causes of hepatomegaly at the bedside. Do this afterwards in the office. Say “I want all of you to come back later and listen to this man's heart murmur in the standing and squatting positions.” You know they won't bother, they know they won't bother, and the patient will be worrying all day.

What are the challenges and barriers that you may face teaching the session in the scenario? - How can these be overcome?

Examples include: Busy clinical setting Difficult to set learning goals as may be opportunistic or at short notice Often delivering to varying levels of learners Unwell patients too sick or unwilling to participate in teaching Patient stays too short to see natural history/progress May impact on doctor-patient or trainee- patient relationship Insecurities regarding admitting errors or gaps in knowledge in front of patients Tendency to lecture rather than interactive, collaborative or social learning Engaging all learners simultaneously can be difficult Awareness of time pressures and learner fatigue

Intro to a teaching model S - Summarise briefly the history and findings N - Narrow the differential to two or three relevant possibilities A - Analyse the differential comparing and contrasting the possibilities P - Probe the perception by asking questions about uncertainties, difficulties or alternative approaches P - Plan management for the patient’s medical issues S - Select a case related issue for self-directed learning.

How to ask questions? Bloom’s taxonomy For example: Knowledge- can you list 5 causes of haemoptysis? Comprehension- can you describe the findings when examining the chest? Application- what could this bronchial breathing mean? What is your differential diagnosis? Analysis- Which is the most likely diagnosis? Synthesis- How would you investigate this patient? Evaluation- Which would be the most useful initial investigation?

Time to have a go You’ve asked a 3rd year medical student to take a history and examination from one of the patients on the ward. They have seen a 68 yo gentleman with a 2 week history of haemoptysis on the background of 3 months of exertional dyspnoea and no weight loss. On examination he has bronchial breathing in the right mid zone

The Skill of Feedback

Pendleton Model Check the learner wants and is ready for feedback. Let the learner give comments/background to the material that is being assessed. The learner states what was done well. The observer(s) state what was done well. The learner states what could be improved. The observer(s) state how it could be improved. An action plan for improvement is made.

Take a prop and have a go

Summary You should be able to: Summarise the SNAPPS teaching model and be able to apply it to teaching interactions in the clinical environment. Indicate the barriers to teaching in the clinical environment and implement strategies to minimise these. Distinguish the different levels of questioning used to target learning using bloom's taxonomy Describe feedback models and employ these in clinical teaching.

Details will be given in the workshop You will have a workshop today or tomorrow to develop a new teaching resource Details will be given in the workshop

Questions and summary