Teaching in OPD Setting Teaching and Learning in Ambulatory Care Setting: A Thematic Review of the Literature Acad Med 70(1995):

Outline pros and cons of OPD teaching pros and cons of OPD teaching effective OPD teacher effective OPD teacher Quality of OPD education Quality of OPD education

Pros & Cons Pros Pros pt seen only in OPD: chronic illness pt seen only in OPD: chronic illness continuity of care continuity of care health promotion and disease prevention health promotion and disease prevention communication and negotiation skill communication and negotiation skill social, financial, and ethical aspects of medical care social, financial, and ethical aspects of medical care Cons Cons variability variability unpredictability unpredictability immediacy immediacy

Context of OPD Education patient problems encountered patient problems encountered type type frequency frequency continuity of care continuity of care working environment of the clinic working environment of the clinic

Patient Encountered type type common disease => similar common disease => similar diversity diversity  depends frequency frequency often: HT, DM, LBP often: HT, DM, LBP others complaint - few cases others complaint - few cases

Patient Encountered continuity of care continuity of care repeat visit = FU + non FU repeat visit = FU + non FU Why important? Why important?  more medical and non-medical problems  realistic  acquainted ~ duration ~ duration  50% in Wk 8  support longitudinal rotation

What happens in OPD Numerous demand Numerous demand brief segmented teaching brief segmented teaching rush teaching rush teaching short demonstration, role modeling short demonstration, role modeling brief discussion brief discussion little time for answer little time for answer Seldom observation Seldom observation infrequently taught clinical decision making infrequently taught clinical decision making rare reflection rare reflection teaching embedded in patient care teaching embedded in patient care physicians’ personal style physicians’ personal style

Educational Interaction between instructor and learner between instructor and learner amount of contact amount of contact  20-30% of cases were observed duration of contact duration of contact  6-15 minutes content of verbal interaction content of verbal interaction

Verbal Interaction

Content of Conversation About family and psychosocial About family and psychosocial 6-20% (even in Fam Med OPD) 6-20% (even in Fam Med OPD) infrequently provide feedback infrequently provide feedback most 3-6% (range 0-16%) most 3-6% (range 0-16%) positive feedback > negative feedback positive feedback > negative feedback rarely discuss about options rarely discuss about options

Wrong Answer How teacher correct? How teacher correct? provide ‘opportunity space’ provide ‘opportunity space’ hint or leading question hint or leading question reframing the question reframing the question treat as plausible but need of further consideration treat as plausible but need of further consideration soft and face-saving strategies soft and face-saving strategies

Clinical Teachers effective clinical teacher effective clinical teacher physician role model physician role model effective supervisor effective supervisor dynamic teacher dynamic teacher supportive person supportive person

Physician Role Model Knowledgeable Knowledgeable clinical competent clinical competent good rapport with patient good rapport with patient

Effective Supervisor give opportunity for patient care give opportunity for patient care review patient with learner review patient with learner involve learner in patient care involve learner in patient care give direction give direction provide constructive feedback provide constructive feedback

Dynamic Teacher teaching with enthusiastic teaching with enthusiastic made an effort to teach made an effort to teach spent time with individual spent time with individual available and accessible available and accessible engage in dialogue engage in dialogue give explanation give explanation ask and answer question ask and answer question

Supportive Person easy and fun to work with easy and fun to work with friendly friendly helpful helpful caring caring valuing learner as individual valuing learner as individual

Recommendation increase continuity increase continuity improve collaboration & SDL improve collaboration & SDL provide faculty development provide faculty development model and teach to the learners model and teach to the learners observe and feedback observe and feedback encourage independent learning encourage independent learning supplement OPD instruction supplement OPD instruction reflect upon and improve teaching reflect upon and improve teaching