Orienting The Learner

Objectives Describe the characteristics of an effective learning environment Describe approaches to creating effective learning environments in the clinical setting Analyze videos to identify strategies for teaching fundamental clinical skills.

Out of the Frying Pan… It’s your first day on a new service. After having received sign out on your patients and surviving a grueling work rounds with your fellow residents, the clerkship director arrives with a new group of 3rd-year med students on the first day of their rotation. As you stare at your patient list and contemplate unchecked boxes too many to count, you realize the student assigned to you is very carefully standing right next to you awaiting instructions.

Carter’s First Day Consider what Dr. Benton did in developing a learning climate –What was effective? –What was ineffective? VIDEO

…Into The Fire Now you’re Benton, what do you do?

Learning Climate Tone Respect and Comfort Stimulation Admission of Limitations Set Expectations

Learning Climate Tone –Genuineness, warmth, humor –Demonstrate interest Introduce yourself Have your student introduce themselves

Learning Climate Respect and Comfort –Learn names! –Treat students as vital team members –Appreciate student opinions and concerns

Learning Climate Stimulation –Show enthusiasm for the work at hand –Challenge Prompt – don’t Pimp! –Encourage participation Learn together in gap areas

Learning Climate Admit your own errors or limitations –Encourage hypothesis testing Reward risk taking Tolerate mistakes –Never Lie! Get comfortable saying, “I don’t know

Learning Climate Set expectations –What are the student’s goals? –What are your goals?

Learning To Play Catch Sandlot! –Assess your learner –Break down the skill –Set your learner up for success VIDEO

Clinical Application History Taking –Assess your learner. –Challenge them to tailor their question set for the interview. –Stress the importance of preparation and critical thinking in approaching clinical work. –Provide specific and immediate feedback

Clinical Application Physical Exam –Assess your learner –Allow them to observe you. –Observe them and highlight ALL findings - benign or pathologic. –Provide immediate and specific feedback.

Clinical Application Oral Presentations –Assess your learner –Make explicit differences between presentations –Emphasize preparation –Provide specific and immediate feedback

Clinical Application Interpersonal/Communication Skills –Assess your learner –Allow them to observe you delivering news to patients and families –Observe them interacting with patients and families –Provide immediate and specific feedback

RIME Reporter Interpreter Manager Educator/Expert –RIME can be useful as a feedback, evaluation, and teaching tool!

RIME as Teaching Tool Set Expectations Third-year Med Students should be reliably Reporting information and honing their Interpretive skills High-performing students should be suggesting Management strategies for their patients (Sub- I’s should be consistently approaching this level) Outstanding students will be Educating their colleagues and patients

Putting it all Together Prepare yourself Model excellent clinical behavior for your students Ask for feedback from your learners Have fun!

Teaching Reflectively Consider yourself Consider the learner

ACKNOWLEDGMENTS Andrew Mutnick, MD Lyuba Konapasek,MD