Principles of Teaching and Learning in Clinical Settings Professor Hossam Hamdy University of Sharjah

Aim  What is Clinical Teaching  Barriers to effective Clinical Teaching  Strategies to improve Clinical Teaching  Teaching and learning in different clinical settings

Clinical Teaching There should be no teaching without the patient for a text and the best teaching is often that taught by the patient himself (William Osler)

Triad Interactive Learning in the Clinical Context Content TeacherPatient Student Context

Teaching with Patient  Bedside “Different from ward rounds”  Outpatient clinic  Emergency ward  Day Care Surgery  O.R

Barriers to Effective Clinical Teaching – A global Concern  Time lack for clinicians.  Insufficient space to teach.  Crowded outpatients.  Increasing number of ‘ super-specialist ’ clinics.

Barriers to Effective Clinical Teaching (cont/-)  Lack of patients and inpatient beds.  Lack of consistency in what is taught.  Lack of organization in what is taught between teachers.

Barriers to Effective Clinical Teaching (cont/-)  Teaching is not considered part of service commitment.  Lack of knowledge and skills about teaching methods.

The Clinical Context  More shift from Hospital setting to Ambulatory settings.  Diminish the significance of bedside teaching “short length of stay”.

The Clinical Context (cont/-)  Hospital populated with critically ill and early post-operative patients.  Early diagnosis – no or little physical signs.

Key Clinical Competencies  What are the key clinical competencies you as a clinical teacher want to ensure that the students have accomplished  Good communication and data gathering (history and physical examination  Clinical reasoning  Decision Making, investigation and treatment

Clinical Teaching  Be available (on time) and approachable.  Introduce yourself and know their names.  Pre select patients/ Ask permission  Ensure respect for patients comfort and dignity Planning “set”

  Clarify expectations and goals appropriate to the setting, patient problems and student level “ prior knowledge ” Clinical Teaching (cont/-) Planning “set” (cont/-)

 Teach from clinical cases.  Go to the bedside or exam room  Use questions to diagnose patient & learners. Teaching “Dialogue” Clinical Teaching

 Role model  Focus the teaching on data gathering by or about the patient “critical player”  Promote student clinical reasoning skills.. Teaching “Dialogue” (cont/-) Clinical Teaching

 Context specificity.  Prior knowledge & net-working.  Schemata and script concordance. Non-Analytical Reasoning “ Pattern recognition ”

Analytical Reasoning  Cues form c/o – duration  Early hypothesis generation  Testing and re-testing hypothesis  Ranking and re-ranking hypothesis

Pre-test Probability TEST Post-test Probability Clinical Reasoning Each question in the history and each physical examination is a diagnostic test. EBM Approach

Combined Model of Clinical Reasoning Patient Presents Hypotheses Tested Non-analytic Interactive Analytic Case Representation

 Increase the student base of scenarios, scripts and mental images.  Students should be guided to relate novel experience with past experiences ‘Anchor proto-type in their memory’. Clinical Teaching Tips

Clinical Teaching Tips (cont/-)  Implicit / Tacit  Explicit  Key features of disease  Relevant information “ focused history & physical exam. ” Model Professional Thinking and Decision Making “ Preceptor Thinking Out Loud ”

Clinical Teaching Tips (cont/-)  Priority in investigations and treatment.  Review diagnostic probabilities and rationale for diagnosis and treatment. Model Professional Thinking and Decision Making “ Preceptor Thinking Out Loud ”

The One Minute Clinical Preceptor Teaching Model Diagnose Patient & Learner Get a commitment Microskill 1: Get a commitment What do you think the patient problem is? Probe for supportive evidence Microskill 2: Probe for supportive evidence Reasoning. Why do you think this is the case?

The One Minute Clinical Preceptor Teach general rules & concepts Microskill 3: Teach general rules & concepts  When this happens, usually …  Take home message

Feedback “closure” Provide regular, well timed feedback. Microskill 4: Provide regular, well timed feedback.  Should be descriptive rather than judgmental.  Reinforces positive behaviors and motivates learner.  Conveys an attitude of concern and interest between instructor and learner. The One Minute Clinical Preceptor

The one Minute Clinical Principle Correct mistakes and promote self assessment and self-directed learning. Microskill 5: Correct mistakes and promote self assessment and self-directed learning.  Focus on behavior, not individual.  Ask learner for their opinion or perception.  Be straightforward, but respectful. Feedback “closure”

The Effective Clinical Teacher (D. Newbie) 1. Encourages active student participation rather than passive observation 2. Emphasis on teaching of applied problem solving 3. Integrates clinical medicine with basic science 4. Close observation of students during interview/examination rather than side-room case presentation

The Effective Clinical Teacher (D. Newbie) 5. Provides adequate opportunity for students to practice skills 6. Provides good role-model for interpersonal relationships with patients 7. Teaching patient-oriented rather than disease- orientated 8. Demonstrates a positive attitude towards teaching

The Effective Clinical Teacher Most important being willing to teach and be enthusiastic about it

Thank You