Clinical Session II Becoming an Effective Medical Educator John T. Benjamin MD The Teaching Center UNC School of Medicine

Objectives of Talk Describe adult learning theory Review what should happen on day 1 Review 1 minute preceptor Discuss various “tricks of the trade”

Anecdote: Recent Grand Rounds Retired academic pediatrician stated publicly that “If we are expert at what we do, then we should be able to teach it.” Reasons to Disagree: –We each learn differently, –We need to identify the needs of our learners, –Teaching is much more than “Telling”

Schon’s Learning Theory Based on Shon’s 1987 publication, his theory became the underlying foundation for the conceptual model of Pedialink.

Clinical Problem Enhanced Care Reflection in Action Reflection on Action Learning Resources

Definitions Reflection in Action: results when a question stimulates thinking about how to answer or resolve an issue. These are brief reflective moments. Reflection on action: The “I don’t knows” prompt looking into answers more completely, and those answers can influence our practices.

Key Quotes: John Parboosingh “Teachers need to be and teach learners how to be stewards for self-directedness” “Learning ultimately is a social phenomenon; this is why we need a “community of learners” either in real time or web-based” –“Learning is dependent on the company we keep”

Cone of Learning Doing the real thing Simulating the real thing Giving a talk Discussion Exhibit Pictures Listening Reading Doing Receiving and Participating Visual receiving Verbal receiving

Underlying Belief about Learning and Teaching Self-directed learning is the most effective method of adult learning Therefore, teaching needs to focus on having the learner teach him or herself.

On Becoming a Clinical Teacher Day 1: Critical to set expectations Ask questions properly Have a “bag of tricks” you can use Utilize the “1 minute preceptor” Understand that feeedback is more important than evaluation if teaching is to be effective.

On Dealing with the Learner Day 1 Key!! Expectations need to be clear from day 1 Goals and Objectives should be shared either in written or verbal form on day 1. Schedules should be reviewed and any expected absences be identified on day 1. Times for teaching should be clarified Times for feedback should be stated day 1

Example: 1 minute preceptor 1. Get a Commitment (What) 2. Probe for Supporting Evidence (Why) 3. Tell learner what did right (Warm Fuzzy) 4. Correct Mistakes (Whoops) 5. Teach General Rules (When) 6. Summarize

1. Get a Commitment Allows you to gain an insight into the learner’s reasoning. Case – 3 yo pulling on left ear. Complains of pain and couldn’t sleep last night.

2. Probe for Supporting Evidence (Why) Give me information that supports your diagnosis. Pertinent history and physical findings

3. Tell Them What They did Right “Your diagnosis of otitis media seems to be supported by history and physical.” Be very specific.

4. Give Guidance About Errors and Omissions “In your presentation, I would have liked to have known about……” Again - be specific – eg include recent history, medications used, allergies to meds, etc.

5. Teach a General Principle Can be anything related to the patient. Just choose 1 topic. Example: if seeing otitis media, can talk about speech, hearing, Prevnar, physical findings…. Just choose one.

6. Summary Let’s summarize: This is a 10 month old with signs and symptoms of otitis media for whom you would like to prescribe high dose Amoxicillin.” Let’s go see the patient.

The Art of Asking Questions Balance between determining level of learner and “pimping”. Use both open ended and closed ended. What about incorrect answers? Must correct, but as a group. Take votes, make it fun!

Examples I Use in my Teaching: Visual Examination 3 minute reports by students (and myself) Students/Residents teach each other topics, figure out what they don’t know, and then report back. Physical findings: at end of rounds go back to child to demonstrate finding. Unknown pictures

Other Techniques Using auditory senses (eg cough) Themes for the day Scavenger hunt for physical findings. Demonstrations Notebook/flash cards 1 minute preceptor Phone call roll plays Share 1 thing learned that day from patient Sign out exercise Repeat, repeat Summarize at the end of rounds (inpatient) or after seeing each patient (outpatient)

Feedback vs. Evaluation These two terms are not equivalent. Evaluation is what is done at the end of the experience with the learner. Feedback should be happening as go along.

Feedback – 5 minutes a week Organized in advance and predictable – not just when things go wrong. Private setting. Start by saying: This is our feedback session. Then ask: “How do you think things are going?” and then listen carefully. Sandwich not always necessary Be explicit and give examples Ask for it to be bidirectional

Conclude Feedback By summarizing and giving a plan of action if needed. If problem, identify specific time to meet again in 3-4 days.

Evaluation: Base on levels of Learning (Lewis First) Observer only (F) Reporter only (+/- P) Interpreter (HP) Manager (H)

Documentation of Teaching

Resident focus: Resident’s Corner: use ILP Bright Futures: Can correlate ACGME competencies with the modules.

Pediatricsinpractice.org Bright Futures website that specifies and exemplifies different types of teaching: –Role Play –Buzz Groups –Brainstorming –Case Presentation –Reflective Exercise –Mini-Presentation

Assignment Write down 5 teaching techniques you have heard about today, try them in your next teaching activity and rank them for their perceived effectiveness.