Introduction to Teaching University of Pittsburgh Academy of Master Educators Teaching Residents to Teach Committee Jonathan Finder MD Raquel Buranosky, MD Jamie Johnston, MD Petronille Vaulx-Smith, MD

Academy of Master Educators Residents as Teachers Committee Jonathan Finder, MD – –Professor of Pediatrics – –Clinical Director, Pediatric Pulmonology Jason Rosenstock MD – –Assistant Professor of Psychiatry – –Director Med Student Education Raquel Buranosky, MD,MPH – –Associate Professor of Medicine – –Director, Internal Medicine Residency Peter Ferson, MD – –Professor of Surgery

Committee Members James Johnston, MD – –Professor of Medicine – –PD, Nephrology Fellowship – –President, AME Rita M Patel MD – –Professor & Vice-Chair, Anesthesiology – –Clinical Procedures UPSOM Course Director – –Associate Dean for GME Kathleen McIntyre-Seltman, MD – –Professor of OB/GYN & Reproductive Sciences – –Advisory Dean, UPSOM Petronilla Vaulx-Smith, MD, PhD – –Assistant Professor of Psychiatry Basil Zitelli, MD – –Professor of Pediatrics

Introduction to Teaching Goal: To help incoming house staff 1) 1) recognize the importance of teaching 2) 2) understand basic do’s and don’ts 3) 3) be open to further development of teaching skills

Orientation Program Introduction to Teaching Why? Helps with patient care Helps with patient care Makes you look good Makes you look good Learners expect it Learners expect it It’s required It’s required –ACGME Competencies –Program/Institutional Requirements

Intro to Teaching: The APPLE Curriculum APPLE Curriculum APPLE Curriculum – A pplication of P rinciples and P ractice of L earning and E ducation Core Core –Fundamental principles of education –Teaching Opportunities –Assessment/Evaluation/Feedback

Conduct of Session Brief introduction to teaching Brief introduction to teaching Case-Based Scenarios Case-Based Scenarios Reflection (Table Discussion) Reflection (Table Discussion) Open Discussion Open Discussion Summary – Teaching Points Summary – Teaching Points

Agenda - 1 Core Core –Fundamental principles of education –Teaching Opportunities –Assessment/Evaluation/Feedback

Dr. Vaulx-Smith

Adult Learning Principles Adult learners: Adult learners: –Are goal-oriented (Why, What and How) –Are autonomous and self-directing –Have preexisting resources (life experiences) Make it relevant, practical & contextual (problem solving) Make it relevant, practical & contextual (problem solving) Be respectful (safe learning environment) Be respectful (safe learning environment) Motivate and reinforce Motivate and reinforce

Agenda - 2 Core Core –Fundamental principles of education –Teaching Opportunities –Assessment/Evaluation/Feedback

“Teachable Moments” Not just a ‘lecture’ Modeling professional behavior Daily opportunities – –Work rounds – –Procedures – –Ambulatory settings Pick your targets (can’t do it all) Be brief (“teaching on the fly”)

What type of teaching useful? A. Procedures, Case Management, 5-min talks, Bedside Teaching B. Physical Diagnosis Rounds C. Lectures, PBL, Simulated Cases, Socratic questioning D. MS I & MS II courses *Students value case-based & bedside teaching over lectures.

“The One Minute Preceptor” 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules and think out loud 4. Tell your learner what he or she did right 5. Correct the learner’s mistakes Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching

SCENARIO #1 Answer the following questions 1. How can you use adult learning principles to improve the educational experience? 2. Identify the teachable moments and critique what you saw

Comments?

1 Minute Preceptor: 1 Get a commitment – –Ask learner to articulate his/her own diagnosis or plan – –Get him/her to commit to an answer (even if wrong)

One Minute Preceptor 2 Probe for supporting evidence – –Evaluate the learner’s knowledge/reasoning – –Ask probing questions Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s answer

One Minute Preceptor: 3 Teach general rules Generalize from the case at hand Give the learner a pearl /take home point Point out how this case is same or different from the general rules

Microskills of Teaching: 4 Reinforce what was done well Provide positive feedback “Catch them doing something right”

One Minute Preceptor: 5 Correct errors Provide constructive corrections and feedback Specific Targeted Recommendations for improvement

The One Minute Preceptor Choose a single teachable point per encounter – –Most generalizable (most useful) – –Most important (don’t miss the life threatening diagnosis) – –Targeted at learner’s area of weakness – –Building on previous teachable point – –Can be diagnosis, management, skill etc

Agenda Core Core –Fundamental principles of education –Teaching Opportunities –Assessment/Evaluation/Feedback

Dr. Buranosky

Feedback vs. Evaluation Immediate Immediate Informal Informal Objective Objective Specific Specific Improvement Improvement Formative Formative Information Information Scheduled Scheduled Formal Formal Subjective Subjective Global Global Grade Grade Summative Summative Judgment Judgment

RIME Evaluation Framework Reporter – Provides data Reporter – Provides data –WBC count 15; chest x-ray infiltrate Interpreter – Integrates data Interpreter – Integrates data –Differential diagnosis including pneumonia Manager – Implements Manager – Implements –Treats with antibiotic, arranges hospital admission Educator – Teaches Educator – Teaches –Shows how individual data led to diagnosis of pneumonia and how to treat it

SCENARIO #2 Answer the following questions: 1. How would you improve the feedback that was given? 2. Use the RIME System to assess the learner

Comments?

Feedback in the Clinical Setting Observe the learner Observe the learner Describe a notable aspect of performance Describe a notable aspect of performance Wait for a response Wait for a response Recommend a next step to Recommend a next step to enhance their performance enhance their performance Arrange for a retry Arrange for a retry

Evaluation of Clinical Learners Reinforce what they are doing well Reinforce what they are doing well Educate about areas in which improvement is possible Educate about areas in which improvement is possible Affirm your belief in their ability to follow this advice Affirm your belief in their ability to follow this advice Check for their understanding by asking for a plan Check for their understanding by asking for a plan Commit to help Commit to help

Teaching Challenges The unmotivated student The unprofessional student Confrontation/Conflict Time constraints Navigating the learner/teacher role

Intro to Teaching: Conclusions It’s important and you’ll do it regularly Make it relevant, practical Capitalize on teachable moments Use your new teaching skills (1 min. preceptor) Give timely feedback, assess with RIME Ask for help, more to come

So Just Take the Plunge