New Faculty Orientation Teaching in the Clinical Setting Tatum Langford Korin, EdD September 19, 2006

The Five P’s of Effective Teaching Preparation Perceptions Professionalism Presentation Participation

Preparation Determine the need of students Integrate previous learning into present lesson Determine the educational level of the students Assemble teaching accessories

Perceptions Student and preceptor Integration of one’s ideas during teaching Positively reinforce the practice of medicine Attitudes are easily conveyed

Professionalism Appearance (clean lab coat) Demeanor –Polite without being overly friendly Preceptor is always Dr. Know students name

Presentation Competing student interest and material Focus on student attention Positive learning environment Three points (presented at first meeting): –What you are going to do –How you are going to do it –What are the students expected to do

Participation Bilateral participation Eye contact Questions=feedback Questions=fact finding mission Orient learners to lesson Review past material Reflect on learning OK to say “I don’t know” Give feedback to learners often Praise is important to the group and individual

Conclusion Reflect on the five P’s and make adjustments for the next teaching experience –Prepare early –Discuss your perceptions –Be professional –Design your presentation –Allow bilateral participation

1-8 Teaching in the Clinical Setting In-depth Lectures Seminars Formal Educational Sessions Extensive Discussion

1-9 Teaching in the Clinical Setting Efficient and effective ambulatory care teaching requires that both the student and preceptor accept the limitations of the outpatient setting. Extensive discussions of differential diagnosis, pathophysiology and psychosocial problems are not possible nor necessarily desirable.

1-10 Teaching in the Clinical Setting Keys to Clinical Teaching Demonstrate enthusiasm Give meaningful (“authentic”) responsibility Possess credible clinical skills

1-11 Characteristics and Behaviors Identified in Studies of Clinical Teaching Effectiveness

3-4 Teaching in the Clinical Setting Pitfalls in clinical case-based teaching “Taking over” the case Inappropriate lectures Insufficient “wait-time” -3-5 second wait to answer your questions Pre-programmed answers -What do you think is going on? Could it be an ulcer?

3-5 Teaching in the Clinical Setting Pitfalls continued… Rapid reward -Effectively ends the student’s thinking process Pushing past ability -Persisting in carrying the students beyond their understanding of what is being asked

3-6 Teaching in the Clinical Setting Teaching Strategy #1 The “One-Minute Preceptor” 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules -Take each encounter to a learning point 4. Provide feedback A. Positive B. Corrective

3-7 Teaching in the Clinical Setting “One-Minute Preceptor” MicroSteps Get commitment (Assess) –“What do you think is going on?” Probe for rationale (Assess) –“What led you to that conclusion?” Teach general rules (Instruct) –“When this happens, do this…” Reinforce what was correct (Feedback) –“You did an excellent job of…” Correct mistakes (Feedback) –“Next time this happens, try this…”

3-8 Teaching in the Clinical Setting “One-Minute Preceptor” Video Vignettes Instructions : Watch the vignette(s) and determine whether correct and effective precepting has taken place:  Preceptor asked for commitment  Preceptor probed for supporting evidence  Preceptor taught a general rule  Preceptor provided feedback

3-9 Teaching in the Clinical Setting “One-Minute Preceptor” Role Play: Case Presentation 3rd-year students in the ambulatory setting Preceptor role: practice the microsteps of the “One-Minute Preceptor” for a 3rd-year medical student in the outpatient setting Student role: receive teaching and supervision in the outpatient setting and respond to the preceptor’s questions

3-10 Teaching in the Clinical Setting Teaching Strategy #1 The “one-minute preceptor”QUIZ 1. Get a _______________________ 2. Probe for ___________________ 3. ____________general rules 4. Provide____________________

4-3 Teaching in the Clinical Setting “Trainees do not perform required skills incorrectly on purpose…errors in performance are typically the result of insufficient feedback. They are seldom the result of insufficient interest or caring.” - Westberg and Jason, 1991

4-5 Teaching in the Clinical Setting FEEDBACK IS: Information you provide to learners about their clinical performance that is intended to guide their future clinical performance -Adapted from K. Skeff

4-13 Teaching in the Clinical Setting Feedback in Ambulatory Care Settings Case presentations with faculty feedback: On Average: 3-6% Positive feedback given more than negative Intensive feedback to residents improves patient satisfaction

4-25 Teaching in the Clinical Setting The “Feedback Sandwich” What was done right What needs improvement What to do next time

4-26 Teaching in the Clinical Setting Giving Feedback A Checklist 1.  Make sure learner is ready 2.  Give it soon and often 3.  Link to goals 4.  Be specific & non-judgmental 5.  Give positive and constructive comments 6.  Suggest correct performance 7.  Don’t give too much 8.  Make sure feedback is understood 9.  Follow up your feedback 10.  Expect learners to develop skills in self- evaluation

Feedback Role Play

Teaching in the Clinical Setting Questions? Comments? Thank you Tatum Langford Korin, EdD. Office of Educational Development & Research Instructional Design & Technology Unit