Program review Resident as teacher

You ask a student to take an H&P from a patient in triage –What can go wrong? Why? You ask a student to present a clinic patient to the attending –What can go wrong? Why? You ask a student to position a gyne patient before surgery –What can go wrong? Why? You pimp a student on a topic they learned in lecture yesterday –What can go wrong? Why? Scenarios

They do not understand the task they are given They do not plan or see the importance in planning for the task They use familiar strategies that don’t work as well in a new setting After they fail: –The effort put into adjusting their strategy is proportionate to their belief about their own ability to learn, and –They believe the reason for their failure is external (that it has nothing to do with their own strategy) What students do wrong

To become self-directed learners, students must learn to: Students should become self- directed learners Assess the demands of the task Evaluate their own knowledge and skills Plan their approach Monitor their progress Adjust their strategies as needed

Initially, be more explicit than you may think is necessary about expectations –Tell students what you want and do not want –Check that the student understands the assignment (allow them to repeat it to you) Provide performance criteria with the assignment (“I will be judging you based on how well you…”) Have students create their own plan –Create assignments that focus on strategizing instead of implementation –“This is a busy day in triage. This is a very talkative patient. How are you going to figure out what is going on with her in the minimum amount of time?” What can we do?

Provide opportunities for self-assessment –Provide simple questions students can ask themselves—”What do I want to accomplish tonight on call?” “Did I achieve my goal with this patient?” –Use peer review: “Student A, you were in clinic yesterday. Will you give Student B some advice about what you did right, what you did wrong, and how she can maximize her own experience in clinic?” Prompt students to analyze the effectiveness of their skills –Especially their study skills Directly address their beliefs about learning –“How do you think you learn best?” “Do you think you can get anything useful out of this rotation?” What can we do?

Model our own metacognitive processes (how we think about thinking): –“I know that clinic is busy today. This patient has a lot of complaints. Today, I am going to help this patient focus on her most important complaint, and we can save her secondary complaints for another visit. One way in which I accomplish this is to start suggesting treatment strategies early in the encounter. This is an efficient way to narrow down what bothers her most and which treatments she would accept.” Use scaffolding to help –Scaffolding refers to the use of instructional supports to help a new learner. They can include: –Educational resources (“Read about prenatal labs before you go to see this patient”) –Providing templates –Decreasing the workload by removing non-educational tasks (“I will set up the examination table while you interview the patient. Then you will do the pelvic exam while I label the specimens.”) –Modeling a task (“I will show you how to prep a patient for surgery. You will prep the next patient.”) What can we do?