1. Teaching Residents to Teach techniques, lessons & outcomes from a longitudinal curriculum Jennifer Martini, MD Marjorie Hermes, MD Valerie Rhodes, DO Ashley Tennyson, MD VCU School of Medicine Fairfax Family Practice Residency Program

2. Disclo sures : None

3. Object ives for our learners Describe teaching challenges and the role of the One Minute Preceptor in addressing them Implement didactics and practice - based educational activities around teaching residents to teach Summarize the outcomes of our longitudinal curriculum implementation

4. Key Concep ts Residents are all teachers, and should be trained for this role Adults learn by repeatedly encountering concepts in increasingly complex ways, starting with what they know For us, improving FEEDBACK SKILLS was key

5. Clinical Teaching Curriculum & Some Practice Outcomes & Data How We’ll Get There

6. Clinical Teaching

7. Clinica l Teachin g in Family Medicine Why it ’ s important, and why it ’ s hard The One Minute Preceptor as a potential solution

8. Clinica l Teachin g in Family Medicine ACGME / Milestones for residency programs LCME Standard 9.1 “ Evaluate the adequacy of the methods used to… prepare [ residents ] for their specific teaching and assessment roles ”

9. Clinica l Teachin g in Family Medicine Residents are often students ’ primary teachers Numerous factors constrain teaching ability Time, inadequate training, competing demands Learning environments influence specialty choices From the literature…

10. Clinica l Teachin g in Family Medicine Resident Perspectives Learning as medical students Teaching as residents

11. Clinica l Teachin g in Family Medicine A potential solution : the One Minute Preceptor / Clinical Microskills Our curriculum development process The OMP as a validated educational tool

12. Clinical Teaching Curriculum & Some Practice

13. Group Teaching Session Clinical Challenges Follow up group sessions “See one, do a whole bunch, teach one”

14. Cupcakes and Cannoli Utilized adult learning theory Start with a familiar concept Build to become progressively more complex Our Curricu lum : Didacti cs

15. Session One Name the famous teachers Outline of our longitudinal course Nuts and bolts of the 3 rd year student curriculum Brief intro to One Minute Preceptor Survey on comfort level of teaching role and methods Our Curricu lum : Didacti cs

16. Session Two OMP 1, 2, and 3 ( commit, probe, reinforce ) Cupcakes and cannoli to demonstrate teaching methods Reviewed survey and introduced Clinical Challenges Our Curricu lum : Didacti cs

17. OMP last 2 steps ( feedback and general concepts ) Levels of feedback Feedback vs. evaluation Role playing Large group review of notes Review of Clinical Challenges and student comments Our Curricu lum : Didacti cs Session Three

18. Session Four Debriefing and post survey Reviewed challenges from the year Brainstormed regarding challenges Our Curricu lum : Didacti cs

20. What OMP skills were demonstrat ed? Get a commit ment Probe for suppor ting eviden ce Teach Genera l Rules Reinfo rce what was done well Correc t mistak es

21. Monthly emails with Challenge and OMP review Students completed chart daily Faculty served as embedded controls Clinica l Challen ges

22. Clinical Teaching Curriculum & Some Practice Outcomes & Data

23. Outcom es & Data Pre / post - survey of PGY - 3 residents Use of One Minute Preceptor in observed precepting encounters Student evaluation data in the clinic

24. Survey Results: Pre-Intervention Makes me Very Uncomfortable; I Don’t Usually Pull it Off Makes me nervous but I pull it off in some situations My palms sweat but I pull it off most of the time Do it in my sleep, baby Getting a commitment 62 Probing for supporting evidence 2 5 1 Teaching general rules 34 1 Reinforcing things done well 26 Feedback/ correcting mistakes 6 2

25. Survey Results: Post-Intervention Makes me Very Uncomfortable; I Don’t Usually Pull it Off Makes me nervous but I pull it off in some situations My palms sweat but I pull it off most of the time Do it in my sleep, baby Getting a commitment 17 Probing for supporting evidence 35 Teaching general rules 44 Reinforcing things done well 1 35 Feedback/ correcting mistakes 2 51

26. Survey Results: Pre-Intervention Um, no. Disagree. Generally disagree, with a few exceptions. Generally agree, w/ a few exceptions. Totally agree. It’s like one mind. I like to teach med students 1 43 I’m good at teaching students 1 61 I like to teach other residents 8 I’m good at teaching residents 2 5 1 I like to teach my patients 3 5 I’m good at teaching my patients 26

27. Survey Results: Post-Intervention Um, no. Disagree. Generally disagree, with a few exceptions. Generally agree, w/ a few exceptions. Totally agree. It’s like one mind. I like to teach med students 44 I’m good at teaching students 25 1 I like to teach other residents 7 1 I’m good at teaching residents 25 1 I like to teach my patients 3 5 I’m good at teaching my patients 4 4

28. Survey Results: Pre-Intervention Um, no. Disagree. Generally disagree, with a few exceptions. Generally agree, with a few exceptions. Totally agree. It’s like one mind. I’ve received instruction on how to teach before 53 I feel well- prepared to teach med students 6 2 I have a method for teaching in clinical settings which I use consistently 8

29. Survey Results: Post-Intervention Um, no. Disagree. Generally disagree, with a few exceptions. Generally agree, with a few exceptions. Totally agree. It’s like one mind. I’ve received instruction on how to teach before 8 I feel well- prepared to teach med students 62 I have a method for teaching in clinical settings which I use consistently 7 1

30. Observed Precepting Encounters

31. Student Evals: OMP steps

32. Student Evals: Learning Experience Satisfaction

33. “We should not judge people by their peak of excellence, but by the distance they have travelled from the point where they started” – Henry Ward Beecher Before the TRT Curriculum, I “didn’t know where to start” during precepting sessions and “felt like students were my guinea pigs.” They thought I “taught too much” and were often frustrated that they “weren’t getting a chance to make their own decisions” or “receive feedback.” After finishing the year-long TRT curriculum, I was able to demonstrate proficiency in outpatient MS3 teaching via the OMP teaching model, as demonstrated by my performance of 100% of the OMP Microskills on a checklist during my faculty-observed teaching encounter with an MS3. Basically, I nailed it.

35. Object ives for our learners Describe teaching challenges and the role of the One Minute Preceptor in addressing them Implement didactics and practice - based educational activities around teaching residents to teach Summarize the outcomes of our longitudinal curriculum implementation

36. Key Concep ts ( a review ) Residents are all teachers, and should be trained for this role Adults learn by repeatedly encountering concepts in increasingly complex ways, starting with what they know For us, improving FEEDBACK SKILLS was the key

37. Commentary, Discussion & Questions * Please evaluate this session at : stfm. org / sessionevaluation Jen Martini : jmartini@ffpcs. com Margie Hermes : mhermes@ffpcs. com