1. Liliana Chiorean (1), Radu Badea (2) Residents education using ultrasound. Teaching with clinical cases 1.Radiology Department, Emergency County Hospital, Cluj-Napoca, Romania 2.Echography Department, Octavian Fodor Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

2. 1. Adult education – features 2. Cases method – case presentation as teaching method 3. Resident as «student» – learning near ultrasound machine 4. Resident as «teacher» – clinical cases presentations for other residents/students, articles Objectives

3. Learn best when there is an immediate need to know Retain information learned when they can apply immediately Thrive in a safe learning environment promoted by teacher They want to be the origin of what they learn Adult education theory We are what we repeatedly do. Excellence then is not a singular act, but a habit. Aristotel

4. Source: Edgar Dale (1969) After two weeks, we tend to hold… I see and I forgot, I hear and I remember, I do and I understand. Confucius 10%20%30%50%70%90% Read Listen Look Movie, presentation, demonstration Discussions, lectures Making a presentation Sharing personal experience

5. Method of one-way communication Not involve significant audience participation Passive way of data acquisition Truncate retaining of study material Learning through courses Change is the final result of real education. Leo Buscaglia

6. The cycle of active learning Work, action, experiment What happened? Which were the results? What does this results imply? How have I influenced the outcome? What will I do different next time?

7. In continuous change Education How many things I dont need exists… Socrate Much more residents Funds – sufficient?Increasing requirements

8. What is the path through succes?

9. Reproduction of real cases Demonstrations, questions with active involvement of the audience who has decision-making role Stimulating discussions, highlighting of the problems faced Imediate impact and relevance Case method I would rather make people fun hoping that they had learned something, than teaching them and hoping that they had fun Walt Disney

10. Socratic method – the dialogue its essential Case method - historical The problem its divided in questions wich hepl in finding the seeking answer The base of learning is the active role of student in solving the case It is based on critical evaluation The only thing I know is that I know nothing - Socrate

11. Where cases have been used?

12. When case method is the best Short time to teach One professor, small number of residents A single clinical aspect It is always more efficient when connected to direct patient care A very good modality to involve the residents The only thing which interferes with my learning is my education. Albert Einstein

13. A familiar scenario Every case has something that can be learned Unique teaching opportunities Integrating the patient in case discussions increasses his satisfaction Ultrasound department Education is an admirable thing, but it is well to remember from time to time that what its valuable cant be teached. Oscar Wilde

14. Learning clinical models Learning communication skills Time management Role in developing behavioral models Ultrasound examination Only an educated mind is able to sustain an idea without accepting it. Aristotel

15. It can be done in front of the patient Establish the residents needs Observation and evaluation of the knowledge base, examination skills, clinical reasoning Direct observation Education is not how much you stored, not even how much you know. Its about making the difference between what you know and what you dont know. Anatole France

16. Find out what residents know and build over Start from general to specific Be organized Include general rules Engage residents in discussion Putting into practice Education is the key who unlocks the door to freedom. George Washington Carver

17. Assertive style Which is the differential diagnosis of a focal liver lession? Teacher-centered Rate the residents knowledgebase Direct questions Brings informations Provides guidance

18. Suggestive style Brings suggestions and alternatives Can share opinions and personal practical experience Although a simple renal scan may be useful, a CT examination without contrast agent is a better diagnostic tool for this patient.

19. Collaborative style Socratic approach oriented towards residents Explore the clinical rationality with challenging questions Produces feelings of belonging, of teamwork Follows the residents collaboration capability How should we proceed? What complementary imagistic examinations would be useful ?

20. Facilitative style Accepts residents ideas in order to self- assessment Uses delayed response, silence Helpfull tags Produces feelings and encourages the residents

21. Find opportunities Splenic abscess Hepatic cysts Duct stone Foreign body in antral wall Melanoma sentinel nodes

22. Use additional resources Subcapsular liver hematomaFocal nodular hyperplasia Ileocaecal, colonic and peritoneal tuberculosis

23. Keys to success Selection of interesting and educative cases Sharing personal experiences Mutual trust Preparation, enthusiasml Needs time and effort, but the reward is great The initial direction of a mans education is the one which will determine his future. Plato

24. Give feedback Praise – Criticize – Praise Start always with what is positive Individualized, well-timed, according to the situation Honest assessment of performance, including suggestions for improvement

25. At the end Conclusion of discussions Focuse their attention to articles and studies which are relevant for the discussion topic Connecting case analysis to theory If I would start again my studies, I would follow Platos advice and start with mathematics. Galileo Galilei

26. Resident as a teacher Preparation of clinical case presentations for teaching others Documentation and cases preparation in order to publish articles Obtain a solid theoretical basis The purpose of education is to replace an empty mind with an open one. Malcolm Forbes

27. Conclusions Near the US machine you can take advantage of the opportunities offered to teach Case presenations are suitable to the theory of adults learning They are enough in order to provide essential informations in a short period of time Data are not information, information are not knowledge, knowledge is not understanding, understanding is not wisdom. Clifford Stoll

28. References 1. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step microskills model of clinical teaching. J Am Board Fam Pract. 1992;5:419-24. 2. Aagaard E, Teherani A, Irby D. Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient and the Learner: Proof of Concept. Acad Med. 2004;79:42-49. 3. Orlander JD. Twelve tips for use of a white board in clinical teaching: reviving the chalk talk. Med Teach. 2007;29(2-3):89-92. 4. Langlois J, Thach S. Teaching and learning styles in the clinical setting. Family Medicine. 2001;33:344-6. 5. Pashler H, McDaniel M, Rohrer D, Bjork R. "Learning styles: Concepts and evidence". Psychological Science in the Public Interest 2008;9:105-119.