1. 1 A CHALK TALK TALK Nichole G. Zehnder, MD Assistant Professor of Medicine Director, Hospitalized Adult Care Clerkship

2. 2 Special Thanks...  Joe Sweigart  Brian Wolfe  Eva Aagaard  Learners Okay With Fumbles

3. 3 LEARNING OBJECTIVES 1. Describe situations when chalk talks are good teaching tools. 2. Identify 8 key elements to effectively give a chalk talk. 3. Practice developing and delivering a chalk talk.

4. 4 Gameplan  Adult Learning Theory Basics  When Chalk Talks Are Best  8-Steps to Forming Effective Chalk Talks  Practice With Partners  Tips and Tricks

5. 5 BEDSORES A Familiar Scenario = A Teachable Moment 5

6. 6 ADULT LEARNING THEORY  Learn best when there is an immediate need to know.  Retain what they have learned when they can apply it immediately.  Want to be the origin of their learning.  Thrive in a safe learning environment fostered by the teacher.

7. 7 = PERFECT opportunity for a chalk talk 7 Neher. A Five Step “Microskills” Model.

8. 8 WHEN CHALK TALKS ARE BEST  Small learner numbers, one teacher  One single clinical question or topic  A short time to teach  Always best when related to direct patient care  A great way to engage learners 8

9. 9 MASTERING THE CHALK TALK 9 John & Zimmerman. Chalk Talk.

10. 10 Step 1: SUMMARIZE & REVISE 10  Sub-I:  “83 yo M with DM... bedsore on his sacrum... horrible smelling stuff... doesn’t hurt... doesn’t tunnel... no erythema or edema... AND HIS NURSE WANTS TO KNOW WHAT I WANT TO DO?” Me: “So in the process of working up a diabetic patient with a fall, you note that he has a stage III pressure ulcer with exudate and his nurse asks you what to do.”

11. 11  “And what you really want to know are specifics about how to treat all types of pressure ulcers.” 11

12. 12  Reinforce why the answer to the question is critical to the situation “So it turns out, this is really way more important than just getting a wound care consult. 25-50% of pts with new pressure ulcers will die in the next year.” STEP 2: REINFORCE 12

13. 13  Foretell the answer to the question.  Chance to introduce ~2 more learning objectives to review. “When we are done you’ll know how to deal with this specific situation but also know how to stage pressure ulcers and which types of dressings or treatments there are for each type.” STEP 3: Set the stage 13

14. 14  Figure out what the learner already knows and build on it. STEP 4: Explore understanding 14

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16. 16  General to specific  Organized  Cover LOs  Engaging STEP 5: DELIVERY 16

17. 17 Engage learners  Set context, capture learners’ attention  Use cases, practical examples  Activate prior knowledge  Enthusiasm matters  Manage the process  Have students look things up, use the board, answer each others questions 17 Aagaard. Teaching in the Small Group Setting.

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19. 19  Have the learner summarize the patient’s case (1-liner)  Learner rephrases original question.  Learner answers their own question. “Now that we’ve talked about our patient, I’d like to pass the baton and see what you want to recommend to Mr. G’s nurse.” STEP 6-8: LEARNER RECRUITMENT 19

20. 20 YOUR TURN  10 minutes for practice with a partner 20

21. 21 MASTERING THE CHALK TALK 21 John & Zimmerman. Chalk Talk.

22. 22 TIPS FOR DOING IT WELL  Best with a case, if none, make one up  Avoid the curse of too much knowledge  Still a presentation, you are the actor  Good chalk talks are recyclable 22

23. 23 Wrap-UP  Chalk talks work well for on-the-fly teachable moments  Build on Adult Learning Theory  Can be done in 8 easy steps 23

24. 24 REFERENCES 1. Chalk Talk: The 8-Step Process developed by Dr. Jonathan Zimmerman, Dr. Lily Go, Dr. Vijaylakshmi Nagappan, Dr. David Sengstock. Accessed at http://www.acgme.org/acwebsite/meetings/2012Conf/presentations/Friday/ses040.pdf on 4/12/2012. http://www.acgme.org/acwebsite/meetings/2012Conf/presentations/Friday/ses040.pdf 2. Centor R. “Didactic Teaching.” Presented November 2009 at The Academic Hospitalist Academy. 3. 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. 4. 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. 5. 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. 24