1. ESSENTIAL SKILLS FOR TEACHING MEDICAL STUDENTS AND RESIDENTS BYRON CROUSE, MD AND STUART HANNAH, MD

2. DISCLOSURES WE HAVE NO CONFLICTS OF INTEREST WE ARE BEING REIMBURSED FOR TIME

3. GOALS AND OBJECTIVES LIST THEORIES AND RATIONALE FOR ADULT LEARNING REVIEW MODELS FOR COMMUNITY-BASED CLINICAL TEACHING CASE SCENARIOS AND SMALL GROUP APPLICATION RESOURCES FOR REFERENCE

4. ADULT LEARNING

5. HOW DO WE TEACH EFFECTIVELY? MJA Volume 181 Number 6 20 September 2004 Student / Intern Graduating Resident

6. ADULT LEARNING PRINCIPLES ADULT LEANERS : LEARN WHAT THEY WANT TO LEARN LEARN WHAT THEY NEED TO LEARN LEARN THROUGH PROBLEM SOLVING BASED ON REALITY LEARN BY DOING NEED PROMPT AND APPROPRIATE FEEDBACK LEARN BEST IN AN INFORMAL AND NON-THREATENING ENVIRONMENT NEED MATERIAL THAT IS RELATED TO EXISTING KNOWLEDGE WANT TO BE TREATED AS INDIVIDUALS LEARN BEST WHEN SELF-PACED VALUE VARIETY IN TEACHING METHODS HOW CAN WE USE THESE WHEN TEACHING? Teaching to Diverse Styles. Jo Anne Preston

7. HOW CAN YOU DO THIS IN YOUR OFFICE? COMBINATION OF TECHNIQUES FOR SPECIFIC GOALS AND STYLES: ROLE MODELING - “WATCH ME CARE FOR THE PATIENT” QUESTIONING - “TELL ME WHAT YOU THINK AND WHY” PERFORMING EXPERT CONSULTATION - “ASK ME WHAT YOU NEED TO KNOW” MINI-LECTURING - “I WILL TELL YOU WHAT I KNOW ABOUT THIS TOPIC” MODELING PROBLEM SOLVING - “I WILL THINK OUT LOUD ABOUT THIS CASE” ENCOURAGING SELF-DIRECTED INDEPENDENT LEARNING - “WHAT DO YOU NEED TO READ ABOUT?” ASSIGNING TEACHER-DIRECTED INDEPENDENT LEARNING – “I THINK YOU SHOULD LOOK THIS UP” Teaching in Your Office, 2 nd Ed, ACP Press

8. OFFICE-BASED TECHNIQUES AND MODELS THE ONE-MINUTE PRECEPTOR (5 MICROSKILLS METHOD) SNAPPS POWER PRECEPTING – OVER-ARCHING METHOD TO ORGANIZE SUPERVISION ENCOUNTERS RIME – A SYNTHETIC METHOD FOR ASSESSMENT AND EVALUATION

9. ONE-MINUTE PRECEPTOR Presentation = 6 minutes Questions = 3 minutes Discussion = 1 “golden” minute 10 Minutes of “Teaching Time”....

10. ONE-MINUTE PRECEPTOR 5 STEP MICROSKILLS 1.GET A COMMITMENT 2.PROBE FOR SUPPORTING EVIDENCE 3.REINFORCE WHAT WAS DONE WELL 4.GIVE GUIDANCE ABOUT ERRORS OR OMISSIONS 5.TEACH A GENERAL PRINCIPLE

11. SNAPPS SUMMARIZE BRIEFLY THE HISTORY AND FINDINGS NARROW THE DIFFERENTIAL TO TWO OR THREE POSSIBILITIES ANALYZE THE DIFFERENTIAL BY COMPARING AND CONTRASTING THE POSSIBILITIES PROBE THE PRECEPTOR BY ASKING QUESTIONS ABOUT UNCERTAINTIES, DIFFICULTIES, ALTERNATIVE APPROACHES PLAN MANAGEMENT FOR THE PATIENT’S MEDICAL ISSUES SELECT A CASE-RELATED ISSUE FOR SELF-DIRECTED LEARNING

12. SNAPPS VS ONE MINUTE PRECEPTOR SUMMARIZE: CONDENSE FACTS. MORE ABSTRACTION. < 50% OF PRECEPTING TIME NARROW: THE DIFFERENTIAL – DDX OF 2 TO 3 MOST LIKELY ANALYZE: THE DIFFERENTIAL – THINKING, ANALYZING PROBE: THE PRECEPTOR – SPECIFIC QUESTIONS, UNCERTAINTIES PLAN: DEVELOP MANAGEMENT PLAN SELECT SPECIFIC CASE FOR REVIEW – SELF DIRECTED LEARNING GET A COMMITMENT – WHAT IS GOING ON? WHAT DO YOU WANT TO DO? PROBE FOR SUPPORTING EVIDENCE – HOW DID YOU DECIDE AND WHAT ELSE DID YOU CONSIDER? TEACH ONE GENERAL RULE TELL THE LEARN WHAT S/HE DID RIGHT AND THE EFFECT IT HAD CORRECT MISTAKES SNAPPS One Minute Preceptor

13. SNAPPS VS ONE MINUTE PRECEPTOR RESIDENT LED (PRECEPTOR FACILITATED) RESIDENT IDENTIFIES LEARNING NEEDS RESIDENT AS ACTIVE LEARNER MORE FOCUS ON CLINICAL REASONING AND THOUGHT PROCESS LESS FOCUS ON FACTS RESIDENT ASKS QUESTIONS AND EXPRESSES UNCERTAINTIES RESIDENT SELECT CASES FOR SELF-DIRECTED LEARNING PRECEPTOR LED PRECEPTOR IDENTIFIES LEARNING NEEDS RESIDENT AS RECEPTIVE LEARNER MORE FOCUS ON FACTS LESS FOCUS ON CLINICAL REASONING AND THOUGHT PROCESS DOES NOT ENCOURAGE RESIDENT-LED QUESTIONS, EXPRESSION OF UNCERTAINTIES LACK OF RESIDENT SELF-DIRECTED LEARNING SNAPPS One Minute Preceptor

14. PO W ER PRECEPTING ‘ACTIVE PRECEPTING IN THE FAMILY MEDICINE CENTER’ PREPARE – PRE-PRECEPTING, ARRIVE EARLY, REVIEW SCHEDULE “HUDDLE” TO PLAN ORCHESTRATE – ANTICIPATE NEEDS, MONITOR FLOW, ORCHESTRATE TEAM FUNCTION W EDUCATE – USE MICROSKILLS, HELP RESIDENTS ARTICULATE CLINICAL QUESTIONS, USE POINT- OF-CARE INFORMATION MANAGEMENT SKILLS TO PERFORM SEARCHES REVIEW – INTERCEPT PROBLEMS EARLY, PROVIDE APPROPRIATE INFORMATION, GUIDE RESIDENTS IN DEFINING, FOCUSING, AND REINFORCING OWN LEARNING NEEDS. DEBRIEF AT THE END OF EACH SESSION

15. (P)RIME ASSESSMENT (PROFESSIONALISM) REPORTER – “WHAT IS HAPPENING?” EXPECTED LEVEL FOR A 3 RD OR 4 TH YEAR MEDICAL STUDENT INTERPRETER – WHY IS IT HAPPENING? EXPECTED LEVEL FOR A SENIOR MEDICAL STUDENT OR 1 ST YEAR RESIDENT MANAGER – WHAT NEXT? EXPECTED LEVEL FOR A 2 ND YEAR RESIDENT EDUCATOR – WHERE ARE THE KNOWLEDGE GAPS? EXPECTED LEVEL – THE IDEAL SENIOR RESIDENT

16. CASE SCENARIOS IN GROUPS

17. QUESTIONS?

18. REFERENCES TEACHING IN YOUR OFFICE 2 ND EDITION, ACP PRESS RURAL FACULTY HANDBOOK, FAMILY MEDICINE RESIDENCY OF WESTERN MONTANA WEBSITE: PRACTICALDOC.CA “BY RURAL DOCTORS FOR RURAL DOCTORS” LILLICH DW, MACE K, GOODELL M, KINNEE C “ACTIVE PRECEPTING IN THE RESIDENCY CLINIC: A PILOT STUDY OF A NEW MODEL” FAM MED 2005; 37(3):205-10.