1. ATTENDING MODELING of End-of-Life Care James Hallenbeck, MD VA Palo Alto HCS

2. GOALS Introduce T-L-C Educational Model Identify special challenges of attending role modeling Suggest specific techniques used in modeling Get you excited about role modeling as an educational intervention

3. Seven Educational Categories Learning Climate Control of Session Communication of Goals Promotion of Understanding and Retention Evaluation Feedback Promotion of Self-Directed Learning

4. Lot’s of questions... Everybody talks about role modeling but… Is being a ‘great physician’ enough to be a great role model? What skills/techniques are useful?

5. TEACHERLEARNER CONTENT T-L-C EDUCATIONAL MODEL

6. TEACHERLEARNER PATIENT TEACHER CONNECTED WITH LEARNER

7. The Challenge... How does the teacher immerse himself or herself in the role without loosing the learner? Specifically, how does the teacher facilitate the learner’s involvement with the content, if the teacher is ‘on stage’?

8. TEACHERLEARNER PATIENT TEACHER IMMERSED IN CONTENT

9. The Big Picture The goal of education is to foster an enduring relationship between the learner and the content. Content areas include: –Attitude –Knowledge –Skill

10. LEARNER CONTENT EDUCATIONAL OBJECTIVE

11. The Context Part of continuity experience? Linked to didactic session(s) Who are the learners? –? Mixed skill levels or homogenous Special learning opportunities? Questions to ask...

12. Setting a theme Useful especially if seeing patients in series May link to didactic session, special learner needs and learning opportunities Assign learner tasks within a theme Examples: –“Why is this patient here?” –“Look at the walls and tabletops” –“What does home mean to this patient?”

13. Three phases of the patient encounter Before During After Each phase has its own skills

14. Before seeing the patient Reinforce theme, if present Collect data Set patient specific tasks- –That you wish to accomplish –Tasks for learners

15. A word about tasks Tasks may be –Cognitive “Determine how we might adjust pain meds” –Observational “Watch to see what techniques I use to put the patient at ease” –Behavioral “When I’m done, examining him, I want you to try it”

16. The patient encounter Goal- Immerse yourself totally in the relationship, but continue to involve the learner –Analogous to a good actor- must become the role, but in a manner that allows the audience to see This so difficult- it’s a life-time practice

17. The Echo Definition: A verbal reflection of internal thought processes Method: –Explain what you are doing –Filter what you don’t want patient to hear –Interpret what you mean so patient/family can understand Example: Patient with red-eyes

18. The Lateral Pass Definition: A means of changing roles to facilitate new forms of interaction Method: Make patient (or learner) the teacher Examples: –Difficult math problem –“You’re the one with pain, what can you teach us about pain (or dying)”

19. Separating what is modeled from modeling technique What do you wish to model? –Example: respect What method do you wish to use? –Example: sitting with patient, using last name What effect do wish this have have on learners –Example: change in attitude, behavior

20. After the patient encounter Opportunity to re-connect learner to content –“What questions do you have?” Opportunity to evaluate –“What did you see?” –“What was I trying to show when I…” Time to comment- fill in the blanks Time to reinforce/summarize

21. Learner’s goals Important to identify Adult learners tend to filter information in line with their goals –If not addressed a barrier to learning new information Opportunity to demonstrate respect May tailor modeling (or other educational encounters) to these goals

22. Teaching un-traditional medicine in a traditional medical environment Modeling a different kind of care Traditional medical environment has strong rules/rituals –May be an ally (familiar turf to teacher/student) –May be a foe (rules of the game may get in the way of what you are trying to teach) Example: “Pimping” –How to “detoxify” questions

23. Teaching from ignorance We can’t know everything Great potential in teaching from ignorance –Importance of modeling comfort with ignorance-balanced by desire to learn –Potent tool to connect learner to content –Requires self-confidence

24. SUMMARY Modeling- a powerful teaching method Little formal work done on the skills involved in modeling in medicine Definable, teachable modeling skills exist By working on your skills, you will become a more effective teaching