1. Teaching and Learning with Patients
Tutors:
Angela Rowlands
Dr Dason Evans
Professor Annie Cushing
Teaching and Learning with Patients CILT 2015

2. Teaching with Patients
Identify challenges to effective
teaching in clinical settings &
devise strategies to overcome them.
Best Practice in setting up a teaching session & negotiating learning outcomes with students
Appreciate the importance of preparation, debriefing, feedback, reflection and planning any changes as a result
Plan for today:
Setting the scene
Some tools, some theory
Practice
Feedback
Teaching and Learning with Patients CILT 2015

3. Group Discussion Teaching with Patients
What do you hope students will learn when you teach with patients?
What are the challenges of teaching with patients?
What things help students learn in this context? (from your experience as a teacher and/or a learner).
Increases relevance for student
Holistic – patient centred method
Narrative of patient illness
Diversity of patient / understanding difference
Development of Empathy
Development of professionalism
Patients can provide feedback
Teaching and Learning with Patients CILT 2015

4. A spectrum of involvement
paper-based or electronic case/scenario
standardised/simulated patient
patient shares their experience with students within faculty-directed curriculum
patient teacher(s) involved in teaching and/or evaluating students
patient teacher(s) as equal partner in student education, evaluation and curriculum development
patient(s) involved at the institutional level in addition to sustained involvement as patient teacher(s) in education, evaluation and curriculum development for students.
There is a range of patient involvement from cadaver/patient notes/anaesthetised patient  partnership teaching  Expert patients  embedded om the institution
Towle, A., Bainbridge, L., Godolphin, W., Katz, A., Kline, C., Lown, B., Thistlethwaite, J. (2010). Active patient involvement in the education of health professionals. Med Educ, 44(1),

5. Teaching and Learning with Patients CILT 2015

6. Teaching and Learning with Patients CILT 2015
Some Tools, some Theory
Teaching and Learning with Patients CILT 2015

7. Click here to skip videos
The one minute teacher
Trainee presents a patient encounter
Get a commitment
Probe underlying reasoning
Reinforce what was done well
Help learner identify & give guidance on omissions/errors
Teach general principle
SPENCER, J Learning and teaching in the clinical environment. BMJ, 326,
Click here to skip videos

8. The One Minute Teacher (preceptor)
Teaching and Learning with Patients CILT 2015

9. SNAPPS teaching
The key is that the learner drives the process, including deciding what they want to ask the teacher.
Students need to be briefed on the process beforehand
The learner…
Summarises the history and findings briefly
Narrow differential to two or three relevant possibilities
Analyse differential by comparing & contrasting possibilities
Probe the clinical teacher with specific questions about uncertainties, difficulties or alternative approaches
Plan management for the patient’s medical issue
Select a case-related issue for self-directed learning

10. SNAPPS https://www.youtube.com/watch?v=rywuzkm8nmY

11. Making the implicit explicit
‘Thinking aloud’
- You often make rapid decisions based on well practised reasoning, ‘thinking aloud’ makes these thought processes explicit to the trainee
‘Talking the talk’
- Each speciality has its own language, unwritten rules of behaviour, culture. Consider sharing some of these with your trainees.
‘Modelling’
- “Do what I say, not what I do” unfortunately does NOT work.
Debriefing
- “Did you notice what happened then?” Helping trainees recognise undercurrents, eg in your consultation with an angry patient.

12. Teaching and Learning with Patients CILT 2015
Planning for learning
Teaching and Learning with Patients CILT 2015

13. Gagné’s instructional events
A. Setting the stage
Step 1: motivate
Step 2: explaining target objectives/level for session
Step 3: Stimulating prior recall
B. Core learning activities
Step 4: General info/overview
Step 5: individualise the information
Step 6: Students apply the learning
Step 7: Providing feedback
C. Summarizing and extending the learning process
Step 8: Assessing learning gain
Step 9: Encourage ongoing practice, SDL and transfer
This is a basic lesson plan for the session
Adapted From O'Connor, H. M. (2002). "Training undergraduate medical students in procedural skills." Emerg Med (Fremantle) 14(2):

14. Steps in Experiential Learning
Preparation - Students & Patient
Action
Feedback & Debrief
Consolidation & New learning goals
Ref: A framework to maximise students’ learning from each patient contact
(modified from Dent and Harden 2001)
Teaching and Learning with Patients CILT 2015

15. Intro Body Close Time Structure T activity S activity
Resources and comments
Intro
Body
Close

16. Teaching and Learning with Patients CILT 2015
References
Spencer J. (2003) Learning and teaching in the clinical environment BMJ 326:
Ker J, Cantillon P, Ambrose L. (2009) Teaching on a ward round BMJ 338: 770-2
Cantillon P, Sargeant J (2008) Giving feedback in clinical settings
Aspergren K, Blomquist P, Borgstrom A. (1998) Live patients and problem-based learning. Medical Teacher 20, No.5;
Ramani S (2003) Twelve tips to improve bedside teaching. Medical Teacher 25, 2; 112-5
Dent J Harding R (2001) A Practical Guide for Medical Teachers. Churchill Livingstone.
Irby, D. M., & Wilkerson, L. (2008). Teaching when time is limited. BMJ, 336(7640), doi: /bmj AD
Wolpaw, T. M., Wolpaw, D. R., & Papp, K. K. (2003). SNAPPS: a learner-centered model for outpatient education. Acad Med, 78(9),
Teaching and Learning with Patients CILT 2015

17. Teaching and Learning with Patients CILT 2015
Practice
Examples of teaching situations
Discussion
Plan
Practice – participants as ‘students’ and teachers.
Teaching and Learning with Patients CILT 2015

18. https://qmul.onlinesurveys.ac.uk/c11120150413
Course evaluation
Teaching and Learning with Patients CILT 2015