1. PROFESSIONAL DEVELOPMENT October 3, 2013 Dr. V. Antao MD, CCFP FCFP, MHSc, Dr. G. Mand MBBS, CCFP, Dr. J. McCabe, MD, CCFP, Dr. Yves Talbot and Dr. Yee-Ling Chang were involved in the creation of this session. STRATEGIES FOR EFFECTIVE TEACHING IN AMBULATORY CARE

2. This set of slides is adapted for DFCM Open. You can download these slides at www.dfcmopen.com/item/basics-effective- teaching. www.dfcmopen.com/item/basics-effective- teaching

3. “ The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” ~William Arthur Ward TEACHING STRATEGIES

4. OBJECTIVES Acquire an increased awareness of challenges in ambulatory care Review the One Minute Preceptor Model as a teaching strategy Review other common teaching strategies and teaching methods

5. OBJECTIVES Be familiar with some resources available to clinician teachers to address common teaching challenges

6. CHALLENGES IN TEACHING Reflect on your own experience: How do you teach? What challenges do you face teaching in your office?

7. ONE MINUTE CLINICAL PRECEPTOR Focuses teaching on learners reasoning Based on 5 Microskills 1. Get a Commitment 2. Probe for evidence 3. Teach general rules 4. Provide feedback 5. Correct mistakes Neher J et al., A Five Step Microskills Model of Clinical Teaching. J. Am Board of Fam Practice, 5:419-24, 1992

8. GET A COMMITMENT What do you think is going on with this pt? What investigations are indicated ? What do you think needs to be accomplished on this visit? * resist asking data gathering questions at this time

9. PROBE FOR SUPPORTING EVIDENCE What are the major findings that lead to your conclusion ? What else did you consider ? What made you choose this particular treatment ? * “thinking out loud” rather than grilling

10. TEACH GENERAL RULES Keep it brief and focused on identified issues Instruction is more memorable when offered as a general rule

11. REINFORCE WHAT WAS DONE RIGHT Be specific General praise does not reinforce a particular behaviour

12. CORRECT ERRORS Consider appropriate time and place Start with learner self evaluation Consider language

13. “ Who dares to teach must never cease to learn.” ~John Cotton Dana TEACHING STRATEGIES

14. COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE 1) Orienting learner 2) Prioritizing or assessing learning needs 3) Problem-oriented learning 4) Priming * 5) Pattern recognition 6) Teaching in the patient’s presence* Heidenreich C et al., Pediatrics 105:231-237,2000

15. COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE 7) Limiting teaching points * 8) Reflective modelling 9) Questioning 10) Feedback 11) Teacher/learner reflection Heidenreich C et al., Pediatrics 105:231-237,2000

16. PRIMING Orientation of learner to pt. and tasks before entering room 1-2 min 1. Tasks 2. Attending role 3. Patient 4. Product

17. TEACHING IN THE PATIENT’S PRESENCE Learner presents findings to preceptor in front of patient –Increases preceptor time with patient –Enables direct verification of history/findings –Enables direct observation –Saves time

18. LIMITING TEACHING POINTS Focus on a few main points, less teaching, more learning General rules more memorable, more transferable At end of clinic, address other issue in more detail At next session review unresolved issues

19. CONCLUSIONS/SUMMARY There are numerous challenges associated with clinical teaching Effective teaching strategies may be used in ambulatory care A learner centred model of teaching is the One-Minute Preceptor (OMP)

20. REFLECTIVE EXERCISE Implement a Method/Strategy -consider using the sample LOG –Why did you chose this method? –Why was approach effective/ineffective? –What would you do differently next time? and why?

21. TEACHING LOG This is a teaching log created by Dr. Helen Batty and used in the Academic Fellowship Program.

22. EFFECTIVENESS OF TEACHING IMPROVEMENT INTERVENTIONS Effective Teaching Interventions: Workshops Teaching Evaluations with Consultation Faculty development fellowship programs Wilkerson L et al., Strategies for Improving Teaching practices: A Comprehensive Approach to Faculty Development. Academic Medicine1998

23. RESOURCES Local undergrad/postgrad/PD representatives Rubenstein W, Talbot Y. Medical Teaching in Ambulatory Care, 2003 Neher J et al., A five Step Microskills Model of Clinical Teaching. J. Am. Board. of Fam. Prac. 5:419-421,1992 Aagard E et al., Effectiveness of the One minute Preceptor Model for Diagnosing the Patient and Learner: Proof of Comcept. Academic medicine 79:42-49,2004

24. TEACHING STRATEGIES Case discussion Case review Direct observation Chart review Chart stimulated recall Criterion chart review Role play Short didactic presentation Rubenstein W, Talbot Y Medical Teaching in Ambulatory Care 2003

25. “ If you have knowledge, let others light their candle at it.” ~Margaret Fuller TEACHING STRATEGIES

26. Thank You