Presentation is loading. Please wait.

Presentation is loading. Please wait.

RATL  Module 2 Teaching 101 Module Created by: John Culberson, M.D., M.S. Assistant Professor of Medicine & Charlene M. Dewey, M.D., M.Ed., FACP Associate.

Similar presentations


Presentation on theme: "RATL  Module 2 Teaching 101 Module Created by: John Culberson, M.D., M.S. Assistant Professor of Medicine & Charlene M. Dewey, M.D., M.Ed., FACP Associate."— Presentation transcript:

1 RATL  Module 2 Teaching 101 Module Created by: John Culberson, M.D., M.S. Assistant Professor of Medicine & Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medicine Web Page and Module Formatting by: Maria Victoria Tejada-Simon, Ph.D. Assistant Professor of Molecular Physiology and Biophysics Residents as Teachers & Leaders

2 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 2 of 130 Welcome Welcome to Module 2: Teaching 101. You should have completed a pre-test for this module. Did you complete the “honesty pledge” question? In that pledge you agreed to take the pre-test first, then read the module and then take the post-test after reading the module. If you did not complete the pre-test, please exit the module now and complete it; then return to the module. Your honesty is appreciated. Click here if you completed the pretest.

3 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 3 of 130 Welcome As a resident physician, you will provide significant and meaningful teaching to students, peers, and even senior residents and faculty. Patient and interdisciplinary education is also an essential part of the healthcare. Your role as a resident teacher will be enhanced by adopting evidence-based teaching principles into your daily routine.

4 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 4 of 130 Welcome Module 2 focuses on teaching skills using a three phase teaching approach. This module is estimated to take minutes. Resources for Module 2 can also be found on the RATL web page.

5 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 5 of 130 Introduction Doctor… What does this word mean to you? A title recognizing a lot of hard work A person skilled in the art of healing An individual who has been taught and has an obligation to teach An individual eligible for licensure to practice medicine

6 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 6 of 130 Introduction While the term physician is defined as “a person skilled in the art of healing,” the word doctor is derived from the Latin term “doctus” “having been taught” and “docere” meaning “to teach.” What does some of the great icons in medicine think about teaching as a physician?

7 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 7 of 130 Introduction "The successful teacher is no longer on a height, pumping knowledge at high pressure into passive receptacles...He is a senior student anxious to help his juniors." -Sir William Osler, The Student Life This statement involves a few key traits of a great teacher. First, it recognizes that teachers are still learners themselves.

8 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 8 of 130 Introduction Second, it implies that the old way of trying to force information into a learner is not the best way to educate. Third, learners are not to be passive receptacles – they should be engaged and involved in their learning. Fourth, the teacher is anxious to help – motivated and enthusiastic about facilitating learning.

9 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 9 of 130 Introduction Fifth, the teacher should not place themselves in a superior position over learners, but rather be at their level to assure learning is bidirectional.

10 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 10 of 130 Introduction “Traditionally, medical residents have not received the formal preparation that is essential to the transmission from full-time learner to at least part-time teacher. Although many residents make that transition successfully through a sort of osmosis, many more do not, and they remain ineffective teachers throughout their residencies. But how can we expect them to do that if we in medical education don’t teach them how?” ~Jordan J. Cohen, M.D., Past-President of the Association of American Medical Colleges Bing-You, Friedland et al, “Resident’s Teaching Skills”, 1999

11 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 11 of 130 Introduction As a teacher, some institutions created a teaching compact between teachers and learners. Do you have a compact between your learners and your institution? Below is an example of the compact at Baylor College of Medicine – it describes the roles and responsibilities of both teachers, learners and the institution. Click on the link below to read, print or save a copy of the Baylor Compact. Click here:

12 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 12 of 130 Introduction As you can see, there are both pledges for the teacher and the learner. Both are important in the education process. More importantly our duty as teachers is stated perfectly as… “All participants in the education mission have a duty to sustain a learning environment conducive to maintaining the knowledge, attitudes, and skills necessary for providing contemporary standards of care. These standards should be respectful of the social contract and thinking essential to the practice of medicine.” ~BCM Education Compact

13 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 13 of 130 Goals Welcome to Module 2. The goals of this module are to: Help you develop your teacher identity. Reflect on characteristics of excellent teachers and leaders. Review the key principles of effective teaching, leadership, and communication.

14 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 14 of 130 Objectives After completing Module 2, you will be able to: Compare and contrast the three (3) parts of organized teaching. Describe the purpose of using learning objectives in teaching. Observe the five steps of the “Microskills Model” of bedside teaching. Discuss the value and proper use of feedback as an essential educational component.

15 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 15 of 130 Agenda Module 2 contains the following content: Teacher Identity Three (3) stages of clinical teaching Creating safe learning environments Organized & efficient teaching Bedside teaching Feedback and evaluation Summary

16 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 16 of 130 Teacher Identity Sir William Osler was and is considered an outstanding teacher and physician. He exemplified teaching of students and residents at the bedside. Here’s a timeless quote regarding your teaching role by Sir William Osler… Sir William Osler,

17 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 17 of 130 The student life, in Aequanimitas: With other addresses to medical students...3rd ed.(Philadelphia: Blakiston's Son, 1932) p.400. "The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.“ ~ Osler 1932 Teacher Identity

18 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 18 of 130 Teacher Identity As a physician you are a care giver, teacher and role model. You cannot NOT teach! Your role automatically implies you are a teacher. You will teach students, patients, peers and others. Your role as a teacher is best summed up as assisting with gaining knowledge and skills development and providing evaluation and feedback to your learners.

19 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 19 of 130 Teacher Identity However, most are not familiar with what they are supposed to teach during a rotation. Have you thought of your teaching role and what content areas you will teach? Think about it for a second. Did you think only about patient care issues or did you also think about the challenges of being a physician, balance, teaching procedures, system issues and cost effectiveness? These and others are all part of your teaching role.

20 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 20 of 130 Teacher Identity Thus you must know what you are responsible for teaching. Teaching is the transfer of knowledge, attitudes, and skills. These three domains correspond to cognitive, affective, and psychomotor domains respectively. DomainBehavior Type Cognitive Affective Psychomotor Knowledge Attitudes Skills

21 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 21 of 130 The best way to know what to teach is by following a written curriculum. The written curriculum is a detailed plan that includes: What is to be taught How it is to be taught How to evaluate its effects – meaning how well it was taught All curricula should have goals and objectives to help guide you. Teacher Identity

22 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 22 of 130 Teacher Identity Goals: are general statements that provide guidance to learners on what they can expect to learn. Objectives: describe specific cognitive, affective or psychomotor behaviors that are to be accomplished by the learner while learning. Stated in terms of a measurable behavior, a well-written objective guides the teacher. Thus your student learning objectives help guide what you need to teach.

23 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 23 of 130 Teacher Identity Example: Goals: To learn how to ride a bike – this is a general description of what’s to be accomplished. Objectives: The learner will ride a 2-wheel bike- pedaling independently after a 2-hr lesson – this is a more specific description of the performance the learner will be able to do as a result of instruction. Note it is a measurable behavior.

24 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 24 of 130 Teacher Identity An important step to being an expert teacher is knowing what to focus your teaching on…take the time to find out what your core student learning objectives are for each rotation. Then make a list of activities you can do for each objective. By knowing what to teach, you are taking on the teacher identity. By asking your learners what they want to learn, you become the teacher and facilitator of new knowledge, skills and attitudes!

25 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 25 of 130 Teacher Identity Does your institution list your student learning objectives for your specialty? Check your medical school’s web page or with your chief resident. Ask for the core student learning objectives…they will be very impressed! (and they should – they may not even be aware of the student objectives…you could start a movement!) “Know your student learning objectives and teach them well!”

26 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 26 of 130 Teacher Identity If you take the time to know your student learning objectives, you will have an idea of the main topics to teach. You are already better off than most residents because you now know where to focus your teaching efforts and what skills are involved. While we could teach about a ton of things in medicine, you have limited time. Focus on what is needed or required, then spend extra or free time teaching other things.

27 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 27 of 130 Teacher Identity A Myth of Clinical Teaching: Unfortunately, in the past, many excellent clinicians have approached clinical teaching as something that “just happens” during the course of routine patient care. Hopefully, these modules will demonstrate that there is more to clinical teaching than simply “throwing one in the fire” or “see-one, do-one, teach-one.”

28 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 28 of 130 Teacher Identity The art of clinical teaching extends far beyond “see-one, do-one, teach-one.” In assuming the role of teacher, the more prepared you are, the more efficient and effective a teacher you will be. Did you know that the LCME, the ACGME, and the AMA all have guidelines on residents as teachers? If interested, read the charges to medical schools over the next few slides or click to skip that part. Learn moreSkip

29 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 29 of 130 Teacher Identity LCME: wants residents to know student learning objectives and be prepared for the teaching role. Programs should have: Written goals/objectives Clear guidance about roles in teaching & evaluation Provide resources (workshops/written materials) to enhance teaching and evaluation skills Central monitoring of resident participation Formal assessment of the teaching/evaluation skills Provide opportunities for remediation if inadequate Use various assessments LCME-ED-24

30 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 30 of 130 Teacher Identity ACGME: The Sponsoring Institution must ensure that residents participate fully in the educational and scholarly activities of their program and, as required, assume responsibility for teaching and supervising other residents and students.

31 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 31 of 130 Teacher Identity The AMA: “In the face of sometimes conflicting demands on their time, educators must work to preserve the priority of education and place appropriate emphasis on the critical role of teacher.” “People in the teaching role (including faculty, residents, and students) need guidance to carry out their educational responsibilities effectively.”

32 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 32 of 130 Teacher Identity Being prepared and giving some thought ahead of time to your teaching style will make you a more efficient, organized and an overall better teacher. For any teaching activity, keep it simple…. 1.Assess your learner’s level of knowledge, skill or attitude 2.Teach to the deficit 3.Assess if they understood it This is a simple recipe for success. A 3-stage process to help you do this is to Prepare, Teach and Reflect.

33 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 33 of 130 Three Stages of Clinical Teaching by Irby: Preparation ReflectionTeaching BeforeDuringAfter Adapted from: David Irby, How attending physicians make instructional decisions when conducting teaching rounds. Acad. Med., 1992; 67(10):

34 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 34 of 130 Three Stages of Teaching Preparation, teaching and reflection. These three stages will keep you focused and organized regardless of whether you are teaching in a patient’s room, in morning report or at a national scientific presentation. Let’s go through the steps in some detail. PreparationReflection Teaching BeforeDuringAfter

35 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 35 of 130 Preparation Reflection Teaching Before DuringAfter Preparation: Prepare yourself and other key players for the teaching process. 1. Learner 2. Teacher 3. Patient 4. Context or learning environment Preparation

36 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 36 of 130 Preparation “It is curious that so many of our most important responsibilities are undertaken without significant preparation. ….The task of medical teaching, on the other hand, is accepted deliberately and dispassionately, yet the preparation for that influential role is equally frail.” ~ GE Miller 1980 in Educating Medical Teachers Preparation

37 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 37 of 130 Preparation Preparation requires organization and the setting of expectations. Organizing & setting expectations with medical students is key!!! Tell students what is expected of them up front. Clerkship expectations are based on their student learning objectives, expectations of professionalism, and service commitments. Preparation

38 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 38 of 130 Preparation-Students There are three ways that you can help students to be prepared to learn in their “clinical classroom.” Ask them what they need to learn. Assist learners in organizing workday and setting priorities. Inform them that patient care is a shared responsibility by all team members. Encourage them to take ownership for their patient’s care. Preparation

39 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 39 of 130 Preparation-Students Keep in mind you will have to help students understand their limitations and when to ask for help! Preparation

40 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 40 of 130 Preparation-Students Assess current knowledge or the “lowest level of the learner” for each student. This is an essential task of the teacher. This helps you identify the area most in need of developing. You can assess their level of knowledge, skill or attitude by asking questions – open ended. This allows you to accurately evaluate a learner’s level so you can teach to their deficits. Why waste time teaching what they already know? Preparation

41 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 41 of 130 Preparation-Students This makes your teaching efficient. Then ask learners, students and patients, to read or learn ahead of time when possible. With the technology available to students today, they can easily look up topics on or on from the team office. Their self learning is very important for retention and efficiency during team rounds.www.pubmed.com Preparation

42 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 42 of 130 Preparation-Students They can also use textbooks and other resources (simulation, videos, web casts, expert opinions, etc.) to help self-teach. Then you as the teacher can focus on the clinical application of the knowledge learned. Directing students to self-teach is a very efficient way of teaching when your time is short or it is late in the day. Preparation

43 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 43 of 130 Preparation-Students Ask the student a few basic, open-ended questions to identify their level of knowledge on the topic. You are making a diagnosis. If they lack basic understanding, they need to do basic self-learning preparation. But don’t forget about yourself!! If you yourself feel uncomfortable with a topic, this method also allows time for you to self-learn before teaching at the bedside. Preparation

44 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 44 of 130 Preparation-Self If you feel uncomfortable with a topic, reviewing the topic ahead of time will also increase your comfort and the student’s perception of your ability. Feel free to ask fellows, chiefs, attendings, nurses, technologists, pharmacists, etc or use other resources to self-teach and prepare yourself. Evidence exists that resident teachers learn the content better because they teach it! So teach often and you will learn better. Preparation

45 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 45 of 130 Preparation-Self Self-learning is vital to protect your patients, especially when teaching potentially harmful or private/personal things such as invasive procedures, a sexual history or doing pelvic exams. Also remember about confidentiality issues when teaching. Avoid discussing identifying information on patients or learners in public spaces. Preparation

46 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 46 of 130 Preparation-Organization In order to complete the process of preparation for teaching, the teacher and learner may organize the workday to establish specific times when teaching will occur. It is important that the student understand that the teaching environment is a shared responsibility. Preparation

47 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 47 of 130 Preparation-Organization Determining in advance, specific patients to best accomplish individual teaching objectives is optimal for both teacher and learner. The next slide consists of a 3 minute photo story sound-bite of how to orient and set expectations with a student. Preparation Click here to skip demonstration Click here to watch demonstration

48 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 48 of 130 Preparation-Skills Teaching procedures requires special skills that will be covered in detail in Module 3. In general, the student must demonstrate a detailed knowledge of the anatomy and technique prior to approaching the patient. The student should be asked to describe the potential complications and problems that might be encountered, and what action is necessary in these circumstances. Preparation

49 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 49 of 130 Preparation-Skills Thus you should never allow a student to perform a procedure on a patient that they are not ready to perform. There are videos, models and simulations that can be used to help students get to the level of performing procedures on patients. You will have to be the judge to determine your own skill, your student’s skill and the risk to the patient. Preparation

50 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 50 of 130 Preparation-Skills We’ll take this time to remind you of the phrase: “Primum non nocere!” – First, do no harm! Never put a patient in danger! Preparation

51 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 51 of 130 Preparation-Patient "Every patient you see is a lesson in much more than the malady from which he suffers.“ ~Sir William Osler, M.D. The student life, in Aequanimitas:With other addresses to medical students...3rd ed.(Philadelphia: Blakiston's Son, 1932) p.406. Preparation

52 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 52 of 130 Preparation-Patient Patients can make significant contributions to the education of all levels of trainees and physicians. They are the optimal learning resource and are often great teachers. Patients, however, also need knowledge of their conditions/diseases and about their health in general (both prevention and management of disease). Preparation

53 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 53 of 130 Preparation-Patient In order to teach at the bedside with a patient, the patient must be present. As the teacher, you are likely to know when patients are out of their rooms for testing or eating a meal. Thus schedule your teaching time around patients’ testing & meals so as not to waste time; but also know that you are not in control of every circumstance and it is possible your team will show up and due to a delay, the patient will be gone. Be flexible and have a back up plan ready. Preparation

54 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 54 of 130 Preparation-Patient Another important issue related to patients in the teaching process is to make sure they are involved and agreeable. Ask their permission the day before or during morning rounds if you can come back with students for teaching later in the day. This demonstrates respect and again enhances your doctor-patient relationship. Preparation

55 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 55 of 130 Preparation-Patient Evidence clearly shows that in general, patients like being a part of the teaching process and want to be involved. However, patients don’t like a lot of people at one time, they want to keep the teaching time short, and they don’t like medical jargon. See more of the key findings by Lehmann et al. on the next slide. Lehmann, et al. NEJM 1997 Preparation

56 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 56 of 130 In 1997 Lehmann et al., surveyed patients about teaching at the bedside, and these were patient’s key recommendations: Limit number of learners Respect patients’ privacy Physicians should be seated Want physicians to pay attention to the presentation ~Lehmann, et al. NEJM 1997 Preparation-Patient Appreciate advanced notification Limit time of session Provide introductions State the purpose Translate medical “jargon” Allow patients to ask questions Preparation

57 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 57 of 130 Preparation-Patient Patient education is another significant topic in teaching. It helps with safety issues and prevention, improves cost utilizations and can increase compliance. But we will not go into all the details in this module. Let’s suffice it to say, you should include patients in your teaching and you should apply all the same principles we will discuss in these four modules. Learning to teach with learners means the learner can be your student or patient. Look for a forth coming module on patient education and safety! Preparation

58 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 58 of 130 As a student, how often did you feel comfortable saying “I don’t know” in front of your colleagues? a.All the time b.Some of the time c.Not often d.Never Preparation-Context Preparation

59 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 59 of 130 A group of first year residents representing all specialties at BCM agreed that they appreciated the right to say “I don’t know” without feeling guilty. While it is imperative that physicians possess the knowledge, attitudes, and psychomotor skills to practice clinical medicine, there will inevitably be times that you just won’t know it all! Preparation-Context Preparation

60 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 60 of 130 The last step in the preparation stage is preparing the learning context or learning environment. You want to create a safe learning environment for everyone and make sure you have everything you need to teach. A “safe” learning environment is positive and encourages honest dialog and interaction in order for all members of the clinical team (students, interns, residents, faculty, nurses, etc.) to continue to grow and learn. Preparation-Context Preparation

61 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 61 of 130 Setting a safe learning environment means everyone should feel safe saying, “I don’t know,” asking questions, and feeling like they are part of a team. You can create a safe learning environment by orienting all the team members to the “ground rules” of the team. You can create your own or use some of these examples. Preparation-Context Preparation

62 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 62 of 130 Preparation-Context Examples of team ground rules: No question is a stupid question. Asking is always better. Every team member should feel comfortable contributing to the discussion. Everyone’s opinion is valuable. You should feel free to stop me if you need clarification on something. Always feel comfortable asking me about the patient's care. As a team we stick together. I don’t know is o.k.! Preparation

63 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 63 of 130 Preparation-Context Do any of these sound familiar? Have you used any of these in the past? Has someone used them with you? Think about how you will set up a safe learning environment for your team. A RATL pocket card is available on the RATL resource page to help orient and set ground rules for your team. Preparation

64 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 64 of 130 Preparation-Context Think of your best experience as a medical student on a ward team. Which of the following terms best describes the context or learning environment that you valued? Inviting Honest Safe Efficient Dedicated Fun Respectful Preparation

65 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 65 of 130 Most of these terms describe elements of a safe learning environment that encourages discussion and open communication. Both “honest” and “safe” create an environment that allows everyone to feel valued, respected, safe, etc. Next time you lead a teaching service – think about preparing your teaching context early and set your ground rules at the beginning of the rotation. Preparation-Context Preparation

66 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 66 of 130 Making sure you have all the teaching tools ahead of time will also be a key component of preparing the learning context. Things to check on include: Room set up Patient and your team will fit in the room Tools, AV, teaching models, etc. are in room Room is comfortable temperature Distractions are limited Preparation-Context Preparation

67 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 67 of 130 Preparation - Context This is important in both clinical teaching and lecturing. Scenario: You are giving a scientific presentation on your research at a noon conference. Is the room set up for your presentation? Is the AV working? Will everyone fit? Is it too hot/cold? Take every step you can to assure a smooth teaching process. Get there early and make sure everything is just as you need it. Have handouts done ahead of time and make sure if food is served it is at the back of the room so late comers won’t interrupt your presentation. Preparation

68 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 68 of 130 Preparation is Life-Long As the teacher and leader, you can help promote a safe learning environment by demonstrating the need to learn and grow as a doctor over time. Learning is a journey… not a destination. It is an admirable goal to remain a “learner” throughout your lifetime. Saying “I don’t know” is o.k. if you make an effort to figure out the right answer – thus further learning will be required. Remember, even Osler said we are all students – we are forever learners. Preparation

69 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 69 of 130 "It goes without saying that no man can teach successfully who is not at the same time a student.“ ~ Osler The student life, in Aequanimitas: With other addresses to medical students...3rd ed.(Philadelphia: Blakiston's Son, 1932) p.419. Preparation-Context Preparation

70 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 70 of 130 In light of the rapid evolution of modern medical advances, a commitment to life-long learning is a core competency at all medical schools and resident training programs. When your answer is “I don’t know,” your next step is look it up or get help. Self-learning is key to keeping up with the changes in health care. Preparation-Context Preparation

71 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 71 of 130 Effective communication is critical to building successful relationships at all levels and will help create a safe learning environment for everyone. Start the month with asking your learners what they hope to get out of the rotation and then letting them know that everyone's opinion is valued and that their questions are not stupid but that they stimulate conversation. Preparation-Context Preparation

72 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 72 of 130 Then spend a few minutes reviewing their student learning objectives and what is expected of them as team members. Are you prepared to teacher your students based on their objectives? Then plan your student orientation. Don’t forget to give them time to communicate their expectations for the month. Preparation-Context Preparation

73 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 73 of 130 Communication will be a theme that will be revisited during this and future modules. The concept of following a brief overview of what you are going to say with specific facts, and finally completing the interaction with feedback regarding specific behaviors will enable others to better understand your expectations and shape their future behavior. Preparation-Context Preparation

74 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 74 of 130 Preparation-Summary In ending our discussion on preparing to teach, you have gained insight into tools for self-learning, preparing your students, patient education and for creating a safe learning environment. Now let’s look at the actual teaching encounter. Preparation

75 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 75 of 130 Teaching Before During Preparation Reflection Teaching After

76 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 76 of 130 Teaching “ Perhaps most important of all, bedside teaching begins to foster another wonderful link with the past. The house staff watches you as carefully as does a child his parent, watch you attend to the patient, watch you observe, they catch your powers of diagnosis, the respect you hold for this other human being; they feel your attitude, your caring. The students witness your own dignity, and love you have for medicine, and for teaching. They link with you, and bond. And mentoring begins.” LaCombe, M.A., Ann Intern Med 1997 Teaching

77 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 77 of 130 Teaching Bedside teaching is an excellent opportunity to apply the principles of clinical teaching in a time-efficient way, while learning in the best context there is…learning from a patient. Osler said in 1903, “There shall be no teaching without the patient for a text, and the best teaching is that taught by the patient himself.” Teaching

78 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 78 of 130 Teaching There are many opportunities to identify “teaching moments” during the routine daily activities of a ward team. Teaching involves a specific pattern of behaviors that can be learned and perfected through practice. After the preparation phase, there are six aspects of clinical teaching to keep in mind: Teaching

79 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 79 of 130 Teaching 1.Create a safe learning environment 2.Diagnose the learners deficits 3.Teach: Teach knowledge to fill in areas of deficits 4.Skills: Break down, demonstrate, then walk through each step 4.Directly observe learners 5.Assist learners when needed 6.Provide continuous formative feedback Teaching

80 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 80 of 130 Teaching After establishing a safe teaching environment, the teacher and student interact to identify and achieve the specific knowledge, attitudes, or psychomotor skills contained in the educational objectives. Teaching

81 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 81 of 130 Teaching As the resident teacher you have to determine the knowledge, skill or attitudinal deficits for each learner. Then you should focus your teaching to that deficit. This keeps teaching focused, efficient, fun and adds significant value to the learner. Teaching

82 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 82 of 130 Teaching There are a number of different methods that may be employed to teach learners. You can chose: 1.Demonstration 2.Observation 3.Educate – provide basic knowledge 4.Role model interpersonal skills or professionalism 5.Assess student presentations with feedback 6.Review charts/notes 7.Patient education Teaching

83 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 83 of 130 Teaching Teachable moments are the “on the spot” teaching episodes that occur when you identify a deficit in knowledge or skill during the course of the work day – it is unplanned – but the process is still the same. Teaching

84 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 84 of 130 Teaching It must be emphasized that student involvement is critical regardless of the method. Students like bedside teaching and need more experience with physical examination and history taking skills in addition to knowledge and experience interacting with a variety of patients. Teaching

85 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 85 of 130 Teaching When you identify a teachable moment or plan to return to a patient’s bedside to teach, you should select the focus or purpose of your teaching effort. Teaching

86 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 86 of 130 Teaching What is the purpose of your teaching? Is your purpose to: 1.Have the student present the patient? 2.Demonstrate a skill to a student/patient? 3.Observe the student performing a history or physical exam? 4.Educate the patient? 5.Review the documentation and charting? Teaching

87 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 87 of 130 Teaching There are several different types of focused teaching experience. Each may have a variety of purposes. The following slides review several examples. Teaching

88 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 88 of 130 Teaching 1.Student presentation – the student presents at the bedside. 2.Demonstration- You show student how to take history, do physical exam, counsel a patient or do procedure. 3.Observation – you observe the student as they take a history, educate a patient; perform a procedure or do a physical exam. Teaching

89 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 89 of 130 Teaching 4.Patient education – teaching the patient about their medical condition and treatments and demonstrating patient counseling for the student. 5.Chart review – assess the quality, clarity and content of the student’s notes, orders or medical forms. Teaching

90 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 90 of 130 Teaching There are several models that describe techniques useful in bedside teaching. We will discuss only one model. Others can be found in the resource pages. The “Microskills Model” (also called the one minute preceptor) is used most often. It may be used at the bedside for either inpatient or outpatient encounters. Teaching

91 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 91 of 130 Teaching There are five steps to the Microskills Model. 1.Get a commitment 2.Probe for supporting evidence 3.Teach general rules 4.Reinforce what was done right 5.Correct mistakes Teaching

92 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 92 of 130 Get a Commitment: Ask the student to commit to a diagnosis, technique, and/or therapeutic plan. Example: A commitment is: “The patient appears to have acute cholecystitis.” A commitment is not: “The patient might have an abdominal problem.” Teaching

93 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 93 of 130 A commitment permits the teacher to identify correct and incorrect clinical thinking and guides the clinical teaching effort. Thus making teaching more focused and efficient. Teaching

94 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 94 of 130 Probe for Supporting Evidence: Why did the student commit to this diagnosis? The use of open-ended questions will permit the student to verbalize their thought process and creates a safe environment. Example: What led you to this conclusion? This encourages the student to reason out loud. You can then assess if they are on the correct path. Teaching

95 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 95 of 130 Teach General Rules: Based upon the clinical case and with an awareness of the student’s current knowledge level, briefly review the content of the specific teaching objective identified for the clinical encounter. A common error is to teach too much material, thereby turning bedside teaching into a long, drawn out, bedside lecture. Teaching

96 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 96 of 130 Example: General rule – “Acute cholecystitis usually presents with RUQ pains that radiate to the right shoulder and is associated with nausea. It is most commonly caused by cystic duct obstruction and inflammation; it does not have to be infectious.” Teaching

97 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 97 of 130 Reinforce what was done right: Be sure to tell the student what they did well so they can keep doing it. Example: “Your organization of this presentation was outstanding. Keep using this format for all your presentations.” Teaching

98 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 98 of 130 Correct mistakes: Make sure to correct any mistakes in skill and/or knowledge. Example: “In thinking about acute cholecystitis, you did not ask about the radiation of the pain and the associated symptoms. You want to ask about these things in every patient suspected of acute cholecystitis.” Teaching

99 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 99 of 130 For a quick recap, what are the five steps in the Microskills Model in the correct order? a)Commit, recap, repeat, teach rule, and reflect b)Commit, repeat, probe, teach rule and reflect c)Commit, probe, reinforce, teach rule and reflect d)Correct, probe, reinforce, teach rule and commit e)Commit, probe, teach rule, reinforce, correct f)Correct, reinforce, teach rule, correct, reflect Click here to see the correct answer. Question Teaching

100 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 100 of 130 Answer The correct answer is E. The five steps of the Microskills Model are: 1.Get a commitment 2.Probe for supporting evidence 3.Teach general rules 4.Reinforce what was done right 5.Correct mistakes Teaching

101 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 101 of 130 To see a demonstration of the Microskills Model, you can go the RATL resources page for a video demonstration or attend the Module 2 workshop. Teaching

102 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 102 of 130 Myth Buster True or False? Pimping (rapid fire questions without order and to embarrass) is an effective way of teaching students. It is a myth that the “pimping” technique is an effective, interactive teaching style. “Pimping” is a series of factual, closed-ended questions that have no direction or purpose except to recall facts. Teaching Answer my questions or you fail!

103 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 103 of 130 Myth Buster It is clear that “pimping” (questioning a learner without a purpose or direction to the point of embarrassment) does not create a “safe” learning environment due to a perceived imbalance in power. It can create fear in the student and causes them to shut down or stop talking. Questioning students is essential for assessing their knowledge and stimulating their learning. But we must use our questioning appropriately. Teaching

104 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 104 of 130 Myth Buster Use questions to guide your learner to the correct answer – not to intimidate them into a frantic and wrong answer. Practice using both open-ended and closed-ended questions during your teaching sessions. Teaching

105 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 105 of 130 Use of Questions Here are some examples of open-ended questions you can use while assessing learners and probing for evidence. Example: Tell me a little about how you came to this conclusion. Think out loud about your thoughts on this disease. Share your ideas about what is going on with this patient. What makes you think that? What would be your management plan for this patient? Teaching

106 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 106 of 130 Use of Questions As you can see, open-ended questions have no quick answers. There is, however, a role for factual questions or closed-ended questions. They help identify knowledge of facts quickly. Thus you don’t have to avoid them all the time and they should be used in balance with open-ended questions. Teaching

107 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 107 of 130 Use of Questions Balance the two types so when you need a fast response such as during a code, you get a quick answer. Resident: ”Have you ever done CPR before?” Student: “No!” Resident: Go to the nurses station and ask them to call a code then return. Teaching

108 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 108 of 130 Use of Questions This is another example of good communication – knowing what type of question to use and when. Contrast this form of teaching with a typical case presentation in “Morning Report.” The large group setting is an excellent teaching environment to model the thought process involved in generating a differential diagnosis. It allows the learner to think out loud. Teaching

109 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 109 of 130 Teaching Remember to include the patient in the bedside teaching encounter. This is an excellent opportunity to model doctor-patient communication. Teaching that involves medical terminology above the understanding of the patient may best be accomplished in a setting away from the patient. However, it is important to rephrase the information for the patient before leaving the bedside. Teaching

110 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 110 of 130 Teaching When teaching procedures, the teaching phase requires more immediate assistance and continuous formative feedback. This feedback must be provided in such a way as to maintain appropriate teacher- learner and doctor-patient relationships. More information on teaching procedures and feedback is covered in Modules 3 & 4. Teaching

111 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 111 of 130 Reflection The Reflection Phase: 1.Elicit learner response 2.Provide feedback 3.Develop a plan for achieving competency Before During Preparation Reflection Teaching After

112 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 112 of 130 Reflection The importance of the reflective phase of clinical teaching cannot be over-emphasized. Both learners and teachers need to reflect on the process and find ways of improving it. Reflection “Let’s think about what just happened.”

113 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 113 of 130 Reflection-Student Once you complete a teaching encounter, ask the student to reflect on it and ask them what went well for them. This reinforces for you, what you did well so you can keep doing it; but it also provides you a glimpse into the student’s view so you can adopt new teaching concepts to meet their needs. Try to use an open-ended question so the student feels comfortable speaking freely. Reflection

114 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 114 of 130 Reflection-Student Example: “So tell me, how did that go for you?” Pause and allow student to answer, then follow up with, “What went well?” After listening to the student’s reflection, you can respond appropriately and prepare to provide your feedback. Reflection

115 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 115 of 130 Reflection-Feedback Feedback is a process by which a teacher provides a learner with the results of an evaluation for the purpose of improving the learner’s performance. There are two major types of feedback: Formative Feedback Summative Feedback Reflection

116 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 116 of 130 Reflection-Feedback Formative: The learner receives immediate and continuous feedback during a teaching moment. Summative: The teacher provides a formal summation of feedback at the end of a training session/rotation. This is often used for evaluation, which is defined as a measure of competence at achieving the specific teaching objectives. Reflection

117 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 117 of 130 Reflection-Feedback Feedback and evaluation will be covered in more detail in Module 4. As with the other phases of clinical teaching, the reflective phase requires practice and attention to detail. The clinical teacher who recognizes the importance of this phase will immediately understand its utility. There are eight characteristics of good feedback. The goal of all feedback is to shape behaviors. Reflection

118 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 118 of 130 Reflection-Feedback Effective feedback is: Expected Timely Positive Specific Nonjudgmental Systematic Based upon observations Of regulated quantity Balanced Kronke, K. J Gen Int Med, Reflection

119 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 119 of 130 Reflection-Feedback Student performance can provide much information to the teacher about the effectiveness of their teaching. Did students achieve the competencies specified in the educational objectives? In this way, the reflective phase becomes feedback for the teacher in addition to the student. Reflection

120 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 120 of 130 Reflection-Planning The last thing to do during your reflection of the teaching process is planning for the future. You and your student should come up with a collaborative plan to continue the learning process. This can be as simple as suggesting the student read a review article on acute cholecystitis or planning for the next attempt at a venipuncture. Reflection

121 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 121 of 130 Reflection-Planning In the end, this process should not take but a few minutes but it carries a significant amount of weight for improving the student’s knowledge, attitudes or skills. Reflect on how you might summarize a teaching encounter with a student and plan for further development of yourself as a teacher and the student or patient as a learner. Reflection

122 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 122 of 130 Summary In summary - Clinical teaching is recognized as an essential aspect of postgraduate medical education and your role as a physician. National organizations such as the LCME (Liaison Committee on Medical Education) and the ACGME (Accreditation Counsel on Graduate Medical Education) have charges to medical institutions to provide residents with basic teaching skills.

123 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 123 of 130 Summary With the emphasis on residents as teachers, many institutions have implemented training programs and added questions to student evaluation forms assessing their resident’s ability to teach. Organized teaching is efficient teaching and is very important as you help guide each student in obtaining new knowledge, attitudes and skills.

124 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 124 of 130 Summary Excellent teaching is highly valued by students and is the product of resident physicians who have assumed a teaching identity. The excellent teaching resident uses adequate preparation, teaching, and reflection skills to create a “safe learning environment” while modeling professional behavior.

125 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 125 of 130 Summary This, in turn, creates an environment in which members of the health care team work together to provide excellent patient care in an environment of academic scholarship.

126 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 126 of 130 Take Home Points You are both a teacher and a learner! Keep the preparation, teaching, reflection model in mind and use it for monthly rotations or small bedside teaching encounters. Remember to include the patient in the teaching of learners. “I don’t know” is always a safe answer – then encourage self-directed learning to find out the correct answer.

127 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 127 of 130 Take Home Points Create safe learning environments. Use the 5 Microskills Model for teaching learners. Reflection is your role as much as it is the learner’s role. Feedback should be expected and timely. You are always role modeling – be it teaching skills, professionalism, humanism, empathy or sympathy – be a good one!

128 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 128 of 130 Closing Instructions You have now successfully completed Module 2: Teaching 101. Please take the post-test for this module immediately upon completion. The evaluation form and other learning materials for module 2 can be found on the main RATL web page. Thank you for participating!!!!!

129 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 129 of 130 PDF References 1.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Busari- Whyresidentsshouldteach-2004.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Busari- Whyresidentsshouldteach-2004.pdf 2.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/5Microskillsf orclinicalteaching(material).pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/5Microskillsf orclinicalteaching(material).pdf 3.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/adultlearnin gtheoryslides(material).pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/adultlearnin gtheoryslides(material).pdf 4.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Agrawall- TechnicalSkillseditorial_April07.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Agrawall- TechnicalSkillseditorial_April07.pdf 5.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/bedsideteac hing.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/bedsideteac hing.pdf 6.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/bedsideteac hingslides(material).pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/bedsideteac hingslides(material).pdf 7.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Bensinger- Residentsasteachers.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Bensinger- Residentsasteachers.pdf 8.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Whittaker- Studentperceptionsofresidentteachersinsurgery-AmJSur pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Whittaker- Studentperceptionsofresidentteachersinsurgery-AmJSur pdf 9.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Gill- NeurolRAT pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Gill- NeurolRAT pdf 10.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/James- RATskillsinmorningreport pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/James- RATskillsinmorningreport pdf 11.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Morrison- 13hrcourseinRATskills.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/Morrison- 13hrcourseinRATskills.pdf 12.http://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/BaylorTeach ingCompact-2005.pdfhttp://www.mc.vanderbilt.edu/medschool/otlm/ratl/references_pdf/Module_2/BaylorTeach ingCompact-2005.pdf

130 RATL  Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, Module 2 Slide 130 of 130 RATL Home


Download ppt "RATL  Module 2 Teaching 101 Module Created by: John Culberson, M.D., M.S. Assistant Professor of Medicine & Charlene M. Dewey, M.D., M.Ed., FACP Associate."

Similar presentations


Ads by Google