Presentation is loading. Please wait.

Presentation is loading. Please wait.

Module 2 Teaching 101 Residents as Teachers & Leaders

Similar presentations


Presentation on theme: "Module 2 Teaching 101 Residents as Teachers & Leaders"— Presentation transcript:

1 Module 2 Teaching 101 Residents as Teachers & Leaders
4/14/2017 Module 2 Teaching 101 Residents as Teachers & Leaders 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 Adaptations RATL title Change Culberson title to Assistant Prof Remove icons

2 Click here if you completed the pretest.
Welcome Welcome to Module 2: Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

3 4/14/2017 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

4 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

5 Introduction Doctor… What does this word mean to you?
4/14/2017 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 Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

6 4/14/2017 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? Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

7 4/14/2017 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

8 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

9 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

10 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

11 4/14/2017 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: Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

12 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

13 Goals Welcome to Module 2. The goals of this module are to:
4/14/2017 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. Justify left Remove icons Introduction sentence and then goals Take out leader – is in module 1 Into sentence identical for Mod1 and Mod2 goals Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

14 Objectives After completing Module 2, you will be able to:
4/14/2017 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. Justify left Remove icons Intro statement then bullets/numbers Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

15 Agenda Module 2 contains the following content: Teacher Identity
4/14/2017 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 Justify left Remove icons Font Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

16 4/14/2017 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… Justify left Remove icons Sir William Osler, Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

17 4/14/2017 Teacher Identity "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 Move picture to first slide and enlarge quote The student life, in Aequanimitas: With other addresses to medical students...3rd ed.(Philadelphia: Blakiston's Son, 1932) p.400. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

18 4/14/2017 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

19 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

20 4/14/2017 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. Domain Behavior Type Cognitive Affective Psychomotor Knowledge Attitudes Skills Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

21 4/14/2017 Teacher Identity 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

22 4/14/2017 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

23 Teacher Identity Example:
4/14/2017 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. Remove icons add “are after goals and objective to make sentences Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

24 4/14/2017 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! Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

25 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!” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

26 4/14/2017 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. Justify left Remove icons Add what skills are included as well Font size Add or required after what is needed first. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

27 Teacher Identity A Myth of Clinical Teaching:
4/14/2017 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.” Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

28 4/14/2017 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. Justify left Remove icons Learn more Skip Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

29 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

30 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

31 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

32 4/14/2017 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…. Assess your learner’s level of knowledge, skill or attitude Teach to the deficit 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. Justify left Remove icons Change second line in paragraph 2 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

33 Three Stages of Clinical Teaching by Irby:
4/14/2017 Three Stages of Clinical Teaching by Irby: Preparation Teaching Reflection Remove icons Before During After Adapted from: David Irby, How attending physicians make instructional decisions when conducting teaching rounds. Acad. Med., 1992; 67(10): Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

34 Three Stages of Teaching
4/14/2017 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. Justify left Remove icons Preparation Teaching Reflection Before During After Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

35 4/14/2017 Preparation Preparation Preparation Teaching Reflection During After Before Preparation: Prepare yourself and other key players for the teaching process. Learner Teacher Patient Context or learning environment Preparation Remove icons Angle cone down more Add: other key individuals are the… Add quote from marines on slide and add just before this one. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

36 Preparation 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

37 4/14/2017 Preparation 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

38 Preparation-Students
4/14/2017 Preparation 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. Justify left Remove icons Font Make two slides Limits or limitations??? Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

39 Preparation-Students
4/14/2017 Preparation Preparation-Students Keep in mind you will have to help students understand their limitations and when to ask for help! Justify left Remove icons Font Make two slides Limits or limitations??? Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

40 Preparation-Students
4/14/2017 Preparation 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? Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

41 Preparation-Students
4/14/2017 Preparation 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. Justify left Remove icons font Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

42 Preparation-Students
4/14/2017 Preparation 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. Justify left Remove icons font Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

43 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

44 4/14/2017 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

45 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

46 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

47 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. Click here to skip demonstration Click here to watch demonstration Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

48 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

49 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

50 Preparation-Skills We’ll take this time to remind you of the phrase:
4/14/2017 Preparation 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! I could not get a picture of Caduceus to open on my VA computer Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

51 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

52 Preparation 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). Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

53 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

54 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

55 Preparation 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

56 Preparation Preparation-Patient In 1997 Lehmann et al., surveyed patients about teaching at the bedside, and these were patient’s key recommendations: Appreciate advanced notification Limit time of session Provide introductions State the purpose Translate medical “jargon” Allow patients to ask questions Limit number of learners Respect patients’ privacy Physicians should be seated Want physicians to pay attention to the presentation ~Lehmann, et al. NEJM 1997 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

57 Preparation 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! Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

58 Preparation-Context As a student, how often did you feel
4/14/2017 Preparation Preparation-Context As a student, how often did you feel comfortable saying “I don’t know” in front of your colleagues? All the time Some of the time Not often Never Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

59 4/14/2017 Preparation Preparation-Context 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! Justify left Move to safe learning environment in teaching 101 or module 2 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

60 4/14/2017 Preparation Preparation-Context 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. Justify left is positive…what?? Explain more or is good or is best - move to teaching 101 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

61 4/14/2017 Preparation Preparation-Context 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

62 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.! Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

63 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

64 4/14/2017 Preparation 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 Justify left Remove icons 2 columns for larger font Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

65 4/14/2017 Preparation Preparation-Context 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. Justify left Remove icons Font Too much on one slide Split into 2 slides Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

66 4/14/2017 Preparation Preparation-Context 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 Justify left Remove icons Font Too much on one slide Split into 2 slides Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

67 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

68 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

69 4/14/2017 Preparation Preparation-Context "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. Move to module 2 or use to emphasize module 2 teaching identity Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

70 4/14/2017 Preparation Preparation-Context 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. Justify left Move to teaching 101 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

71 4/14/2017 Preparation Preparation-Context 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. Justify left Remove icons Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

72 Preparation Preparation-Context 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

73 4/14/2017 Preparation Preparation-Context 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. Feedback??? Or communication – change locations Move to module 2 – teaching and communication Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

74 Preparation 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

75 Teaching Teaching Before During Preparation Reflection After
Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

76 Teaching 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

77 Teaching 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

78 Teaching 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: Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

79 Teaching Create a safe learning environment
Diagnose the learners deficits Teach: Teach knowledge to fill in areas of deficits Skills: Break down, demonstrate, then walk through each step Directly observe learners Assist learners when needed Provide continuous formative feedback Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

80 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

81 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

82 Teaching Teaching There are a number of different methods that may be employed to teach learners. You can chose: Demonstration Observation Educate – provide basic knowledge Role model interpersonal skills or professionalism Assess student presentations with feedback Review charts/notes Patient education Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

83 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

84 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

85 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

86 Teaching What is the purpose of your teaching? Is your purpose to:
Have the student present the patient? Demonstrate a skill to a student/patient? Observe the student performing a history or physical exam? Educate the patient? Review the documentation and charting? Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

87 Teaching Teaching There are several different types of focused teaching experience. Each may have a variety of purposes. The following slides review several examples. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

88 Teaching Student presentation – the student presents at the bedside.
Demonstration- You show student how to take history, do physical exam, counsel a patient or do procedure. Observation – you observe the student as they take a history, educate a patient; perform a procedure or do a physical exam. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

89 Teaching Teaching Patient education – teaching the patient about their medical condition and treatments and demonstrating patient counseling for the student. Chart review – assess the quality, clarity and content of the student’s notes, orders or medical forms. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

90 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

91 Teaching There are five steps to the Microskills Model.
Get a commitment Probe for supporting evidence Teach general rules Reinforce what was done right Correct mistakes Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

92 Teaching Teaching 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

93 Teaching Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

94 Teaching Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

95 Teaching Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

96 Teaching Teaching 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

97 Teaching Teaching 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

98 Teaching Teaching 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.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

99 Click here to see the correct answer.
Teaching Question For a quick recap, what are the five steps in the Microskills Model in the correct order? Commit, recap, repeat, teach rule, and reflect Commit, repeat, probe, teach rule and reflect Commit, probe, reinforce, teach rule and reflect Correct, probe, reinforce, teach rule and commit Commit, probe, teach rule, reinforce, correct Correct, reinforce, teach rule, correct, reflect Click here to see the correct answer. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

100 Teaching Answer The correct answer is E. The five steps of the Microskills Model are: Get a commitment Probe for supporting evidence Teach general rules Reinforce what was done right Correct mistakes Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

101 Teaching Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

102 Myth Buster True or False?
Teaching 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. Answer my questions or you fail! Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

103 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

104 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

105 Teaching 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? Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

106 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

107 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

108 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

109 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

110 Teaching 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

111 Reflection The Reflection Phase: Elicit learner response
Preparation Teaching Reflection Before During After The Reflection Phase: Elicit learner response Provide feedback Develop a plan for achieving competency Reflection Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

112 Reflection 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. “Let’s think about what just happened.” Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

113 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

114 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

115 Reflection 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 Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

116 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

117 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

118 Reflection-Feedback Effective feedback is: Expected Timely Positive
Specific Nonjudgmental Systematic Based upon observations Of regulated quantity Balanced Kronke, K. J Gen Int Med, 1992. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

119 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

120 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

121 Reflection 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

122 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

123 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

124 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

125 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

126 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. Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

127 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! Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

128 Closing Instructions You have now successfully completed
4/14/2017 Closing Instructions You have now successfully completed Module 2: Teaching 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!!!!! Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

129 PDF References Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

130 RATL Home Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.


Download ppt "Module 2 Teaching 101 Residents as Teachers & Leaders"

Similar presentations


Ads by Google