Teaching tips

Society for Academic Emergency Medicine Teaching in residency u PGY-1: Core content u PGY-2: Supervisory roles in MICU, SICU u PGY-3: Supervisory role in ED, teaching workshops and procedural lab u Other: Outside lectures, workshops, ACLS courses

Society for Academic Emergency Medicine Overview u Curriculum development and instructional systems design u Characteristics of adult learners u Using questions and feedback to promote critical thinking u Effective presentation styles u Teaching procedures

Society for Academic Emergency Medicine What is learning? u A planned behavior change that has permanence u Based on KSA (Knowledge, Skills, and Attitudes)

Society for Academic Emergency Medicine Determine Learning Outcomes Develop Evaluation Procedures Determine Instructional Strategies Select Media & Methods Develop Instruction Implement Instruction Evaluate Instruction

Society for Academic Emergency Medicine Curriculum development and instructional systems design u Determine learner outcomes u Develop evaluation process u Determine instructional strategies u Select media and methods u Develop instruction u Implement instruction u Evaluate instruction

Society for Academic Emergency Medicine Objectives u Facts: information with arbitrary relationship u Concepts: classes of elements with common characteristics u Principles: correlational effects, explains WHY u Procedures: set of sequential steps performed to accomplish purpose, explains HOW

Society for Academic Emergency Medicine Facts Overdosing on facts is like giving thyroxine to a tadpole-you get an instant frog, but unfortunately a rather small one Smith L: Medical education for the 21st century. J Med Educ 60: , 1985

Society for Academic Emergency Medicine Characteristics of adult learners u Experienced u Oriented by need/problem (WII-FM) u Learners decide content u Concerned for immediate need u Prefer active learning u Skills-oriented u Informal u Self-directed u Equal u Intrinsic rewards

Society for Academic Emergency Medicine Information giving and Prescribing u Limit the amount of information given u Give the most important facts first u Stress importance of information to learners needs u Avoid jargon u Relate information to the problem at hand u Use repetition for emphasis u Make instructions specific, behavioral, and measurable u Present alternately acceptable treatments or procedures

Society for Academic Emergency Medicine People will remember u 10% of what they read u 20% of what they hear u 30% of what they see u 50% of what they see and hear u 70% of what they say and write u 90% of what they do

Society for Academic Emergency Medicine Six levels of cognitive objectives u Knowledge u Comprehension u Application u Analysis u Synthesis u Evaluation

Society for Academic Emergency Medicine Questioning u Teachers talked 70% of time u Asked questions 4% of time u Wait time of 1.8 sec

Society for Academic Emergency Medicine Questioning Clinical teachers can make sure that their interactions simulate problem solving by asking questions rather than giving answers. Learners may think they are learning more by being given answers, but actually being asked questions is far more productive

Society for Academic Emergency Medicine Effective clinical teaching behaviors u Creates positive learning environment u Communicates expectations (avoids assumptions) u Controls session u Uses questions to guide and promote understanding u Provides tangible and constructive feedback u Uses techniques to increase understanding: the FACS model. Focus… Activate… Crystallize… Summarize u Motivates and energizes group with personal commitment and enthusiasm

Society for Academic Emergency Medicine Counterproductive instructor behavior u Discussion stoppers *teacher talks 75% of time *teacher answers 75%of their own questions *teacher cuts-off or interrupts students u Providing indirect feedback with WDY questions *Why Did You u Feedback focuses on whats wrong rather than whats right

Society for Academic Emergency Medicine Helpful instructive behaviors u Guide learning with questions (FPC) *Focus, Probe, Challenge u Ask questions that explore the why and how as well as the what, when, and where u Give learners time to answer questions or perform procedures (dont interrupt!)

Society for Academic Emergency Medicine Constructive feedback u Provide useable feedback (not just you did lousy) u Limit the quantity of feedback: stick to the main points u Remember the 4 Ps: praise in public, perfect in private u Use the collective we: were still having a little trouble with…

Society for Academic Emergency Medicine Constructive feedback u Use the praise sandwich: praise…corrective feedback…praise u Use appropriate timing: no distractions, adequate time for discussion, no one freaking out (student or teacher) u Be descriptive and specific: avoid WDY messages, focus on actions, not presumed intentions u Develop several calming responses to defensive reactions from students * Okay, Im sure you feel this way now, but lets look down the road… * Fine, I can appreciate that, but I want you to know my perspective

Society for Academic Emergency Medicine Questions (summary) u Avoid discussion stopping behavior u Avoid WDY questions u Use FPC questions u Ask why and how as well as what and when u Provide constructive feedback u Wait long enough for a response

Society for Academic Emergency Medicine Effective presentation skills u Say what you are going to say, say it, and say it again u Elements of lecture: introduction, body, summation and closure u Paper primacy u Advantages of lectures u Disadvantages of lectures

Society for Academic Emergency Medicine The 10 commandments of slidemaking u Keep it simple u Talk more-show less u Be visually consistent u One message, one slide u Never apologize for a slide

Society for Academic Emergency Medicine The 10 commandments of slidemaking u Design for the back row u Use only readable type face u Make headlines u No red text u Drive 55…. 5 words per line, 5 lines per slide

Society for Academic Emergency Medicine Levels of competency u Unconsciously incompetent u Consciously incompetent see one u Consciously competent do one u Unconsciously competent do one more

Society for Academic Emergency Medicine Teaching procedures u Do not talk about superfluous material (indications...) u Break down the procedure in small parts (demonstrate) u Have learner verbalize parts of procedure u Stop learner if they do something incorrect (with procedures people do NOT learn from their mistakes, they learn their mistakes) u Give enough supervised practice

Society for Academic Emergency Medicine Resources u Whitman N. and Shenk TL. The physician as teacher. Whitman and Associates 1997 (801) u Bland et al. Successful faculty in academic medicine. Essential skills and how to acquire them Springer u Irby D. Teaching and learning in ambulatory care settings: A thematic review of the literature. Acad Med 70: , 1995

Society for Academic Emergency Medicine Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5: , 1994 u Paid attention to my concerns u Highlighted essential points to remember u Explained, demonstrated, practiced climbing maneuvers u Balanced talking and doing u Explained safety system, made efficient use of time, set comfortable pace u Divided time fairly among group

Society for Academic Emergency Medicine Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5: , 1994 u Clarified learner goals and objectives u Explained the plan for the day u Let learner know what to expect u Got to know learner well before teaching u Offered help when the learner was stuck u Provided positive feedback to encourage learners

Society for Academic Emergency Medicine Author Credit – Teaching Tips: Felix Ankel MD Questions

Society for Academic Emergency Medicine Postresidency Tools of the Trade CD 1) Career Planning – Garmel 2) Careers in Academic EM – Sokolove 3) Private Practice Career Options - Holliman 4) Fellowship/EM Organizations – Coates/Cheng 5) CV – Garmel 6) Interviewing – Garmel 7) Contracts for Emergency Physicians – Franks 8) Salary & Benefits – Hevia 9) Malpractice – Derse/Cheng 10) Clinical Teaching in the ED – Wald 11) Teaching Tips – Ankel 12) Mentoring - Ramundo 13) Negotiation – Ramundo 14) ABEM Certifications – Cheng 15) Patient Satisfaction – Cheng 16) Billing, Coding & Documenting – Cheng/Hall 17) Financial Planning – Hevia 18) Time Management – Promes 19) Balancing Work & Family – Promes & Datner 20) Physician Wellness & Burnout – Conrad /Wadman 21) Professionalism – Fredrick 22) Cases for professionalism & ethics – SAEM 23) Medical Directorship – Proctor 24) Academic Career Guide Chapter 1-8 – Nottingham 25) Academic career Guide Chapter 9-16 – Noeller