Clinical Teaching Tricks and Tips Julie Story Byerley, MD, MPH

Adult Learning Theory Adults are self-directed –Want to set their own learning objectives –Learn from experience –Want knowledge that can be applied –Learn best in an environment of mutual respect –Want to evaluate their progress

Adult Learning - Applied Teachers should coach, not prescribe Learners should participate, not watch Instruction should occur in the field, not the classroom Learning requires action, reflection, and feedback Jack Ende, assessing Adult Learning Theory as understood by John Dewey

Take home point… It’s not about YOU as a teacher… …it’s about your student/resident as a LEARNER

Case 1 The rotation change is today. You are coming on service with 2 interns who have been there 2 days and 2 students who have been there 3 days. The attending is a “regular”. How will you orient your team?

Day 1 - Establish the Learning Environment Step into the role of educator Connect with the students, interns, and residents Establish your role with the attending Acknowledge that they are working to learn, grow, and improve Ask them what they would like to learn Use key words: TEACH, LEARN, FEEDBACK

Clarify your Expectations Clarify the expectations at the first encounter –How the learner will help you –How you will help the learner –BE SPECIFIC –Provide details When, where, what, how…you want it How your attending wants it Challenge your learner in a supportive environment

Talk with your neighbor… What specifically will you say to orient your learners and establish your expectations?

Case 2 You are working with a brand new student, and you have to go talk with a family others have described as “difficult”. You hope the student learns something, but you don’t want to let the student cause trouble by saying anything inappropriate in this complex situation. How can you assure you do the talking, without the student feeling left out?

Activated Observation Tell the learner what you want him/her to observe Debrief afterwards, allowing them to tell you what they saw

Case 3 You are night float for the first time at Wake. Your intern has now worked with 4 different upper levels at night. How can you let her keep up with a system that works for her, but also be sure you teach her something?

Label Your Teaching “Here, let me teach you this.” “Have you learned..?” “…because I have learned…” “What can I teach you?” “I just taught you something.” “What did I teach you today?” “Name 3 things you learned…”

Add “because” to the end of your sentence

Strategies for Efficient Clinical Teaching Teach in small bites Teach through the work you are already doing Teach the patient in front of the student Think out loud –Say “I’m thinking…” Illustrate your questions and find answers to those questions with your learners

Case 4 You and a learner walk in to do what you thought was a routine admission for bronchiolitis, but you find the child much sicker than was billed…you see respiratory distress and need to quickly intervene. How can you assure the learner gets something out of the experience as well?

Teachable Moments Talk about what is given to you Particularly applicable to procedures, the physical exam, and teaching of communication skills

Case 5 You sent your student down to start the admission in the ED. You arrive and she has talked with the patient for about half an hour. How can you hear about the patient and teach your learner something along the way?

The One Minute Preceptor

One Minute Preceptor An interactive clinical teaching model Allows the learner to focus on knowledge that can be applied, establishing their background knowledge for you to add to

One Minute Preceptor Skills Get a commitment What do you think is going on? Probe for supporting evidence Why do you think that? Teach general rules In this setting, the general issue is…. Support what was done right I agree with…because…. Correct mistakes Next time also think…because….

Case 6 Surprisingly you only have 4 patients on service, and there are 4 learners on the team! How will you make the day worthwhile?

“Teaching Scripts” Planned teaching scripts we are prepared to give when there is down time or when familiar scenarios arise Make a list of 5 and plan how you will address them

Other Techniques in the “Bag of Tricks” Lit review “What if the patient was…?” Role play…pretend I’m your attending…. Teach the patient…. Theme for the day

Giving Feedback A Very Important Teaching Strategy

How to Give Effective Feedback Set the climate and establish the expectations Make it routine (feedback Friday, daily feedback) Maintain the focus on improvement Deal with performance not performer –In negative and positive feedback –Focus on remediable behaviors Separate feedback from evaluation –Give feedback all along –Fill out an evaluation at the end

Label Your Feedback “Would you like some feedback on how you did?” “Here’s some feedback.” “Let me give you some feedback that will improve your presentations.” “Your/our attending is going to want…let me help you with some feedback” “Here’s feedback - next time try this…”

Giving Feedback Effectively: Content Demand self-assessment –What did you do well? –Where do you need to improve? Focus on behavior, not personality Relate feedback to goals and objectives Describe specifics, not generalizations Limit the quantity –Correct one error at a time

FEEDBACK Deal with performance not performer –It took a long time Not “you are slow” –The mother looked confused and unsettled Not “you’re a poor communicator” –This note doesn’t accurately reflect the patient’s condition Not “you are a terrible writer” Keep the focus on what can be improved

Conclusions Teaching is an expectation of your role as a resident Teaching will help you to learn Effective teaching will make your job easier Effective teaching will improve the care of your patients, and the enjoyment of your job