A Framework for Effective Clinical Teaching Skills John (Jack) D. Buckley, MD, MPH Henry Ford Hospital April 9, 2005

GOALS Review our Teaching Duty Review our Teaching Duty Introduce a validated Educational Framework designed to enhance effective teaching skills Introduce a validated Educational Framework designed to enhance effective teaching skills Framework Outline Framework Outline Seminars Seminars Personal Goal Setting Personal Goal Setting Demonstration Demonstration

Are Good Teachers Simply Born? Is it genetic and you either have it or you don’t? Is it genetic and you either have it or you don’t?OR Can ineffective teachers become better? Can ineffective teachers become better? Can you make a good teacher even more effective? Can you make a good teacher even more effective?

Traditional Teaching of Clinical Medicine If you know the material, you can teach it. If you know the material, you can teach it. See one, do one, teach one See one, do one, teach one I teach the same way as I was taught. I teach the same way as I was taught. The ceiling effect The ceiling effect

“I’m a good teacher. The problem is they aren’t very good learners.” -Anonymous faculty member

“Self-pity and projected blame – the recipe for a well-lived life!” -Parker, The Courage to Teach, 1998

How much formal training in teaching skills have you had?

Train-the-Trainer Model Stanford Faculty Development Center Clinical Teaching Program Seminar Facilitators Seminar Participants (Faculty & Residents) LearnersInstitution

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate The tone or atmosphere of the clinical teaching setting including whether it is stimulating and whether learners can comfortably identify and address their limitations. The tone or atmosphere of the clinical teaching setting including whether it is stimulating and whether learners can comfortably identify and address their limitations. Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session The manner in which the teaching interaction is focused and paced as influenced by the teacher’s leadership style. The manner in which the teaching interaction is focused and paced as influenced by the teacher’s leadership style. Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals The establishment and explicit expression of a teacher’s and/or learner’s expectations for the learners. The establishment and explicit expression of a teacher’s and/or learner’s expectations for the learners. Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention This category describes approaches the teacher can use to: This category describes approaches the teacher can use to: Explain the content being taught Explain the content being taught Have the learner meaningfully interact with that content, thus assisting the learner to understand and retain it. Have the learner meaningfully interact with that content, thus assisting the learner to understand and retain it. Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation The process by which the teacher assesses the learners’ knowledge, skills, and attitudes, based on criteria related to the educational goals. The process by which the teacher assesses the learners’ knowledge, skills, and attitudes, based on criteria related to the educational goals. Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback The process by which the teacher provides learners with information about their performance for the purpose of improving their performance. The process by which the teacher provides learners with information about their performance for the purpose of improving their performance. Promoting Self-Directed Learning Promoting Self-Directed Learning Stanford Faculty Development Center

Categories of Effective Teaching Skills Learning Climate Learning Climate Control of Session Control of Session Communication of Goals Communication of Goals Promoting Understanding and Retention Promoting Understanding and Retention Evaluation Evaluation Feedback Feedback Promoting Self-Directed Learning Promoting Self-Directed Learning This form of learning is initiated by the individual learner’s needs, goals, and interests. This category deals with approaches the teacher can use to influence learner motivation and use of resources, thereby fostering self- directed learning. This form of learning is initiated by the individual learner’s needs, goals, and interests. This category deals with approaches the teacher can use to influence learner motivation and use of resources, thereby fostering self- directed learning. Stanford Faculty Development Center

Seminars: The Full Package Eight sessions Eight sessions One dedicated to each category One dedicated to each category One for reviewing personal / institutional goal setting One for reviewing personal / institutional goal setting Two-hours each Two-hours each Components Components Mini-lecture Mini-lecture Review and Analysis of video Review and Analysis of video Role Play Role Play Goal Setting Goal Setting

Seminar Descriptions cont. These seminars are NOT: These seminars are NOT: Rules Rules A proscriptive method for good teaching A proscriptive method for good teaching They are intended to: They are intended to: Increase your awareness of your own teaching skills. Increase your awareness of your own teaching skills. Use the framework to analyze your teaching. Use the framework to analyze your teaching. Use the framework to help identify options that may improve your teaching. Use the framework to help identify options that may improve your teaching.

Does THIS framework actually work? Clinical Teaching Program - 18 years old Clinical Teaching Program - 18 years old 99 facilitators from over 60 academic medical centers. 99 facilitators from over 60 academic medical centers. Over 2000 participants Over 2000 participants 76 peer-reviewed manuscripts 76 peer-reviewed manuscripts

Clinical Teacher Model: Assessment Improving Clinical Teaching: Evaluation of a National Dissemination Program. -Skeff KM et al. Arch Intern Med Faculty rated seminars as highly useful and would recommend to others. Faculty rated seminars as highly useful and would recommend to others. Pre & Post Seminar Faculty Questionnaires Pre & Post Seminar Faculty Questionnaires Rated teaching ability higher after seminars Rated teaching ability higher after seminars Pre & Post seminar Housestaff (85%) and Medical Student (15%) Questionnaires Pre & Post seminar Housestaff (85%) and Medical Student (15%) Questionnaires Rated teaching higher Rated teaching higher

Clinical Teacher Model: Assessment Use of faculty development to improve ambulatory care education. - Stratos GA et al. Med Teacher Facilitators: faculty development program: 64 ambulatory teachers: 11 western region VA institutions 10 Facilitators: faculty development program: 64 ambulatory teachers: 11 western region VA institutions Participants rated usefulness: 4.8 on a 5 pt Likert Participants rated usefulness: 4.8 on a 5 pt Likert Clinical teaching skills self assessments pre-post intervention: p<.001 improvement in all 7 domains Clinical teaching skills self assessments pre-post intervention: p<.001 improvement in all 7 domains

Clinical Teacher Model: Applications Factorial Validation of a Widely Disseminated Educational Framework for Evaluating Educational Framework for Evaluating Clinical Teachers. -Litzelman DK et al. Acad Med Reduced the 58 subcomponents to 25 items Reduced the 58 subcomponents to 25 items Found overlap between descriptors of teacher knowledge and promotion of self directed learning Found overlap between descriptors of teacher knowledge and promotion of self directed learning Provides evidence that the 7 category framework is a valid and useful way to analyze complex teaching activity Provides evidence that the 7 category framework is a valid and useful way to analyze complex teaching activity

LEARNING CLIMATE (1) A. DEFINITION B. EDUCATIONAL PURPOSE C. TIMING (initial, ongoing) D. KEY COMPONENTS Stimulation Learner Involvement Respect/Comfort Admission of Limitations

LEARNING CLIMATE (2) D. KEY COMPONENTS & SPECIFIC BEHAVIORS 1. STIMULATION TEACHING BEHAVIORS: show enthusiasm for topic and for learners show interest through body language use animated voice provide conducive physical environment 2. LEARNER INVOLVEMENT TEACHING BEHAVIORS: look at learners listen to learners encourage learners to participate avoid monopolizing discussion

LEARNING CLIMATE (3) D. KEY COMPONENTS & SPECIFIC BEHAVIORS 3. RESPECT/COMFORT TEACHING BEHAVIORS: use learners' names acknowledge learners' problems/situation invite learners to express opinions state respect for divergent opinions avoid ridicule, intimidation, or interruption 4. ADMISSION OF LIMITATIONS TEACHING BEHAVIORS: acknowledge learner limitations invite learners to bring up problems admit own errors or limitations avoid being dogmatic

Demonstration: Learning Climate Participants: Participants: Attending Physician Attending Physician Fellow Fellow Resident Resident 4 th -year Medical Student 4 th -year Medical Student Setting: Setting: Morning Rounds in the Intensive Care Unit Morning Rounds in the Intensive Care Unit

Personal Goal Setting: Specific Teaching Behaviors STIMULATION show enthusiasm for topic and for learners show interest through body language use animated voice provide conducive physical environment LEARNER INVOLVEMENT look at learners listen to learners encourage learners to participate avoid monopolizing discussion RESPECT/COMFORT use learners' names acknowledge learners' problems/situation invite learners to express opinions state respect for divergent opinions avoid ridicule, intimidation, or interruption ADMISSION OF LIMITATIONS acknowledge learner limitations invite learners to bring up problems admit own errors or limitations avoid being dogmatic

Summary Effective teaching is more than an art. Effective teaching is more than an art. Teaching requires a conscious effort, practice, and self-assessment. Teaching requires a conscious effort, practice, and self-assessment. A framework can help you improve your teaching skills. A framework can help you improve your teaching skills.