CHAMP Teaching on Today’s Wards Session 1 – Improving the Process Chad Whelan, MD Julie Johnson, PhD Paula Podrazik, MD

Today’s Agenda 10:00 – 10:10Overview of Teaching on Today’s Wards, Sessions 1-5 and Introduction to Session 1 10:10 – 10:30Introduction to Mapping the Process 10:30 – 11:15Small Group Exercise 11:15 – 11:25Break 11:25 – 11:45Debriefing from Small Group Exercise 11:45 – 12:00Take Home Points and Homework Assignment for Session 2

Teaching on Today’s Wards Overall Objectives Recognize teaching as a processRecognize teaching as a process Review & affect barriers to teachingReview & affect barriers to teaching Link to Clinical Teaching courseLink to Clinical Teaching course Link to ACGME competenciesLink to ACGME competencies Develop Strategies forDevelop Strategies for –Improving teaching on today’s wards –Teaching ACGME competencies Learn some new tools for applying these strategiesLearn some new tools for applying these strategies

Clinical Teaching Course Improving Your Teaching Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

ACGME Competencies What are they? Patient CarePatient Care Medical KnowledgeMedical Knowledge Practice-based Learning & Improvement Practice-based Learning & Improvement Interpersonal & Communication Skills Interpersonal & Communication Skills Professionalism Professionalism Systems-based Practice Systems-based Practice

Teaching on Today’s Wards Session Outline Sessions #1-2 Review your teaching process — successes and barriersReview your teaching process — successes and barriers Recognize how your process influences the decisions you makeRecognize how your process influences the decisions you make Sessions #3-5 Teaching systems-based learningTeaching systems-based learning Teaching practice-based learningTeaching practice-based learning Teaching lifelong learningTeaching lifelong learning

Teaching On Today’s Wards Session #1 Objectives Learn generalizable process mapping skillsLearn generalizable process mapping skills Recognize teaching as a processRecognize teaching as a process Map your teaching processMap your teaching process –Link to communication –Link to professionalism –ID successes and problem areas

Teaching on Today’s Wards Session #1 Intro. –teaching process on the wardsIntro. –teaching process on the wards Overview of the month-long processOverview of the month-long process –Setting goals –Setting expectations –When can teaching occur? –Preventing burn-out

Teaching on Today’s Wards Session #1 Overview of the day on the wardsOverview of the day on the wards –Setting goals –Setting expectations –ID the teachable moment –Incorporate the clinical trigger Maintaining Balance!!!?!!!?Maintaining Balance!!!?!!!?

What is your Primary Goal when on the Wards? Achieving Excellence in Clinical Care and TeachingAchieving Excellence in Clinical Care and Teaching Providing outstanding teaching and clinical care, getting your work done, getting residents home, and maintaining balanceProviding outstanding teaching and clinical care, getting your work done, getting residents home, and maintaining balance

Teaching on Today’s Wards Session #1 Intro. to mapping the teaching processIntro. to mapping the teaching process Demonstration of sample teaching mapsDemonstration of sample teaching maps –Link to teaching professionalism –Link to teaching communication Small Group exerciseSmall Group exercise

Process Mapping A process map or flowchart is a picture of the sequence of steps in a processA process map or flowchart is a picture of the sequence of steps in a process Useful forUseful for –Planning a project –Describing a process –Documenting a standard way for doing a job –Building consensus about the process (correct misunderstandings about the process)

Process Mapping Ovals are beginnings and endingsOvals are beginnings and endings Boxes are steps or activitiesBoxes are steps or activities Diamonds are questionsDiamonds are questions Arrows show sequence and chronologyArrows show sequence and chronology

“The first step is to draw a flow diagram. Then everyone understands what his job is. If people do not see the process, they cannot improve it.” W.E. Deming, 1993

Process Mapping Can be “high-level” to get an overview of the processCan be “high-level” to get an overview of the process Go to see patient Go to next patient Team meets in work room Rounds complete Bedside teaching? No Yes Make teaching point

Process Mapping Can also be very detailed and “drilled down” to show the details and rolesCan also be very detailed and “drilled down” to show the details and roles Team has test results to review Team meets in work room Team leaves work room Team prioritizes order to see patients Team Discusses routine patients

Process Mapping Detailed process maps are especially helpful to standardize and improve processesDetailed process maps are especially helpful to standardize and improve processes For use as an improvement tool, it is important to map the current process, not the desired processFor use as an improvement tool, it is important to map the current process, not the desired process

Process Mapping The teaching processThe teaching process –Sample maps in handout Disclaimer before looking at mapsDisclaimer before looking at maps –The evidence about how to teach/where to teach is mixed –There isn’t a wrong or right way – they are just different

Process of Teaching Post Call Day – Case Study 1

Process of Teaching Post Call Day – Case Study 2

How Are These Processes Similar/Different? What, if anything, surprises you about the maps?What, if anything, surprises you about the maps? What are some similarities between the maps?What are some similarities between the maps? What are some differences between the maps?What are some differences between the maps? Where are links to communication and professionalismWhere are links to communication and professionalism

Small Group Exercise Mapping Your Process The Goals of this exercise are toThe Goals of this exercise are to –Learn how to create a process map –Recognize teaching as a process –Recognize the differences in our teaching processes InstructionsInstructions –Form a dyad –Interview each other to create the first draft of the process map of your post call day

Demonstration Mapping Chad’s process (a hypothetical process for example purposes)Mapping Chad’s process (a hypothetical process for example purposes)

Small Group Exercise Debriefing Re-group discussion sessionRe-group discussion session –What insights do you have about your teaching process? –Where in your process does teaching occur? –Where does teaching not happen because of clinical care needs?

What are some of the barriers to teaching on the wards? What are some of the barriers to teaching on the wards?

Some of the barriers we came up with... Time constraintsTime constraints MisdiagnosisMisdiagnosis Maintaining resident interestMaintaining resident interest Power strugglesPower struggles When can I call it a day?When can I call it a day? ??????

Take Home Points from Process Mapping Everyone has his/her own style for teachingEveryone has his/her own style for teaching Being explicit about your process for teaching will provide insight into how to improve the process / overcome some of the barriersBeing explicit about your process for teaching will provide insight into how to improve the process / overcome some of the barriers This type of exercise can be applied to any issue that you want to understand and improve – the method can be generalizedThis type of exercise can be applied to any issue that you want to understand and improve – the method can be generalized

Homework Assignment Finalize your process mapFinalize your process map Review your process teaching mapReview your process teaching map –ID the successful portions of your map –ID the problem areas of your map –Link your process to the best places to teach communication and professionalism –Where does your process serve you well? –Where does your process start to interfere with the ultimate goal of achieving excellence in teaching? How will these teaching activities affect providing clinical care?