1. Todd Felix, MD, Sam Faber, MD, Dave Richard, MD
Coffee Talks: A Novel Approach to Teaching Evidence Based Higher Order Thinking Skills
STFM- Houston
January, 2011
Todd Felix, MD, Sam Faber, MD, Dave Richard, MD

2. Objectives
Create an interactive learning environment that promotes higher order thinking skills (HOTS) in clinical decision making
Review Evidence-based Medicine (EBM) precepts in a case based format
Formally institute EBM education in Family Medicine clerkship curriculum

3. Coffee Talks
History: a format developed to expand a learner’s HOTS given time constraints for teaching “on the run” in a busy practice
Starting in , this was expanded to include all third year clerks on the Family Medicine rotation within 1 hour of campus (7-11/month) midway through their rotation in a half-day session
Discussion is facilitated by 3 Family Medicine faculty members

4. Format
Students are required to bring a case they have seen during the rotation for discussion allowing for “buy-in” and avoiding faculty-driven assignments
All students are brought into discussion with faculty facilitation
Faculty have no prior knowledge of case – “stump the chump”
Average case takes minutes

5. Concepts This is what a Family Practitioner does daily:
1) How do we think through the case?
2) What is important to know?
3) What determines what we ask, examine, order, and/or prescribe for the patient?
4) At each step, how does this change our differential diagnosis and WHY??

6. Teaching Moments
Continuous refinement of a differential diagnosis and treatment plan – examining the available clues
While the story unfurls, the differential narrows
Why do we choose a certain clinical path – what changed as we learned more?

7. What’s the evidence?
Builds upon EBM curriculum from years 1 & 2 – specifically approach to utilizing e-resources
Students are asked to develop at least one clinical question for each case presented
Led by Family Medicine and library science faculty, the students are introduced to the concepts of Information Mastery that are utilized to answer questions that clinicians encounter daily in the practice of medicine
The goal is to develop learning habits that the students can use for lifelong education

8. EBM Format
Students are grouped in pairs/triads to review the identified clinical questions
Under the auspices of a faculty member, they identify available resources, formulate the clinical question, search valid electronic resources, and answer the question with supporting evidence.

9. EBM Resources

10. EBM Discussion
Students return to main group to review how they answered their assigned questions, what evidence was found, and how they found it
Students are able to share their experiences with their colleagues enhancing their abilities to learn other approaches

11. Putting it all together
Coffee Talks teaches students to use clinical reasoning to gather, evaluate and interpret information, formulate clinical questions and, when appropriate, search for the answers in available EBM resources.
Highlights clinical experiences, collaboration with colleagues, literature review and professionalism in patient care

12. Limitations
Faculty expertise – but the point is also how we deal with what we don’t know as a learning paradigm
We did not see the patient – diagnoses and treatments are multi-factorial so we do review what was done and why by the preceptor
“The rest of the story” – we may have only gotten some of the story

13. Evaluations

14. Evaluations

15. Future Directions
PICO (Patient, Information, Comparison, Outcome) presentation by (individual) students on a clinical question they have identified
Expansion of HOTS to include formalized education on medical decision making
Export the concepts behind Coffee Talks to other clerkships during the third year

16. Thanks!
Questions??