1. Teaching 101: Becoming an Effective Teacher
Text
Brent Mothner, MD, FAAP Assistant Professor of Pediatrics Pediatric Hospital Medicine
Meghan McClure, MD, FAAP
Assistant Professor of Pediatrics
Pediatric Hospital Medicine
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2. Disclosure We have no financial disclosures Text
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3. The task faced by the clinical teacher “is unique in the entire realm of teaching. In no other field does the nature of the material demand of the teacher this degree of preparedness without preparation.”
Reichsman F, Browning FE, Hinshaw JR. Observations of undergraduate clinical teaching in action. J Med Educ 1964; 39:147-63

4. Objectives To identify features of effective teaching sessions
To list at least 2 methods to enhance interactivity in teaching sessions
To understand the importance of setting expectations, asking questions, and giving feedback in the clinical setting
Text
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5. Activity
Pair-share
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6. Activity
Think for a moment about a positive learning experience you had with a teacher. How did they enable a more positive learning environment? Why were they memorable?
Pair-share
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7. Your Teaching Toolbox In the Classroom In the Clinic:
Format optimization
Interactivity
In the Clinic:
Role Modeling
- One Minute Preceptor
Feedback

8. In the Classroom

9. Average retention rate after 24 hours ________________ 5% 10% 20% 30%
50%
75%
90%
________________
Verbal processing
_____________
Verbal and visual
Doing
Listening
Reading
Audiovisual
Demonstration
Discussion group
Practice by doing
Teach others/immediate use
National Training Laboratories for Applied Behavioral Sciences, Alexandria, VA
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10. What might matter (a lot)
Student characteristics – THE LEARNERS
Learning conditions
Materials
Criterion tasks
Implementation issues
THE SESSION AND THE PRESENTER
Attention spans are short. Retention seems to be improved with varying activities.
Active learning exercises promote increased thought and caring about the material.
Dunlosky J et al. Improving students’ learning with effective learning techniques…Psych Sci Public Interest 2013;14(1):4-58
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11. https://www.polleverywhere.com/multiple_choice_polls/ IEJZwZXFLbrF0xC

12. https://www.polleverywhere.com/multiple_choice_polls/ lGP8yX5emSTDBxF

13. Characteristics of a the presenter
Capture and sustain attention
Employ effective delivery techniques
Build trust and community
Present information in organized, structured manner
Encourage interaction

14. Research on student attention in lectures has demonstrated that attention levels naturally vary during lectures in predictable ways. In fact, attention is high during the first minutes, then it falls down and stays flat for the rest of the lecture. Toward the end of the lecture, attention picks up again, with some fluctuation, according to the following graph (Bligh 2000). The implication of this finding for teaching is that instructors need to periodically grab and refocus student attention. Several of the suggestions above will serve this function (e.g., examples, periodic summaries, instructional cues requesting attention or signaling a transition). In addition, these techniques are likely to elicit attention:The implication of this finding for teaching is that instructors need to periodically grab and refocus student attention. Several of the suggestions above will serve this function (e.g., examples, periodic summaries, instructional cues requesting attention or signaling a transition).
ctionalstrategies/lectures.html
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15. https://learningtechnologies. epigeum
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16. https://learningtechnologies. epigeum

17. Characteristics of session
Introduction, with goals and objectives
Present only 3-5 concepts
Cluster information in 15 minute segments
Incorporate questions, activities, discussions between segments
1 concept every minutes 
monologues by the instructor not longer than minutes.
Interactive questions allow the working memory to rest and allows attention span to reset and sensory input from the immediate memory to again be efficiently transfer to the working memory
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18. https://www.polleverywhere.com/free_text_polls/VP9Ib KITh6vNeoe

19. Interactive Techniques: Activities
Audience Response:
PollEverywhere- Multiple choice, word cloud
Card selection
ARS
Format – debate, mini lecture, pair share, etc..
Flipped Classroom

20. Interactive Techniques: Materials
NearPod platform
Print-bingo.com : create custom bingo cards
Custom scavenger hunts/ crossword puzzles. (puzzlemaker.com)

21. Scenarios Do we have any scenarios to put here?
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22. In the Clinic

23. Planning Orient the learner to your expectations AND
Give the learner the opportunity to orient you to their expectations and background

24. Orienting the Learner
Not meant to be a “traditional” orientation session
Issues & behaviors that are expected
Doesn’t take a lot of time
Can be supplemented with written material
Need not occur in a single session
May be the best spent 10 minutes of the educational encounter!
Get to know who your learner is and what learning objectives they may have.
Orientation should include a quick tour of the ED, give pertinent phone numbers, charting issues, how to discharge and admit patients

25. How do you foster learning?
Create a safe learning environment
Lay down the ground rules
Define roles
Stimulate discussion
Be available
Teach to the level of the learner
Use higher order questions
Use a variety of teaching techniques

26. Behaviors to avoid “Pimping” Frequent interruptions Making judgments
Inappropriate behaviors
Humiliating learners
Arguing
Criticizing colleagues and learners

27. Questioning as a teaching tool
Why do we ask a lot of questions in medicine?
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28. Questions… To evaluate what learners know
To encourage analytical thinking
To role model the need to question

29. Types of questions Analysis/Synthesis Recall
Requires learners to show an understanding of the topic
Can be used to assess the learner’s knowledge, skills and attitudes
How do the patient’s symptoms relate to each other?
Recall
Facts
Scientific
Medical
Patient information
What are three causes of abdominal pain?

30. Types of questions Application Self-assessment
Ask the learner to apply knowledge to a specific patient
How will you treat this patient’s pain?
Can you show me if this patient has ascites?
Self-assessment
Central to ACGME competency of “practice-based learning’
Do you have enough experience to comfortably manage this patient with complex congenital heart disease?

31. Practice
Rephrase a question to a colleague that was going to be a “yes or no” and identify the added value to the information received.
Formulate a question that inspires critical thinking

32. One Minute Preceptor 1. Get a commitment Ask them:
–What do you think is going on?
--What would you like to do next?
Critical to help the learner to process the key facts that they have just presented. Try to get them to commit to a diagnosis- right or wrong.
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33. One Minute Preceptor 2. Probe for supporting evidence
Questions to ask:
– What led you to that conclusion?
--What factors in the history and physical support this diagnosis?
--What made you rule out other diagnoses?
Ask the learner what made them come to conclusion that they did. Ask them the other diagnoses they were considering and why they ruled those out. This can help you to identify holes in their knowledge or that they just made a “lucky guess”. Resist the immediate urge to agree or disagree with their assessment.
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34. One Minute Preceptor 3. Teach general rules: “Pearls”
--These specific physical exam findings make up the triad of xxx
--I agree that this patient likely has xxx, we generally get this follow up study or start this medication in this situation
At this point a teaching pearl that is salient to the case can be taught. Try to stick to general rules and concepts that can be easily applied to the case. Resist the urge to tell the learner anything and everything that pertains. At this point you can also role model looking up resources if you are unsure- eg clinical guidelines.
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35. One Minute Preceptor 4. Reinforce what was right
“Great job, great presentation” is not specific enough.
– Specifically, you did an excellent job of…
--Your diagnoses of XXX is well supported by the history and physical exam findings that you describe, I can tell that you considered XXX but the facts that you describe appear to rule these out.

36. One Minute Preceptor 5. Correct Mistakes
Discuss errors as soon as possible.
– Next time this happens, try this…
--Although I agree with you that XXX is a potential diagnoses, in this case I believe that the more likely thing is XXX because of XXX.
Focus on the behavior or lack of knowledge and not the individual. If possible allow the individual to critique their performance and attempt to identify their weaknesses themselves.
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37. Role Modeling Modeling shows learners what they can be.
More than just professional behavior and knowledge
Your excitement, enthusiasm and attitude sets the tone for the entire group

38. Think and Reason Out Loud…
Show your learner your reasoning process
“I am thinking whether I need to call orthopedic surgery to perform a bone biopsy for this patient with presumed osteomyelitis or should I call interventional radiology?”
Versus, “Call Ortho”
Often, we are thinking while the team sits or stands quietly. Demonstrate aloud your process.

39. Motivation = Effective facilitator
Serve as a catalyst for learning!
Remember the E’s:
Encouraging
Empowering
Enabling
Enthusiastic
Allow session to be learner centered
Assist in developing clinical reasoning

40. Giving Feedback Make sure learner is ready
Give feedback soon and often
Link feedback to specific objectives
Be specific & non-judgmental
Give positive and constructive comments
Barriers to feedback: Lack of direct observation
Lack of clearly stated standards
No vocabulary for trainee/learner deficiencies
Concern about emotional reaction
Lack of role models in own training
Lack of preceptor initiative
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41. Giving Feedback Suggest correct performance Don’t give too much
Make sure feedback is understood
Follow up your feedback
Expect learners to develop skills in self-evaluation
An example of how to give feedback may be “I think you’re working in a very professional manner – one thing standing between you and your patients however is … “strong odor”, “the black lipstick you wear”, etc.

42. Giving Feedback – useful questions
What are your goals for this rotation?
How do you think it’s going?
What has gone well so far?
What could be improved?
What will you do next time?
What changes can you make?

43. Group Feedback Ever try feedback in a group setting?
Peer feedback utilized by all team members
Great opportunity to receive feedback
“What did you learn? What was useful? How could we have improved?”

44. Today’s session Introduction, with goals
Present only 3 concepts/learning objectives
Cluster information in ~15 minute segments
Incorporate questions, activities, discussions between segments
Have learners DO something with the information

45. Today’s Interactive Techniques
Pair-Share
Audience Response
Group brainstorming

46. Summary
Active learning exercises promote increased thought and caring about the material
Keep in mind characteristics of the learners, presenters and presentation when planning interactive learning sessions
Enhance learning in the clinical setting by setting expectations, understanding your learner, asking good questions and giving timely feedback

47. References and Credits
Dr. Geeta Singhal
Whitman and Schwenk, The Physician as Teacher,2nd edition, 1997.
Dunlosky J et al. Improving students’ learning with effective learning techniques…Psych Sci Public Interest 2013;14(1):4- 58
Newble and Cannon, A Handbook for Medical Teachers, 4th edition, 2001
Weinholtz and Edwards, Teaching During Rounds,1992
Muething, et al. “Family-Centered Bedside Rounds: A New Approach to Patient Care and Teaching,” Pediatrics, April
Balmer,et al.” Learning Behind the Scenes: Perceptions and Observations of Role Modeling in Pediatric Residents” Continuity Experience,” Ambulatory Pediatrics, 2007.
SD Brookfield, The Skillful Teacher, San Francisco, CA. Jossey-Bass,1990.
Smith, C.,et al. “Evaluating the Performance of Inpatient Attending Physicians”, JGIM, July 2004.
Ramani, S., “Twelve Tips to Improve Bedside Teaching,”Medical Teacher, Vol 25, No.2, 2003,pp