1. Experiential Education: Maximizing the Teaching Moment Frank Massaro, PharmD and Lynne Sylvia, PharmD

2. April 28, 2010 2 Experiential Education “Tell me and I will forget, show me and I may remember, involve me and I will understand.” Confucius, c 550 BCE

3. April 28, 2010 3 Experiential Education Experiential education involves learning through experience in an immediate and relevant setting. How do people learn in an experiential setting? How can we engage our residents in activities that have real consequence? What teaching strategies are most effective in developing professional competence?

4. April 28, 2010 4 Experiential Education 5:30 Monday morning

5. April 28, 2010 5 Experiential Education Characteristics Needs Characteristics

6. April 28, 2010 6 Experiential Education Characteristics Needs Characteristics

7. April 28, 2010 7 Experiential Education Education is the kindling of a flame, not the filling of a vessel. Socrates 470 BCE How do we kindle the flame?

8. April 28, 2010 8 How do people learn? Constructivism Knowledge: CO = SV x HR Assumptions: All patients with HF have EF < 40% Experiences: Grandpa has HF Heart Failure Rotation: How will I help the resident create new knowledge? How will I help him use the knowledge he already has?

9. April 28, 2010 9 Preparing for the Resident “I had a different kind of relationship with the residents. It was important to bring them to a higher level. They can’t wait to get to that higher level, but they have to start at the beginning.” Louis P. Jeffrey Personal Communication (Paul L Jeffrey) from an Oral History of LP Jeffrey, 4/14/10

10. April 28, 2010 10 Preparing for the Resident How often do you… Ask about the resident’s prior experiences –Will your rotation be a side trip or part of the journey to professional competence? Assess their starting points –What are their self-assessments of baseline cognitive, psychomotor and affective learning relative to your rotation? Identify assumptions –What do they understand about your rotation? What are their perceptions of what you do, to whom you provide care? Review reflections on learning –What do they value? What have they yet to experience?

11. April 28, 2010 11 “…education is not what the teacher gives and is not acquired by listening to words, but by experiences upon the environment.” Maria Montessori,c1909 “To Serve, To Strive, and not To Yield” Outward Bound Motto Where does learning take place?

12. April 28, 2010 12 Experiential Education Foundation Skills and Knowledge Practical Application Culminating Integration Direct Instruction Modeling Coaching Facilitation (Source: Nimmo CM, Green SA, Gurerro R, Taylor JT, eds. Staff development for pharmacy practice. Washington, DC: ASHP:2000)

13. April 28, 2010 13 Recognizing the Teaching Moment Look Listen Feel

14. April 28, 2010 14 Problem-based Learning Massaro FJ, Harrison MR, Soares A. Use of problem-based learning in staff training and development. Am J Health-Syst Pharm. 2006;63:2256-9 Develops the skills necessary for: Critical thinking Self-directed learning Communication Collaboration

15. April 28, 2010 15 Problem-based Learning Massaro FJ, Harrison MR, Soares A. Use of problem-based learning in staff training and development. Am J Health-Syst Pharm. 2006;63:2256-9 JM is a 26 year-old man who came to the urgent care clinic complaining of fatigue, swelling of his feet and dark brown urine. Want to KnowKnowHypothesesLearning Questions

16. April 28, 2010 16 Kolb’s Experiential Learning Cycle Interview patient about medication allergies Duration? Quality? Patient response? Hypotheses: Duration Quality, Response Revise the interview Technique Test hypotheses

17. April 28, 2010 17 Experiential Education Do Do you offer concrete experiences? Review Do you ask the resident to reflect on the experience? (Do you reflect on your teaching?) Plan Do you encourage the resident to plan, to reinvent? (Do you plan and reinvent your teaching?)

18. April 28, 2010 18 Experiential Education Direct Instruction Modeling Coaching Facilitation (Source: Nimmo CM, Green SA, Gurerro R, Taylor JT, eds. Staff development for pharmacy practice. Washington, DC: ASHP:2000) Can I alter my instruction to allow for interaction? What do I model? How comprehensive is my approach? Do I coach or do I lead? What situations allow for this level of teaching?

19. April 28, 2010 19 Experiential Education “Learning is not a spectator sport. Students must talk about what they are learning, write about it, relate it to past experiences, apply it to daily lives. They must make what they learn part of themselves.” AW Chickering 1987.

20. April 28, 2010 20 Experiential Education: Summary To maximize the teaching moment: Embrace the environment Prepare: know the learner Recognize the teaching moment when it presents itself Offer concrete experiences Encourage reflective practice Ask questions –Socratic teaching model: Find the truth through questioning –One Minute Preceptor method –Problem-based Learning

21. April 28, 2010 21 Recommended Reading Massaro FM, Harrison MR, Soares A. Use of PBL in staff training and development. Am J Health-System Pharm 2006;63:2256-9. Spencer J. ABCs of learning and teaching in medicine: learning and teaching in the clinical environment. BMJ 2003 (Mar 15);326:591-594. Neher JO, Gordon KC, Myer B, Stevens N. A five-step microskills model of clinical teaching. J American Board of Family Practice. 1992;5:419-424. Irby DM, Wilkerson L. Teaching Rounds: Teaching when time is limited. BMJ 2008;336:384-7. Sylvia LM. What Matters in Experiential Education? In: Sylvia LM, Barr JT. Pharmacy Education: What Matters in Learning and Teaching. Jones and Bartlett, Sudbury MA (In press)