1. Practical Tips for Effective Teaching Ricardo La Hoz, MD Ryan Kraemer, MD

2. Roadmap Fellow as a Teacher: Retention Pearls Fellow as a Teacher: Retention Pearls Five Microskills of Clinical Teaching Five Microskills of Clinical Teaching Do’s and Dont’s of a Chalk Talk Do’s and Dont’s of a Chalk Talk Take Home Points Take Home Points

3. The Fellow as a Teacher

4. Barriers Time Clinical duties Not interested learner Knowledge Limited Instruction on how to be a teacher

5. The Fellow as a Teacher Great learning tool The more you teach the more you learn how to teach Mentoring the next generation of physicians Impacts patient care It feels good! Benefits

6. Promoting Retention

7. Learning Levels Early Learners: Early Learners: - Teach less and they learn more - Focus on the methods of teaching instead of the details - Emphasize understanding over memorization of details Advanced Learners: Advanced Learners: - Find and fill in knowledge gaps

8. Advanced Organizers Mental constructs useful to organize knowledge Mental constructs useful to organize knowledge Increases retention of material taught Increases retention of material taught Algorithms and diagrams, acronyms, pneumonics, Algorithms and diagrams, acronyms, pneumonics, Ausubel, D.P. (1960). The use of advance organizers in the learning and retention of meaningful verbal material. Journal of Educational Psychology, 51, 267-272.

9. Promotion of retention and self directed learning Instead of “Read about your patients” Instead of “Read about your patients” The learner picks one patient they admitted and reads about their main problem The learner picks one patient they admitted and reads about their main problem The resident then applies what they read to their patient The resident then applies what they read to their patient “Learn by doing” “Learn by doing”

10. Promoting Retention Ask lots of questions Ask lots of questions - Helps the learner recognize their deficiencies - Lets you know on what level to teach - Encourages active participation instead of passive learning

11. Promoting Retention Ask lots of questions Ask lots of questions - The Socratic method of teaching - Use a series of easy questions to guide learners through an advanced topic - Great way to teach basic pathophysiology - Repetition, repetition, repetition

12. Preceptor-Learner Interaction Simulation

13. What went wrong? We want some feedback!

14. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules 4. Reinforce what was done right 5. Correct mistakes Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

15. 5 Microskills Model 1. Get a commitment Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

16. Get a Commitment How do you obtain a commitment? How do you obtain a commitment? When the learner has finished - Resist the urge! When the learner has finished - Resist the urge! Examples: Examples: - What do you think is going on with this patient? - How do you want to workup this patient? - What would be your initial approach to the management of this patient? Why is this important? Why is this important? Supportive environment Supportive environment Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

17. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

18. Probe for Supporting Evidence Suppress the desire to pass judgment Suppress the desire to pass judgment Examples Examples - What were the major findings that led to your diagnosis? - What else did you consider? What kept you from those other choices? - What factors did you consider when choosing those antibiotics? Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

19. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

20. Teach General Rules You have diagnosed your learner! You have diagnosed your learner! Tips Tips - Keep the information general - Avoid anecdotes and idiosyncratic preferences Examples Examples - Patients with pancreatitis usually present with… - Causes of FUO are broken into the… Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

21. Teach General Rules Wrong: “No you don't need to get a CT scan on Mr. Jones” Wrong: “No you don't need to get a CT scan on Mr. Jones” Right: In patients with a history and physical exam consistent with pancreatitis and an elevated lipase, you don't need a CT scan to make the diagnosis. Right: In patients with a history and physical exam consistent with pancreatitis and an elevated lipase, you don't need a CT scan to make the diagnosis. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

22. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules 4. Reinforce what was done right Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

23. Reinforce what was done right

24. Why is it important? Why is it important? Focus on specific observations Focus on specific observations Example Example - Your considered the patient’s finances in your selection of therapy. Your sensitivity to this will certainly contribute to improving his compliance. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

25. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules 4. Reinforce what was done right 5. Correct mistakes Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

26. Correct Mistakes Find the correct space and time Find the correct space and time Be specific Be specific Examples Examples - You could be right, this liver transplant patient could have C. difficile infection, given low sensitivity of the toxin assay, but CMV colitis can occur with negative blood PCR. We should probably perform a colonoscopy. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

27. 5 Microskills Model 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules 4. Reinforce what was done right 5. Correct mistakes Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.

28. 5 Microskills Situations Inpatient presentations Inpatient presentations Outpatient presentations Outpatient presentations When asked a question When asked a question After seeing a new patient with a resident After seeing a new patient with a resident

30. Five Microskills Simulation

31. Do’s and Don’t of a Chalk Talk

32. Chalk Talk Tips

33. Goal  To give you practical helpful tools to succeed in giving great chalk talks

34. Chalk Talks Definition Definition - Presenter lead discussion about a defined topic - With or without writing - 5 minutes – 1 hour - Usually a small audience - NOT a formal powerpoint lecture

35. Name 2 attributes of great chalk talks Organized Interactive Time Effective Practical Know your audience – Target them! Simple Good audiovisuals or other tools Use of Advanced organizers

37. Chalk Talks Name 2 attributes of terrible chalk talks Name 2 attributes of terrible chalk talks

38. Considerations Who is your audience? Who is your audience? How much time do you have? How much time do you have? What is the setting?...Learning environment! What is the setting?...Learning environment! Is the audience’s priority the talk?...choose a good time to give the chalk talk. Is the audience’s priority the talk?...choose a good time to give the chalk talk.

39. What is the goal of a chalk talk? Retention Retention - Less is more - For details  give handouts or articles

40. What is the goal of a chalk talk? Retention Retention - Less is more - For details  give handouts or articles Use Advance Organizers: mental constructions useful to organize knowledge Use Advance Organizers: mental constructions useful to organize knowledge - Acronyms - Pneumonics - Algorithms

41. Chalk Talk Examples Approach to Elevated LFT’s Approach to Elevated LFT’s Approach to Hypercalcemia Approach to Hypercalcemia Approach to Chest pain Approach to Chest pain Approach to Hyponatremia Approach to Hyponatremia ACLS ACLS Ventilator Management Ventilator Management

42. What should I talk about? Chalk talks on common presentations the team will encounter Chalk talks on common presentations the team will encounter Chalk talks on a topic the team had deficient knowledge in Chalk talks on a topic the team had deficient knowledge in

43. Build a Repertoire Develop a list of chalk talks of various topics Develop a list of chalk talks of various topics - Allows you to give learners choices - Allows you to utilize talks at key moments Make the talks flexible Make the talks flexible - Small sections that make up a larger talk

44. It’s a Performance Rules for speakers: Rules for speakers: - Enthusiasm and Energy - Use “the pause” effectively - Make eye contact - Use learner’s names - Use humor

45. Hook Them Early Tell them what you are going to accomplish with your talk Tell them what you are going to accomplish with your talk Establish relevance Establish relevance

46. Tell a Story Make it Case-Based Make it Case-Based - Refer to patients your team has managed - The more anecdotes the better Adult Learning Theory Adult Learning Theory - Learning must be relevant - Need to know why before committing to learn - Adults Learn best via “real world” examples: Case Based Discussions

47. Take Home Messages Have take home points (1-3) Have take home points (1-3) - Repeat them, repeat them, repeat them - Have an anecdote or story or case about each

48. Question! Two functions of Questions: Two functions of Questions: - To establish baseline understanding of a concept - To evaluate understanding of a concept you have reviewed

49. Interaction It must be interactive It must be interactive

50. Feedback After you have given a talk get feedback After you have given a talk get feedback

51. Practice, practice, practice Practice, practice, practice

52. Take Notes Observe others giving chalk talks and what effective behaviors they have Observe others giving chalk talks and what effective behaviors they have Steal good topics Steal good topics

53. ACP Teaching Medicine Series

54. Take Home Points Promote knowledge retention Promote knowledge retention 5 Microskills 5 Microskills Key points for a successful chalk talk Key points for a successful chalk talk

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