ESSENTIAL SKILLS FOR TEACHING MEDICAL

STUDENTS AND RESIDENTSBYRON CROUSE, MD

AND

STUART HANNAH, MD

DISCLOSURES

• WE HAVE NO CONFLICTS OF INTEREST

• WE ARE BEING REIMBURSED FOR TIME

GOALS AND OBJECTIVES

• LIST THEORIES AND RATIONALE FOR ADULT LEARNING

• REVIEW MODELS FOR COMMUNITY-BASED CLINICAL TEACHING

• CASE SCENARIOS AND SMALL GROUP APPLICATION

• RESOURCES FOR REFERENCE

ADULT LEARNING

HOW DO WE TEACH EFFECTIVELY?

MJA • Volume 181 Number 6 • 20 September 2004

Student / Intern

Graduating Resident

ADULT LEARNING PRINCIPLES

ADULT LEANERS:

LEARN WHAT THEY WANT TO LEARN

LEARN WHAT THEY NEED TO LEARN

LEARN THROUGH PROBLEM SOLVING BASED ON REALITY

LEARN BY DOING

NEED PROMPT AND APPROPRIATE FEEDBACK

LEARN BEST IN AN INFORMAL AND NON-THREATENING ENVIRONMENT

NEED MATERIAL THAT IS RELATED TO EXISTING KNOWLEDGE

WANT TO BE TREATED AS INDIVIDUALS

LEARN BEST WHEN SELF-PACED

VALUE VARIETY IN TEACHING METHODS

HOW CAN WE USE THESE WHEN TEACHING?Teaching to Diverse Styles. Jo Anne Preston

HOW CAN YOU DO THIS IN YOUR OFFICE?

• COMBINATION OF TECHNIQUES FOR SPECIFIC GOALS AND STYLES:

• ROLE MODELING - “WATCH ME CARE FOR THE PATIENT”

• QUESTIONING - “TELL ME WHAT YOU THINK AND WHY”

• PERFORMING EXPERT CONSULTATION - “ASK ME WHAT YOU NEED TO KNOW”

• MINI-LECTURING - “I WILL TELL YOU WHAT I KNOW ABOUT THIS TOPIC”

• MODELING PROBLEM SOLVING - “I WILL THINK OUT LOUD ABOUT THIS CASE”

• ENCOURAGING SELF-DIRECTED INDEPENDENT LEARNING - “WHAT DO YOU NEED TO READ ABOUT?”

• ASSIGNING TEACHER-DIRECTED INDEPENDENT LEARNING – “I THINK YOU SHOULD LOOK THIS UP”

Teaching in Your Office, 2nd Ed, ACP Press

OFFICE-BASED TECHNIQUES AND MODELS

• THE ONE-MINUTE PRECEPTOR (5 MICROSKILLS METHOD)

• SNAPPS

• POWER PRECEPTING – OVER-ARCHING METHOD TO ORGANIZE SUPERVISION ENCOUNTERS

• RIME – A SYNTHETIC METHOD FOR ASSESSMENT AND EVALUATION

ONE-MINUTE PRECEPTOR

Presentation = 6 minutes

Questions = 3 minutes

Discussion = 1 “golden” minute

10 Minutes of “Teaching Time” . . . .

ONE-MINUTE PRECEPTOR5 STEP MICROSKILLS

1. GET A COMMITMENT

2. PROBE FOR SUPPORTING EVIDENCE

3. REINFORCE WHAT WAS DONE WELL4. GIVE GUIDANCE ABOUT ERRORS OR OMISSIONS5. TEACH A GENERAL PRINCIPLE

SNAPPS

• SUMMARIZE BRIEFLY THE HISTORY AND FINDINGS

• NARROW THE DIFFERENTIAL TO TWO OR THREE POSSIBILITIES

• ANALYZE THE DIFFERENTIAL BY COMPARING AND CONTRASTING THE POSSIBILITIES

• PROBE THE PRECEPTOR BY ASKING QUESTIONS ABOUT UNCERTAINTIES, DIFFICULTIES, ALTERNATIVE APPROACHES

• PLAN MANAGEMENT FOR THE PATIENT’S MEDICAL ISSUES

• SELECT A CASE-RELATED ISSUE FOR SELF-DIRECTED LEARNING

SNAPPS VS ONE MINUTE PRECEPTOR

• SUMMARIZE: CONDENSE FACTS. MORE ABSTRACTION. < 50% OF PRECEPTING TIME

• NARROW: THE DIFFERENTIAL – DDX OF 2 TO 3 MOST LIKELY

• ANALYZE: THE DIFFERENTIAL – THINKING, ANALYZING

• PROBE: THE PRECEPTOR – SPECIFIC QUESTIONS, UNCERTAINTIES

 

• PLAN: DEVELOP MANAGEMENT PLAN

• SELECT SPECIFIC CASE FOR REVIEW – SELF DIRECTED LEARNING

• GET A COMMITMENT – WHAT IS GOING ON? WHAT DO YOU WANT TO DO?

• PROBE FOR SUPPORTING EVIDENCE – HOW DID YOU DECIDE AND WHAT ELSE DID YOU CONSIDER?

• TEACH ONE GENERAL RULE

• TELL THE LEARN WHAT S/HE DID RIGHT AND THE EFFECT IT HAD

• CORRECT MISTAKES

SNAPPS One Minute Preceptor

SNAPPS VS ONE MINUTE PRECEPTOR

• RESIDENT LED (PRECEPTOR FACILITATED)

• RESIDENT IDENTIFIES LEARNING NEEDS

• RESIDENT AS ACTIVE LEARNER

• MORE FOCUS ON CLINICAL REASONING AND THOUGHT PROCESS

• LESS FOCUS ON FACTS

• RESIDENT ASKS QUESTIONS AND EXPRESSES UNCERTAINTIES

• RESIDENT SELECT CASES FOR SELF-DIRECTED LEARNING

• PRECEPTOR LED

• PRECEPTOR IDENTIFIES LEARNING NEEDS

• RESIDENT AS RECEPTIVE LEARNER

• MORE FOCUS ON FACTS

• LESS FOCUS ON CLINICAL REASONING AND THOUGHT PROCESS

• DOES NOT ENCOURAGE RESIDENT-LED QUESTIONS, EXPRESSION OF UNCERTAINTIES

• LACK OF RESIDENT SELF-DIRECTED LEARNING

SNAPPS One Minute Preceptor

POWER PRECEPTING‘ACTIVE PRECEPTING IN THE FAMILY

MEDICINE CENTER’• PREPARE – PRE-PRECEPTING, ARRIVE EARLY, REVIEW SCHEDULE “HUDDLE” TO PLAN

• ORCHESTRATE – ANTICIPATE NEEDS, MONITOR FLOW, ORCHESTRATE TEAM FUNCTION

• W

• EDUCATE – USE MICROSKILLS, HELP RESIDENTS ARTICULATE CLINICAL QUESTIONS, USE POINT-OF-CARE INFORMATION MANAGEMENT SKILLS TO PERFORM SEARCHES

• REVIEW – INTERCEPT PROBLEMS EARLY, PROVIDE APPROPRIATE INFORMATION, GUIDE RESIDENTS IN DEFINING, FOCUSING, AND REINFORCING OWN LEARNING NEEDS. DEBRIEF AT THE END OF EACH SESSION

(P)RIME ASSESSMENT

• (PROFESSIONALISM)

• REPORTER – “WHAT IS HAPPENING?”

• EXPECTED LEVEL FOR A 3RD OR 4TH YEAR MEDICAL STUDENT

• INTERPRETER – WHY IS IT HAPPENING?

• EXPECTED LEVEL FOR A SENIOR MEDICAL STUDENT OR 1ST YEAR RESIDENT

• MANAGER – WHAT NEXT?

• EXPECTED LEVEL FOR A 2ND YEAR RESIDENT

• EDUCATOR – WHERE ARE THE KNOWLEDGE GAPS?

• EXPECTED LEVEL – THE IDEAL SENIOR RESIDENT

CASE SCENARIOS IN GROUPS

QUESTIONS?

REFERENCES

• TEACHING IN YOUR OFFICE 2ND EDITION, ACP PRESS

• RURAL FACULTY HANDBOOK, FAMILY MEDICINE RESIDENCY OF WESTERN MONTANA

• WEBSITE: PRACTICALDOC.CA “BY RURAL DOCTORS FOR RURAL DOCTORS”

• LILLICH DW, MACE K, GOODELL M, KINNEE C “ACTIVE PRECEPTING IN THE RESIDENCY CLINIC: A PILOT STUDY OF A NEW MODEL” FAM MED 2005; 37(3):205-10.