how to teach medical … busy general surgery service: a guide for surgery residents aliu sanni md...

How to Teach Medical Students on A Busy General Surgery Service: A Guide for Surgery Residents

Aliu Sanni MD May 23, 2013

Surgery Grand Rounds

www.downstatesurgery.org

Goals • Demonstrate that this new curriculum:

–Is simple –Little to no preparation –Minimal time commitment –Immediately applicable –Effective


Answer the questions: • Why do we think a new approach to

teaching medical students is even needed? • How do I implement this? • Does it work? • What are the benefits of this curriculum?


Why did we think a new approach to teaching medical students was even

needed?


Residents are already teaching

• “Clinical Assistant Instructors” • This curriculum is meant to augment or

assist in already developed teaching styles.


3 reasons residents cite for NOT teaching effectively:

Time constraints

Students seem unmotivated

Unclear goals

“It’s only the first week and we have 12 weeks to study.”

“What topics are appropriate to teach medical students?”

“We are forced to cram patient care duties into fewer hours, so we got rid of teaching.”


How do I implement this new curriculum?


Hierarchy

Chief Resident

Junior Residents Medical Students

Most experienced with greatest background knowledge

Refresh previously learned topics &

better patient care

Target group of curriculum


Assign Present Discuss

3 Steps to implementation www.downstatesurgery.org

Teaching Styles Directed (Chief) • “Traditional,” didactic • Senior, experienced

lecturer presents entirety of information

• Instructor-driven • Large groups

(typically)

Inductive (MS3) • Gaining acceptance • Senior serves as guide

for discussion • Student-driven • Small groups


General Surgery Topics GENERAL SURGERY Wound Healing Anal cancer Perioperative management Perianal infections Surgical infections Hemorrhoids Fluid and electrolytes Inflammatory bowel disease Appendicitis Colonic obstruction and volvulus Small bowel obstruction Aneurysms Diverticular disease Carotid disease Gallstone disease Septic Shock Pancreatitis Ventilator management, acid/base Hernias Thyroid carcinoma Bleeding/Coagulation cascade Pheochromocytoma Surgical nutrition Portal hypertension Breast cancer Chronic liver disease scores Peripheral Vascular disease MEN Colorectal polyps and cancer Disorders of splenic function


Trauma Surgery Topics TRAUMA/ACUTE CARE SURGERY Wound Healing Pelvic injuries Perioperative management Surgical bleeding Surgical infections Shock Fluid and electrolytes Head injuries Initial assessment of trauma patient Thoracic injury Small bowel obstruction Extremity trauma Mgt of blunt abdominal trauma Pediatric trauma Gallstone disease Trauma in the elderly Pancreatitis Vascular injuries Appendicitis Diaphragmatic injuries Management of Head injuries Damage control operation Diverticular disease Management of rectal injuries Penetrating abdominal trauma Splenic and Liver injuries Neck injuries Cardiac injuries Spinal cord injuries Management of Facial trauma


SICU Topics SICU Wound Healing Management of Liver Failure Perioperative management Endocrine Dysfunction Surgical infections Traumatic Brain Injury Fluid and electrolytes Shock Ventilator Modes & Extubation Ventilator Associated Pneumonia Invasive Monitoring in the ICU Acid Base Disorders Surgical Nutrition Multiple Organ Dysfunction Management of ARDS Airway Management Use of pressors in the ICU Sepsis Management of Renal Failure Hematological Disorders in the ICU Abdominal Compartment Syndrome Management of Tachycardias End Points of Rescusitation


May SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

5 6 7 8 9 10 11

Infections/ Fluids & Electrolytes

Appendicitis/ SBO

Wound/ Diverticular dz

Gallstone dz/ Pancreatitis

12 13 14 15 16 17 18

Hernias/ Perioperative

Bleeding/ Coagulation

Nutrition/ Breast ca PVD/

Colorectal

19 20 21 22 23 24 25

Anal ca/ Perianal infections

Hemorrhoids/ IBD

Colonic obs. & volvulus/ Aneurysms

Carotid dz/ Septic Shock

26 27 28 29 30 31

Ventilator/ acid/base

Thyroid ca/ Pheo

Portal HTN/ Liver dz scores

MEN/ Splenic d/o


Assign

• 30 predetermined Topics

• Pretest

Present

Discuss

3 Steps to implementation

Present


What do I actually tell the students to do?

• Oral presentation • No powerpoints!

–Must be able to be given “on the fly” during rounds

• May supplement with handout, but emphasize that you do NOT want them to simply read it.


Presentations • Strict time limit of 5 minutes

per presentation • Have one student set a timer

with an alarm. – Explain that this is not to rush the

student, rather to teach them to be concise.


Design Core surgical topics

Explicit outline of how topics should be covered along with a

recommended textbook (Lawrence)

Presentations during morning

rounds limited to 5 mins with a timer


When and where?

• Presentations may be given any time during morning rounds, or preferably when rounding on a patient with relevant symptoms or diagnoses

Bedside Rounds

• Downstate General Surgery • KCHC GS/Trauma/SICU • RUMCI • BVA

Group Teaching

• LICH General Surgery • UHB CT/Transplant/GS


What if I’m interrupted?

• PGY3/ PGY2 most important member of the teaching team

• Can also take over if called to OR • Should be present during rounds anyway


But doesn’t this mean a lot of preparation on my part?

• NO! • We have made available a compilation of

the most informative presentations, qbanks & topic schedules. http://www.downstatesurgery.org/forms.aspx

• Chiefs can be easily refreshed just before rounds or even during the student presentation!


http://www.downstatesurgery.org/forms.aspx

Past Presentation Refresher The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.


Assign


• Pretest

Present

• 5 min presentations on daily rounds

Discuss

3 Steps to implementation

Discuss


Discuss • No more than 3 minutes by chief

• Adding relevant information • Correcting erroneous presentation data • Referencing a current patient on the floor • Likely exam questions


Assign


• Pretest

Present

• 5 min presentations on daily rounds

Discuss

• Correct errors, add missed information, cite patients

• Post test

3 Steps to implementation www.downstatesurgery.org

Does it work?


Significant improvement in pre and post test scores

43.0 65.4 0

10

20

30

40

50

60

70

80

Total p < 0.05


Better results than when simply listening to the chief!

15.3 26.2 0

5

10

15

20

25

30

35

Total Axis Title

Average Improvement in Scores

Medical Students

Chief p < 0.05


Improved Shelf Scores

72.3 78.0 66

68

70

72

74

76

78

80

82

Total Axis Title

Control Group

Study Group

p < 0.05


Students find it useful

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Curiosity improved learning

Interested in surgical topics

Explaining topics focused studying

Outline of topics focused studying

Pre-clerkship test focused studying

Student Ratings of Study Styles


And prefer it!

0% 5%

10% 15% 20% 25% 30% 35% 40% 45% 50%

Preparing presentations

Questions on rounds

Question banks Hearing presentations

Student #1 Ratings of Studying Techniques


52.92 72.9 30

35

40

45

50

55

60

65

70

75

80

Axis Title Pretest Posttest p < .05

Residents Learned As Well www.downstatesurgery.org

Benefits for the teacher

• Other than assigning the presentations at the beginning of the month, no extra preparation

• Structured teaching plan with < 15 min per presentation day

• Mentorship and Role modeling • Easy evaluation tool • Receive more positive student feedback


Benefits for the student

• Structure to the clerkship • Have a list of topics to help direct

studying, especially earlier in rotation • Improved knowledge base, presentation

skills and shelf scores • More opportunity to interact with chief

residents


Benefits for the program

• Structured & disciplined surgical team • Highly motivated and dedicated residents

& medical students • Better performance on the shelf and

ABSITE examinations • Excellent patient care


What came from this study? 12 Podium presentations, 5 Manuscripts


Future • Update and adjust curriculum

yourself to meet specific needs • Continued research opportunity for

current residents and students


Thank You • Dr. Alfonso • Dr. Schulze

Research Group • Chris Turner • Mike Klein • Kaylene Barrera • Bethany Malone (MS3) • Keith Wirth (MS3)


Questions?


how to teach medical … busy general surgery service: a guide for surgery residents aliu sanni md...

Documents