Introduction to Introduction to TeachingTeaching

University of PittsburghUniversity of Pittsburgh

School of MedicineSchool of MedicineAcademy of Master EducatorsAcademy of Master Educators

Teaching Residents to Teach Teaching Residents to Teach CommitteeCommittee

Academy of Master Educators Teaching Residents to Teach

Committee Raquel Buranosky,

MD,MPH– Chair of CommitteeChair of Committee– Associate Professor of Associate Professor of

MedicineMedicine– Associate Program Associate Program

Director, Internal Medicine Director, Internal Medicine ResidencyResidency

Jason Rosenstock MD– Assistant Professor of

Psychiatry– Director Med Student

Education

  James Johnston, MDJames Johnston, MD– Professor of Medicine Professor of Medicine – Program Director, Program Director,

Nephrology FellowshipNephrology Fellowship– President, Academy of President, Academy of

Master EducatorsMaster Educators

Jonathan Finder, MD– Professor of Pediatrics– Clinical Director,

Pediatric Pulmonology

Committee Members, Ctd.

Rita M Patel MD– Professor & Vice-Chair,

Anesthesiology– Clinical Procedures UPSOM

Course Director– Associate Dean for GME

Basil Zitelli, MD– Professor of Pediatrics– Division Chief, Paul C.

Gaffney Diagnostic Referral Service

Kathleen McIntyre-Seltman, MD– Professor of OB/GYN &

Reproductive Sciences– Advisory Dean, Office of

Student Affairs, UPSOM

Richard Saladino, MD– Professor of Pediatrics– Division Chief, Pediatric

Emergency Medicine

Committee Members, Ctd David E. Eibling, MDDavid E. Eibling, MD

– Professor of Professor of OtolaryngologyOtolaryngology

Helen Westman, MDHelen Westman, MD– Professor of Professor of

Anesthesiology Anesthesiology

Peter Bulova, MDPeter Bulova, MD– Associate Professor Associate Professor

of Medicineof Medicine

Introduction to Teaching

Goal:To help incoming house staff 1) recognize the importance of

teaching2) understand basic do’s and don’ts3) be open to further development

of teaching skills

Agenda

CoreCore

– Fundamental principles of Fundamental principles of educationeducation

– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

Conduct of SessionConduct of Session

Brief introduction to teachingBrief introduction to teaching Case-Based ScenarioCase-Based Scenario Reflection Reflection Audience-Response SystemAudience-Response System Summary – Teaching PointsSummary – Teaching Points

Agenda - 1

CoreCore

– Fundamental principles of Fundamental principles of educationeducation

– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

AdultAdult Learning Learning PrinciplesPrinciples

Adult learners: Adult learners: – Are Are goal-oriented goal-oriented (Why, What and How)(Why, What and How)– Are Are autonomous and self-directingautonomous and self-directing– Have Have preexisting resources preexisting resources (life (life

experiences)experiences) Make it relevant, practical & contextual Make it relevant, practical & contextual

(problem solving)(problem solving) Be respectful (safe learning Be respectful (safe learning

environment) environment) Motivate and reinforceMotivate and reinforce

Agenda - 2

CoreCore

– Fundamental principles of Fundamental principles of educationeducation

– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/Assessment/Evaluation/

FeedbackFeedback

“Teachable Moments”

Not just a ‘lecture’ Modeling professional behavior Daily opportunities

– Work rounds– Procedures– Ambulatory settings

Pick your targets (can’t do it all) Be brief (“teaching on the fly”)

What type of teaching What type of teaching useful?useful?

0

10

20

30

40

50

60

70

% Re

sponse

s

A B C D

High ------------------------------------------------Low

MS Resident Prog Dir

A.A. Procedures, Case Procedures, Case Management, 5-Management, 5-min talks, Bedside min talks, Bedside TeachingTeaching

B.B. Physical Diagnosis Physical Diagnosis RoundsRounds

C.C. Lectures, PBL, Lectures, PBL, Simulated Cases, Simulated Cases, Socratic Socratic questioningquestioning

D.D. MS I & MS II MS I & MS II coursescourses

*Students value *Students value case-based & case-based & bedside bedside teaching over teaching over lectures.lectures.

““The One Minute The One Minute Preceptor” Preceptor”

1.1. Get a commitmentGet a commitment2.2. Probe for supporting evidenceProbe for supporting evidence3.3. Teach general rules and think out Teach general rules and think out

loudloud4.4. Tell your learner what he or she Tell your learner what he or she

did did rightright5.5. Correct the learner’s mistakesCorrect the learner’s mistakes

Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching

1 Minute Preceptor: 1

Get a commitment

– Ask learner to articulate his/her own diagnosis or plan

– Get him/her to commit to an answer (even if wrong)

One Minute Preceptor 2

Probe for supporting evidence

– Evaluate the learner’s knowledge/reasoning

– Ask probing questions Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s

answer

One Minute Preceptor: 3

Teach general rules

•Generalize from the case at hand

•Give the learner a pearl /take home point

•Point out how this case is same or different from the general rules

One-Minute Preceptor: 4

Reinforce what was done well

•Provide positive feedback•“Catch them doing something right”

One Minute Preceptor: 5

Correct errors

•Provide constructive corrections and feedbackSpecificTargetedRecommendations for improvement

The One Minute Preceptor

Choose a single teachable point per encounter– Most generalizable (most useful)– Most important (don’t miss the life

threatening diagnosis)– Targeted at learner’s area of weakness– Building on previous teachable point– Can be diagnosis, management, skill

etc

Agenda - 3

CoreCore

– Fundamental principles of Fundamental principles of educationeducation

– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/Assessment/Evaluation/

FeedbackFeedback

FeedbackFeedback vs.vs. EvaluationEvaluation ImmediateImmediate InformalInformal SubjectiveSubjective SpecificSpecific Improvement Improvement FormativeFormative InformationInformation

ScheduledScheduled FormalFormal ObjectiveObjective GlobalGlobal GradeGrade SummativeSummative JudgmentJudgment

RIMERIME Evaluation Evaluation FrameworkFramework RReporter eporter – Provides data– Provides data

– WBC count 15; chest x-ray infiltrateWBC count 15; chest x-ray infiltrate

IInterpreternterpreter – Integrates data – Integrates data– Differential diagnosis including pneumoniaDifferential diagnosis including pneumonia

MManager anager – Implements– Implements– Treats with antibiotic, arranges hospital Treats with antibiotic, arranges hospital

admissionadmission

EEducator ducator – Teaches – Teaches – Shows how individual data led to diagnosis of Shows how individual data led to diagnosis of

pneumonia and how to treat itpneumonia and how to treat it

Scene - ERScene - ER

Jim – Medical StudentJim – Medical Student– MS III, midway through rotationMS III, midway through rotation– Spent 2 hours with patient and familySpent 2 hours with patient and family– Presenting patient with chest pain & Presenting patient with chest pain &

anxietyanxiety Rita – Emergency Medicine ResidentRita – Emergency Medicine Resident

– Supervising residentSupervising resident

(RIME Evaluation)(RIME Evaluation)

I think in this scenario the I think in this scenario the medical student fit into the medical student fit into the category of:category of:– ReporterReporter– InterpreterInterpreter– ManagerManager– EducatorEducator

Giving Effective Feedback

• Feedback : a process of sharing observations and recommendations with a learner – should be formative– Contrasts with evaluation – often summative

• Residents almost universally agree that giving and getting feedback is stressful. – best way to reduce that stress is to learn to give

feedback effectively

Giving Effective Feedback

• Well-timed–should be given as soon after the observed behavior as is practical

• Based on Firsthand Data– Secondhand data will often lack specificity, or worse, authenticity

Giving Effective Feedback

• Regulated in Quantity– Too much feedback will be seen as berating.

• Elicit the Learner’s Perspective– Listen to what the learner has to say

• Descriptive and Nonjudgmental– Be specific about what needs to be changed– you are correcting the behavior, not the person

Giving Effective Feedback

• Concerned With Decisions and Actions, Rather Than Intentions and Interpretations– Concentrate on WHAT was done or said, rather

than WHY

• Providing Guidance to Resolve the Problem– Offer suggestions in ways to improve

Giving Effective Feedback

• Limit to Remediable Behavior– Stay focused on the behavior, even if you feel it

originates from a less-than-ideal personality

• Remember the Positive!– Positive feedback is based on the criteria just

discussed

Take Home Points

Qualities of Feedback • Expected• Well-timed• Based on Firsthand Data• LIMITED in Quantity• Eliciting the Learner’s Perspective• Descriptive and Nonjudgmental• Concerned With Decisions and Actions

Take Home PointsTake Home Points

Reinforce what they are doing wellReinforce what they are doing well Educate about areas in which Educate about areas in which

improvement is possibleimprovement is possible Affirm your belief in their ability to Affirm your belief in their ability to

follow this advicefollow this advice Check for their understanding by Check for their understanding by

asking for a planasking for a plan Commit to helpCommit to help

Intro to Teaching…. Conclusions

It’s important and you’ll do it regularly Make it relevant, practical Capitalize on teachable moments Use your new teaching skills (1 min.

preceptor) Give timely feedback, assess with RIME Ask for help, more to come

So Just Take the Plunge