practical tips for effective teaching ricardo la hoz, md ryan kraemer, md

Practical Tips for Practical Tips for Effective TeachingEffective Teaching

Ricardo La Hoz, MDRicardo La Hoz, MD

Ryan Kraemer, MDRyan Kraemer, MD

RoadmapRoadmap

Fellow as a Teacher: Retention PearlsFellow as a Teacher: Retention Pearls

Five Microskills of Clinical Teaching Five Microskills of Clinical Teaching

Do’s and Dont’s of a Chalk TalkDo’s and Dont’s of a Chalk Talk

Take Home Points Take Home Points

The Fellow as a TeacherThe Fellow as a Teacher


BarriersBarriers TimeTime Clinical dutiesClinical duties Not interested learnerNot interested learner KnowledgeKnowledge Limited Instruction on Limited Instruction on

how to be a teacherhow to be a teacher


Great learning toolGreat learning tool The more you teach the The more you teach the

more you learn how to more you learn how to teachteach

Mentoring the next Mentoring the next generation of physiciansgeneration of physicians

Impacts patient careImpacts patient care It feels good!It feels good!

BenefitsBenefits

Promoting RetentionPromoting Retention

Learning LevelsLearning Levels

Early Learners: Early Learners: - Teach less and they learn moreTeach less and they learn more- Focus on the methods of teaching instead of Focus on the methods of teaching instead of

the detailsthe details- Emphasize understanding over memorization Emphasize understanding over memorization

of detailsof details

Advanced Learners: Advanced Learners: - Find and fill in knowledge gapsFind and fill in knowledge gaps

Advanced OrganizersAdvanced Organizers

Mental constructs useful to organize Mental constructs useful to organize knowledgeknowledge

Increases retention of material taughtIncreases retention of material taught

Algorithms and diagrams, acronyms, Algorithms and diagrams, acronyms, pneumonics, 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.

Promotion of retention and self Promotion of retention and self directed learningdirected learning

Instead of Instead of ““Read about your patientsRead about your patients””

The learner picks one patient they admitted and The learner picks one patient they admitted and reads about their main problemreads about their main problem

The resident then applies what they read to their The resident then applies what they read to their patientpatient

““Learn by doing”Learn by doing”


Ask lots of questionsAsk lots of questions

- Helps the learner recognize their Helps the learner recognize their deficienciesdeficiencies

- Lets you know on what level to teach Lets you know on what level to teach

- Encourages active participation instead Encourages active participation instead of passive learningof passive learning


Ask lots of questionsAsk lots of questions

- The Socratic method of teachingThe Socratic method of teaching- Use a series of easy questions to guide learners Use a series of easy questions to guide learners

through an advanced topicthrough an advanced topic- Great way to teach basic pathophysiologyGreat way to teach basic pathophysiology

- Repetition, repetition, repetitionRepetition, repetition, repetition

Preceptor-Learner InteractionPreceptor-Learner InteractionSimulationSimulation

What went wrong?What went wrong?

We want some feedback!We want some feedback!

5 Microskills Model5 Microskills Model

1.1. Get a commitmentGet a commitment

2.2. Probe for supporting evidenceProbe for supporting evidence

3.3. Teach general rulesTeach general rules

4.4. Reinforce what was done rightReinforce what was done right

5.5. Correct mistakesCorrect 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.

Get a CommitmentGet 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?What do you think is going on with this patient?- How do you want to workup this patient?How do you want to workup this patient?- What would be your initial approach to the What would be your initial approach to the

management of this patient?management of this patient?

Why is this important?Why is this important?

Supportive environmentSupportive environmentNeher 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.

Probe for Supporting EvidenceProbe for Supporting Evidence

Suppress the desire to pass judgmentSuppress the desire to pass judgment

ExamplesExamples- What were the major findings that led to your What were the major findings that led to your

diagnosis?diagnosis?- What else did you consider? What kept you from What else did you consider? What kept you from

those other choices?those other choices?- What factors did you consider when choosing What factors did you consider when choosing

those antibiotics?those antibiotics?


Teach General RulesTeach General Rules

You have diagnosed your learner!You have diagnosed your learner!

TipsTips- Keep the information generalKeep the information general- Avoid anecdotes and idiosyncratic preferencesAvoid anecdotes and idiosyncratic preferences

ExamplesExamples- Patients with pancreatitis usually present with…Patients with pancreatitis usually present with…- Causes of FUO are broken into the… Causes of FUO are broken into the…


Teach General RulesTeach General Rules

Wrong: Wrong: ““No you don't need to get a CT scan on No you don't need to get a CT scan on Mr. JonesMr. Jones””

Right: In patients with a history and physical Right: In patients with a history and physical exam consistent with pancreatitis and an exam consistent with pancreatitis and an elevated lipase, you don't need a CT scan to elevated lipase, you don't need a CT scan to make the diagnosis.make the diagnosis.


Reinforce what was done rightReinforce what was done right

Reinforce what was done rightReinforce what was done right

Why is it important?Why is it important?

Focus on specific observationsFocus on specific observations

ExampleExample- Your considered the patient’s finances in your Your considered the patient’s finances in your

selection of therapy. Your sensitivity to this selection of therapy. Your sensitivity to this will certainly contribute to improving his will certainly contribute to improving his compliance.compliance.


Correct MistakesCorrect Mistakes

Find the correct space and timeFind the correct space and time

Be specificBe specific

ExamplesExamples- You could be right, this liver transplant patient You could be right, this liver transplant patient

could have C. difficile infection, given low could have C. difficile infection, given low sensitivity of the toxin assay, but CMV colitis sensitivity of the toxin assay, but CMV colitis can occur with negative blood PCR. We can occur with negative blood PCR. We should probably perform a colonoscopy.should probably perform a colonoscopy.


5 Microskills Situations5 Microskills Situations

Inpatient presentationsInpatient presentations

Outpatient presentationsOutpatient presentations

When asked a questionWhen asked a question

After seeing a new patient with a residentAfter seeing a new patient with a resident

Five MicroskillsFive MicroskillsSimulationSimulation

Do’s and Don’t of a Do’s and Don’t of a Chalk TalkChalk Talk

Chalk Talk TipsChalk Talk Tips

GoalGoal

To give you practical helpful tools to To give you practical helpful tools to succeed in giving great chalk talkssucceed in giving great chalk talks

Chalk TalksChalk Talks

DefinitionDefinition- Presenter lead discussion about a defined topicPresenter lead discussion about a defined topic- With or without writing With or without writing - 5 minutes – 1 hour5 minutes – 1 hour- Usually a small audienceUsually a small audience- NOT a formal powerpoint lectureNOT a formal powerpoint lecture

Name 2 attributes of great chalk Name 2 attributes of great chalk talkstalks

Organized Interactive Time Effective Practical Know your audience –

Target them! Simple Good audiovisuals or

other tools Use of Advanced

organizers

Chalk TalksChalk Talks

Name 2 attributes of terrible chalk talksName 2 attributes of terrible chalk talks

ConsiderationsConsiderations

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 What is the setting?...Learning environment!environment!

Is the audienceIs the audience’’s priority the talk?...choose s priority the talk?...choose a good time to give the chalk talk. a good time to give the chalk talk.

What is the goal of a chalk What is the goal of a chalk talk?talk?

RetentionRetention- Less is moreLess is more- For details For details give handouts or articles give handouts or articles

What is the goal of a chalk What is the goal of a chalk talk?talk?

RetentionRetention- Less is moreLess is more- For details For details give handouts or articles give handouts or articles

Use Use Advance OrganizersAdvance Organizers: mental : mental constructions useful to organize knowledgeconstructions useful to organize knowledge- AcronymsAcronyms- PneumonicsPneumonics- AlgorithmsAlgorithms

Chalk Talk ExamplesChalk Talk Examples

Approach to Elevated LFTApproach to Elevated LFT’’ss Approach to HypercalcemiaApproach to Hypercalcemia Approach to Chest painApproach to Chest pain Approach to HyponatremiaApproach to Hyponatremia ACLSACLS Ventilator ManagementVentilator Management

What should I talk about?What should I talk about?

Chalk talks on common presentations the Chalk talks on common presentations the team will encounterteam will encounter

Chalk talks on a topic the team had Chalk talks on a topic the team had deficient knowledge indeficient knowledge in

Build a RepertoireBuild a Repertoire

Develop a list of chalk talks of various topicsDevelop a list of chalk talks of various topics- Allows you to give learners choicesAllows you to give learners choices- Allows you to utilize talks at key momentsAllows you to utilize talks at key moments

Make the talks flexible Make the talks flexible - Small sections that make up a larger talkSmall sections that make up a larger talk

ItIt’’s a Performances a Performance

Rules for speakers:Rules for speakers:- Enthusiasm and EnergyEnthusiasm and Energy- Use Use ““the pausethe pause”” effectively effectively- Make eye contactMake eye contact- Use learnerUse learner’’s namess names- Use humorUse humor

Hook Them EarlyHook Them Early

Tell them what you are going to Tell them what you are going to accomplish with your talkaccomplish with your talk

Establish relevanceEstablish relevance

Tell a Story

Make it Case-BasedMake it Case-Based- Refer to patients your team has managedRefer to patients your team has managed- The more anecdotes the betterThe more anecdotes the better

Adult Learning TheoryAdult Learning Theory- Learning must be relevantLearning must be relevant- Need to know why before committing to learnNeed to know why before committing to learn- Adults Learn best via Adults Learn best via ““real worldreal world”” examples: examples:

Case Based Discussions Case Based Discussions

Take Home Messages

Have take home points (1-3)Have take home points (1-3)- Repeat them, repeat them, repeat themRepeat them, repeat them, repeat them- Have an anecdote or story or case about eachHave an anecdote or story or case about each

Question!

Two functions of Questions:Two functions of Questions:- To establish baseline understanding of a To establish baseline understanding of a

conceptconcept- To evaluate understanding of a concept you To evaluate understanding of a concept you

have reviewedhave reviewed

InteractionInteraction

It must be interactiveIt must be interactive

FeedbackFeedback

After you have given a talk get feedback After you have given a talk get feedback

Practice, practice, practicePractice, practice, practice

Take NotesTake Notes

Observe others giving chalk talks and Observe others giving chalk talks and what effective behaviors they havewhat effective behaviors they have

Steal good topicsSteal good topics

ACP Teaching Medicine SeriesACP Teaching Medicine Series

Take Home PointsTake Home Points

Promote knowledge retentionPromote knowledge retention

5 Microskills5 Microskills

Key points for a successful chalk talkKey points for a successful chalk talk

practical tips for effective teaching ricardo la hoz, md ryan kraemer, md

Documents

retention slide

teacher slide

repetition slide

md slide

passive learning slide

retention pearls fellow

promotion of retention

lots of questions