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Professional Development Series October 20, 2011

Teaching in the Clinical Setting. Professional Development Series October 20, 2011. Professional development interests identified in the Faculty Development Committee survey. Teaching methods/evaluations Time management Stress management Negotiation skills Communication skills

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Professional Development Series October 20, 2011

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  1. Teaching in the Clinical Setting Professional Development Series October 20, 2011

  2. Professional development interests identified in the Faculty Development Committee survey Teaching methods/evaluations Time management Stress management Negotiation skills Communication skills Resources for grant writing Work/life balance Supervisory/Management skills

  3. Clinical Teaching Workshop Purpose:Improving capacity for clinical faculty to find and take advantage of “teaching moments” with students, residents and fellows in direct patient settings. Outcome: Best practices for teaching in clinical settings despite the barriers

  4. Workshop Agenda 7:30 Welcome and video, Dr. Ellen Hartenbach 7:45 What gets in the way of teaching in clinical settings? Dr. Laura Sabo 8:00 Table conversations. Facilitator Darrin Harris What works well (best practices) for teaching in the clinical setting? Facilitated Discussion of Assembled Group: collection of best practices 8:45 Teaching Modules: 1 Min Preceptor: Dr. Mary Landry BID model: Dr. Steve Rose 9:20 Discussion of ongoing learning and application: Dr. Ellen Hartenbach 9:45 Closing remarks, Dr. Ellen Hartenbach Next Professional Development Series: Feedback & Evaluation, Feb. 16, 7-9 AM

  5. How not to teach….

  6. How can each one of us improve our teaching in the clinical setting? Reflect on our experience- what techniques did or favorite educators/mentors utilize Review our feedback- how do the learners rate our teaching performance Peer mentoring- listen to colleagues/award winning teachers in the department Ask the experts- review the literature Make a plan to try new approaches- make a commitment to improve

  7. Madison, Wisconsin

  8. What gets in the way of teaching in clinical settings? Dr. Laura Sabo

  9. Teaching Challenges Time Schedule issues Adapting to varying levels of learner knowledge, skill and/or quality Not certain of expectations Difficulty relaying constructive criticism Don’t feel skilled in teaching

  10. Teaching Challenges Time Schedule issues Adapting to varying levels of learner knowledge, skill and/or quality Not certain of expectations Difficulty relaying constructive criticism Don’t feel skilled in teaching

  11. The One Minute Preceptor Model- Dr. Mary Landry 10 Minutes of “Teaching Time”... (average for teaching encounter in the clinical setting) 3 Minutes (clarifying preceptor questions) Questioning Discussion 1 Minute (actual teaching time) Presentation Neher et al, J Am Board of Fam Prac, 5, 419-424 (1992) 6 Minutes (learner presentation)

  12. Get a Commitment: Probe for Supporting Evidence: Teach a General Rule: Reinforce What Was Done Right: Feedback! Correct mistakes: Feedback! The One Minute Preceptor Model 5 microskills

  13. What commitment you ask for depends on what you are trying to teach… Gathering info: Differential diagnosis Secondary amenorrhea, pelvic pain, 3rd trimester elevated BP, IUGR Processing info: Management decisions Abnormal PAP, intrapartum non reassuring FHT’s, adnexal mass, intra-op bleeding Providing care: How you do What you do From an attending perspective- Performance From a patient perspective- Quality of care

  14. Why? Encourages learner to process further and problem solve. Examples... What is your differential? What would you bet $100 is the cause? What is your plan? What would you like to do next? How do you think that case went? Did the patient seem content with your assessment? Do you think the patient will follow your recommendations? Get a Commitment

  15. Why?… Helps you to assess the learners knowledge and thinking process. Examples... “What factors did you consider?” “Why other options?” Probe for Supporting Evidence

  16. Symptoms, treatment options, or resources to look information up Why?… Allows learning to be more easily transferred to other situations. Examples… “Remember, the false negative rate for PAP smear is 40%” Teach General Rules

  17. Describe specific behaviors and likely outcomes Why?... Behaviors that are reinforced will be more firmly established. Example… “I liked that your differential took into account the patient’s age, recent exposures, & symptoms.” Reinforce What Was Done Right: Feedback!

  18. Describe what was wrong (be specific), what the consequence might be, and how to correct it for the future Why?… Corrects mistakes and forms foundation for improvement. Example… “During the pelvic exam the patient seemed uncomfortable. Let’s go over how to insert the speculum” Correct Mistakes: Feedback!

  19. Why? Encourages learner to process further and problem solve. Examples... What is your differential? What would you bet $100 is the cause? What is your plan? What would you like to do next? How do you think that case went? Did the patient seem content with your assessment? Do you think the patient will follow your recommendations? Get a Commitment

  20. Recipe for a good teacher and judge of performance… Let them fly Insight Experience Confidence Closed sphincters (oral and anal) Open coronaries

  21. BID Surgical teaching model: Dr. Steve Rose Brief Intraoperative Teaching Debrief Roberts et al, J Am Coll Surg, 208 (2), 2009

  22. Brief 2-3 minute interaction at scrub sink jointly establish learning objective to guide both learner and teacher attending surgeon asks about resident’s previous experience and goal for learning during the operation Example- How many laparoscopic BSO’s have you done? What would you like to work on this time?

  23. Intraoperative Teaching Attending surgeon guides resident through operation with focus on the learning objective(s) set in the briefing Teaching is not simply a nonspecific flow of talk, but instead, discussion focused on mutually shared learning objective(s) Example- Walk me through your next step. How will you improve efficiency?

  24. Debrief After the operation is finished, during the closing, the teacher and learner debrief about the operation Debriefing consists of four elements: reflection, rules, reinforcement, and correction Debriefing begins with attending physician asking the learner to reflect on his or her performance and attainment of stated objective(s)

  25. Debrief Example- Teacher: “Were you able to improve your efficiency today?” Learner: “I think I did pretty well by positioning quickly and deciding where to place ports ahead of time” Teacher: “I agree, your efficiency improved with focus and planning. Make sure you place your ports in a strategic position and directly through the abdominal wall next time to improve your angle to the surgical site”

  26. Great job Almost done with this workshop!

  27. Educational Resources Association of Professor’s of Gynecology and Obstetrics (APGO) http://www.apgo.org UW Health GME website http://www.uwhealth.org/health-professionals/gme/graduate-medical-education/26182 Association of American Medical Colleges (AAMC) https://www.aamc.org/ AAMC Med Ed Portal https://www.mededportal.org/browse/

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