Experiential Education: Maximizing the Teaching Moment

1. Experiential Education:Maximizing the Teaching Moment Frank Massaro, PharmD and Lynne Sylvia, PharmD

2. Experiential Education “Tell me and I will forget, show me and I may remember, involve me and I will understand.”Confucius, c 550 BCE

3. Experiential Education Experiential education involves learning through experience in an immediate and relevant setting. • How do people learn in an experiential setting? • How can we engage our residents in activities that have real consequence? • What teaching strategies are most effective in developing professional competence?

4. Experiential Education 5:30 Monday morning

5. Experiential Education Characteristics Needs Characteristics

6. Experiential Education Characteristics Needs Characteristics

7. Experiential Education Education is the kindling of a flame, not the filling of a vessel.Socrates 470 BCE How do we kindle the flame?

8. How do people learn? Constructivism Knowledge: CO = SV x HR Assumptions: All patients with HF have EF < 40% Experiences: Grandpa has HF Heart Failure Rotation: How will I help the resident create new knowledge? How will I help him use the knowledge he already has?

9. Preparing for the Resident “I had a different kind of relationship with the residents. It was important to bring them to a higher level. They can’t wait to get to that higher level, but they have to start at the beginning.”Louis P. Jeffrey Personal Communication (Paul L Jeffrey) from an Oral History of LP Jeffrey, 4/14/10

10. Preparing for the Resident How often do you… • Ask about the resident’s prior experiences • Will your rotation be a side trip or part of the journey to professional competence? • Assess their starting points • What are their self-assessments of baseline cognitive, psychomotor and affective learning relative to your rotation? • Identify assumptions • What do they understand about your rotation? What are their perceptions of what you do, to whom you provide care? • Review reflections on learning • What do they value? What have they yet to experience?

11. Where does learning take place? “…education is not what the teacher gives and is not acquired by listening to words, but by experiences upon the environment.” Maria Montessori,c1909 “To Serve, To Strive, and not To Yield” Outward Bound Motto

12. Facilitation Coaching Modeling Direct Instruction Experiential Education Culminating Integration Practical Application Foundation Skills and Knowledge (Source: Nimmo CM, Green SA, Gurerro R, Taylor JT, eds. Staff development for pharmacy practice. Washington, DC: ASHP:2000)

13. Recognizing the Teaching Moment Look Listen Feel

14. Problem-based Learning Develops the skills necessary for: • Critical thinking • Self-directed learning • Communication • Collaboration Massaro FJ, Harrison MR, Soares A. Use of problem-based learning in staff training and development. Am J Health-Syst Pharm. 2006;63:2256-9

15. Problem-based Learning JM is a 26 year-old man who came to the urgent care clinic complaining of fatigue, swelling of his feet and dark brown urine. Know Want to Know Hypotheses Learning Questions Massaro FJ, Harrison MR, Soares A. Use of problem-based learning in staff training and development. Am J Health-Syst Pharm. 2006;63:2256-9

16. Kolb’s Experiential Learning Cycle Interview patient about medication allergies Revise the interview Technique Test hypotheses Duration? Quality? Patient response? Hypotheses: Duration Quality, Response

17. Experiential Education Do Do you offer concrete experiences? Review Do you ask the resident to reflect on the experience? (Do you reflect on your teaching?) Plan Do you encourage the resident to plan, to reinvent? (Do you plan and reinvent your teaching?)

18. Facilitation Coaching Modeling Direct Instruction Experiential Education What situations allow for this level of teaching? Do I coach or do I lead? What do I model? How comprehensive is my approach? Can I alter my instruction to allow for interaction? (Source: Nimmo CM, Green SA, Gurerro R, Taylor JT, eds. Staff development for pharmacy practice. Washington, DC: ASHP:2000)

19. Experiential Education “Learning is not a spectator sport. Students must talk about what they are learning, write about it, relate it to past experiences, apply it to daily lives. They must make what they learn part of themselves.” AW Chickering 1987.

20. Experiential Education: Summary To maximize the teaching moment: • Embrace the environment • Prepare: know the learner • Recognize the teaching moment when it presents itself • Offer concrete experiences • Encourage reflective practice • Ask questions • Socratic teaching model: Find the truth through questioning • One Minute Preceptor method • Problem-based Learning

21. Recommended Reading • Massaro FM, Harrison MR, Soares A. Use of PBL in staff training and development. Am J Health-System Pharm 2006;63:2256-9. • Spencer J. ABCs of learning and teaching in medicine: learning and teaching in the clinical environment. BMJ 2003 (Mar 15);326:591-594. • Neher JO, Gordon KC, Myer B, Stevens N. A five-step microskills model of clinical teaching. J American Board of Family Practice. 1992;5:419-424. • Irby DM, Wilkerson L. Teaching Rounds: Teaching when time is limited. BMJ 2008;336:384-7. • Sylvia LM. What Matters in Experiential Education? In: Sylvia LM, Barr JT. Pharmacy Education: What Matters in Learning and Teaching. Jones and Bartlett, Sudbury MA (In press)