TEACHING IN GENERAL PRACTICE

1. TEACHING IN GENERAL PRACTICE Or teaching on the hop ! Dr Anne Pauleau 9/9/2009

2. Teaching when time is limited: Identify the needs of each learner Teach according to those specific needs Provide feedback on performance

3. Identify the learner�s needs: Target then teach. Focus on teaching what is needed. Save time by not teaching what the learner already knows or is not ready to learn.

4. Assessing learner�s needs: Good questions Ability to listen and observe.

5. Conduct a two minute observation: Allows teacher to observe the learner�s performance instead of making inferences about the ability of the student from the case presentation alone The teacher slips in and out of the consultation without intervening in order to gather more information about the learner�s needs. The teacher needs to be outside the patients field of vision and refrain from participating in any manner Time needed for discussion and feedback afterwards.

6. Methods of rapid teaching: The �one minute�preceptor model The Aunt Minnie model The SNAPPS model �Activated � demonstrations

7. The �one minute� preceptor model: Find out what the student thinks is going on with the patient. Probe for underlying reason and alternative explanations Teach a general principle Provide positive feedback for what the student did that was right Correct any errors by making suggestions forifor improvement.

8. The Aunt Minnie Model: Promote pattern recognition If someone walks down the street and walks and dresses like you Aunt Minnie then she is probably your Aunt Minnie even if you cannot see her face.

9. SNAPPS Summarize Narrow down the differential to one or more possibilities Analyze the differential by comparing and contrasting the possibilities Probe the clinical teacher by asking questions Plan the management of the patient�s medical problems Select a case for self directed learning

10. �Activated � demonstrations Ask the student to observe a specific part of the consultation and then ask the student to describe what happened.

11. Challenges A heavy workload can overwhelm attempts to teach Time must be made for the patient and the student. Students can be bad at judging what their deficiencies are. Teaching is not just about whiteboards and lectures.

12. Creating a learning environment: General practice very conducive to this.

13. Ambulatory care teaching Patients less sick than in hospital and more likely to interact with the students. Patients better known to health team , hence more complete understanding of patient�s illness and impact on patient�s life. More health promotion.

14. Creating a learning environment: Orientation Organization of clinic for effective teaching. Encouraging learners to take responsibility for their own learning.

15. Orientation Get to know students The lay out of the land: loos, place for coats and bags , tea and coffee, where to eat,access to internet and library. Assess learning needs Introduce to other members of staff.

16. Get to know students Student previous life experience Find out student �s expectations and concerns. Try and facilitate a shared learning plan- the teacher is a facilitator , not a director of the process. Basic knowledge of curriculum helpful but guidance notes can be provided to the busy members of the health team.

17. Clinic organisation for effective teaching Patient consent Time management

18. Patient consent Posters in waiting room. Ask patients

19. Time management: patient flow available space teaching roles

20. Managing teachers: How to best use available teaching resources. How should you brief and organize your teachers. Who best teaches what?

21. The learner takes responsability for their own learning Precepting preparation Feedback Reflection

22. General practice rich learning environment careful attention needs to be given to balancing service commitment and education

23. 4 steps to a learning environment: orientation to the learning environment providing opportunities to observe the learner timely feedback encourage the learner to take responsability for their own learning

24. Any questions?