Teaching Residents to... Teach

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Teaching Residents to... Teach
Peter DeBlieux,MD LSUHSC Clinical Professor of
Medicine LSUIH Emergency Department
Director Emergency Medicine Director of Resident
and Faculty Development
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Objectives

• At the end of this presentation participants will
  be able to
• Demonstrate principles of Adult Learning
• Perform a One Minute Preceptor
• Reflect on their own teaching practices

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Great Teachers are... Made not BornExample is
not the main thing in influencing others. It is
the only thing.- Albert Schweitzer
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Majority of Academic Physicians are Accidental
EducatorsDid you actually plan on a life of
teaching?
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Medical Education

• Learning the knowledge, skills, attitudes, and
  behaviors that promote the development of a
  physician.

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The Golden Rule of Medical Education...

• Treat learners as you would like them to treat
  patients. As if that patient was you!

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The Purpose of Education is to Make Yourself
Obsolete as a Teacher
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Continuum of Medical Education/Competence
Continuum

• Student Clinician

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Faculty Supervision
Patient Care Responsibility
Expert
Novice
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Patient Caring and Learning

• Patient
• Facilitator Learner

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Establishing Ground Rules

• Creates a safe learning environment
• No put downs verbal or non-verbal, no matter how
  tempting
• Speak for yourself
• Everyone is responsible for their own learning
• Expect unfinished business, too many exercises,
  not enough time

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Why Should Doctors Teach?

• Enhancement of their own knowledge base and
  problem solving skills
• Development of learning habits and skills
  enabling lifelong maintenance of professional
  competence
• Creation of and fostering a TEAM mentality

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Why Should Doctors Teach?

• Fosters goodwill among house-staff
• Self satisfaction of teaching
• Availability of residents you are doing it
  anyway, near peer phenomenon, role modeling

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Barriers to Teaching

• Time
• Training
• Service vs Education

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Structure of Adult Learning
Problem Solving Concepts Concepts Principles
Principles Principles Facts Facts Facts
Facts Facts
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Principles of Adult Learning

• Motivation is established, the material is useful
• Assurance that learning is active
• Concepts not facts are taught
• Feedback is provided promptly

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Principles of Adult Learning

• Environment is non-threatening
• Material is related to existing knowledge
• Learners are treated as individuals
• Learning is best when self-paced

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Bedside Teaching

• Medicine is learned at the bedside and not in the
  classroom the best teaching is that taught by
  the patient himself.-
• Sir William Osler

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Attributes of Effective Teachers

• Enthusiasm for the mission
• Incorporates student in the learning process
• Problem solving emphasis
• Student-centered instruction
• Humanistic Orientation

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Attributes of Effective Teachers

• Organization/clarity
• Knowledge
• Group instructional skills
• Clinical supervision
• Clinical competence
• Modeling professional characteristics

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Techniques for Successful Bedside Instruction

• Clear planning and preparation
• Effective leadership
• Total and constructive participation

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Delivering Feedback
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Performance Model
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Evaluations

• Summative
• Judgement
• After the fact
• Formative
• Change in behavior
• Ongoing

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Ideal Behaviors for Delivering Feedback

• Eye contact
• Enthusiasm
• Ask and encourage questions

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Ideal Behaviors for Delivering Feedback

• Clinical supervision
• Clinical competence
• Modeling professional characteristics

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Ideal Behaviors for Effective Feedback

• Interested in the learner
• Honest
• Well defined goals

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Ideal Behaviors for Effective Feedback

• Clear explanations
• Problem solving emphasis
• Student centered instruction

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Ideal Behaviors for Effective Feedback

• Timely fashion
• Focused on behaviors
• Limited in volume

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Ideal Behaviors for Effective Feedback

• Safe environment chosen
• Focused on patient caring
• Allows learner self assessment

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Ideal Behaviors for Effective Feedback

• Use of open ended questions
• Offers recommendations for improvement
• Summarizes for closure

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Barriers to Effective Feedback

• Requires role models
• Emotional investment
• Observable behaviors
• Time

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Pearls for Effective Feedback

• Praise in public.Perfect in private
• Ego sandwich- first praise for appropriate
  responses then- identify performance challenges
  and correct lastly-- finish with encouragement
  for participation
• Ask learner to summarize take home messages

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One Minute PreceptorTeaching on the Go!

• Get a commitment
• Probe for supporting evidence
• Teach general rules
• Reinforce what is done correctly
• Correct mistakes
• Reinforce what is done correctly

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One Minute PreceptorTeaching on the Go!

• Get a commitment
• A 3 year old with ear pain- do you think this OM?
• Probe for supporting evidence
• What leads you to make this diagnosis?
• Teach general rules
• Reinforce what is done correctly
• Correct mistakes
• Reinforce what is done correctly

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One Minute PreceptorTeaching on the Go!

• Get a commitment
• Probe for supporting evidence
• Teach general rules
• The majority of OM cases are not caused by
  bacteria
• Reinforce what is done correctly
• I like the way that you made the child feel safe
  and comfortable during your exam
• Correct mistakes
• Reinforce what is done correctly

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One Minute PreceptorTeaching on the Go!

• Get a commitment
• Probe for supporting evidence
• Teach general rules
• Reinforce what is done correctly
• Correct mistakes
• I think you should spend more time teaching the
  mother about the risk-benefit of antibiotics in
  OM
• Reinforce what is done correctly
• I think that your search on OM and complications
  was a brilliant way to prepare you for ..

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One Minute PreceptorTeaching on the Go!

• Select a partner-one plays the role of the
  student/learner, the other the preceptor
• Choose one of the following
• URI-viral syndrome
• Asthma
• Vaccinations
• Get a commitment
• Probe for supporting evidence
• Teach general rules
• Reinforce what is done correctly
• Correct mistakes
• Reinforce what is done correctly