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Teaching in the Office: Assessment and Evaluation

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Teaching in the Office: Assessment and Evaluation Joan E. St. Onge, M.D. UMMSM April 17, 2014 – PowerPoint PPT presentation

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Title: Teaching in the Office: Assessment and Evaluation


1
Teaching in the Office Assessment and
Evaluation
  • Joan E. St. Onge, M.D.
  • UMMSM
  • April 17, 2014

2
Evaluation is the key!
  • Many ways of effectively teaching that gives the
    preceptor insight to the residents fund of
    knowledge and clinical judgment
  • Few key steps
  • Identify the fund of knowledge at the start of
    the rotation (The Starting Point)
  • Set goals for the rotation
  • Use case based learning approaches in the office
    to assist in evaluation

3
Case Based Learning
  • 5 rules for effective teaching have been
    described by Neher and coworkers as a practical
    model of case based learning.
  • - Combines expert consultation with the
    technique to address learner and patient needs
    efficiently and effectively.
  • Neher JO, Gordon KC, Meyer B, Stevens N. A five
    step microskills model of clinical teaching. J
    Am Board pf Fam Prac.19925419-24.

4
5 Micro Skills for Effective Teaching
  • 1 Get a Commitment
  • Probe for Supporting evidence
  • Teach the general rule
  • Reinforce positive behavior
  • Correct mistakes

5
1. Get a Commitment
  • Get the learner to commit to some decision or
    plan of action
  • What do you think is going on?
  • Would you recommend a surgical approach to this
    problem?
  • Why do you think this patient is on three
    Antihypertensive medications?
  • Unhelpful methods
  • Sounds like pneumonia. Right?
  • Can you think of anything else?
  • Questions do not probe for understanding, but can
    be answered by yes or no.

6
2. Probe for supporting evidence
  • Questions that ask the learner to demonstrate his
    or her thinking as it pertains to the case
  • AVOID the GUESS WHAT I AM THINKING? questions!
  • Helpful approaches
  • What about his presentation led you to this
    diagnosis?
  • What did you find on the exam that makes you
    think it is a surgical abdomen?
  • Unhelpful
  • What are the possible causes of dyspnea on
    exertion?
  • This seems like a clear case of gout to me, how
    about you?
  • -Does not allow learner to demonstrate critical
    thinking skills.

7
3. Teach the general rule
  • Whenever possible, attempt to teach the general
    rule the rule of thumb
  • Helpful approaches
  • In a young patient with low back pain, Xrays are
    not indicated initially.
  • It is helpful to address code status when the
    patient is healthy.
  • Unhelpful approaches
  • Mr. Smith does not need an xray today
  • Why dont we discuss code status with Mrs. Jones
    today?

8
4. Reinforce What Was Done Right
  • Provide positive feedback
  • Builds confidence, promotes self esteem,
    heightens awareness to corrective criticism
  • Helpful
  • You evaluated this patient in a stepwise
    fashion and considered the patients preferences
    in your recommendations.
  • You did a good job in noting the possible role
    of medications side effects in the diagnosis.
  • Unhelpful
  • Strong work!Great Job!

9
5. Correct Mistakes
  • Choose appropriate time and place to present this
    to the resident
  • Have learners review their own performance
  • Follow up with your own comments

10
Correct Mistakes
  • Helpful
  • I agree that Goodpastures could be a cause of
    this patients symptoms, but bacterial sinusitis
    is a more likely cause based on disease
    prevalance and lack of other findings.
  • Unhelpful
  • I cant believe you know so little at this point
    in the third year.

11
Constructive Feedback
12
Descriptive, not evaluative
  • Describes the behavior you observe without
    attributing value to it
  • Good example
  • You did not make eye contact with the last
    patient during the interview
  • Poor example
  • You are not interested in patient care

13
Specific, not general
  • Identifies the precise behavior you wish to
    highlight, avoiding generalities
  • Good example
  • You were able to convey empathy and
    understanding during the interview
  • Poor example
  • You did a good job

14
Focused on issues the learner can control
  • Provides tips on how to improve
  • Good example
  • When taking the history, speak slower and
    check for understanding
  • Poor example
  • My patients cannot understand you because of
    your accent

15
Well timed
  • Makes feedback an expectation, not an exception
  • Good example
  • When it is provided regularly throughout the
    learning experience and as close as possible to
    the event that brought about the feedback
  • Poor example
  • When it is provided only at the end of the
    rotation

16
Limited in amount
  • Make the message memorable
  • Good example
  • When it focuses on a single, important message
  • Poor example
  • When the learner is overwhelmed with information

17
Addresses learner goals
  • Use of Student Contract
  • Good example
  • When it addresses goals that were identified
    by the learner at the beginning of the office
    experience
  • Poor example
  • When the learners goals are ignored

18
  • Feedback should be ongoing and frequent
  • Most common complaints from students is that
    nobody tells them how they are doing
  • Give the feedback as soon as possible after a
    critical incident
  • Use notes to help you recall points you wish to
    make
  • Describe the observed behavior
  • Be as specific as possible
  • End the feedback with detailed instructions for
    improvement
  • Follow-up with positive feedback when the
    improvements occur

19
Patient satisfaction survery
20
  • Independent Learning

21
Identify the need
  • After the presentation, have the student either
    identify the learning question(s) or ask the
    following
  • Based on your patients today, what questions do
    you have?
  • What one area would you like to learn more
    about?
  • What troubled you today?
  • What would you like to improve on?

22
Make an assessment
  • Ask the student to formulate the question
  • Ask the student to research the answers to the
    question
  • Specify a time for the student to report back to
    you with the results of the research

23
Identify potential resources
  • Medline or other databases
  • Textbooks
  • Journal articles
  • Consultants

24
Close the Loop
  • The student reports back on the research
  • Gives an oral presentation
  • Incorporates it into a patient write-up or
    assessment
  • Submits a written outline

25
Reference
  • Teaching in Your Office, A Guide to Instructing
    Medical Students and Residents
  • By
  • Patrick C. Alguire, MD, Dawn E. DeWitt, MD, Linda
    E. Pinsky, MD, Gary S. Ferenchick, MD
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