Post on 24-Dec-2015
New Faculty OrientationTeaching in the Clinical Setting
Tatum Langford Korin, EdD
September 19, 2006
The Five P’s of Effective Teaching
• Preparation
• Perceptions
• Professionalism
• Presentation
• Participation
Preparation
• Determine the need of students
• Integrate previous learning into present lesson
• Determine the educational level of the students
• Assemble teaching accessories
Perceptions
• Student and preceptor
• Integration of one’s ideas during teaching
• Positively reinforce the practice of medicine
• Attitudes are easily conveyed
Professionalism
• Appearance (clean lab coat)
• Demeanor– Polite without being overly friendly
• Preceptor is always Dr.
• Know students name
Presentation
• Competing student interest and material
• Focus on student attention
• Positive learning environment
• Three points (presented at first meeting):– What you are going to do– How you are going to do it– What are the students expected to do
Participation• Bilateral participation• Eye contact• Questions=feedback• Questions=fact finding mission• Orient learners to lesson• Review past material• Reflect on learning• OK to say “I don’t know”• Give feedback to learners often• Praise is important to the group and individual
Conclusion
• Reflect on the five P’s and make adjustments for the next teaching experience– Prepare early– Discuss your perceptions– Be professional– Design your presentation– Allow bilateral participation
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Teaching in the Clinical Setting
In-depth LecturesSeminarsFormal Educational SessionsExtensive Discussion
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Teaching in the Clinical Setting
Efficient and effective ambulatory care teaching requires that both the student and preceptor accept the limitations of the outpatient setting.
Extensive discussions of differential diagnosis, pathophysiology and psychosocial problems are not possible nor necessarily desirable.
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Teaching in the Clinical Setting
Keys to Clinical Teaching
• Demonstrate enthusiasm
• Give meaningful (“authentic”) responsibility
• Possess credible clinical skills
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CHARACTERISTICS AND BEHAVIORS IDENTIFIED IN STUDIES OF CLINICAL TEACHINGEFFECTIVENESS
Organized,Planned
Approach toTeaching
SystematicTeachingPractices
DemonstratesKnowledge,
ClinicalCompetence and
ProfessionalDemeanor
Respectfuland
HumanisticOrientation
Enthusiastic,StimulatingApproach to
Teaching
JACOBSON(1966)
-Available tostudents
-Systematicevaluatorpractices
-Systematicteachingpractices
-Apparent knowledge-Professionalcompetence
-Interpersonalrelations withstudents and
others-Personal
characteristicSTRITTER
ET AL(1975)
-Accessible tostudents
-Prepares forcontracts with
students-Identifies what’s
important
-Answersquestionscarefully
-Explains basesfor action-Provides
opportunity forpractice
-Summarizesmajor points
-Explains lucidity
-Provides competentclinical care
-Corrects w/obelittling
-Approachesteaching withenthusiasm-Genuineinterest inteaching
IRBY (1978) -Accessible tostudents-Clarity,
organization
-Breadth of knowledge-Competent
-Friendliness-Interested in
students,patients,residents
-Enthusiasm-Enjoyment
GJERDE &COBLE(1982)
-Takes time fordiscussion and
questions-Accessible to
residents-Well prepared for
teaching
-Answersquestions clearly
-Providesopportunity for
practicetechniques andpsychological
skills-Discuss practical
application ofknowledge and
skills-Provides
constructivefeedback
-Shares knowledge andexperience
-Asksquestions in
non-threatening
way
-Demonstratesenthusiasm for
teaching
ULLIAN &BLAND(1983)
-Available forfrequent contact
-Explains clearly-Feedback given-Given residentresponsibility
-Good medicalknowledge
-Clinically competent
-Encouragesdifferences of
opinion-Builds
relationshipwith residents
-Enthusiastic-Interested in
teaching
WEINHOLTZ ET AL(1983)
-Allocates time forinstruction
-Provides initialorientation
-System forlistening to case
presentations andmanaging
discussions-Makes didacticpresentations
-Conducts finalevaluation-System fortransferring
teachingresponsibility
-Clinically credible -Createsclimate in
non-threatening
way
Characteristics and Behaviors Identified in Studies of Clinical Teaching Effectiveness
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Teaching in the Clinical SettingPitfalls in clinical
case-based teaching
• “Taking over” the case• Inappropriate lectures• Insufficient “wait-time”
-3-5 second wait to answer your questions
• Pre-programmed answers
-What do you think is going on? Could it be an ulcer?
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Teaching in the Clinical Setting
Pitfalls continued…
• Rapid reward-Effectively ends the student’s thinking process
• Pushing past ability-Persisting in carrying the students beyond their understanding of what is being asked
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Teaching in the Clinical Setting
Teaching Strategy #1The “One-Minute Preceptor”
1. Get a commitment
2. Probe for supporting evidence
3. Teach general rules-Take each encounter to a learning point
4. Provide feedbackA. PositiveB. Corrective
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Teaching in the Clinical Setting“One-Minute Preceptor” MicroSteps
• Get commitment (Assess)– “What do you think is going on?”
• Probe for rationale (Assess)– “What led you to that conclusion?”
• Teach general rules (Instruct)– “When this happens, do this…”
• Reinforce what was correct (Feedback)– “You did an excellent job of…”
• Correct mistakes (Feedback)– “Next time this happens, try this…”
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Teaching in the Clinical Setting “One-Minute Preceptor”
Video VignettesInstructions: Watch the vignette(s) and determine
whether correct and effective precepting has taken place:
Preceptor asked for commitment Preceptor probed for supporting evidence Preceptor taught a general rule Preceptor provided feedback
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Teaching in the Clinical Setting “One-Minute Preceptor”Role Play: Case Presentation
3rd-year students in the ambulatory setting
Preceptor role: practice the microsteps of the “One-Minute
Preceptor” for a 3rd-year medical student in the outpatient
setting
Student role: receive teaching and supervision in the outpatient setting and respond to the preceptor’s questions
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Teaching in the Clinical Setting
Teaching Strategy #1The “one-minute preceptor”
QUIZQUIZ1. Get a _______________________
2. Probe for ___________________
3. ____________general rules
4. Provide____________________
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Teaching in the Clinical Setting
“Trainees do not perform required skills incorrectly on purpose…errors in
performance are typically the result of insufficient feedback. They are seldom the
result of insufficient interest or caring.”
-Westberg and Jason, 1991
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Teaching in the Clinical Setting
FEEDBACK IS:Information you provide to learners about
their clinical performance that is intended to guide their future clinical
performance
-Adapted from K. Skeff
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Teaching in the Clinical Setting
Feedback in Ambulatory Care Settings
• Case presentations with faculty feedback: On Average: 3-6%
• Positive feedback given more than negative
• Intensive feedback to residents improves patient satisfaction
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Teaching in the Clinical Setting
The “Feedback Sandwich”The “Feedback Sandwich”
What was done right
What needs improvement
What to do next time
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Teaching in the Clinical SettingGiving Feedback
A Checklist11 Make sure learner is ready11 Give it soon and often11 Link to goals11 Be specific & non-judgmental11 Give positive and constructive comments11 Suggest correct performance11 Don’t give too much11 Make sure feedback is understood11 Follow up your feedback111 Expect learners to develop skills in self-
evaluation