Heidi Kromrei, PhDAssistant Vice-President, Academic Affairs, Associate Designated Institutional Official

Detroit Medical CenterGraduate Medical Education

Alfred E. Baylor, III, MDAssistant Professor, Department of SurgeryWayne State University School of Medicine

Presented at the SEMCME Chief & Senior Resident Workshop

April 28, 2017

My Favorite Teacher

Who is or was your favorite teacher?

What did he/she do that impressed you?

How did those teaching strategies make you feel?

Session Goals

1. Understand how adults learn

2. Recognize effective instructional strategies for medical education settings

3. Develop your own plan to teach residents how to teach

Andragogy: Teaching The Adult Learner

Pedagogy vs. Andragogy

Pedagogy

The art, science, or profession of teaching

Andragogy

The art and science of helping adults learn

Source: Knowles, M. S. (1980)

The Learner’s Experience

Pedagogy

Learner has little experience

Experience of instructor is most influential

Andragogy

Learner brings volume/quality of experience

Adults bring diversity of experience; are rich resource for one another

Source: Knowles, M. S. (1980)

The Learner

Pedagogy

Learner is dependent

Teacher is responsible for what is learned

Teacher evaluates learning

Andragogy

Learner is self-directed

Learner is responsible for his/her learning

Self-evaluation is a characteristic approach

Source: Knowles, M. S. (1980)

Self Concept

Self concept moves from dependence to self-direction

Experience

As repertoire of experience grows, experience becomes increasing resource for learning

Readiness to Learn

Readiness to learn becomes increasingly oriented to the developmental tasks of societal roles

Orientation to Learning

Application focus shifts from postponed application of knowledge toward immediacy of application, from subject-centeredness to problem centeredness

Motivation to Learn

Shift from extrinsic to intrinsic (path to lifelong learner)

The Adult Learner

Source: Knowles, M. S. (1980)

Instructional Strategies

Malcolm Knowles Principles of Andragogy:

Adults need to be involved in the planning and evaluation of their instruction.

Experience (including mistakes) provides the basis for learning activities.

Adults are most interested in learning subjects that have immediate relevance to their job or personal life.

Adult learning is problem-centered rather than content-oriented.

What Teachers Need to Know

Source: Knowles, M. S. (1980)

Modeling3rd year med student observes efficient intern, 2nd year resident

4th year med student pairs with 3rd year resident

2nd year resident pairs with chief resident (pre-call)

CoachingCoaching on Rounds: Feed to the next learner level

Chief or Fellow run rounds, faculty interject

Try to make the leader an expert

Reinforce what to expect from team members at each level

Coach

Articulation“Cognitive Think Aloud”

Case discussion at the scrub sink:

Resident articulates…•Differential diagnosis•Pathophysiology•Surgical plan

Reflection• FLS –problem solving and

comparison

• ATLS, ACLS

• Simulation Labs

ExplorationTeaching Strategies When On Call:

• Forces critical problem solving

• Eventual feedback

Teaching in the Healthcare Setting: Residents as

Teachers

Knowledge Retention Rates of Common Teaching Strategies

Lecture (Low: 5%)

Reading (Low: 10%)

Audio-Visual Learning (Low: 20%)

Discussion Group (Moderate: 50%)

Practice by Doing (High: 75%)

Teaching Others (Highest: 90%)

Effectiveness of Common Instructional Strategies

Source: HMS Academy Lecture [National Training Laboratories, Bethel, Maine ]02/14/2013

Traditional Preceptor Model One Minute Preceptor Model SNAPPS

Case presentation strategy for higher clinical reasoning

Simulations High Fidelity Low Fidelity

OSCEs Objective Structure Clinical Examination

SOAPS Critical evaluation of oral case presentation

Feedback Audio-Visual Strategies Lectures and Conferences

Journal Club M&M

Common Med Ed Instructional Models

My least favorite teacher

Who is or was your least favorite teacher?

What did he/she do that annoyed you?

How did those teaching strategies make you feel?

NOT

Teaching At Its Best

Set high, attainable expectations

Relate your material to existing knowledge

Make it relevant and applicable

Enthusiasm & Passion

Creativity & Invention

Active learning techniques

Problem-based methods

Multiple teaching modalities

Include self-assessment

Multiple assessment points/methods

Motivate & reinforce with emotions

Source: Nilson, 2010

Group Activity: Case Study

You observed a junior resident berating a first year resident for not being able to accurately present a patient during rounds.

The junior “teaching” resident implies that the first year is “an idiot” comments that “your presentation is all wrong” and makes other derogatory personal remarks about the first year presenter

Questions As chief resident, what should

you do?

How can you help the junior resident become a better teacher?

What methods might you share to help him/her?

What Will You Do?

1.Think about ways to “teach your residents to teach”

2.Note your ideas and plans

3.Share with large group

Questions?

Thank you for your attention and participation

hkromrei@dmc.org abaylor@med.wayne.edu

Teaching Principles and Practices

Bain, K. (2011). What the best college teachers do. Harvard University Press.

Bloom, B. S. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Suggested Reading

Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make it stick. Harvard University Press.

Driscoll, M.P. (2004). Psychology of Learning for Instruction (3rd edition). Needham Heights, Massachusetts: Pearson.

Knowles, M. S. (1980). The Modern Practice of Adult Education: From Pedagogy to Androgogy (2nd ed.) New York: Cambridge Books.

Nilson, L.B. (2010). Teaching at Its Best: A Research-Based Resource for College Instructors. Jossey-Bass.

Stolovitch, H. D., & Keeps, E. J. (2011). Telling Ain't training. American Society for Training and Development.

Teaching Residents in the Heath Care Setting

Furney, S. L., Orsini, A. N., Orsetti, K. E., Stern, D. T., Gruppen, L. D., & Irby, D. M. (2001). Teaching the one‐minute preceptor. Journal of general internal medicine, 16(9), 620-624.

Gigante, J. Dell, M., & Sharkey, A. (2010). Beyond “Good Job” How to Give Effective Feedback. Pediatrics, 127(2), 205-207.

Irby, D. M., & Wilkerson, L. (2008). Teaching rounds: teaching when time is limited. BMJ: British Medical Journal, 336(7640), 384.

Kern, D. E., Thomas, P. A., & Hughes, M. T. (Eds.). (2010). Curriculum development for medical education: a six-step approach. JHU Press.

Morrison, E. H., Rucker, L., Boker, J. R., Gabbert, C. C., Hubbell, F. A., Hitchcock, M. A., & Prislin, M. D. (2004). The effect of a 13-hour curriculum to improve residents' teaching skills: a randomized trial. Annals of internal medicine, 141(4), 257-263.

Pian-Smith, M. C., Simon, R., Minehart, R. D., Podraza, M., Rudolph, J., Walzer, T., & Raemer, D. (2009). Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. Simulation in Healthcare, 4(2), 84-91.

Pinsky, L. E., Monson, D., & Irby, D. M. (1998). How excellent teachers are made: reflecting on success to improve teaching. Advances in health sciences education, 3(3), 207-215.

Ramani, S. (2003). Twelve tips to improve bedside teaching. Medical teacher, 25(2), 112-115.

Roberts, N. K., Brenner, M. J., Williams, R. G., Kim, M. J., & Dunnington, G. L. (2012). Capturing the teachable moment: a grounded theory study of verbal teaching interactions in the operating room. Surgery, 151(5), 643-650.

Romanelli, F., Smith, K. M., & Brandt, B. F. (2005). Teaching residents how to teach: a scholarship of teaching and learning certificate program (STLC) for pharmacy residents. American Journal of Pharmaceutical Education, 69(1-5), 126.

Smith, C. A., Ganschow, P. S., Reilly, B. M., Evans, A. T., McNutt, R. A., Osei, A., ... & Yadav, S. (2000). Teaching residents evidence-based medicine skills. Journal of General Internal Medicine, 15(10), 710-715.

White, C. B., Bassali, R. W., & Heery, L. B. (1997). Teaching residents to teach: an instructional program for training pediatric residents to precept third-year medical students in the ambulatory clinic. Archives of pediatrics & adolescent medicine, 151(7), 730-735.

References & Suggested Reading