Introduction to Introduction to TeachingTeaching

University of PittsburghUniversity of Pittsburgh

Academy of Master EducatorsAcademy of Master Educators

Teaching Residents to Teach CommitteeTeaching Residents to Teach CommitteeJonathan Finder MDJonathan Finder MD

Raquel Buranosky, MDRaquel Buranosky, MD

Jamie Johnston, MDJamie Johnston, MD

Petronille Vaulx-Smith, MDPetronille Vaulx-Smith, MD

Academy of Master Educators Residents as Teachers Committee

Jonathan Finder, MD– Professor of Pediatrics– Clinical Director,

Pediatric Pulmonology

Jason Rosenstock MD– Assistant Professor of

Psychiatry– Director Med Student

Education

Raquel Buranosky, MD,MPH– Associate Professor

of Medicine– Director, Internal

Medicine Residency

Peter Ferson, MD– Professor of

Surgery

Committee Members

James Johnston, MD– Professor of Medicine – PD, Nephrology

Fellowship– President, AME

Rita M Patel MD– Professor & Vice-Chair,

Anesthesiology– Clinical Procedures

UPSOM Course Director– Associate Dean for GME

Kathleen McIntyre-Seltman, MD– Professor of OB/GYN &

Reproductive Sciences– Advisory Dean, UPSOM

Petronilla Vaulx-Smith, MD, PhD– Assistant Professor of

Psychiatry Basil Zitelli, MD

– Professor of Pediatrics

Introduction to Teaching

Goal:To help incoming house staff 1) recognize the importance of

teaching2) understand basic do’s and don’ts3) be open to further development

of teaching skills

Orientation ProgramOrientation Program Introduction to Teaching Introduction to Teaching

Why?Why?

Helps with patient careHelps with patient care Makes you look goodMakes you look good Learners expect itLearners expect it It’s requiredIt’s required

– ACGME CompetenciesACGME Competencies– Program/Institutional RequirementsProgram/Institutional Requirements

Intro to Teaching:Intro to Teaching:The The APPLEAPPLE Curriculum Curriculum

APPLEAPPLE Curriculum Curriculum – AApplication of pplication of PPrinciples and rinciples and PPractice ractice

of of LLearning and earning and EEducationducation CoreCore

– Fundamental principles of educationFundamental principles of education– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

Conduct of SessionConduct of Session

Brief introduction to teachingBrief introduction to teaching Case-Based ScenariosCase-Based Scenarios Reflection (Table Discussion)Reflection (Table Discussion) Open DiscussionOpen Discussion Summary – Teaching PointsSummary – Teaching Points

Agenda - 1

CoreCore– Fundamental principles of educationFundamental principles of education– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

Dr. Vaulx-SmithDr. Vaulx-Smith

AdultAdult Learning Learning PrinciplesPrinciples

Adult learners: Adult learners: – Are Are goal-oriented goal-oriented (Why, What and How)(Why, What and How)– Are Are autonomous and self-directingautonomous and self-directing– Have Have preexisting resources preexisting resources (life (life

experiences)experiences) Make it relevant, practical & contextual Make it relevant, practical & contextual

(problem solving)(problem solving) Be respectful (safe learning Be respectful (safe learning

environment) environment) Motivate and reinforceMotivate and reinforce

Agenda - 2

CoreCore– Fundamental principles of educationFundamental principles of education– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

“Teachable Moments”

Not just a ‘lecture’ Modeling professional behavior Daily opportunities

– Work rounds– Procedures– Ambulatory settings

Pick your targets (can’t do it all) Be brief (“teaching on the fly”)

What type of teaching What type of teaching useful?useful?

0

10

20

30

40

50

60

70

% Re

sponse

s

A B C D

High ------------------------------------------------Low

MS Resident Prog Dir

A.A. Procedures, Case Procedures, Case Management, 5-Management, 5-min talks, Bedside min talks, Bedside TeachingTeaching

B.B. Physical Diagnosis Physical Diagnosis RoundsRounds

C.C. Lectures, PBL, Lectures, PBL, Simulated Cases, Simulated Cases, Socratic Socratic questioningquestioning

D.D. MS I & MS II MS I & MS II coursescourses

*Students value *Students value case-based & case-based & bedside bedside teaching over teaching over lectures.lectures.

““The One Minute The One Minute Preceptor” Preceptor”

1.1. Get a commitmentGet a commitment2.2. Probe for supporting evidenceProbe for supporting evidence3.3. Teach general rules and think Teach general rules and think

out loudout loud4.4. Tell your learner what he or she Tell your learner what he or she

did rightdid right5.5. Correct the learner’s mistakesCorrect the learner’s mistakes

Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching

SCENARIO #1

Answer the following questions

1.1. How can you use adult learning How can you use adult learning principles to improve the principles to improve the educational experience?educational experience?

2.2. Identify the teachable moments Identify the teachable moments and critique what you sawand critique what you saw

Comments?

1. 2.3.4.

1 Minute Preceptor: 1

Get a commitment– Ask learner to articulate his/her

own diagnosis or plan– Get him/her to commit to an

answer (even if wrong)

One Minute Preceptor 2

Probe for supporting evidence– Evaluate the learner’s

knowledge/reasoning– Ask probing questions

Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s answer

One Minute Preceptor: 3

Teach general rules• Generalize from the case at hand• Give the learner a pearl /take home

point• Point out how this case is same or

different from the general rules

Microskills of Teaching: 4

Reinforce what was done well• Provide positive feedback• “Catch them doing something right”

One Minute Preceptor: 5

Correct errors• Provide constructive corrections and

feedback Specific Targeted Recommendations for improvement

The One Minute Preceptor

Choose a single teachable point per encounter– Most generalizable (most useful)– Most important (don’t miss the life

threatening diagnosis)– Targeted at learner’s area of weakness– Building on previous teachable point– Can be diagnosis, management, skill

etc

Agenda

CoreCore– Fundamental principles of educationFundamental principles of education– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

Dr. BuranoskyDr. Buranosky

FeedbackFeedback vs.vs. EvaluationEvaluation ImmediateImmediate InformalInformal ObjectiveObjective SpecificSpecific Improvement Improvement FormativeFormative InformationInformation

ScheduledScheduled FormalFormal SubjectiveSubjective GlobalGlobal GradeGrade SummativeSummative JudgmentJudgment

RIMERIME Evaluation Evaluation FrameworkFramework RReporter eporter – Provides data– Provides data

– WBC count 15; chest x-ray infiltrateWBC count 15; chest x-ray infiltrate

IInterpreternterpreter – Integrates data – Integrates data– Differential diagnosis including pneumoniaDifferential diagnosis including pneumonia

MManager anager – Implements– Implements– Treats with antibiotic, arranges hospital Treats with antibiotic, arranges hospital

admissionadmission

EEducator ducator – Teaches – Teaches – Shows how individual data led to diagnosis of Shows how individual data led to diagnosis of

pneumonia and how to treat itpneumonia and how to treat it

SCENARIO #2

Answer the following questions:

1.1. How would you improve the How would you improve the feedback that was given? feedback that was given?

2.2. Use the RIME System to assess Use the RIME System to assess the learnerthe learner

Comments?

1. 2.3.4.

Feedback Feedback in thein the Clinical Clinical SettingSetting

Observe the learnerObserve the learner Describe a notable aspect of Describe a notable aspect of

performanceperformance Wait for a responseWait for a response Recommend a next step to Recommend a next step to

enhance their performanceenhance their performance Arrange for a retryArrange for a retry

Evaluation Evaluation ofof Clinical Clinical LearnersLearners

Reinforce what they are doing wellReinforce what they are doing well Educate about areas in which Educate about areas in which

improvement is possibleimprovement is possible Affirm your belief in their ability to Affirm your belief in their ability to

follow this advicefollow this advice Check for their understanding by Check for their understanding by

asking for a planasking for a plan Commit to helpCommit to help

Teaching Challenges

The unmotivated student The unprofessional student Confrontation/Conflict Time constraints Navigating the learner/teacher

role

Intro to Teaching: Conclusions

It’s important and you’ll do it regularly Make it relevant, practical Capitalize on teachable moments Use your new teaching skills (1 min.

preceptor) Give timely feedback, assess with RIME Ask for help, more to come

So Just Take the Plunge