Teaching Learners in the Ambulatory Clinical SettingTali Bogler, May Loganathan, Kim Lazare

June 18, 2015

Knowles’ Adult Learning Principles• The learner should be prepared for the learning program• An environment conducive to learning should be created • A mutual planning procedure should involve the learner in

deciding what he/she will learn• Involving learners in diagnosing their own learning needs• Co-create learning objectives• Design own learning plans• Help learners carry out their learning plans• Involve learners in evaluating their own learning

Domains of LearningCognitive domain - recall, recognition of factsPsychomotor domain - technical/procedural skills Affective domain - attitude, values, language

Patients Charts Educational Techniques

Case discussion Chart review Role play and simulation

Case review Chart-simulated recall Short didactic presentation

Direct observation Criterion chart review

Teaching Strategies

Case Discussion: student sees patient then presents to preceptorCase Review: review a large number of cases at the endDirect Observation: supervision of interviewing, P/E, clinical skillsChart Review: review chart by chart with learnerChart-simulated Recall: choose two charts to review in detailCriterion Chart Review: audit charts on your own timeRole Play/Simulation: role play to recreate an office visitShort Didactic Presentation: the learner presents a topic to teacher/team

THE DEFENSIVE LEARNER • learning contract • use concepts of process learning to diffuse behaviour• act in a collegial manner with students • psychological safety • involve students in patient discussions with colleagues• learning contract improves learner's self- assessment skills rather than having to respond to your comments• involving them in discussions with colleagues about difficult patients you have

THE SLOW LEARNER• lack of knowledge of office routines: ask an office assistant or secretary to provide assistance• use role modeling to demonstrate that providing clear and brief explanations to patients is better than lengthy ones• use role play to practice focused history taking• review prevalence and likelihood of particular diseases• book fewer patients• limit your own discussion between patients

THE UNPROFESSIONAL LEARNER• work with learner to identify causes: • learner: cognitive, clinical skills, personal values, medical illness, substance abuse• preceptor: teaching skills, personal values, educational knowledge, medical illness• system: work load, time demands, learner support, preceptor supports• be direct; discuss what it conveys and how unprofessionalism can impact patient care• try to get an understanding of why the learner may have this problem

Strategies for Dealing With Challenging Learning Situations

Kolb’s Learning Styles

References