Cumming School of Medicine Department of Family Medicine

Cumming School of Medicine Department of Family Medicine

Cumming School of Medicine Department of Family Medicine Clinical Teaching Stephen Mintsioulis, MSc, MD, CCFP Clinical Assistant Professor Director, Calgary Residency Program Department of Family Medicine University of Calgary Revised by Dr J. Lemaire for teaching in Lao PDR Oct 2018 Conflict of Interest

Nothing to declare Acknowledgements Dr. Keith Wycliffe-Jones Dr. Sonya Lee Dr. Jazmin Marlinga Dr. Martina Kelly

Revision Dr. Jane Lemaire Oct 21 2018 for teaching in Lao PDR Objectives To review what makes a good teacher To identify a framework for Clinical Teaching To describe effective questioning techniques

To identify models for giving feedback Clinical Teaching True or false: Being a good teacher makes a difference to your learners Studies show that medical students working with best teachers have better results on end of training exams Griffith CH, Haist SA , Ramsbottom-Lucier M, Wilson JF. Relationships of How Well Attending Physicians Teach to their Students Performance and Residency Choice. AcadMed. 1997; 72: s118-s126 Georgesen JC, Griffith CH, Wilson JF. Six-Yes Documentation of the Association Between Excellent Clinical Teaching and Improved Students Examination Performances. Acad Med. 2000; 75:S62-64

What Makes a Good Teacher? What do you think makes a good teacher? Role models being an excellent doctor Supervises (watches over) learners Teaches in an active way Is a supportive person (kind, caring, helpful) What Makes a Good Teacher? Role Models Clinical credibility = Trusted and respected as good doctor Teaching credibility = Trusted and respected as

good teacher who has knowledge of teaching and learning principles Has knowledge about patients, about clinical medicine, about learners Has good relationships with patients Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med.1995;70(10):898-931 Ullian JA. A `Family Practice Residents Perceptions of the role of the Preceptor: A content analysis of written evaluative comments. PhD diss., University of Minnesota, 1989 What Makes a Good Teacher? Supervises (watches over) learners Involves learner in patient care Gives learner

correct level of responsibility for patient care real life problems requiring real life solutions opportunities to do procedures Provides helpful feedback and guidance Teaches to learners needs What Makes a Good Teacher? Teaches in an active way Interested, excited about teaching Prepares and is clear and organized when teaching Makes time to teach, and spends time with

learners asks questions answers questions discusses together Learners can find teacher when needed What Makes a Good Teacher? Is a supportive person (kind, caring, helpful) Makes a safe and supportive environment so it is easier to learn Has a positive attitude about teaching Easy and fun to work with Friendly, helpful and caring

Establishes relationship with learner appreciates them as a person treats them with respect Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med.1995;70(10):898-931 Ullian JA. A `Family Practice Residents Perceptions of the role of the Preceptor: A content analysis of written evaluative comments. PhD diss., University of Minnesota, 1989 Clinical Teaching Framework Before During

After Planning Teaching Reflecting Preparation Orientation Briefing Observe

Teaching Strategies Model Climate setting Relationship building Ongoing needs assessment Irby and Bowen 2004

Discussion Thinking Reading FEEDBACK Clinical Teaching BEFORE TEACHING: PLANNING Planning: Preparation Preparation Remember the learner is coming

Have clinical workspace for learner Schedule orientation with learner before they come to work if possible If not, given them document about orientation Planning: Orientation Orient yourself Know the learner, their experiences and expectations Orient the learner What do you usually do?

Orient the learner Explain the experience and patient care Explain the practice Explain your expectations Explain what do to if problems arise Planning: Briefing Briefing or Priming A small amount of time spent with the learner before they see the patient Help direct and focus the learner Help create a supportive learning

environment Can you think of an example of briefing? Clinical Teaching Framework Before During After Planning

Teaching Reflecting Observe Teaching Strategies Role model Preparation Orientation Briefing

Climate setting Relationship building Ongoing needs assessment Irby and Bowen 2004 Discussion Thinking

Reading FEEDBACK Clinical Teaching DURING: TEACHING Teaching: Strategies Using Good Questioning as a Teaching Tool Questioning as a Teaching Tool Why should you ask questions?

Stimulate Diagnose Reinforce Why ask Questions Stimulate: Questions help to... Make learners think Make teaching and learning more fun Put focus on learners not teacher Actively involve the learners Help learners with clinical reasoning and

critical thinking Why ask Questions Diagnose: Questions help teacher to... Understand what and how the learner is thinking Assess learner level of knowledge Identify gaps in learner knowledge and errors in reasoning Follow learner progress

Why ask Questions Reinforce: When learners answer questions, they... Identify most important issues Summarize key issues Understand better Reflect and self-assess Effective Questioning We can use different types of questions, to

test different learning objectives Blooms Taxonomy (Classification) of Educational (Learning) Objectives Evaluation Synthesis Analysis Comprehension Knowledge

Bloom B, Taxonomy of educational objectives. Allyn and Bacon, Boston, MA 1984 Hierarchy (pyramid) of Medical Knowledge Clinical Reasoning Evaluation Synthesis Analysis

Basic Medical Facts Comprehension Knowledge Bloom B, Taxonomy of educational objectives. Allyn and Bacon, Boston, MA 1984 What are the Different Types of Questions? Lower order questions Knowledge (Factual recall) Explore knowledge base What are the symptoms of a myocardial infarction?

Comprehension Understand cause, effects, interpretation Why do patients with infarction have shortness of breath? What are the Different Types of Questions? Higher order questions Analysis Detect patterns, find relevant data, reject not important data In THIS setting of chest pain, what are the possible causes?

What do the investigations suggest? How do you decide between diagnosis A and B? Synthesis Predict, make conclusions What is the diagnosis and why? How would you manage this patient if she deteriorated? What is the prognosis? What are the Different Types of Questions? Higher order questions Evaluation Reviewing performance

Would you manage this patient differently next time? What have you learned? What are the Different Types of Questions? Open question How well have you managed this patient? What have you learned? Evaluation In this patient, what is the diagnosis? treatment plan? likely outcome? What do these findings mean?

What are the causes? effects? What do you understand by ? What is the name of ? Where ? Synthesis Analysis Comprehension Knowledge

Bloom B, Taxonomy of educational objectives. Allyn and Bacon, Boston, MA 1984 Closed question Practice different types of questions Good Questioning Technique What is some advice for good questioning technique? Remember questioning can be frightening for learner Think about the purpose of your question Ask one question at a time, expect silence and wait

Remember sometimes the learner will say I dont know Make questions clear Give verbal and non-verbal encouragement Encourage learner to think Be a good listener Bad Questioning Techniques What is some advice for bad questioning technique? Interrupting the student Asking questions that are too hard for learners level

Asking many questions at the same time Asking the hardest question first Not waiting enough time for student to answer Not creating a supportive environment Leaving questions unanswered Clinical Teaching Framework Before During After

Planning Teaching Reflecting Observe Teaching Strategies Model Preparation

Orientation Briefing Climate setting Relationship building Ongoing needs assessment Irby and Bowen 2004

Discussion Thinking Reading FEEDBACK Clinical Teaching Feedback ART ATTACK Activity Groups of 2 people One person draws 5 minutes The other person gives feedback on the drawing 5 minutes

Clinical Teaching Feedback How did you feel about giving feedback? How did you feel about receiving feedback? Clinical Teaching Feedback Why Give Feedback? Help learners to: Evaluate knowledge, practice skills Define teachers expectations Identify their strengths/weaknesses without punishment Improve problem areas

Help teachers to: Evaluate and change their teaching style and content Recognize student progress and achievement .Jennifer R. Kogan Lisa M. Bellini Feedback workshop Pennsylvania School of Medicine 2004 Clinical Teaching Feedback Effective feedback is Expected, arrange a time, announce I am giving you feedback Not overwhelming Constructive and related to agreed upon goals Based on first-hand observation Specific

Focused on behavior and not the individual Associated with a plan for follow-up Ende J. Feedback in clinical medical education. JAMA 1983;250:777-781 Miser F .www.ohioafp.org/pdfs/members/educator resources/ GivingEffectiveFeedback.pdf Clinical Teaching Feedback Endes guidelines for feedback Give feedback as soon as possible unless emotions will interfere with the feedback Use descriptive not evaluative language (Describe, do not judge) Be positive about what the learner did well, and correct what they did not know

Limit feedback to things the learner can improve Clinical Teaching Feedback SET-GO model for descriptive feedback What I Saw What Else I Saw What do you Think? What are our Goals? Any Offers on how to achieve those goals?

Describe what you saw Describe what happened next Reflect back to the learner Learning objectives Suggestions for change Clinical Teaching : Feedback Pendletons Rules for feedback Ask learner what he/she did well Discuss what went well, adding own observations Ask learner what went less well and what they would do differently next time

Discuss what went less well, adding own observations and recommendations Pendleton D, Scofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984 ART ATTACK!!! Try again but use models of feedback we discussed Clinical Teaching - Feedback

Be timely Be specific Be descriptive Be constructive Summary

Effective Teaching Framework for Clinical Teaching Orienting the Learner Effective Questioning Feedback Skills

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