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Liliana Chiorean(1), Radu Badea(2)
Residents education using ultrasound.
Teaching with clinical cases
1. Radiology Department, Emergency County Hospital, Cluj-Napoca, Romania2. Echography Department, “Octavian Fodor” Institute of Gastroenterology and
Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
1. Adult education – features
2. Cases method – case presentation as teaching method
3. Resident as «student» – learning near ultrasound machine
4. Resident as «teacher» – clinical cases presentations for other residents/students, articles
Objectives
Learn best when there is an immediate need to know
Retain information learned when they can apply immediately
Thrive in a safe learning environment promoted by teacher
They want to be the origin of what they learn
Adult education theory
“We are what we repeatedly do. Excellence then is not a singular act, but a habit.” Aristotel
Source: Edgar Dale (1969)
After two weeks, we tend to hold…
“I see and I forgot, I hear and I remember, I do and I understand.” Confucius
10%
20%
30%
50%
70%
90%
Read
Listen
Look
Movie, presentation, demonstration
Discussions, lectures
Making a presentation
Sharing personal experience
Method of one-way communication
Not involve significant audience participation
Passive way of data acquisition
Truncate retaining of study material
Learning through courses
“ Change is the final result of real education.” Leo Buscaglia
Experience
Notice Analyze
Generalizes
Apply
The cycle of active learning
Work, action, experiment
What happened?Which were the
results?
What does this results imply?
How have I influenced the outcome?
What will I do different next
time?
In continuous change
Education
“ How many things I don’t need exists…” Socrate
Much more residents
Funds – sufficient?Increasing requirements
What is the path through succes?
Reproduction of real cases
Demonstrations, questions with active involvement of the audience who has decision-making role
Stimulating discussions, highlighting of the problems faced
Imediate impact and relevance
Case method
“I would rather make people fun hoping that they had learned something, than teaching
them and hoping that they had fun” Walt Disney
Socratic method – the dialogue it’s essential
Case method - historical
The problem it’s divided in questions wich hepl in finding the seeking answer
The base of learning is the active role of student in solving the case
It is based on critical evaluation
“The only thing I know is that I know nothing” - Socrate
Where cases have been used?
When case method is the best
Short time to teach
One professor, small number of residents
A single clinical aspect
It is always more efficient when connected to direct patient care
A very good modality to involve the residents
“ The only thing which interferes with my learning is my education.” Albert Einstein
A familiar scenario
Every case has something that can be learned
Unique teaching opportunities
Integrating the patient in case discussions increasses his satisfaction
Ultrasound department
“ Education is an admirable thing, but it is well to remember from time to time that what it’s valuable can’t be teached.” Oscar Wilde
Learning clinical models
Learning communication skills
Time management
Role in developing behavioral models
Ultrasound examination
“ Only an educated mind is able to sustain an idea without accepting it.”
Aristotel
It can be done in front of the patient
Establish the resident’s needs
Observation and evaluation of the knowledge base, examination skills, clinical reasoning
Direct observation
“ Education is not how much you stored, not even how much you know. It’s about making the difference between what you know and what you
don’t know.” Anatole France
Find out what residents know and build over
Start from general to specific
Be organized
Include general rules
Engage residents in discussion
Putting into practice
“ Education is the key who unlocks the door to freedom.” George Washington Carver
Assertive style
“Which is the differential diagnosis of a focal liver lession?”
Teacher-centered
Rate the resident’s knowledgebase
Direct questions
Brings informations
Provides guidance
Suggestive style
Brings suggestions and alternatives
Can share opinions and personal practical experience
“Although a simple renal scan may be useful, a CT examination without contrast agent is a better diagnostic tool for this patient.”
Collaborative style
Socratic approach oriented towards residents
Explore the clinical rationality with challenging questions
Produces feelings of belonging, of teamwork
Follows the resident’s collaboration capability
“How should we proceed?”“What complementary imagistic examinations would be useful ?”
Facilitative style
Accepts residents ideas in order to self-assessment
Uses delayed response, silence
Helpfull tags
Produces feelings and encourages the residents
Find opportunities
Splenic abscess
Hepatic cysts
Duct stone
Foreign body in antral wallMelanoma sentinel
nodes
Use additional resources
Subcapsular liver hematoma Focal nodular hyperplasia
Ileocaecal, colonic and peritoneal tuberculosis
Keys to success
Selection of interesting and educative cases
Sharing personal experiences
Mutual trust
Preparation, enthusiasml
Needs time and effort, but the reward is great
“The initial direction of a man’s education is the one which will determine his future.” Plato
Give feedback
“Praise – Criticize – Praise”
Start always with what is positive
Individualized, well-timed, according to the situation
Honest assessment of performance, including suggestions for improvement
At the end
Conclusion of discussions
Focuse their attention to articles and studies which are relevant for the discussion topic
Connecting case analysis to theory
“ If I would start again my studies, I would follow Plato’s advice and start with mathematics.” Galileo Galilei
Resident as a “teacher”
Preparation of clinical case presentations for teaching others
Documentation and cases preparation in order to publish articles
Obtain a solid theoretical basis
“ The purpose of education is to replace an empty mind with an
open one.” Malcolm Forbes
Conclusions
Near the US machine you can take advantage of the opportunities offered to teach
Case presenations are suitable to the theory of adults learning
They are enough in order to provide essential informations in a short period of time
“Data are not information, information are not knowledge,
knowledge is not understanding, understanding is not wisdom.”
Clifford Stoll
References
1. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract. 1992;5:419-24.
2. Aagaard E, Teherani A, Irby D. Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient and the Learner: Proof of Concept. Acad Med. 2004;79:42-49.
3. Orlander JD. Twelve tips for use of a white board in clinical teaching: reviving the chalk talk. Med Teach. 2007;29(2-3):89-92.
4. Langlois J, Thach S. Teaching and learning styles in the clinical setting. Family Medicine. 2001;33:344-6.
5. Pashler H, McDaniel M, Rohrer D, Bjork R. "Learning styles: Concepts and evidence". Psychological Science in the Public Interest 2008;9:105-119.
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