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

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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.