Teaching inTeaching inOPD SettingOPD Setting

Teaching and Learning in Ambulatory Care Setting: A Thematic Review of the Literature

- -Acad Med 70(1995): 898 909 931

OutlineOutline pros and cons of OPD teachingpros and cons of OPD teaching effective OPD teachereffective OPD teacher Quality of OPD educationQuality of OPD education

Pros & ConsPros & Cons ProsPros

pt seen only in OPD: chronic illnesspt seen only in OPD: chronic illness continuity of carecontinuity of care health promotion and disease preventionhealth promotion and disease prevention communication and negotiation skillcommunication and negotiation skill social, financial, and ethical aspects of medical caresocial, financial, and ethical aspects of medical care

ConsCons variabilityvariability unpredictabilityunpredictability immediacyimmediacy

Context of OPD EducationContext of OPD Education

patient problems encounteredpatient problems encountered typetype frequencyfrequency continuity of carecontinuity of care

working environment of the clinicworking environment of the clinic

Patient EncounteredPatient Encountered

typetype common disease => similarcommon disease => similar diversitydiversity

depends depends

frequencyfrequency often: HT, DM, LBPoften: HT, DM, LBP others complaint - few casesothers complaint - few cases

Patient EncounteredPatient Encountered

continuity of carecontinuity of care repeat visit = FU + non FUrepeat visit = FU + non FU Why important?Why important?

more medical and non-medical problemsmore medical and non-medical problems realisticrealistic acquaintedacquainted

~ duration~ duration < 10% in Wk 4 => 50% in Wk 8< 10% in Wk 4 => 50% in Wk 8 support longitudinal rotationsupport longitudinal rotation

What happens in OPDWhat happens in OPD Numerous demandNumerous demand brief segmented teacbrief segmented teac

hinghing rush teachingrush teaching short demonstration, short demonstration,

role modelingrole modeling brief discussionbrief discussion little time for answerlittle time for answer

Seldom observationSeldom observation infrequently taught clinfrequently taught cl

inical decision makininical decision makingg

rare reflectionrare reflection teaching embedded in teaching embedded in

patient carepatient care physicians’ personal sphysicians’ personal s

tyletyle

Educational InteractionEducational Interaction

between instructor and learnerbetween instructor and learner amount of contactamount of contact

20-30% of cases were observed20-30% of cases were observed duration of contactduration of contact

6-15 minutes6-15 minutes content of verbal interactioncontent of verbal interaction

Verbal InteractionVerbal Interaction

discussion

clarifying

presentation

Verbal InteractionVerbal Interaction

teacher talk42%

learner talk58%

Content of ConversationContent of Conversation

About family and psychosocialAbout family and psychosocial 6-20% (even in Fam Med OPD)6-20% (even in Fam Med OPD)

infrequently provide feedbackinfrequently provide feedback most 3-6% (range 0-16%)most 3-6% (range 0-16%) positive feedback > negative feedbackpositive feedback > negative feedback

rarely discuss about optionsrarely discuss about options

Wrong AnswerWrong Answer How teacher correct?How teacher correct?

provide ‘opportunity space’provide ‘opportunity space’ hint or leading questionhint or leading question reframing the questionreframing the question treat as plausible but need of further ctreat as plausible but need of further c

onsiderationonsideration soft and face-saving strategiessoft and face-saving strategies

Clinical TeachersClinical Teachers effective clinical teachereffective clinical teacher

physician role modelphysician role model effective supervisoreffective supervisor dynamic teacherdynamic teacher supportive personsupportive person

Physician Role ModelPhysician Role Model KnowledgeableKnowledgeable clinical competentclinical competent good rapport with patientgood rapport with patient

Effective SupervisorEffective Supervisor give opportunity for patient caregive opportunity for patient care review patient with learnerreview patient with learner involve learner in patient careinvolve learner in patient care give directiongive direction provide constructive feedbackprovide constructive feedback

Dynamic TeacherDynamic Teacher teaching with enthusiasticteaching with enthusiastic made an effort to teachmade an effort to teach spent time with individualspent time with individual available and accessibleavailable and accessible engage in dialogueengage in dialogue give explanationgive explanation ask and answer questionask and answer question

Supportive PersonSupportive Person easy and fun to work witheasy and fun to work with friendlyfriendly helpfulhelpful caringcaring valuing learner as individualvaluing learner as individual

RecommendationRecommendation increase continuityincrease continuity improve collaboration & SDLimprove collaboration & SDL provide faculty developmentprovide faculty development model and teach to the learnersmodel and teach to the learners observe and feedbackobserve and feedback encourage independent learningencourage independent learning supplement OPD instructionsupplement OPD instruction reflect upon and improve teachingreflect upon and improve teaching