Teaching Residents to... Teach Peter DeBlieux,MD LSUHSC Clinical Professor of Medicine LSUIH Emergency Department Director Emergency Medicine Director

Teaching Residents Teaching Residents

to... to... TeachTeach

Peter DeBlieux,MDLSUHSC Clinical Professor of MedicineLSUIH Emergency Department DirectorEmergency Medicine Director of Resident and Faculty Development

ObjectivesObjectivesAt the end of this presentation At the end of this presentation

participants will be able to:participants will be able to:

Demonstrate principles of Adult Demonstrate principles of Adult LearningLearning

Perform a One Minute Preceptor Perform a One Minute Preceptor

Reflect on their own teaching Reflect on their own teaching practicespractices

Great Teachers are... Great Teachers are...

Made not Made not BornBorn

Example is not the main thing in Example is not the main thing in influencing others. It is the only influencing others. It is the only

thing.- Albert Schweitzerthing.- Albert Schweitzer

Majority of Academic Majority of Academic Physicians are…Physicians are…

Accidental Accidental EducatorsEducators

Did you actually plan on a life of teaching?Did you actually plan on a life of teaching?

Accidental Educator

Medical EducationMedical Education

– – Learning the knowledge, Learning the knowledge, skills, attitudes, and skills, attitudes, and behaviors that promote the behaviors that promote the development of a physician.development of a physician.

The Golden Rule of Medical The Golden Rule of Medical Education...Education...

––Treat learners as you Treat learners as you would like them to would like them to treat patients. As if treat patients. As if that patient was you!that patient was you!

The Purpose of The Purpose of Education is to Education is to Make Yourself Make Yourself Obsolete as a Obsolete as a

TeacherTeacher

Continuum of Medical Continuum of Medical Education/Competence Education/Competence

ContinuumContinuum

StudentStudent ClinicianClinician

Patient Care Responsibility

Faculty Supervision

ExpertNovice

Patient Caring Patient Caring and Learningand Learning

PatientPatient

FacilitatorFacilitator Learner Learner

Establishing Ground RulesEstablishing Ground Rules

Creates a safe learning environmentCreates a safe learning environment No put downs verbal or non-verbal, no No put downs verbal or non-verbal, no matter how temptingmatter how tempting

Speak for yourselfSpeak for yourself Everyone is responsible for their own Everyone is responsible for their own learninglearning

Expect unfinished business, too many Expect unfinished business, too many exercises, not enough timeexercises, not enough time

Why Should Doctors Teach?Why Should Doctors Teach?

Enhancement of their own knowledge Enhancement of their own knowledge base and problem solving skillsbase and problem solving skills

Development of learning habits and Development of learning habits and skills enabling lifelong maintenance of skills enabling lifelong maintenance of professional competenceprofessional competence

Creation of and fostering a TEAM Creation of and fostering a TEAM mentalitymentality

Why Should Doctors Teach?Why Should Doctors Teach?

Fosters goodwill among house-Fosters goodwill among house-staffstaff

Self satisfaction of teachingSelf satisfaction of teachingAvailability of residents – you are Availability of residents – you are doing it anyway, near peer doing it anyway, near peer phenomenon, role modelingphenomenon, role modeling

Barriers to TeachingBarriers to TeachingTimeTimeTrainingTrainingService vs EducationService vs Education

Structure of Adult Structure of Adult LearningLearning

Problem SolvingProblem Solving

Concepts ConceptsConcepts Concepts

Principles Principles PrinciplesPrinciples Principles Principles

Facts Facts Facts Facts FactsFacts Facts Facts Facts Facts

Principles of Adult Principles of Adult LearningLearning

Motivation is established, the Motivation is established, the material is usefulmaterial is useful

Assurance that learning is activeAssurance that learning is active Concepts not facts are taughtConcepts not facts are taught Feedback is provided promptlyFeedback is provided promptly

Principles of Adult Principles of Adult LearningLearning

Environment is non-threateningEnvironment is non-threatening Material is related to existing Material is related to existing

knowledgeknowledge Learners are treated as Learners are treated as

individualsindividuals Learning is best when self-pacedLearning is best when self-paced

Bedside TeachingBedside TeachingMedicine is learned at the bedside Medicine is learned at the bedside

and not in the classroom; the best and not in the classroom; the best teaching is that taught by the teaching is that taught by the patient himself.-patient himself.-

Sir William OslerSir William Osler

Attributes of Effective Attributes of Effective TeachersTeachers

Enthusiasm for the missionEnthusiasm for the mission Incorporates student in the Incorporates student in the

learning processlearning process Problem solving emphasisProblem solving emphasis Student-centered instructionStudent-centered instruction Humanistic OrientationHumanistic Orientation

Attributes of Effective Attributes of Effective TeachersTeachers

Organization/clarityOrganization/clarity KnowledgeKnowledge Group instructional skillsGroup instructional skills Clinical supervisionClinical supervision Clinical competenceClinical competence Modeling professional characteristicsModeling professional characteristics

Techniques for Successful Techniques for Successful Bedside InstructionBedside Instruction

• Clear planning and preparationClear planning and preparationEffective leadershipEffective leadershipTotal and constructive Total and constructive

participationparticipation

Delivering Delivering FeedbackFeedback

Performance Performance ModelModel

EvaluationsEvaluationsSummativeSummative–JudgementJudgement

–After the factAfter the fact

FormativeFormative–Change in behaviorChange in behavior

–OngoingOngoing

Ideal Behaviors for Ideal Behaviors for Delivering FeedbackDelivering Feedback

Eye contact Eye contact EnthusiasmEnthusiasmAsk and encourage Ask and encourage questionsquestions

Ideal Behaviors for Ideal Behaviors for Delivering FeedbackDelivering Feedback

Clinical supervisionClinical supervisionClinical competenceClinical competenceModeling professional Modeling professional characteristicscharacteristics

Ideal Behaviors for Ideal Behaviors for Effective FeedbackEffective Feedback

Interested in the learnerInterested in the learnerHonestHonestWell defined goalsWell defined goals


Clear explanationsClear explanationsProblem solving emphasisProblem solving emphasisStudent centered instructionStudent centered instruction


Timely fashionTimely fashionFocused on behaviorsFocused on behaviorsLimited in volumeLimited in volume

Ideal Behaviors for Ideal Behaviors for Effective FeedbackEffective FeedbackSafe environment chosenSafe environment chosenFocused on patient caringFocused on patient caringAllows learner self assessmentAllows learner self assessment

Ideal Behaviors for Ideal Behaviors for Effective FeedbackEffective FeedbackUse of open ended questionsUse of open ended questionsOffers recommendations for Offers recommendations for improvementimprovement

Summarizes for closureSummarizes for closure

Barriers to Effective Barriers to Effective FeedbackFeedback

–Requires role modelsRequires role models–Emotional Emotional investmentinvestment–Observable behaviorsObservable behaviors–TimeTime

Pearls for Effective Pearls for Effective FeedbackFeedback

–Praise in public….Perfect in privatePraise in public….Perfect in private–Ego sandwich- first praise for Ego sandwich- first praise for

appropriate responses then- identify appropriate responses then- identify performance challenges and correct performance challenges and correct lastly-- finish with encouragement for lastly-- finish with encouragement for participationparticipation

–Ask learner to summarize “take home Ask learner to summarize “take home messages”messages”

One Minute PreceptorOne Minute PreceptorTeaching on the Go!Teaching on the Go!

Get a commitmentGet a commitmentProbe for supporting evidenceProbe for supporting evidenceTeach general rulesTeach general rulesReinforce what is done correctlyReinforce what is done correctlyCorrect mistakesCorrect mistakesReinforce what is done correctlyReinforce what is done correctly


Get a commitmentGet a commitment A 3 year old with ear pain- do you think A 3 year old with ear pain- do you think

this OM?this OM? Probe for supporting evidenceProbe for supporting evidence

What leads you to make this diagnosis?What leads you to make this diagnosis? Teach general rulesTeach general rules Reinforce what is done correctlyReinforce what is done correctly Correct mistakesCorrect mistakes Reinforce what is done correctlyReinforce what is done correctly


Get a commitmentGet a commitment Probe for supporting evidenceProbe for supporting evidence Teach general rulesTeach general rules

The majority of OM cases are not caused by The majority of OM cases are not caused by bacteria bacteria

Reinforce what is done correctlyReinforce what is done correctly I like the way that you made the child feel safe I like the way that you made the child feel safe

and comfortable during your examand comfortable during your exam Correct mistakesCorrect mistakes Reinforce what is done correctlyReinforce what is done correctly


Get a commitmentGet a commitment Probe for supporting evidenceProbe for supporting evidence Teach general rulesTeach general rules Reinforce what is done correctlyReinforce what is done correctly Correct mistakesCorrect mistakes

I think you should spend more time teaching I think you should spend more time teaching the mother about the risk-benefit of antibiotics the mother about the risk-benefit of antibiotics in OM in OM

Reinforce what is done correctlyReinforce what is done correctly I think that your search on OM and I think that your search on OM and

complications was a brilliant way to prepare complications was a brilliant way to prepare you for …..you for …..


Select a partner-one plays the role of the Select a partner-one plays the role of the student/learner, the other the preceptorstudent/learner, the other the preceptor

Choose one of the following:Choose one of the following: URI-viral syndromeURI-viral syndrome AsthmaAsthma VaccinationsVaccinations

Get a commitmentGet a commitment Probe for supporting evidenceProbe for supporting evidence Teach general rulesTeach general rules Reinforce what is done correctlyReinforce what is done correctly Correct mistakesCorrect mistakes Reinforce what is done correctlyReinforce what is done correctly

Documents

Teaching Residents to... Teach Peter DeBlieux,MD LSUHSC Clinical Professor of Medicine LSUIH Emergency Department Director Emergency Medicine Director