Heidi Kromrei, PhDAssistant Vice-President, Academic Affairs, Associate Designated Institutional Official
Detroit Medical CenterGraduate Medical Education
Alfred E. Baylor, III, MDAssistant Professor, Department of SurgeryWayne State University School of Medicine
Presented at the SEMCME Chief & Senior Resident Workshop
April 28, 2017
My Favorite Teacher
Who is or was your favorite teacher?
What did he/she do that impressed you?
How did those teaching strategies make you feel?
Session Goals
1. Understand how adults learn
2. Recognize effective instructional strategies for medical education settings
3. Develop your own plan to teach residents how to teach
Andragogy: Teaching The Adult Learner
Pedagogy vs. Andragogy
Pedagogy
The art, science, or profession of teaching
Andragogy
The art and science of helping adults learn
Source: Knowles, M. S. (1980)
The Learner’s Experience
Pedagogy
Learner has little experience
Experience of instructor is most influential
Andragogy
Learner brings volume/quality of experience
Adults bring diversity of experience; are rich resource for one another
Source: Knowles, M. S. (1980)
The Learner
Pedagogy
Learner is dependent
Teacher is responsible for what is learned
Teacher evaluates learning
Andragogy
Learner is self-directed
Learner is responsible for his/her learning
Self-evaluation is a characteristic approach
Source: Knowles, M. S. (1980)
Self Concept
Self concept moves from dependence to self-direction
Experience
As repertoire of experience grows, experience becomes increasing resource for learning
Readiness to Learn
Readiness to learn becomes increasingly oriented to the developmental tasks of societal roles
Orientation to Learning
Application focus shifts from postponed application of knowledge toward immediacy of application, from subject-centeredness to problem centeredness
Motivation to Learn
Shift from extrinsic to intrinsic (path to lifelong learner)
The Adult Learner
Source: Knowles, M. S. (1980)
Instructional Strategies
Malcolm Knowles Principles of Andragogy:
Adults need to be involved in the planning and evaluation of their instruction.
Experience (including mistakes) provides the basis for learning activities.
Adults are most interested in learning subjects that have immediate relevance to their job or personal life.
Adult learning is problem-centered rather than content-oriented.
What Teachers Need to Know
Source: Knowles, M. S. (1980)
Modeling3rd year med student observes efficient intern, 2nd year resident
4th year med student pairs with 3rd year resident
2nd year resident pairs with chief resident (pre-call)
CoachingCoaching on Rounds: Feed to the next learner level
Chief or Fellow run rounds, faculty interject
Try to make the leader an expert
Reinforce what to expect from team members at each level
Coach
Articulation“Cognitive Think Aloud”
Case discussion at the scrub sink:
Resident articulates…•Differential diagnosis•Pathophysiology•Surgical plan
Reflection• FLS –problem solving and
comparison
• ATLS, ACLS
• Simulation Labs
ExplorationTeaching Strategies When On Call:
• Forces critical problem solving
• Eventual feedback
Teaching in the Healthcare Setting: Residents as
Teachers
Knowledge Retention Rates of Common Teaching Strategies
Lecture (Low: 5%)
Reading (Low: 10%)
Audio-Visual Learning (Low: 20%)
Discussion Group (Moderate: 50%)
Practice by Doing (High: 75%)
Teaching Others (Highest: 90%)
Effectiveness of Common Instructional Strategies
Source: HMS Academy Lecture [National Training Laboratories, Bethel, Maine ]02/14/2013
Traditional Preceptor Model One Minute Preceptor Model SNAPPS
Case presentation strategy for higher clinical reasoning
Simulations High Fidelity Low Fidelity
OSCEs Objective Structure Clinical Examination
SOAPS Critical evaluation of oral case presentation
Feedback Audio-Visual Strategies Lectures and Conferences
Journal Club M&M
Common Med Ed Instructional Models
My least favorite teacher
Who is or was your least favorite teacher?
What did he/she do that annoyed you?
How did those teaching strategies make you feel?
NOT
Teaching At Its Best
Set high, attainable expectations
Relate your material to existing knowledge
Make it relevant and applicable
Enthusiasm & Passion
Creativity & Invention
Active learning techniques
Problem-based methods
Multiple teaching modalities
Include self-assessment
Multiple assessment points/methods
Motivate & reinforce with emotions
Source: Nilson, 2010
Group Activity: Case Study
You observed a junior resident berating a first year resident for not being able to accurately present a patient during rounds.
The junior “teaching” resident implies that the first year is “an idiot” comments that “your presentation is all wrong” and makes other derogatory personal remarks about the first year presenter
Questions As chief resident, what should
you do?
How can you help the junior resident become a better teacher?
What methods might you share to help him/her?
What Will You Do?
1.Think about ways to “teach your residents to teach”
2.Note your ideas and plans
3.Share with large group
Questions?
Thank you for your attention and participation
Teaching Principles and Practices
Bain, K. (2011). What the best college teachers do. Harvard University Press.
Bloom, B. S. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Suggested Reading
Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make it stick. Harvard University Press.
Driscoll, M.P. (2004). Psychology of Learning for Instruction (3rd edition). Needham Heights, Massachusetts: Pearson.
Knowles, M. S. (1980). The Modern Practice of Adult Education: From Pedagogy to Androgogy (2nd ed.) New York: Cambridge Books.
Nilson, L.B. (2010). Teaching at Its Best: A Research-Based Resource for College Instructors. Jossey-Bass.
Stolovitch, H. D., & Keeps, E. J. (2011). Telling Ain't training. American Society for Training and Development.
Teaching Residents in the Heath Care Setting
Furney, S. L., Orsini, A. N., Orsetti, K. E., Stern, D. T., Gruppen, L. D., & Irby, D. M. (2001). Teaching the one‐minute preceptor. Journal of general internal medicine, 16(9), 620-624.
Gigante, J. Dell, M., & Sharkey, A. (2010). Beyond “Good Job” How to Give Effective Feedback. Pediatrics, 127(2), 205-207.
Irby, D. M., & Wilkerson, L. (2008). Teaching rounds: teaching when time is limited. BMJ: British Medical Journal, 336(7640), 384.
Kern, D. E., Thomas, P. A., & Hughes, M. T. (Eds.). (2010). Curriculum development for medical education: a six-step approach. JHU Press.
Morrison, E. H., Rucker, L., Boker, J. R., Gabbert, C. C., Hubbell, F. A., Hitchcock, M. A., & Prislin, M. D. (2004). The effect of a 13-hour curriculum to improve residents' teaching skills: a randomized trial. Annals of internal medicine, 141(4), 257-263.
Pian-Smith, M. C., Simon, R., Minehart, R. D., Podraza, M., Rudolph, J., Walzer, T., & Raemer, D. (2009). Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. Simulation in Healthcare, 4(2), 84-91.
Pinsky, L. E., Monson, D., & Irby, D. M. (1998). How excellent teachers are made: reflecting on success to improve teaching. Advances in health sciences education, 3(3), 207-215.
Ramani, S. (2003). Twelve tips to improve bedside teaching. Medical teacher, 25(2), 112-115.
Roberts, N. K., Brenner, M. J., Williams, R. G., Kim, M. J., & Dunnington, G. L. (2012). Capturing the teachable moment: a grounded theory study of verbal teaching interactions in the operating room. Surgery, 151(5), 643-650.
Romanelli, F., Smith, K. M., & Brandt, B. F. (2005). Teaching residents how to teach: a scholarship of teaching and learning certificate program (STLC) for pharmacy residents. American Journal of Pharmaceutical Education, 69(1-5), 126.
Smith, C. A., Ganschow, P. S., Reilly, B. M., Evans, A. T., McNutt, R. A., Osei, A., ... & Yadav, S. (2000). Teaching residents evidence-based medicine skills. Journal of General Internal Medicine, 15(10), 710-715.
White, C. B., Bassali, R. W., & Heery, L. B. (1997). Teaching residents to teach: an instructional program for training pediatric residents to precept third-year medical students in the ambulatory clinic. Archives of pediatrics & adolescent medicine, 151(7), 730-735.
References & Suggested Reading