small group teaching teaching residents and fellows to teach… deb bynum, md division of geriatric...

Small Group Teaching

Teaching Residents and Fellows to Teach…Deb Bynum, MD

Division of Geriatric Medicine

University of North Carolina

Introduction to the Series… Teaching to Teach See one, do one, teach one…

Importance of Teaching

Student perspective: validate importance of resident teaching in student curriculum

-written curriculum-unwritten curriculum…

Resident perspective: validate importance of teaching as something that should be taught in the curriculum

Importance of Teaching

Informal (hidden, unwritten) curriculumProfessionalismTeamworkRole modelingCulture of the institutionHow to get things done at your site (nuts and

bolts of every day)

Importance of residents as teachers Informal curriculum Residents “closer” to student experience Amount of time residents/interns spend with students Recognition from School of Medicine accreditation

councils Ability to “think aloud” Residents oversee the “team”, assign patients to

students, dictate how/when rounds occur Residents feed in to student evaluations

What is Small Group Teaching?

It is what we do in clinical education

Dr. Bates – The book is not enough…

What do you Need?

-Teacher

-Students

-Patient/Case

Small Group Teaching – When?

Work Rounds “Down Time” Admitting patients Teaching rounds Acute Care

What are the Benefits?

Active participation and learning Ultimate in Case based learning Takes advantage of the “teachable

moment” Efficiency: combining care of patients with

teaching

What are the Challenges?

Different learners at different levels Time restraints Acuity of patients Perceived lack of knowledge: What do I

have to offer?

The Game Plan…

PrePlan Orient the group Ask open ended questions Summarize, summarize, summarize Give individual feedback Correct errors when needed Receive feedback and evaluate your own

skills

Switch it up…

Orientation

Ask learners what they need/wantGoals and objectives

Determine needs Determine levels of learners Set expectations

Will they present?Will they look up questions?

Plan for feedback sessions

General Principles

Keep it fun Keep it interactive Keep it patient/case based Ask questions

Techniques

One Minute Preceptor Model Canned Talks Think out loud Case based short presentations Evidence based medicine: start with a

clinical question

One Minute Preceptor…

Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Well Give Guidance About Errors and

Omissions Teach a General Principle Conclusion : Summarize, Review

One Minute Preceptor…

Get a Commitment: What do you think is going on? Probe For Supporting Evidence: Why? Reinforce what was done well: You have a thorough

differential… Give guidance/correct errors: It is also important to

consider…. Teach a general principle: When you see this, you

should always think of… Conclusion: Let’s go see…

One Minute Preceptor: Basics

WHATWhat do you think is going on?

WHYWhy do you think that?

WHEN….When you see this, you need to think of ….

Other strategies

Role playing Case discussions (resident report) Student/learner short presentations Scavenger hunt for physical findings Teach at bedside Check out: learners share one thing learned from

the day Sign out exercises Unknown pictures Summarize at end of presentation, day, week…

Feedback

Call it feedback Separate from evaluation Be explicit, give details Ask learners to self assess Do in private Correct errors immediately Have plan of action if needed Do not always need the “sandwich” Ask for feedback also

Tradition: Just Because You’ve Always Done it That Way Doesn’t Mean It’s Not Incredibly Stupid