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Finding Clarity:Finding Clarity:Establishing Goals and Establishing Goals and
ExpectationsExpectations
Brad Sharpe, M.D.Associate Clinical Professor
Division of Hospital Medicine
u
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Clinical Teaching
Memorable Teacher?Memorable Teacher?
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Clinical Teaching
Memorable Teacher?Memorable Teacher?
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Clinical Teaching
A Skill like other skillsA Skill like other skills
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
Didactic Video Reviews
Exercise Visualization
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Clinical Teaching
Goals for TodayGoals for Today
• List 3 techniques to improve the learning climate.
• Recognize the effective establishment and expression of learner goals/expectations.
• Identify techniques to negotiate goals with learners.
• Appreciate the importance of establishing clear goals and expectations.
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Clinical Teaching
CaveatsCaveats
• Cannot do it all today.• May be already doing some (or all)
of these things day-to-day.• Nothing “magical” about being a
great teacher.
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
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Clinical Teaching
Stanford Faculty Development Stanford Faculty Development CenterCenter
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Clinical Teaching
Clinical Teaching Clinical Teaching FrameworkFramework
• Learning Climate• Control of Session• Communication of Goals• Promotion of Understanding & Retention• Evaluation• Feedback• Promotion of Self-Directed Learning
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Clinical Teaching
Clinical Teaching Clinical Teaching FrameworkFramework
• Learning Climate• Control of Session• Communication of Goals• Promotion of Understanding & Retention• Evaluation• Feedback• Promotion of Self-Directed Learning
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
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Clinical Teaching
Learning ClimateLearning Climate
Think of a time when you were a student/learner and you did not want to be part of a teaching session . . .
Why didn’t you want to be there?
What was the teacher doing or not doing?
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Clinical Teaching
Learning ClimateLearning Climate
Definition: The tone or atmosphere of the clinical teaching setting, including whether it is stimulating and whether learners can comfortably identify and address their limitations.
Do the learners want to be there?
Does the student want to come to clinic each week to work with you?
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Clinical Teaching
Learning Climate: Learning Climate: StimulationStimulation
• Show enthusiasm** for topic & learners
** Evidence-based teaching
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Clinical Teaching
Learning Climate: Learning Climate: StimulationStimulation
• Provide a conducive physical environment
▪ Avoid the “block-out”▪ Chair arrangement matters
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Clinical Teaching
Learning Climate: Learning Climate: Respect & Respect & ComfortComfort
• Use learner’s names
• Acknowledge learners’ problems/situations
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Clinical Teaching
Learning Climate: Learning Climate: Respect & Respect & ComfortComfort
• Use learner’s names• Acknowledge learners’
problems/situations▪ “This is a really complicated patient with lots
of problems.”▪ “I know you just started in clinic and it can be
hard to get used to how things flow.”▪ “It can be challenging to take a history and
do a focused exam in 15 minutes.”
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Clinical Teaching
Learning Climate: Learning Climate: Respect & Respect & ComfortComfort
• Use learner’s names• Acknowledge learners’ problems/situation
• Admit your own limitations▪ “You know, I really struggled trying to prioritize
problem lists when I started.”▪ “I still have trouble balancing efficiency and
seeing patients quickly with being empathetic.”
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Clinical Teaching
Learning ClimateLearning Climate
• Stimulation▪ Show enthusiasm▪ Avoid the “block out”▪ Chair arrangement matters
• Respect and Comfort▪ Use names▪ Acknowledge their situation ▪ Admit your own errors or limitations
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Clinical Teaching
Video: Learning ClimateVideo: Learning Climate
Learning Climate Faculty LC2
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Clinical Teaching
Learning ClimateLearning Climate
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
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Clinical Teaching
Goals and Expectations?Goals and Expectations?
Challenges and frustrations?
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
Definition: The establishment and explicit expression of a teacher’s and/or learners’ goals/expectations for the learners.
Do the learners know what they are supposed to be learning?
Do the learners know what you expect of them?
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Clinical Teaching
DefinitionsDefinitions
• Educational goals (= learning objectives)
▪ What you want them to learn.▪ Knowledge, skills, or attitudes you want them
to learn.
• Expectations▪ What you want them to do. ▪ What do you expect of your learners in the
clinical care of patients.
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
Definition: The establishment and explicit expression of a teacher’s and/or learners’ goals/expectations for the learners.
Why is this important?
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
• Let learners know what they should learn or do.
• Guide teacher in planning the teaching.
• Provide learner and teacher with a basis for evaluation and feedback.
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Clinical Teaching
Establish your goals/expectations in your own mind.
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Establish your goals/expectations in your own mind.
1) Define goals as learner behaviors (handout)
-- Be specific.
2) Prioritize goals3) Re-establish goals (change over time)
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
• Establish your goals/expectations in your own mind.
• Express your goals/expectations to your learners.
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
How many of you routinely meet at the
start of a rotation/teaching session to discuss
specific expectations with learners?
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Clinical Teaching
Express your goals/expectations to your learners.
1) State goals clearly and concisely.2) State goals as learner behaviors.3) State relevance of the goals to the
learners.4) Repeat goals periodically.
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
• Establish your expectations in your own mind.
• Express your goals to your learners.• Negotiate the goals/expectations with
your learners.
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Clinical Teaching
Negotiate the goals with your learners.
1) Check out learner acceptance of your goals.
2) Ask learners for their goals.3) Agree on goals.
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
• Establish your expectations in your own mind.
• Express your goals to your learners.• Negotiate the goals/expectations with
your learners.
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Clinical Teaching
Video: Communication of GoalsVideo: Communication of Goals
Comm of Goals #1: Ch 5
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
• Write down 1 educational goal and 1 expectations you have for your learner/learners.
• Write down a statement of relevance (why it is important for them)
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
Each person pick the goal that was most challenging and discuss with your partner.
•Are the goals or expectations clearly stated as learner behaviors?•Are the relevance statements convincing?
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Clinical Teaching
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations
▪ Putting it into practice.
• Miscellaneous Teaching• Wrap-up
Barriers to putting it into practice?
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Clinical Teaching
Putting it into practice.Putting it into practice.
1) Establish your goals/expectations.▪ Write them down.
2) Meet at the start of the teaching sessions to express your goals.
▪ Just have to find the time.
3) Negotiate with learners.▪ Consider writing down their specific goals.
4) Revisit goals over time.▪ Halfway through the rotation – “Let’s see how we’re
doing…”
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Clinical Teaching
Communication of Communication of Goals/ExpectationsGoals/Expectations
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Clinical Teaching
Works for Works for Lectures/DidacticsLectures/Didactics
• Establish your ends goals for the lecture or didactic.
▪ “By the end of the lecture . . .”
• May express those goals.• May negotiate the goals with the
learners.
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
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Clinical TeachingClinical Teaching
Miscellaneous TipsMiscellaneous Tips
• You are role modeling every second you are with learners.
• If you see a learner struggling, think learning climate (acknowledge the situation).
• If the marker is out of ink, throw it away.
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Clinical Teaching
Clinical Teaching Clinical Teaching FrameworkFramework
• Learning Climate• Control of Session• Communication of Goals• Promotion of Understanding & Retention• Evaluation• Feedback• Promotion of Self-Directed Learning
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Clinical Teaching
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Clinical Teaching
RoadmapRoadmap
• Background• Learning Climate• Goals and Expectations• Miscellaneous Teaching• Wrap-up
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Clinical Teaching
Goals for TodayGoals for Today
• List 3 techniques to improve the learning climate.
• Recognize the effective establishment and expression of learner goals/expectations.
• Identify techniques to negotiate goals with learners.
• Appreciate the importance of establishing clear goals and expectations.
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Clinical Teaching
A Skill like other skillsA Skill like other skills
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Clinical Teaching
Becoming a great teacherBecoming a great teacher
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Clinical Teaching
What will you do differently?What will you do differently?
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Finding Clarity:Finding Clarity:Establishing Goals and Establishing Goals and
ExpectationsExpectations
Bradley A. Sharpe, M.D.Associate Clinical Professor
Division of Hospital Medicine
University of California,San Francisco
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Clinical Teaching
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Clinical Teaching
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Clinical Teaching
Didactic TeachingDidactic Teaching
Have formal didactic teaching sessions routinely?
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Clinical Teaching
Choosing ContentChoosing Content
Teach about patients/diseases on your team.
▪ Write down topics as they come up post-call
▪ Ask your team on the post-call day
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Clinical Teaching
Choosing ContentChoosing Content
• Teach about patients/diseases on your team
• Prepare “mini-lectures”
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Clinical Teaching
High-quality or excellent High-quality or excellent teachersteachers
Among many qualities, 4 stand out:
1) Enthusiasm2) Mini-lectures 3) Teaching at the bedside4) Providing feedback Elnicki. JGIM. 2005.
Elzubeir. Med Educ.2001Guarino. JGIM. 2006.Irby. J Med Educ. 1991.Torre. Acad Med. 2005.Wright. NEJM. 1998.
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Clinical Teaching
Choosing ContentChoosing Content
• Teach about patients/diseases on your team
• Prepare “mini-lectures”▪ Small piece of a larger topic
(Differential diagnosis for hyponatremia) (Duke’s criteria)
▪ Superficially cover broad topic(Pancreatic pseudocyst)(Metastatic bladder cancer)
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Clinical Teaching
Preparing ContentPreparing Content
• Ask yourself, “What do I want them to learn?”
• When they walk out of the room, they should be able to ________.
• Teaching is guided not by the content but by the learners (your goals for them)
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Clinical Teaching
Preparing ContentPreparing Content
• Knowledge▪ State appropriate duration of
therapy for VAP.
• Skills▪ Recognize junctional tachycardia on
an EKG.
• Attitude▪ Appreciate challenge in giving a
cancer diagnosis to a young patient.
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Clinical Teaching
Preparing ContentPreparing Content
• Ask yourself, “What do I want them to learn?”
• When they walk out of the room, they should be able to . . .
• Teaching is guided not by the content but by the learners (your goals for them)
“What did you learn today?”
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Clinical Teaching
Setting an AgendaSetting an Agenda
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Clinical Teaching
Setting an AgendaSetting an Agenda
• Tell them where you are going• Outline topics you will cover• Finish on time (a little early?)
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Clinical Teaching
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Clinical Teaching
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Clinical TeachingClinical Teaching
RoadmapRoadmap
• Evidence-based inpatient teaching• Learning Climate on Rounds• Evaluation (“pimping”)• Bedside Teaching• Miscellaneous Principles
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Clinical TeachingClinical Teaching
““Pimping?”Pimping?”
How many here “pimp” your students and residents?
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Clinical TeachingClinical Teaching
““Pimping?”Pimping?”
How many here ask questions of their students and residents?
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Clinical TeachingClinical Teaching
““Pimping” Origin?Pimping” Origin?
Origin?
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Clinical TeachingClinical Teaching
““Pimping”Pimping”
Harvey in 1628 lamenting the dedication of his students:
“They know nothing of Natural Philosophy, these pinheads. Drunkards, sloths, their bellies filled with Mead and Ale. 0 that I might see them pimped!"
Flexner in 1916 after visiting Johns Hopkins:“Rounded with Osler today. Riddles house officers
with questions. Like a Gatling gun. Welch says students call it 'pimping.' Delightful.”
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Clinical TeachingClinical Teaching
Why do we ask Why do we ask questions??questions??
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Clinical TeachingClinical Teaching
Evaluation??Evaluation??
• To embarrass or ridicule?• To show off?
• To keep people engaged• To help them remember next time…• To evaluate learners
▪ What they know and don’t know▪ How else can you make them better?
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Clinical TeachingClinical Teaching
Asking Questions?Asking Questions?
How can we do this well?
Small group discussion.
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Clinical TeachingClinical Teaching
Five “Rules of Five “Rules of Engagement”Engagement”
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Clinical TeachingClinical Teaching
Five Rules of EngagementFive Rules of Engagement
1) Set up the expectations
“I am going to ask all of you questions sometimes on rounds – this is not done to embarrass or mock you. It lets me figure out what you know and don’t know. That way I can teach you something and not waste your time teaching you things you already know. It also makes sure you stay awake . . .”
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Clinical TeachingClinical Teaching
Five Rules of EngagementFive Rules of Engagement
2) Tell them it is OK to say “I don’t know”
“I want you to know that if I ask you a question and you don’t know the answer, it is OK to say ‘I don’t know.’ I hope, though, that you will look it up and come back and tell us the answer.”
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Clinical Teaching
Five Rules of EngagementFive Rules of Engagement
3) When students get nervous, learning is about to happen
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Clinical Teaching
Five Rules of EngagementFive Rules of Engagement
3) When students get nervous, learning is about to happen
But watch your psychological size.
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Clinical TeachingClinical Teaching
Five Rules of EngagementFive Rules of Engagement
4) Remember the __ second rule
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Clinical TeachingClinical Teaching
Five Rules of EngagementFive Rules of Engagement
4) Remember the 3 second rule
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Clinical Teaching
Five Rules of EngagementFive Rules of Engagement
5) Know how you will deal with wrong answers.
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Clinical Teaching
Five Rules of EngagementFive Rules of Engagement
1) Set up the expectations2) OK to say “I don’t know”3) It is good to be a little anxious4) Three second rule5) How to deal with wrong answers
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Clinical TeachingClinical Teaching
EvaluationEvaluation