Innovative Teaching

Teaching using an index card“Attending rounds in your pocket”

Adam Segal, MD

My last medicine block

• Typical team:– 3rd year resident– 2 interns– Sub-I – 2 3rd year medical students

– Me

Initial teaching session

• Discussion of case with the team

DISASTER!

My teaching goals

• Make it fun/ engaging • “Show the magic”

• Teach clinical reasoning1. “Triggers” = provide distinguishing/ differentiating

information2. Generate a broad differential and work-up3. Understand “why”

Index card

• Index card with 3-4 details given to the learner– Review during down time– Generate a complete differential and work-up

– Present to the group the next day– Most likely diagnosis– Show how they solved the problem

76MAcute renal failureCarotid bruitBP 104/78Lisinopril Renal US: 8cm Left kidney ; 11cm Right kidney

72MRecent fallsOrthostatic hypotension4+ proteinuria

18FObeseHypertensionSeizure

44FNigerianSOBPulmonary edemaPMI not displacedEKG only significant for LAH

34MChronic diarrheaKidney stonesHyperparathyroidism

48FK 2.8 HCO3 32BP 112/74Concerned about her weightAldosterone level elevatedRenin level elevated

The result

• Transformed teaching experience• Medical students engaged• Enthusiasm of the students infectious• Challenged all learners irrespective of their level• Goal Achieved: – Fun– Clinical Reasoning taught

• Generated broad differentials• Identified clinical ‘triggers’ • Addressed ‘Why’

“I loved the index card problems. It was much more fun to ponder the connection between “8cm kidney," "12 cm kidney," "normal BP," "lisinopril," and "PVD," than to just read about renal artery stenosis in a textbook. (And 3 months later, I still remember what I learned!)

I think this also provides students with positive reinforcement, which is very encouraging since we are still in the learning stage. The format is also fun because it turns research into a very useful and high-yield game. D, A and I really did like figuring these out. Thank you for making my first couple of weeks on Medicine fun. :)”

Some important teaching principles:

1. If what you’re doing isn’t working, stop doing it and experiment2. Enthusiasm is infectious….3. Learners should be actively involved4. Receive immediate feedback