medical education 5th year teaching 2
DESCRIPTION
A clinical education talk for 5th year medical students given from an emergency medicine, medical education and toxicological perspective.TRANSCRIPT
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
5th Year medical student teachingPort Hedland – Rural Clinical School Wed 8th Feb 2012
Dr Bishan Rajapakse – Emergency Medicine Advanced TraineePhD Candidate – Toxicology/ Medical Education
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
ObjectivesObjective based learning
◦CAN Meds PrinciplesApproach to self-poisoning
◦Organophosphate Poisoning case (separate presentation)
Clinical CasesTips for getting the most from
your clinical education
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Objective based learning
http://www.slideshare.net/DeirdreB
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Objectives vs competency
http://www.slideshare.net/DeirdreB
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Practice makes perfect! (or at least unconsciously competent)
http://www.slideshare.net/DeirdreB
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Roles
http://www.slideshare.net/DeirdreB
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Discussion: what do these role mean to you – give real examples?
Slide from Western Australia ASM May 2011 given by Allan Killen (CEO ACEM)
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Do you know your learning objectives?For each clinical context;
◦Overall?◦By term?◦Each day?◦Every patient?
For each learning encounterClarify (& communicate)
objectives◦Before, During and After
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Organophosphate Poisoning(see separate presentation)
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Self-Poisoning PrinciplesHistory
◦Names of Drug(s) taken◦Quantity/Dose◦When◦Veracity (how believable – operate
on worst case scenario) ◦Co-ingestants (eg Alcohol)
Doctor -Thought processes◦Pharmacokinetics
Onset – peak action - Off-set
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Examination & InvestigationExamination
◦Looking for poisoning Toxidromes Eg Opiate toxicity – pinpoint pupils,
decreased LOC
Investigations ◦Fbc, U&Es, LFTs, Blood sugar◦ECG ◦Blood Gases
Acidosis?
◦CXR Aspiration
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
General Management Principles
DRsABCDE◦Send for help
First resuscitateThen decontaminate if
appropriateAppropriate anti-dote
◦Seek consultation & Expert advice EARLY
CLINICAL CASES(see “clinical ED cases 8-2-12”)
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Getting the most from your clinical education AttendanceCommunicate
◦Clarify & develop teacher-learner relationship
◦Update frequently for different contexts
Record & Reflect◦Record patients seen
Ask good questionsAvoid conflict
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Barriers to Asking for Helpwhen you don’t know something
Feeling Inadequate◦Knowledge◦Skills
Feeling Guilt & Shame◦Should know this already
Fear of “loss of face”Ignorance to not knowingNot knowing and Not Caring
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Strategies to support asking for help
TRAINEE TEACHER / TRAINER
INADEQUATE
GUILT FOR NOT KNOWING
FEAR OF LOSS OF FACE
IGNORANCE
NOT CARING
Recognising that they are still training
Trying to find out information from a quick reference book, or larger text
Learning how to ask a question from a senior
Presenting pt history well Telling what they already
know about the patient
ASKING THE QUESTION
• By recognising that they are still training
• By being compassionate– Remembering what it was
like not to know
– Thinking of subject that they are themselve vague about Obscure rashes dermatology?
• Acknowledging what that trainee knows, and did correctly
• Education – Telling what the trainee
could have done better
– and what they needed to know
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Strategies to support asking for help TRAINEE TEACHER /
TRAINER
INADEQUATE
GUILT FOR NOT KNOWING
FEAR OF LOSS OF FACE
IGNORANCE
NOT CARING
Recognising that they are still training
Trying to find out information from a quick reference book, or larger text
Learning how to ask a question from a senior
Presenting pt history well Telling what they already
know about the patient
ASKING THE QUESTION
• By recognising that they are still training
• By being compassionate– Remembering what it was
like not to know
– Thinking of subject that they are themselve vague about Obscure rashes dermatology?
• Acknowledging what that trainee knows, and did correctly
• Education – Telling what the trainee
could have done better
– and what they needed to know
“The only stupid question is the one not asked!”
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Communication is KeyBut still - how do we practice it?Insights from Simulation…
◦Practice in front with audience◦Ask for feedback◦Hopefully receive “compassionate
feedback”◦Practice some more & improve
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Positive feedback first! Human mind has tendency to negativity“we are like velcro to the negative
feedback and teflon to the positive stuff”
Is the ‘shit sandwich’ is rubbish?◦Or perhaps “insincerity” is the problem?
Give sincere positive feedback on regular basis (builds confidence)
Thereafter give constructive criticism (builds expertise)
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Positive Feedback & Constructive criticism
“Whatever your message deliver it with love, otherwise both the message and the messenger will be rejected”
Mahatma Ghandi
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Avoid ConflictBe considerate of Staff pressuresBut look after yourself
◦Don’t take abuse – avoid it◦Avoid negative situations where
possible◦If incident occurs – discuss with your
seniorDon’t take it personally
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
4 Agreements
Be impeccable in your speech
Don’t take it personallyDon’t make assumptionsDo you best
Don Miguel Ruiz
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Making MistakesFear NOT making a Mistake!
◦Mistakes are part of learning◦In medicine we must make them
safely Simulation is a safe place! Supervision Debriefing Compassionate feedback Learning
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Final Tips!Be social - doctors and non
doctors alike◦Stay in touch with society◦Remember the patient is part of
society & society is part of the patient
Read widely (within & outside medicine)
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Tips: Use technology and social media to your advantage..
Presentation on Social media and Emergency Medicine (Mike Cadogan)◦ “Survey of 212 students in 2010 – 90% used social
networking sites, 20% read blogs frequently, 8% had their own blog..” (slide 17/53)
◦ http://www.slideshare.net/sandnsurf/into-the-jungle-of-social-medicine-4719295
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Tips: Watch TED talks & Education talks
TEDx - Lawrence Sherman on “Turning medical education upside down”◦Patient centred education
Clinical contact from day one
◦Collaborative◦“WE are all patients”
http://youtu.be/YpSd5u_di9w
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
TED talks & Education talks
Sir Ken Robinson on Changing education paradigms
http://youtu.be/zDZFcDGpL4U
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
TED talks & Education talks
Mel Herbert (EM Rap) on today’s Med Ed
http://youtu.be/aOYzUZ1_4Vk
“unless I can get it on my ipod, my ipad, or I can get it in an archived format that I can go over again and again the education is a waste of time… the average person needs to go over it 5 times before it goes into long term memory”
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Tips: Show respect, empathy & compassion towards patients!
“You treat a disease you win, you lose, you treat a person.. you win no matter what the outcome” - Patch Adams (Doctor & Clown)
http://www.youtube.com/watch?v=1gTwkAL3kLY
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
Tips: See if Mind Maps work for you?
mind map this talk!
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
But most importantly!Never stop doing what you
love doing!Try to lead a balanced life;
Always follow your heart and your "own" dreams as life is too short to follow someone else's dreams
Life is not a race, but unfortunately we live on a race course
Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)
SummaryLearn with an objectiveHave an ‘approach’ for PoisoningClinical cases teach us much
medicine◦Ask questions & ask good questions!
Practice & communicate compassionately, Avoid conflict
But most of all “have fun” whilst you learn!