practical tips for effective teaching ricardo la hoz, md ryan kraemer, md
TRANSCRIPT
Practical Tips for Practical Tips for Effective TeachingEffective Teaching
Ricardo La Hoz, MDRicardo La Hoz, MD
Ryan Kraemer, MDRyan Kraemer, MD
RoadmapRoadmap
Fellow as a Teacher: Retention PearlsFellow as a Teacher: Retention Pearls
Five Microskills of Clinical Teaching Five Microskills of Clinical Teaching
Do’s and Dont’s of a Chalk TalkDo’s and Dont’s of a Chalk Talk
Take Home Points Take Home Points
The Fellow as a TeacherThe Fellow as a Teacher
The Fellow as a TeacherThe Fellow as a Teacher
BarriersBarriers TimeTime Clinical dutiesClinical duties Not interested learnerNot interested learner KnowledgeKnowledge Limited Instruction on Limited Instruction on
how to be a teacherhow to be a teacher
The Fellow as a TeacherThe Fellow as a Teacher
Great learning toolGreat learning tool The more you teach the The more you teach the
more you learn how to more you learn how to teachteach
Mentoring the next Mentoring the next generation of physiciansgeneration of physicians
Impacts patient careImpacts patient care It feels good!It feels good!
BenefitsBenefits
Promoting RetentionPromoting Retention
Learning LevelsLearning Levels
Early Learners: Early Learners: - Teach less and they learn moreTeach less and they learn more- Focus on the methods of teaching instead of Focus on the methods of teaching instead of
the detailsthe details- Emphasize understanding over memorization Emphasize understanding over memorization
of detailsof details
Advanced Learners: Advanced Learners: - Find and fill in knowledge gapsFind and fill in knowledge gaps
Advanced OrganizersAdvanced Organizers
Mental constructs useful to organize Mental constructs useful to organize knowledgeknowledge
Increases retention of material taughtIncreases retention of material taught
Algorithms and diagrams, acronyms, Algorithms and diagrams, acronyms, pneumonics, pneumonics,
Ausubel, D.P. (1960). The use of advance organizers in the learning and retention of meaningful verbal material. Journal of Educational Psychology, 51, 267-272.
Promotion of retention and self Promotion of retention and self directed learningdirected learning
Instead of Instead of ““Read about your patientsRead about your patients””
The learner picks one patient they admitted and The learner picks one patient they admitted and reads about their main problemreads about their main problem
The resident then applies what they read to their The resident then applies what they read to their patientpatient
““Learn by doing”Learn by doing”
Promoting RetentionPromoting Retention
Ask lots of questionsAsk lots of questions
- Helps the learner recognize their Helps the learner recognize their deficienciesdeficiencies
- Lets you know on what level to teach Lets you know on what level to teach
- Encourages active participation instead Encourages active participation instead of passive learningof passive learning
Promoting RetentionPromoting Retention
Ask lots of questionsAsk lots of questions
- The Socratic method of teachingThe Socratic method of teaching- Use a series of easy questions to guide learners Use a series of easy questions to guide learners
through an advanced topicthrough an advanced topic- Great way to teach basic pathophysiologyGreat way to teach basic pathophysiology
- Repetition, repetition, repetitionRepetition, repetition, repetition
Preceptor-Learner InteractionPreceptor-Learner InteractionSimulationSimulation
What went wrong?What went wrong?
We want some feedback!We want some feedback!
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
3.3. Teach general rulesTeach general rules
4.4. Reinforce what was done rightReinforce what was done right
5.5. Correct mistakesCorrect mistakes
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Get a CommitmentGet a Commitment How do you obtain a commitment?How do you obtain a commitment?
When the learner has finished - Resist the urge!When the learner has finished - Resist the urge!
Examples: Examples: - What do you think is going on with this patient?What do you think is going on with this patient?- How do you want to workup this patient?How do you want to workup this patient?- What would be your initial approach to the What would be your initial approach to the
management of this patient?management of this patient?
Why is this important?Why is this important?
Supportive environmentSupportive environmentNeher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Probe for Supporting EvidenceProbe for Supporting Evidence
Suppress the desire to pass judgmentSuppress the desire to pass judgment
ExamplesExamples- What were the major findings that led to your What were the major findings that led to your
diagnosis?diagnosis?- What else did you consider? What kept you from What else did you consider? What kept you from
those other choices?those other choices?- What factors did you consider when choosing What factors did you consider when choosing
those antibiotics?those antibiotics?
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
3.3. Teach general rulesTeach general rules
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Teach General RulesTeach General Rules
You have diagnosed your learner!You have diagnosed your learner!
TipsTips- Keep the information generalKeep the information general- Avoid anecdotes and idiosyncratic preferencesAvoid anecdotes and idiosyncratic preferences
ExamplesExamples- Patients with pancreatitis usually present with…Patients with pancreatitis usually present with…- Causes of FUO are broken into the… Causes of FUO are broken into the…
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Teach General RulesTeach General Rules
Wrong: Wrong: ““No you don't need to get a CT scan on No you don't need to get a CT scan on Mr. JonesMr. Jones””
Right: In patients with a history and physical Right: In patients with a history and physical exam consistent with pancreatitis and an exam consistent with pancreatitis and an elevated lipase, you don't need a CT scan to elevated lipase, you don't need a CT scan to make the diagnosis.make the diagnosis.
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
3.3. Teach general rulesTeach general rules
4.4. Reinforce what was done rightReinforce what was done right
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Reinforce what was done rightReinforce what was done right
Reinforce what was done rightReinforce what was done right
Why is it important?Why is it important?
Focus on specific observationsFocus on specific observations
ExampleExample- Your considered the patient’s finances in your Your considered the patient’s finances in your
selection of therapy. Your sensitivity to this selection of therapy. Your sensitivity to this will certainly contribute to improving his will certainly contribute to improving his compliance.compliance.
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
3.3. Teach general rulesTeach general rules
4.4. Reinforce what was done rightReinforce what was done right
5.5. Correct mistakesCorrect mistakes
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
Correct MistakesCorrect Mistakes
Find the correct space and timeFind the correct space and time
Be specificBe specific
ExamplesExamples- You could be right, this liver transplant patient You could be right, this liver transplant patient
could have C. difficile infection, given low could have C. difficile infection, given low sensitivity of the toxin assay, but CMV colitis sensitivity of the toxin assay, but CMV colitis can occur with negative blood PCR. We can occur with negative blood PCR. We should probably perform a colonoscopy.should probably perform a colonoscopy.
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Model5 Microskills Model
1.1. Get a commitmentGet a commitment
2.2. Probe for supporting evidenceProbe for supporting evidence
3.3. Teach general rulesTeach general rules
4.4. Reinforce what was done rightReinforce what was done right
5.5. Correct mistakesCorrect mistakes
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-24.
5 Microskills Situations5 Microskills Situations
Inpatient presentationsInpatient presentations
Outpatient presentationsOutpatient presentations
When asked a questionWhen asked a question
After seeing a new patient with a residentAfter seeing a new patient with a resident
Five MicroskillsFive MicroskillsSimulationSimulation
Do’s and Don’t of a Do’s and Don’t of a Chalk TalkChalk Talk
Chalk Talk TipsChalk Talk Tips
GoalGoal
To give you practical helpful tools to To give you practical helpful tools to succeed in giving great chalk talkssucceed in giving great chalk talks
Chalk TalksChalk Talks
DefinitionDefinition- Presenter lead discussion about a defined topicPresenter lead discussion about a defined topic- With or without writing With or without writing - 5 minutes – 1 hour5 minutes – 1 hour- Usually a small audienceUsually a small audience- NOT a formal powerpoint lectureNOT a formal powerpoint lecture
Name 2 attributes of great chalk Name 2 attributes of great chalk talkstalks
Organized Interactive Time Effective Practical Know your audience –
Target them! Simple Good audiovisuals or
other tools Use of Advanced
organizers
Chalk TalksChalk Talks
Name 2 attributes of terrible chalk talksName 2 attributes of terrible chalk talks
ConsiderationsConsiderations
Who is your audience?Who is your audience?
How much time do you have?How much time do you have?
What is the setting?...Learning What is the setting?...Learning environment!environment!
Is the audienceIs the audience’’s priority the talk?...choose s priority the talk?...choose a good time to give the chalk talk. a good time to give the chalk talk.
What is the goal of a chalk What is the goal of a chalk talk?talk?
RetentionRetention- Less is moreLess is more- For details For details give handouts or articles give handouts or articles
What is the goal of a chalk What is the goal of a chalk talk?talk?
RetentionRetention- Less is moreLess is more- For details For details give handouts or articles give handouts or articles
Use Use Advance OrganizersAdvance Organizers: mental : mental constructions useful to organize knowledgeconstructions useful to organize knowledge- AcronymsAcronyms- PneumonicsPneumonics- AlgorithmsAlgorithms
Chalk Talk ExamplesChalk Talk Examples
Approach to Elevated LFTApproach to Elevated LFT’’ss Approach to HypercalcemiaApproach to Hypercalcemia Approach to Chest painApproach to Chest pain Approach to HyponatremiaApproach to Hyponatremia ACLSACLS Ventilator ManagementVentilator Management
What should I talk about?What should I talk about?
Chalk talks on common presentations the Chalk talks on common presentations the team will encounterteam will encounter
Chalk talks on a topic the team had Chalk talks on a topic the team had deficient knowledge indeficient knowledge in
Build a RepertoireBuild a Repertoire
Develop a list of chalk talks of various topicsDevelop a list of chalk talks of various topics- Allows you to give learners choicesAllows you to give learners choices- Allows you to utilize talks at key momentsAllows you to utilize talks at key moments
Make the talks flexible Make the talks flexible - Small sections that make up a larger talkSmall sections that make up a larger talk
ItIt’’s a Performances a Performance
Rules for speakers:Rules for speakers:- Enthusiasm and EnergyEnthusiasm and Energy- Use Use ““the pausethe pause”” effectively effectively- Make eye contactMake eye contact- Use learnerUse learner’’s namess names- Use humorUse humor
Hook Them EarlyHook Them Early
Tell them what you are going to Tell them what you are going to accomplish with your talkaccomplish with your talk
Establish relevanceEstablish relevance
Tell a Story
Make it Case-BasedMake it Case-Based- Refer to patients your team has managedRefer to patients your team has managed- The more anecdotes the betterThe more anecdotes the better
Adult Learning TheoryAdult Learning Theory- Learning must be relevantLearning must be relevant- Need to know why before committing to learnNeed to know why before committing to learn- Adults Learn best via Adults Learn best via ““real worldreal world”” examples: examples:
Case Based Discussions Case Based Discussions
Take Home Messages
Have take home points (1-3)Have take home points (1-3)- Repeat them, repeat them, repeat themRepeat them, repeat them, repeat them- Have an anecdote or story or case about eachHave an anecdote or story or case about each
Question!
Two functions of Questions:Two functions of Questions:- To establish baseline understanding of a To establish baseline understanding of a
conceptconcept- To evaluate understanding of a concept you To evaluate understanding of a concept you
have reviewedhave reviewed
InteractionInteraction
It must be interactiveIt must be interactive
FeedbackFeedback
After you have given a talk get feedback After you have given a talk get feedback
Practice, practice, practicePractice, practice, practice
Take NotesTake Notes
Observe others giving chalk talks and Observe others giving chalk talks and what effective behaviors they havewhat effective behaviors they have
Steal good topicsSteal good topics
ACP Teaching Medicine SeriesACP Teaching Medicine Series
Take Home PointsTake Home Points
Promote knowledge retentionPromote knowledge retention
5 Microskills5 Microskills
Key points for a successful chalk talkKey points for a successful chalk talk
?