the power of teaching handout -...
TRANSCRIPT
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The POWER of Teaching, the Ripple Effects in Clinical Practice.
John DeWitt, PT, DPT, SCS, ATC Mel Kidder, PT, DPT, OCS
Objectives:
By the end of this presentation, the audience will: • Discuss evidence to promote the clinical physical
therapist as an educator. • Describe strategies to train clinicians to become more
effective educators within clinical practice. • Analyze how residency and fellowship teaching
experiences enhance the clinical culture that positively impacts clinical practice and inter-collaborative partnerships.
• Discuss how the integration of post- professional programs facilitates talent recruitment, development, and retention.
•
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Ripple effect - a spreading, pervasive, and usually unintentional effect or influence - Merriam Webster
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Mel
Patients = 16 yrs
Residents = 20
Students = 192
CI = 7
Jacque
Patients =10 yr, community ed 50
Residents = 3
Students = 354
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Unlimited potential!
Patients
Roody
Patients = 4 yr, community 400
Students (PT and DO) = 216
What is YOUR professional dream?
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PTs as Educators
Why do we all need to be educators?
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PTs as Educators
• APTA Educational Strategic Plan ‒ Goal 15:
Provide opportunities for academic and clinical faculties to develop approaches to teaching using evidenced-based strategies that are effective in promoting learning
• APTA Vision Statement for 2020 - ….”Guided by integrity, lifelong learning, and commitment to comprehensive and accessible health programs for all people…”
• Embedded in all components of clinical care and all core documents. (CPI, Guide, etc.)
• Elements of education in Descriptions of Specialty Practice (DSP)
PTs as Educators: Descriptions of Specialty Practice
BEHAVIORAL SCIENCES: Teaching and Learning
EDUCATION CONSULTATION and ADVOCACY
Teaching and Learning Theory1234
Implementing and evaluating and educational plan13
Education and Health Promotion2345
Principles of Adult Education1234
Peer-assessment2
Teaching Methodology123
Interacting with Community-based organizations, residency programs234
Student Instruction1234
1: Neurologic 2: Geriatric 3: Pediatric
4: Orthopedic 5: Sports
PTs as Educators
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PT
Patients
Continuing Education Instruction
Academia
Clinical Instructor
(CI)
Community Education
Residency/Fellowship
Mentor
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Patient Education
Audience
Impact
PTs as Educators
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Community Education
Audience
Impact
PTs as Educators
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Academia Audience
Research
Service
Impact
Role?
PTs as Educators
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Integrated Model of Clinical Development
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Level of Clinical Development
Teaching Implications
Novice
Novice
Advanced Beginner
Advanced Beginner
Novice Advanced Beginner Competent Proficient Expert Master
(Carraccio, 2008 and Tichenor, 2010)
Clinical Instructor
Audience
Support
Flexible
Impact
PTs as Educators
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Integrated Model of Clinical Development
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Level of Clinical Development
Teaching Implications
Novice
Novice
Advanced Beginner Advanced Beginner
Competent Competent
Novice Advanced Beginner Competent Proficient Expert Master
(Carraccio, 2008 and Tichenor, 2010)
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CEU Instructor
Audience
Location
Impact
Endurance
Time and $
PTs as Educators
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Integrated Model of Clinical Development
Novice Advanced Beginner Competent Proficient Expert Master
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Level of Clinical Developement Teaching Implications
Competent
Competent
Proficient Proficient
Expert Expert
Master
Master
(Carraccio, 2008 and Tichenor, 2010)
Residency/ Fellowship
Audience
Impact
PTs as Educators
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Integrated Model of Clinical Development
Novice Advanced Beginner Competent Proficient Expert Master
(Carraccio, 2008 and Tichenor, 2010)
Level of Clinical Development
Teaching Implications
Competent
Competent
Proficient Proficient
Expert
Expert
Master
Master
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PTs as Educators: Expert Practice
Expert practitioners are thought to “do something better,” because they know how to do the “right thing at the right time,” and thereby “provide better care.” (Rothstein JM, 1999)
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Vital components in expert practice • Knowledge • Adaptability • Individualized patient-
centered care • Psychosocial sensitivity • Accountable • Excellent observational
skills • Excellent listening skills
(Jenson, et al 2007)
Attributes of an expert practitioner • Recognizes patterns or features • Work toward understanding problem • Collaborates with patient, colleagues • Good at self assessment and
metacognition • Uses various means of clinical
reasoning • Highly reflective
Developing expertise- • Attained in a stepwise fashion • Moves from deliberate, explicit thinking ->
intuitive thinking based on knowledge and experience
• component is reflection
PTs as Educators: Expert practice
PTs as Educators: Expert practice
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“A means by which practitioners can develop a greater self-awareness about the nature and impact of their performance, an awareness that creates opportunities for professional growth and development” (Osterman and Kottkamp, 1993)
REFLECTION
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Clinical Reasoning
Cognition The process of
acquiring knowledge by the use of reasoning, intuition or perception
Knowledge Possession of
information, facts, ideas, truths or
principles Metacognition “the use of different
strategies for thinking more
deeply about [your] thinking or clinical
reasoning”
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Metacogni5on? • “Assis5ng a resident to learn how to assess or cri5que his/her own clinical performance is essen5al and a founda5onal component of the reflec5ve process. Residents must then be able to use different strategies for thinking more deeply about their thinking or clinical reasoning, a process called metacogni*on. The use of worksheets and clinical supervision prepara5on forms that focus on clinical reasoning and judgment are good metacogni5ve tools. Mentors have a good grasp of clinical knowledge aNained through reflec5on on their experience. They challenge residents with ques5ons to facilitate that same growth and development of the resident’s clinical knowledge. Residents must con5nue to self-‐assess performance as a tool for advancing clinical reasoning”
• (APTA, AAOMPT Guidelines ’01) 26
PTs as Educators: Mentors
Often, resident focuses on practice techniques and insufficient time is devoted to clinical reasoning and patient management skills.
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Novice Advanced Beginner Competent Proficient Expert Master
(Shepard and Jensen, 2002.)
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PTs as Educators: Mentors Metacogni5on (goals of mentoring)
o Monitor clinician’s thinking processes and conclusions
o Detect rela5onships and inconsistencies between clinical data and clinical paNerns
o Reflect on soundness of observa5ons and conclusions
o Cri5que the reasoning process itself – what have I missed?
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PTs as Educators: Mentors
Six Roles of a Mentor 1. Teacher – enhances person’s skill, intellect 2. Sponsor – uses his/her influence to for the benefit of the
protégé 3. Host and guide – professional socialization for values,
resources, contacts, customs 4. Exemplar – role model 5. Counselor - moral support • All need to occur in a mentoring relationship
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(Levinson 1978)
PTs as Educators: CI vs Mentor?
• (Jenson GM, et al. 2000)
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Student Resident • Goal is to move toward “entry-
level” • Need close supervision to abide
by state and regulatory laws/rules
• Guidance needed for learning, initiative
• Assist them in learning basic skills
• Goal is to move them toward expert practice
• Licensure not an issue so supervision corresponds to need only
• Residents take initiative or guided to delve deeper, research, justify, explain
• Assist them in learning more advanced skills
CI for Student
Mentor for Resident
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Acedemic Faculty Role Models/Mentors
CI Professional Collegues/Mentors
Involved in prof org, PT ed, & clinical practice
Involved in prof org & activities
Involved in prof org & activities, encourage prof engagement
Dedicated to their field and students
Dedicated to their patients, being a patient advocate
Dedicated to their work and patients.
Knowledgeable and up to date
Open, clear and honest in communication, clear expectations, feedback
Knowledgeable and current in their area of practice.
Encourage students to think critically and ask “why”
Patient, made student feel comfortable and welcome.
Creative “Think outside the box”
Modeled Evidence Based Practice
Treated student as member of the team.
Collaborator, “team player”
(+) & respectful with students Respectful of students and prof colleagues
Modeled prof behaviors: Respectful of students and prof colleagues
Well-rounded
Committed to assisting student to learn
Supportive of CI as a clinician and cliniacal teacher, took under their wing
(Jenson et al, 2013)
Why does it benefit you to step into the role as an educator?
• Gratifying to help others • Pure enjoyment of teaching • YOU will LEARN
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To teach is to learn… a generally accepted concept
“Tell me and I’ll forget; show me and I may remember; involve me and I’ll understand.”
– Chinese Proverb “To teach is to learn”
-Japanese proverb
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To teach is to learn: Laying the foundation
• Evidence that teaching
encourages learning and deeper learning
(Reyes-Hernandez et al, 2015)
To teach is to learn: Cogni5ve effects of teaching
Preparing to teach
Presenting to the students
Responding to questions
3 stages of teaching
(Bargh et al 1980)
Tutors learn by explaining
Comprehension-‐monitoring
Answering ques5ons
Genera5ng and
ar5cula5ng explana5ons
Use of examples
Selec5ng and summarizing main ideas
Meta memory
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Peer teachers learn more when using
higher metacognitive
abilities
Integration
Comprehension-monitoring Reflection
(Amorosa et al, 2011)
To teach is to learn
To teach is to learn
(Bargh and Schul,1980) (Fiorella and Mayer, 2014)
Study for the test
Prepare to teach Teach
To teach is to learn– Medical education
• Residency teaching model (Jibson et al, 2010) • Faculty intentional with teaching to residents • Outcomes of each program included an increased career
focus on future teaching activities • Didactic teaching, professional teaching (ie CEUs),
presentations, and clinical education of future residents.
• Near peer teaching, a medical school equivalent, provide med students valuable input for clinical and communication skills and enhance their professional development . (Alkhail, 2015)
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To teach is to learn: Near-Peer teaching
Teacher-Student • Traditional model
Near-Peer • 2-5 years more
experience than the student
• Social and cognitive congruence with student
• Similar learning experiences
Peer –Peer • Peer tutoring = 1:1 teaching
• Resident to resident • Resident to clinician/colleague
To teach is to learn: PT-related evidence
• Near-peer teaching in gross anatomy by 2nd year DPT students to 1st year DPT students ‒ Students
• Found it useful in their learning • Increased performance on practical exam
‒ Peer tutors • Increased their understanding of anatomy • Enhanced their teaching skills • Improved organizational and time management skills • Increased confidence
(Youdas et al 2008)
Why does it benefit you to step into the role as an educator?
AVOIDS STAGNATION of our profession
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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Sports Residency
2018
Ortho Residency
Pediatric Residency
Neurologic Residency
Upper Extremity Athlete Fellowship
OMPT Residency
Geriatric Residency
Women’s Health Residency
Performing Arts Fellowship
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Program Resident/Fellows PT School Alumni
Sports Residency Jennifer Fath Angelo State University 17 Alumni
Katilyn Schlueter Duke University
Mitch Therriault Duke University
Orthopaedic Residency Tessa Kasmar Marquette University 12 Alumni
Rachel King Marquette University
Neurologic Residency Nathan Casey Cleveland State University 11 Alumni
Douglas Eck
Virginia Commonwealth University
Pediatric Residency Lyndsey Tobias The Ohio State University 7 Alumni
Upper Extremity Athlete Fellowship Jeremy Harris Youngstown State University 5 Alumni
OMPT Fellowship Cody Mansfield Duke University New
Danielle Chelette Duke University
Geriatric Residency (Candidacy)
Sarah Kidd The Ohio State University New
Women’s Health Residency (Candidacy)
OSU OP Rehab New
Performing Arts Fellowship (Candidacy)
OSU Sports Medicine New
Why Residencies and Fellowships
Talent Recruitment
71 residents/fellows (current and alumni)
Talent Development
Didactic curriculum Teaching Research Mentored clinical practice
Talent Retention
33% stay with OSUWMC or partner institution
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What does this mean for our clinics?
• 76 Board Certified specialists (OCS, SCS, NCS, GCS, WCS) ‒ 33% residency trained
• 3 FAAOMPTs • 39 Residency Faculty members • 23 of adjunct or guest lecturers • 6 pursuing advanced degrees (PhD, MPH, etc) • 32 Presentations at CSM • Administrative support and recognition
Residency/Fellowship history
50
1900 1980
Medicine 1914
2020
Pharmacy 1963
Nursing 2008
Physical Therapy 1999
1920 1940 1960 2000
ACS published first residency 1940
Dentistry 1975
Occupational Therapy 2015
Athletic Training 2013
Definitions
• Residency: A post-professional planned learning experience in a focused area of practice.
• Fellowship: A post-professional planned learning experience in a focused advanced area of practice
www.abprfe.org
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Framework of a residency program
Description of Specialty Practice
Mentoring
At least 150hrs (1:1 clinical mentoring)
100hrs Resident PCP
50hrs Observation/Other
Didactic
75hrs
Clinical Practice
At least 1500hrs
Event Coverage (Sports only)
200hrs
Teaching is easy…EDUCATION is hard.
• Teaching: Something taught, usually by authority.
• Educating: The process of facilitating leaning or acquisition of knowledge, skills, values, beliefs and habits.
Pedagogy
Andragogy
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ABPTRFE Mentoring Resource Manual, 2014
Personal • Capacity for self-reflection/
development • Willingness to learn/teach • Eagerness to pursue
excellence • Trust • Intellectual humility • Internal locus of control
Interactions • Good communicator • Values partnership • Demonstrated initiative/
motivation • Confidence to try something
new • Commitment to learner
engagement • Open to Feedback • Able to function in uncertain
situation
Mentoring: A two way street
You Smell
You Smell
We both Smell
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Adult Learners – Six Principles
• MOTIVATED • EXPERIENCED • GOAL-ORIENTED • SEEK RELEVANCY • PRACTICAL • VALUE RESPECT
Motivated
• Definition
‒ Internally motivated and self-directed
• Facilitator role ‒ Encourage inquiry before
supplying too many facts ‒ Acknowledge and design
instruction to preferred learning style (VARK)
‒ Structure learning to give progressive autonomy
• Impact ‒ Annual Mentoring in-
services to understand learning style
‒ Senior to junior resident mentoring
Experienced
• Definition ‒ Bring life experience and
prior knowledge • Facilitator role
‒ Get to know students, encourage sharing of previous experience
‒ Encourage reflective practice
‒ Assist them to draw on previous experience
• Impact ‒ Early assessments ‒ Inter-residency
conferences
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Goal Oriented
• Definition ‒ Goal-oriented
• Facilitator Role ‒ Meet with learner to set
personal goals ‒ Provide learning
opportunities in line with goal
‒ Give feedback to modify path toward goal
• Impact ‒ Semester and weekly
goal development
Relevancy
• Definition ‒ Want to see the relevance of
the materials/exercises • Facilitator Role
‒ Reflective exercise on how materials apply to meeting goal
‒ Give choice in learning experience (ie clinic site, elective)
‒ Case-based/problem-based learning opportunities
• Impact ‒ Added cases to didactic
curriculum ‒ Changed journal club to case-
based experiences
Practical
• Definition ‒ Want to understand the
practical application of new knowledge
• Facilitator Role ‒ Introduce clinical
applications to basic science lectures
‒ Promote active participation
‒ Give feedback on learner’s application of knowledge
• Impact ‒ Added OSCEs and lab to
curriculum ‒ Modified Anatomy lab
experience
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Respect
• Definition ‒ Adult learners perform best
when respected • Facilitator Role
‒ Get to know learner ‒ Encourage respectful
interactions ‒ Regard learner as colleague,
not subordinate ‒ Be receptive and encourage
learner expression of ideas • Impact
‒ Resident/faculty get-togethers
‒ Annual Residency/fellowship alumni happy hour
‒ Quarterly newsletters to highlight accomplishments
One-minute preceptor
1. Get a commitment 2. Probe for Supporting evidence 3. Reinforce what was done well 4. Correct mistakes 5. Teach a principle
Neher, 1992, 2003
Mentoring Video
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Teaching within the residency
Residents as Teachers (RATs)
• Positive impact • Peer teaching enhances learning
‒ Spend 3x more time reviewing content (Peets, 2009) ‒ 45-60% better retention (Karpicke)
• Lack of confidence is common
(Bene, 2014)
How do we integrate teaching into our programs?
• Residents/fellows ‒ Academic Lab (Classroom) ‒ ICE (integrated clinical experience) ‒ Residency/fellowship conferences ‒ Journal Club ‒ Professional presentations ‒ Academic lecture
• Faculty ‒ Mentoring ‒ Residency/fellowship conferences ‒ Journal Club
‒ Professional presentations ‒ Academic lecture
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Teaching in the Residency Graduate Survey
Which program did you complete?
• 29 Total responses ‒ 19 OSU Residents ‒ 10 CCHMC Residents
What type of teaching was required within your residency program?
Small Group
Teaching (i.e. clinic in-service)
Large Group Teaching (i.e.
residency conference,
grand rounds, etc.)
Lecture within academic PT
program
Laboratory within
academic PT program
Professional
Conference presentation (i.e. CSM, OPTA, etc.)
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How many hours did you spend/week teaching?
Answer Choices Responses None 0.00% 0-3 51.85% 3-5 14.81% 5-10 33.33% 10-15 0.00% >15 0.00%
Format of teaching skills format
None
One-time retreat or workshop
Lecture(s) on teaching skills
Role-playing
Critiquing residents during or after actual teaching encounters
Practice teaching with standardized students
Facilitated interactive discussions in large groups
Facilitated interactive discussions in small groups
20%: no training at all
56%: would prefer more
Educational responsibility at your current place of employment.
No education role
Clinical instructor
Residency or fellowship mentor/faculty member
Intra-facility presentation
Continuing education instructor
Adjunct faculty member (Entry level
program) Academic faculty member (Entry level
program)
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Teaching Competency
Clinical Instructor
for PT Student
Small Group Teaching (i.e.
clinic in-service)
Large Group Teaching (i.e.
residency conference,
grand rounds, etc.)
Professional
Conference (i.e. CSM,
OPTA, etc.)
Academic Course
Patient instruction
*COMPARED TO PHYSICAL THERAPISTS WITH EQUAL AMOUNT OF CLINICAL EXPERIENCE
Residency Graduate Comments:
“I believe it was a very important part of my residency. It helped me expand my knowledge
along with become responsible for it. I recommend that anyone looking into a residency
have a teaching component. “
“I specifically chose my residency because there was an opportunity to teach. I found a passion for
teaching I didn't know I had and it was an important part of my drive to gain a deeper
understanding of the content for the sake of the patients.”
DPT Student Survey: comments
“The residents are early in their careers, are close to their last major learning experiences, and have established technique. They also are getting
constant feedback from their own mentors and experience with patients, and so are able to integrate that feedback into what they teach us. It's a fabulous
part of our curriculum.”
“It helps to have a peer who understands what we are going through…., but having a resident present really helped ease the nerves (especially during the
earlier practicals).”
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Conclusion
• Ripple effect • Flight pattern • Teaching is important to who we are as a profession.
‒ Great value to our patients • Education is key to expert practice.
‒ Teaching and learning found in DSP • Teaching strategies can be incorporated in many aspects
of residency training.
Resources
• Webpage: (www.abptrfe.org) ‒ List of credentialed and developing programs ‒ RF-PTCAS information and application link ‒ FAQ’s re: postprofessional education ‒ Much, MUCH more ‒ Link to Store
• Description of Specialty Practice documents
• Section Websites • Individual Program Websites
‒ Mission, Goals, Objectives ‒ Policies and Procedures ‒ Admission requirements ‒ Financial Information
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Thank You wexnermedical.osu.edu
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