Clinical Teaching

 

Key Points:

  • You don't have to be the smartest person in the room to be an excellent teacher.
  • Qualities of the highest ranked teachers: spent >25% of time teaching, gave in-depth feedback, got to know students personally, stressed doctor-patient relationship and psychosocial aspects of disease, had a planned curriculum but also improvised topics
  • Adult learners perform better when they feel they are functioning autonomously and when they are solving questions that are important to them.
  • Common pitfalls include taking over too quickly, not understanding the learner's level, not waiting long enough for answers, and giving the answers instead of asking questions.
  • Clinical questioning can come in many forms including: asking for specific facts, asking for justification of a diagnosis, asking for addition options for diagnoses or plans, asking questions based on adding additional hypothetical information about the patient (ex. What if the patient had ST elevation?), asking for advantages and disadvantages of the proposed course of action
  • Consider an educational contract: what are the learner's needs, how do they learn best, what they need from the teacher, teacher's expectation of the learner, plan for feedback and reflection
  • When asking teaching questions to a group of learners, pause a moment beforehand to focus your learners and only call on a single person after the question is posed. Calling on a single person can be softened by saying that they can get help from the group.
  • Two-thirds of your feedback should be positive. Feedback should be as immediate as possible within the limits of the clinical setting and be specific.
  • When correcting mistakes, ask the learner to critique themselves and make suggestions on how to correct the mistake.
  • Not every student needs to do everything for or examine every patient.
  • Clinical teaching format
    • Learner commits to a diagnosis or plan
    • Teacher probes for reasoning behind the diagnosis or plan and what made the alternatives fall lower on the list
    • Teacher provides take home points
    • Teacher reinforces positive aspects of the analysis
    • Teacher suggests what could be improved
    • Teacher facilitates self-reflection (ex. What are two things you learned today and what is something you still need to look up to understand better?)

 

Objectives:

  • Prepare for and standardize your approach to clinical teaching
  • Implement new strategies in your clinical teaching

 

Recommended Resources: 

Brief Review

Watch

♥New Preceptor Start-Up Package. Matthew Eberly. 6 minutes. 
https://vimeo.com/107549792

♥One Minute Preceptor. Matthew Eberly. 7 minutes.
https://vimeo.com/76305964

♥Direct Observation. Matthew Eberly. 7 minutes.
https://vimeo.com/76304683

♥The Rhythm of RIME. Matthew Eberly. 11 minutes.
https://vimeo.com/76308600

♥Giving Feedback. Matthew Eberly. 12 minutes.
https://vimeo.com/76300757

♥Teaching Tools. Matthew Eberly. 11 minutes.
https://vimeo.com/76299720

The Bedside 5 Minute Moment (How We Teach the Bedside Physical Exam). Stanford Medicine. 3 minutes.
http://youtu.be/UMK5NWfCpKk

Stanford Medicine. Various physical exam videos.
https://www.youtube.com/user/eozdalga/videos

Lawrence Sherman "Turning medical education inside out and upside down" TEDx Talks. 16 minutes.
http://youtu.be/YpSd5u_di9w

Orienting Learners. Practical Doc. 1 minute.
http://www.practicaldoc.ca/teaching/practical-prof/preparing-to-teach/orienting-learners/

PocketSnips. Free clinical videos for you to use. These videos are covered by Creative Commons licensing. Topics include suturing, gloving, etc.
http://www.nosm.ca/pocketsnips/
http://www.nosm.ca/pocketsnips/videos/default.aspx

Read

Powell N, Bruce CG, Redfern O. Teaching a 'good' ward round. Clin Med. 2015 Apr;15(2):135-8. doi: 10.7861/clinmedicine.15-2-135. PubMed PMID: 25824064.
http://www.clinmed.rcpjournal.org/content/15/2/135.long

Rannelli L, Coderre S, Paget M, Woloschuk W, Wright B, McLaughlin K. How do medical students form impressions of the effectiveness of classroom teachers? Med Educ. 2014 Aug;48(8):831-7. doi: 10.1111/medu.12420. PubMed PMID:25039739
http://www.ncbi.nlm.nih.gov/pubmed/25039739

Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, Harrell H, Hemmer PA, Kernan WN, Kogan JR, Rafferty C, Wong R, Elnicki DM. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med. 2013 Mar;28(3):412-20. doi:10.1007/s11606-012-2259-2. Epub 2012 Nov 6. PubMed PMID: 23129164
http://www.ncbi.nlm.nih.gov/pubmed/23129164

Dunlosky J, et al. Improving students' learning with effective learning techniques promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 2013; 4-58.
http://psi.sagepub.com/content/14/1/4.full.pdf+html

Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med. 2008 May;83(5):452-66. doi: 10.1097/ACM.0b013e31816bee61. Review. PubMed PMID: 1844889
http://www.ncbi.nlm.nih.gov/pubmed/18448899

Parrot S, Dobbie A, Chumley H, Tysinger JW. Evidence-based office teaching--the five-step microskills model of clinical teaching. Fam Med. 2006 Mar;38(3):164-7. PubMed PMID: 16518731
http://www.ncbi.nlm.nih.gov/pubmed/16518731

Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Acad Med. 2004 Jan;79(1):42-9. PubMed PMID: 14690996
http://www.ncbi.nlm.nih.gov/pubmed/14690996

Kaufman DM. Applying educational theory in practice. BMJ. 2003 Jan 25;326(7382):213-6. Review.
PubMed PMID: 12543841
http://www.ncbi.nlm.nih.gov/pubmed/12543841

Lake FR, Vickery AW, Ryan G. Teaching on the run tips 7: Effective use of questions. Med J Aust. 2005 Feb 7;182(3):126-7. Review. PubMed PMID: 15698359
http://www.ncbi.nlm.nih.gov/pubmed/15698359

Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med. 1998 Dec 31;339(27):1986-93. PubMed PMID: 9869671.
http://www.ncbi.nlm.nih.gov/pubmed/9869671

Teaching Skills for Community Based Preceptors . University of British Columbia Faculty of Medicine. 45 page handbook: What is an effective clinical teacher; How do we learn; Preparing to teach.; Teaching with patients; Observation, feedback & assessment; What to do with learners with problems.
https://circle.ubc.ca/bitstream/handle/2429/26718/Teaching_Skills_for_Community_17_Feb_2012.pdf?sequence=19

Models for Teaching in the Ambulatory Setting. UCLA School of Medicine. Workshop materials.
http://www.oucom.ohiou.edu/fd/Models%20for%20Teaching%20in%20the%20Ambulatory%20Setting.pdf

Azer SA. The Top-Cited Articles in Medical Education: A Bibliometric Analysis. Acad Med. 2015 Jun 9. PubMed PMID: 26061861.
http://www.ncbi.nlm.nih.gov/pubmed/26061861

Do

Preceptor Development Initiative. 8 interactive online modules: Setting The Stage; The Role Learning Plays; Enhancing Your Teaching Skills; Fostering Clinical Reasoning; Giving Feedback; The Evaluation Process: Supporting The Struggling Student; Conflict Resolution.
http://www.practiceeducation.ca/about.html

Preceptor Development Program. University of Virginia Health System. 7 online modules: Taking a Student into Your Office, Teaching and Learning Styles, Interacting with Your Medical Student, Providing Feedback, The One-Minute Preceptor, Teaching the “Clinical Competencies,: Evaluating Your Student.
http://www.med-ed.virginia.edu/courses/fm/precept

Ramani S. Tips for Effective Bedside Clinical Teaching. MedEdPORTAL Publications; 2006. Workshop materials including definition and learning outcomes of bedside teaching, application of educational principles of experiential learning to bedside teaching, techniques for effective bedside teaching, and challenges to bedside teaching.
https://www.mededportal.org/publication/220

 

In-Depth Review

Watch

♥How Young Doctors Think: Teaching Clinical Decision Making. Nationwide Children's Hospital. 59 minutes.
http://youtu.be/SOesiCMSukI

Faculty Development: Bedside Teaching. Mt. Sinai Icahn School of Medicine. 50 minutes.
http://youtu.be/SXtKeL1nabg

♥Bates' Visual Guide to Physical Examination, 4th Edition. 19 video playlist.
https://www.youtube.com/playlist?list=PLrFv8WKsFN8RWvrr4NJwH7ROZLwyW6pAE

Joint-by-Joint Musculoskeletal Physical Exam. 7 video playlist.
https://www.youtube.com/playlist?list=PLijalQObzAG7giwNTjHPusirYphK6Now9

Clinical Teaching 102 Introduction. Inis Jane Bardella, M.D. Rosalind Franklin University of Medicine. 30 minutes.
https://youtu.be/fBLAY1NCzdk?list=PLmiqXUpQ27qr_ZvqlS6KYCgkh8zx2FUqL

Clinical Teaching 102 Continued. Inis Jane Bardella, M.D. Rosalind Franklin University of Medicine. 16 minutes.
https://youtu.be/CVCrS7dUxj4?list=PLmiqXUpQ27qr_ZvqlS6KYCgkh8zx2FUqL

Read

♥Clinical Teaching Guidebook by Deirdre Bonnycastle. The Clinical Teaching Guidebook is an overview for preceptors of clerks and residents who are teaching in their office or hospital setting. Free in the Apple iBookstore.
https://itunes.apple.com/ca/book/clinical-teaching-guidebook/id681319811?mt=11

Learning and Teaching at the Bedside, Physical Diagnosis Skills. University of Washington.
http://depts.washington.edu/physdx/gettingstarted.html 

 Do 

The Expert Preceptor Interactive Curriculum. FIPSE project group, Office of Educational Development, University of North Carolina School of Medicine.
http://www.med.unc.edu/epic/

Premkumar K, D'Eon M, Bonnycastle D. Medical Teaching Resources for Faculty Developers. MedEdPORTAL Publications; 2013. 40 video vignettes depicting effective and not so effective teaching methods including Presentation Skills, Active Learning Strategies, Small Group Teaching, and Clinical Teaching.
https://www.mededportal.org/publication/9336

Tattelman E, Karnik A, Fornari A. Questioning as a Tool in Teaching. MedEdPORTAL Publications; 2011. Handout to introduce the questioning strategies using modified Bloom's Taxonomy followed by an example of how to use it. An included PowerPoint can be used as part of an interactive teaching session.
https://www.mededportal.org/publication/8419

Morrison E. Bringing Education and Service Together (BEST): Resident Physicians' Curriculum in Clinical Teaching Skills. MedEdPORTAL Publications; 2005. A 15 hour teaching skills program set up to be delivered in one-hour sessions. Modules include: (1) leading teams/role modeling, (2) orienting learners, (3) giving feedback, (4) bedside teaching, (5) teaching procedures, (6) group teaching/inpatient work rounds, (7) teaching charting, and (8) giving mini-lectures.
https://www.mededportal.org/publication/104

O'Toole J, Calaman S, Everhart J, Bismilla Z, Good B, Guiot A, Johnstone N, Nilforoshan V, Noble E, Rosenbluth G, Schwartz S, Solan L, Tse L, West D, Weiser J, Landrigan C, Sectish T, Srivastava R, Starmer A, Spector N. I-PASS Handoff Curriculum: Medical Student Workshop. MedEdPORTAL Publications; 2014. Workshop curriculum for medical students to describe the importance of effective communication in reducing medical errors, detail the essential content and sequence of effective handoffs, apply effective team training strategies to improve handoffs, and practice handoff skills.
https://www.mededportal.org/publication/9854

International Clinican Educators Network. Continuing Medical Education For Clinician Educators by Clinician Educators. 2015 Workshops.
http://anzahpeamea2015.com.au/program/workshops/

♥Teaching and Assessing Clinical Skills. Coursera, University of Michigan.
https://www.coursera.org/course/clinicalskills

 

Specialty-Specific

Presenting Patient Information

Patient Presentation. Anna Pickens. 6 minutes.
https://www.youtube.com/watch?v=isM2MJdRjyE

Psychiatry

Clinical Skills Initiative eModules and Videos. The Association of Directors of Medical Student Education in Psychiatry (ADMSEP) offers a number of web-based case modules (with self-evaluation questions and videos) on a variety of core psychiatric diagnoses for FREE. These modules are available to educators and medical students on our web site, as well as through MedEdPORTAL, which means that they have gone through a peer-reviewed process. Currently about 10 modules are available, with another 10-12 in the works. The diagnoses that the Clinical Simulation Initiative committee focus on align with the recent publication of the ADMSEP Key Diagnoses, Learning Objectives and Milestones for Undergraduate Medical Education in Psychiatry.
http://www.admsep.org/csi-eModules.php

Anesthesiology

Anesthesiology. Medical Education Videos. 9 video playlist.
https://www.youtube.com/playlist?list=PLVnjTkEwv-uOvGYtk-K6-Dh2m9_w6Bb_m

An Introduction to Anesthesia. UCL Centre for Anesthesia. 10 minutes.
https://www.youtube.com/watch?v=R3sOJc4imUs

Anesthesia Operating Room Setup. UT Health. 5 minutes.
https://www.youtube.com/watch?v=oXn0wqGB6So

Learn to Intubate During General Anaesthesia. USMLE Steps 123. 2 minutes.
https://www.youtube.com/watch?v=CrLJwwSnUws

Basics of Airway Management. Anesthesia with Dr. Sappenfield. 19 minutes.
https://www.youtube.com/watch?v=J2gPumQErsQ

Cardiology

Cardiology. Medical Education Videos. 13 video playlist.
https://www.youtube.com/playlist?list=PLVnjTkEwv-uNtHIc0UNO3QARyyw2Q4K8Z

Operating Room

Operating Theatre Etiquette for Medical Students. Oxford University Hospitals. 14 minutes. Typical differences in the United States: You will be using shoe covers instead of changing into surgical clogs. Never carry your cell phone in the OR or pre/postop areas. Always address doctors as Dr. ____, even if other people call them by their first names.
https://www.youtube.com/watch?v=E3VX-Ij6ch8

Orientation to the Operating Room. UBC Anesthesia. 11 minutes.
https://www.youtube.com/watch?v=5iGAY6m89fY