Introduction to Teaching
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Transcript of Introduction to Teaching
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Introduction to Introduction to TeachingTeaching
University of PittsburghUniversity of Pittsburgh
School of MedicineSchool of MedicineAcademy of Master EducatorsAcademy of Master Educators
Teaching Residents to Teach Teaching Residents to Teach CommitteeCommittee
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Academy of Master Educators Teaching Residents to Teach
Committee Raquel Buranosky,
MD,MPH– Chair of CommitteeChair of Committee– Associate Professor of Associate Professor of
MedicineMedicine– Associate Program Associate Program
Director, Internal Medicine Director, Internal Medicine ResidencyResidency
Jason Rosenstock MD– Assistant Professor of
Psychiatry– Director Med Student
Education
James Johnston, MDJames Johnston, MD– Professor of Medicine Professor of Medicine – Program Director, Program Director,
Nephrology FellowshipNephrology Fellowship– President, Academy of President, Academy of
Master EducatorsMaster Educators
Jonathan Finder, MD– Professor of Pediatrics– Clinical Director,
Pediatric Pulmonology
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Committee Members, Ctd.
Rita M Patel MD– Professor & Vice-Chair,
Anesthesiology– Clinical Procedures UPSOM
Course Director– Associate Dean for GME
Basil Zitelli, MD– Professor of Pediatrics– Division Chief, Paul C.
Gaffney Diagnostic Referral Service
Kathleen McIntyre-Seltman, MD– Professor of OB/GYN &
Reproductive Sciences– Advisory Dean, Office of
Student Affairs, UPSOM
Richard Saladino, MD– Professor of Pediatrics– Division Chief, Pediatric
Emergency Medicine
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Committee Members, Ctd David E. Eibling, MDDavid E. Eibling, MD
– Professor of Professor of OtolaryngologyOtolaryngology
Helen Westman, MDHelen Westman, MD– Professor of Professor of
Anesthesiology Anesthesiology
Peter Bulova, MDPeter Bulova, MD– Associate Professor Associate Professor
of Medicineof Medicine
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Introduction to Teaching
Goal:To help incoming house staff 1) recognize the importance of
teaching2) understand basic do’s and don’ts3) be open to further development
of teaching skills
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Agenda
CoreCore
– Fundamental principles of Fundamental principles of educationeducation
– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback
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Conduct of SessionConduct of Session
Brief introduction to teachingBrief introduction to teaching Case-Based ScenarioCase-Based Scenario Reflection Reflection Audience-Response SystemAudience-Response System Summary – Teaching PointsSummary – Teaching Points
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Agenda - 1
CoreCore
– Fundamental principles of Fundamental principles of educationeducation
– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback
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AdultAdult Learning Learning PrinciplesPrinciples
Adult learners: Adult learners: – Are Are goal-oriented goal-oriented (Why, What and How)(Why, What and How)– Are Are autonomous and self-directingautonomous and self-directing– Have Have preexisting resources preexisting resources (life (life
experiences)experiences) Make it relevant, practical & contextual Make it relevant, practical & contextual
(problem solving)(problem solving) Be respectful (safe learning Be respectful (safe learning
environment) environment) Motivate and reinforceMotivate and reinforce
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Agenda - 2
CoreCore
– Fundamental principles of Fundamental principles of educationeducation
– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/Assessment/Evaluation/
FeedbackFeedback
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“Teachable Moments”
Not just a ‘lecture’ Modeling professional behavior Daily opportunities
– Work rounds– Procedures– Ambulatory settings
Pick your targets (can’t do it all) Be brief (“teaching on the fly”)
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What type of teaching What type of teaching useful?useful?
0
10
20
30
40
50
60
70
% Re
sponse
s
A B C D
High ------------------------------------------------Low
MS Resident Prog Dir
A.A. Procedures, Case Procedures, Case Management, 5-Management, 5-min talks, Bedside min talks, Bedside TeachingTeaching
B.B. Physical Diagnosis Physical Diagnosis RoundsRounds
C.C. Lectures, PBL, Lectures, PBL, Simulated Cases, Simulated Cases, Socratic Socratic questioningquestioning
D.D. MS I & MS II MS I & MS II coursescourses
*Students value *Students value case-based & case-based & bedside bedside teaching over teaching over lectures.lectures.
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““The One Minute The One Minute Preceptor” Preceptor”
1.1. Get a commitmentGet a commitment2.2. Probe for supporting evidenceProbe for supporting evidence3.3. Teach general rules and think out Teach general rules and think out
loudloud4.4. Tell your learner what he or she Tell your learner what he or she
did did rightright5.5. Correct the learner’s mistakesCorrect the learner’s mistakes
Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching
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1 Minute Preceptor: 1
Get a commitment
– Ask learner to articulate his/her own diagnosis or plan
– Get him/her to commit to an answer (even if wrong)
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One Minute Preceptor 2
Probe for supporting evidence
– Evaluate the learner’s knowledge/reasoning
– Ask probing questions Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s
answer
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One Minute Preceptor: 3
Teach general rules
•Generalize from the case at hand
•Give the learner a pearl /take home point
•Point out how this case is same or different from the general rules
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One-Minute Preceptor: 4
Reinforce what was done well
•Provide positive feedback•“Catch them doing something right”
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One Minute Preceptor: 5
Correct errors
•Provide constructive corrections and feedbackSpecificTargetedRecommendations for improvement
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The One Minute Preceptor
Choose a single teachable point per encounter– Most generalizable (most useful)– Most important (don’t miss the life
threatening diagnosis)– Targeted at learner’s area of weakness– Building on previous teachable point– Can be diagnosis, management, skill
etc
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Agenda - 3
CoreCore
– Fundamental principles of Fundamental principles of educationeducation
– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/Assessment/Evaluation/
FeedbackFeedback
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FeedbackFeedback vs.vs. EvaluationEvaluation ImmediateImmediate InformalInformal SubjectiveSubjective SpecificSpecific Improvement Improvement FormativeFormative InformationInformation
ScheduledScheduled FormalFormal ObjectiveObjective GlobalGlobal GradeGrade SummativeSummative JudgmentJudgment
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RIMERIME Evaluation Evaluation FrameworkFramework RReporter eporter – Provides data– Provides data
– WBC count 15; chest x-ray infiltrateWBC count 15; chest x-ray infiltrate
IInterpreternterpreter – Integrates data – Integrates data– Differential diagnosis including pneumoniaDifferential diagnosis including pneumonia
MManager anager – Implements– Implements– Treats with antibiotic, arranges hospital Treats with antibiotic, arranges hospital
admissionadmission
EEducator ducator – Teaches – Teaches – Shows how individual data led to diagnosis of Shows how individual data led to diagnosis of
pneumonia and how to treat itpneumonia and how to treat it
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Scene - ERScene - ER
Jim – Medical StudentJim – Medical Student– MS III, midway through rotationMS III, midway through rotation– Spent 2 hours with patient and familySpent 2 hours with patient and family– Presenting patient with chest pain & Presenting patient with chest pain &
anxietyanxiety Rita – Emergency Medicine ResidentRita – Emergency Medicine Resident
– Supervising residentSupervising resident
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(RIME Evaluation)(RIME Evaluation)
I think in this scenario the I think in this scenario the medical student fit into the medical student fit into the category of:category of:– ReporterReporter– InterpreterInterpreter– ManagerManager– EducatorEducator
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Giving Effective Feedback
• Feedback : a process of sharing observations and recommendations with a learner – should be formative– Contrasts with evaluation – often summative
• Residents almost universally agree that giving and getting feedback is stressful. – best way to reduce that stress is to learn to give
feedback effectively
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Giving Effective Feedback
• Well-timed–should be given as soon after the observed behavior as is practical
• Based on Firsthand Data– Secondhand data will often lack specificity, or worse, authenticity
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Giving Effective Feedback
• Regulated in Quantity– Too much feedback will be seen as berating.
• Elicit the Learner’s Perspective– Listen to what the learner has to say
• Descriptive and Nonjudgmental– Be specific about what needs to be changed– you are correcting the behavior, not the person
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Giving Effective Feedback
• Concerned With Decisions and Actions, Rather Than Intentions and Interpretations– Concentrate on WHAT was done or said, rather
than WHY
• Providing Guidance to Resolve the Problem– Offer suggestions in ways to improve
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Giving Effective Feedback
• Limit to Remediable Behavior– Stay focused on the behavior, even if you feel it
originates from a less-than-ideal personality
• Remember the Positive!– Positive feedback is based on the criteria just
discussed
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Take Home Points
Qualities of Feedback • Expected• Well-timed• Based on Firsthand Data• LIMITED in Quantity• Eliciting the Learner’s Perspective• Descriptive and Nonjudgmental• Concerned With Decisions and Actions
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Take Home PointsTake Home Points
Reinforce what they are doing wellReinforce what they are doing well Educate about areas in which Educate about areas in which
improvement is possibleimprovement is possible Affirm your belief in their ability to Affirm your belief in their ability to
follow this advicefollow this advice Check for their understanding by Check for their understanding by
asking for a planasking for a plan Commit to helpCommit to help
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Intro to Teaching…. Conclusions
It’s important and you’ll do it regularly Make it relevant, practical Capitalize on teachable moments Use your new teaching skills (1 min.
preceptor) Give timely feedback, assess with RIME Ask for help, more to come
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So Just Take the Plunge