New Faculty OrientationTeaching in the Clinical Setting

Tatum Langford Korin, EdD

September 19, 2006

The Five P’s of Effective Teaching

• Preparation

• Perceptions

• Professionalism

• Presentation

• Participation

Preparation

• Determine the need of students

• Integrate previous learning into present lesson

• Determine the educational level of the students

• Assemble teaching accessories

Perceptions

• Student and preceptor

• Integration of one’s ideas during teaching

• Positively reinforce the practice of medicine

• Attitudes are easily conveyed

Professionalism

• Appearance (clean lab coat)

• Demeanor– Polite without being overly friendly

• Preceptor is always Dr.

• Know students name

Presentation

• Competing student interest and material

• Focus on student attention

• Positive learning environment

• Three points (presented at first meeting):– What you are going to do– How you are going to do it– What are the students expected to do

Participation• Bilateral participation• Eye contact• Questions=feedback• Questions=fact finding mission• Orient learners to lesson• Review past material• Reflect on learning• OK to say “I don’t know”• Give feedback to learners often• Praise is important to the group and individual

Conclusion

• Reflect on the five P’s and make adjustments for the next teaching experience– Prepare early– Discuss your perceptions– Be professional– Design your presentation– Allow bilateral participation

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Teaching in the Clinical Setting

In-depth LecturesSeminarsFormal Educational SessionsExtensive Discussion

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Teaching in the Clinical Setting

Efficient and effective ambulatory care teaching requires that both the student and preceptor accept the limitations of the outpatient setting.

Extensive discussions of differential diagnosis, pathophysiology and psychosocial problems are not possible nor necessarily desirable.

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Teaching in the Clinical Setting

Keys to Clinical Teaching

• Demonstrate enthusiasm

• Give meaningful (“authentic”) responsibility

• Possess credible clinical skills

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CHARACTERISTICS AND BEHAVIORS IDENTIFIED IN STUDIES OF CLINICAL TEACHINGEFFECTIVENESS

Organized,Planned

Approach toTeaching

SystematicTeachingPractices

DemonstratesKnowledge,

ClinicalCompetence and

ProfessionalDemeanor

Respectfuland

HumanisticOrientation

Enthusiastic,StimulatingApproach to

Teaching

JACOBSON(1966)

-Available tostudents

-Systematicevaluatorpractices

-Systematicteachingpractices

-Apparent knowledge-Professionalcompetence

-Interpersonalrelations withstudents and

others-Personal

characteristicSTRITTER

ET AL(1975)

-Accessible tostudents

-Prepares forcontracts with

students-Identifies what’s

important

-Answersquestionscarefully

-Explains basesfor action-Provides

opportunity forpractice

-Summarizesmajor points

-Explains lucidity

-Provides competentclinical care

-Corrects w/obelittling

-Approachesteaching withenthusiasm-Genuineinterest inteaching

IRBY (1978) -Accessible tostudents-Clarity,

organization

-Breadth of knowledge-Competent

-Friendliness-Interested in

students,patients,residents

-Enthusiasm-Enjoyment

GJERDE &COBLE(1982)

-Takes time fordiscussion and

questions-Accessible to

residents-Well prepared for

teaching

-Answersquestions clearly

-Providesopportunity for

practicetechniques andpsychological

skills-Discuss practical

application ofknowledge and

skills-Provides

constructivefeedback

-Shares knowledge andexperience

-Asksquestions in

non-threatening

way

-Demonstratesenthusiasm for

teaching

ULLIAN &BLAND(1983)

-Available forfrequent contact

-Explains clearly-Feedback given-Given residentresponsibility

-Good medicalknowledge

-Clinically competent

-Encouragesdifferences of

opinion-Builds

relationshipwith residents

-Enthusiastic-Interested in

teaching

WEINHOLTZ ET AL(1983)

-Allocates time forinstruction

-Provides initialorientation

-System forlistening to case

presentations andmanaging

discussions-Makes didacticpresentations

-Conducts finalevaluation-System fortransferring

teachingresponsibility

-Clinically credible -Createsclimate in

non-threatening

way

Characteristics and Behaviors Identified in Studies of Clinical Teaching Effectiveness

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Teaching in the Clinical SettingPitfalls in clinical

case-based teaching

• “Taking over” the case• Inappropriate lectures• Insufficient “wait-time”

-3-5 second wait to answer your questions

• Pre-programmed answers

-What do you think is going on? Could it be an ulcer?

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Teaching in the Clinical Setting

Pitfalls continued…

• Rapid reward-Effectively ends the student’s thinking process

• Pushing past ability-Persisting in carrying the students beyond their understanding of what is being asked

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Teaching in the Clinical Setting

Teaching Strategy #1The “One-Minute Preceptor”

1. Get a commitment

2. Probe for supporting evidence

3. Teach general rules-Take each encounter to a learning point

4. Provide feedbackA. PositiveB. Corrective

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Teaching in the Clinical Setting“One-Minute Preceptor” MicroSteps

• Get commitment (Assess)– “What do you think is going on?”

• Probe for rationale (Assess)– “What led you to that conclusion?”

• Teach general rules (Instruct)– “When this happens, do this…”

• Reinforce what was correct (Feedback)– “You did an excellent job of…”

• Correct mistakes (Feedback)– “Next time this happens, try this…”

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Teaching in the Clinical Setting “One-Minute Preceptor”

Video VignettesInstructions: Watch the vignette(s) and determine

whether correct and effective precepting has taken place:

Preceptor asked for commitment Preceptor probed for supporting evidence Preceptor taught a general rule Preceptor provided feedback

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Teaching in the Clinical Setting “One-Minute Preceptor”Role Play: Case Presentation

3rd-year students in the ambulatory setting

Preceptor role: practice the microsteps of the “One-Minute

Preceptor” for a 3rd-year medical student in the outpatient

setting

Student role: receive teaching and supervision in the outpatient setting and respond to the preceptor’s questions

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Teaching in the Clinical Setting

Teaching Strategy #1The “one-minute preceptor”

QUIZQUIZ1. Get a _______________________

2. Probe for ___________________

3. ____________general rules

4. Provide____________________

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Teaching in the Clinical Setting

“Trainees do not perform required skills incorrectly on purpose…errors in

performance are typically the result of insufficient feedback. They are seldom the

result of insufficient interest or caring.”

-Westberg and Jason, 1991

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Teaching in the Clinical Setting

FEEDBACK IS:Information you provide to learners about

their clinical performance that is intended to guide their future clinical

performance

-Adapted from K. Skeff

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Teaching in the Clinical Setting

Feedback in Ambulatory Care Settings

• Case presentations with faculty feedback: On Average: 3-6%

• Positive feedback given more than negative

• Intensive feedback to residents improves patient satisfaction

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Teaching in the Clinical Setting

The “Feedback Sandwich”The “Feedback Sandwich”

What was done right

What needs improvement

What to do next time

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Teaching in the Clinical SettingGiving Feedback

A Checklist11 Make sure learner is ready11 Give it soon and often11 Link to goals11 Be specific & non-judgmental11 Give positive and constructive comments11 Suggest correct performance11 Don’t give too much11 Make sure feedback is understood11 Follow up your feedback111 Expect learners to develop skills in self-

evaluation

Feedback Role Play

Teaching in the Clinical Setting

Questions?Comments?

Thank you

Tatum Langford Korin, EdD.Office of Educational Development & Research

Instructional Design & Technology UnitTkorin@mednet.ucla.edu