PROFESSIONAL DEVELOPMENTOctober 3, 2013

Dr. V. Antao MD, CCFP FCFP, MHSc, Dr. G. Mand MBBS, CCFP, Dr. J. McCabe, MD, CCFP, Dr.

Yves Talbot and Dr. Yee-Ling Chang were involved in the creation of this session.

STRATEGIES FOR EFFECTIVE TEACHING IN AMBULATORY CARE

• This set of slides is adapted for DFCM Open. You can download these slides at www.dfcmopen.com/item/basics-effective-teaching.

“ The mediocre teacher tells. The good teacher explains. The superior teacher

demonstrates. The great teacher inspires.”

~William Arthur Ward

TEACHING STRATEGIES

OBJECTIVES

• Acquire an increased awareness of challenges in ambulatory care

• Review the One Minute Preceptor Model as a teaching strategy

• Review other common teaching strategies and teaching methods

OBJECTIVES

• Be familiar with some resources available to clinician teachers to address common teaching challenges

CHALLENGES IN TEACHING

• Reflect on your own experience:

• How do you teach?

• What challenges do you face teaching in your office?

ONE MINUTE CLINICAL PRECEPTOR

• Focuses teaching on learners reasoning• Based on 5 Microskills

1. Get a Commitment 2. Probe for evidence3. Teach general rules4. Provide feedback5. Correct mistakes

Neher J et al., A Five Step Microskills Model of Clinical Teaching. J. Am Board of Fam Practice, 5:419-24, 1992

GET A COMMITMENT

• What do you think is going on with this pt?• What investigations are indicated ?• What do you think needs to be

accomplished on this visit?

* resist asking data gathering questions at this time

PROBE FOR SUPPORTING EVIDENCE

• What are the major findings that lead to your conclusion ?

• What else did you consider ?• What made you choose this particular

treatment ?

• * “thinking out loud” rather than grilling

TEACH GENERAL RULES

• Keep it brief and focused on identified issues

• Instruction is more memorable when offered as a general rule

REINFORCE WHAT WAS DONE RIGHT

• Be specific• General praise does not reinforce a

particular behaviour

CORRECT ERRORS

• Consider appropriate time and place• Start with learner self evaluation• Consider language

“ Who dares to teach must never cease to learn.”

~John Cotton Dana

TEACHING STRATEGIES

COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE

1) Orienting learner2) Prioritizing or assessing learning needs3) Problem-oriented learning4) Priming *5) Pattern recognition6) Teaching in the patient’s presence*

Heidenreich C et al., Pediatrics 105:231-237,2000

COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE

7) Limiting teaching points *8) Reflective modelling9) Questioning10) Feedback11) Teacher/learner reflection

Heidenreich C et al., Pediatrics 105:231-237,2000

PRIMING

• Orientation of learner to pt. and tasks before entering room 1-2 min

1. Tasks

2. Attending role

3. Patient

4. Product

TEACHING IN THE PATIENT’S PRESENCE

• Learner presents findings to preceptor in front of patient– Increases preceptor time with patient– Enables direct verification of history/findings– Enables direct observation– Saves time

LIMITING TEACHING POINTS

• Focus on a few main points, less teaching, more learning

• General rules more memorable, more transferable

• At end of clinic, address other issue in more detail

• At next session review unresolved issues

CONCLUSIONS/SUMMARY

• There are numerous challenges associated with clinical teaching

• Effective teaching strategies may be used in ambulatory care

• A learner centred model of teaching is the One-Minute Preceptor (OMP)

REFLECTIVE EXERCISE

• Implement a Method/Strategy• -consider using the sample LOG

– Why did you chose this method?– Why was approach effective/ineffective?– What would you do differently next time? and

why?

TEACHING LOG

This is a teaching log created by Dr. Helen Batty and used in the Academic Fellowship Program.

EFFECTIVENESS OF TEACHING IMPROVEMENT INTERVENTIONS

Effective Teaching Interventions:

• Workshops• Teaching Evaluations with Consultation• Faculty development fellowship programs

• Wilkerson L et al., Strategies for Improving Teaching practices: A Comprehensive Approach to Faculty Development. Academic Medicine1998

RESOURCES

• Local undergrad/postgrad/PD representatives• Rubenstein W, Talbot Y. Medical Teaching in Ambulatory

Care, 2003• Neher J et al., A five Step Microskills Model of Clinical

Teaching. J. Am. Board. of Fam. Prac. 5:419-421,1992• Aagard E et al., Effectiveness of the One minute

Preceptor Model for Diagnosing the Patient and Learner: Proof of Comcept. Academic medicine 79:42-49,2004

TEACHING STRATEGIES

• Case discussion• Case review• Direct observation• Chart review• Chart stimulated recall• Criterion chart review• Role play• Short didactic presentation

Rubenstein W, Talbot Y Medical Teaching in Ambulatory Care

2003

“ If you have knowledge, let others light their candle at it.”

~Margaret Fuller

TEACHING STRATEGIES

Thank You