I don't think Cleveland Clinic is alone in attempting to balance high standards for clinical teaching quality and the need for greater clinical productivity. The same way that experienced clinicians seem able to efficiently care for patients without a drop in patient satisfaction or quality of care, so then, experienced clinical teachers seem to be able to "teach" both efficiently and well.
The other day I was observing a clinical teacher with a group of residents and students during rounds. It was quite a sight. I wish I would have had a video camera, because this was a clear example of teaching expertise in action. The attending interacted with everyone on the team, the flow was quick and there did not seem to be a minute wasted as the team moved from room to room. The questions she asked were insightful. She provided quick feedback and was at the same time respectful to the "senior", asking him to "teach" at one point.
So... What is your secret? How do you make time to observe, give feedback, provide focused teaching? If each person that receives this BLOG could share one idea, we would really have something worth saving!
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9 comments:
Quality teaching can be quick. One thing I do that residents seem to appreciate is sa before going in the OR.. "OK, What is the one thing you want to learn from this surgery" And then we do it.
On a particularly busy day it is important to remind residents that learning from the clinical encounters is as critical as doing "work".
One way to do that is to ask the resident after each encounter what was the one thing they learned or had a question about that they will look up.
definitely...the very fact that it is teaching in a clinical context with an actual patient makes it high quality because the retention power is going to be higher. In medicine the one thing I ask MYSELF on every case is..what is the most important thing the students could learn from this and then teach them that. another thing which I prefer at times is a 5 minute quick 'down to the basics' spiel on the diagnosis of the patient.
The teacher must command respect for their own time. If the teaching point is basic, and found in every medical textbook chapter on the subject, the teacher can gently point this out, and encourage the learner to read and revisit fine points later. The teacher and learner will then, literally, be on the same page.
If you are a specialist, you need to be very disciplined in the amount of time and detail that you give to learners who are on "required rotations", or on electives that may have little relevance to their future careers. You may hold their interest and impress them with the minutiae of your specialty, but they are very, very unlikely to ever use that level of information in their future practice. There are just so many hours in the day -- dispensing "400level" information to "100 level" students may make the teacher feel smart, but ultimately it steals time that you should be spending with your advanced learners (e.g. fellows).
I encourage senior residents to teach juniors and interns. I usually give them some warning, but I may just ask them to "diagram a case"
I agree with comments by Steve and Neil, to keep the teaching learner-centered by asking the residents or students what they want to know or learn more about the patient presented or the clinical encounter. The learners' comments help me assess what they are observing, picking up on, and what they thinking. My teaching points can then be more specific for each of the learners. Also if residents and learners know that they will be asked for their observations or thoughts, they hopefully will be paying attention even when it's not their own patient.
I think that the residents and medical student benefits from experiential learning - and this can be done easily while on rounds - small things seen in every single patient can have a very important long term impact.
Occasionally, residents are unaware that what the attending is saying is actually a teaching point, so we should actively emphasize "this is a teaching point" and show in real time how it is applied.
As we are writing orders or requesting a certain diagnositc test, we can emphasize and show our rationale for that...this builds immediate knowledge to the residents.
As well, suggesting to read some material related to the teaching points observed is very useful (as it has been based on an experiential learning first, and then it creates a solid background for academic learning).
I try to talk out loud re clinical treatment algorithms or how I have weighted a pattern of signs and symptoms in a differential diagnosis to make explicit both clinical decision making while also including one cite for further training reading.
I've seen a lot of good advice here, One additional idea is to ask the residents to prepare for rounds. Send a reading and discuss it as the morning progresses.
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