The Resident s Teaching Workshop

3. The Resident�s Teaching Workshop

4. Workshop Faculty Joseph S. Alpert Sarver Heart Center/Office of the Dean Randy Horwitz Department of Medicine Nancy Koff Office of Medical Student Education

5. Workshop Facilitators Joseph Alpert Rosemary Browne Colleen Cagno Conrad Clemens Janet Campion Carol Galper Randy Horwitz Lane Johnson Patricia Lebensohn Tieraona Low Dog Phil Malan Rick Mandel Kevin Moynahan Amy Waer James Warneke

6. Workshop Support Nicole Capdarest Mar�a Chavez Liz da Cunha Angelica Gomez Raquel Givens Susan Knowles Saira Sheikh Hildi Williams

7. Workshop Sponsor Philip Malan, PhD, MD Vice Dean for Academic Affairs

8. Icebreaker At each table Introduce yourself Where are you from? Where did you go to medical school? What is your new residency program? Tell us one unusual thing about yourself, for example, �Read Gray�s Anatomy while skydiving!� JAJA

9. Time Remaining

10. Resident�s Role as Teacher However, residents often do not� promote participation ask problem solving questions give feedback JAJA

11. Workshop Objectives Illustrate the importance of the resident�s role in teaching Identify opportunities for teaching Present simple, effective teaching techniques Review principles for providing feedback JAJA

12. Our Real Goal For each of you to Affirm the value of good teaching � your role is very important Commit to becoming a skillful teacher Integrate teaching into your work JAJA

13. Ground rules One at a time Speak clearly Be concise Be respectful Have fun! JAJA

14. Workshop Structure Dramatic vignette Small group discussion Analysis of vignette Teaching approaches Large group discussions combined with short presentations of good teaching principles JAJA

15. Educational Philosophy First, a comment about lectures JA Our philosophy; moving away from lectures. JA Our philosophy; moving away from lectures.

16. Value of Lectures Longstanding tradition Useful in Quickly broadcast information Introductory material New information Overview Potentially compelling JA Lectures began centuries ago readings from the great texts. Still has its place I the hands of a master, can be powerful. JA Lectures began centuries ago readings from the great texts. Still has its place I the hands of a master, can be powerful.

17. Limitations of Lectures Three criticisms Implies learning is passive data acquisition � passive learning has poorer retention of material than active learning Data is not accurately or fully transferred Poorly suited for higher-order learning JA Now a bit of educational JA Now a bit of educational

18. Educational Philosophy Teach & learn through Dialogue Inquiry Exploration JAJA

19. Vignette #1 An attending physician is rounding with a resident and a medical student RHRH

21. Small Group Assignment Think back over your education� Ineffective teaching Forgettable teaching (�I can�t remember what was taught��) RHRH

22. Time Remaining RHRH

23. Discussion What did your teacher do that made their teaching so ineffective? RHRH

24. Small Group Assignment Think back over your education� Skillful, effective teaching You still remember the lessons RHRH

25. Time Remaining RH RH

26. Discussion What did your teacher do that made their teaching so memorable? RH RH

27. MicroSkills Easy to learn Efficient Evidence based Use while you work RH RH

28. MicroSkills Selected questions that are strategically asked during case presentations & discussions RH RH

29. To use the MicroSkills Listen for a cue When you hear the cue, use the MicroSkill RH Ring the bell.RH Ring the bell.

30. How do I know if I�m using the MicroSkills correctly? Teaching will be integrated in your daily activities Students will be talking more than you RH Ring the bell.RH Ring the bell.

31. The Educational Cycle RH RH

32. MicroSkills in Practice - 1 A medical student is joining the team today RH RH

33. The First MicroSkill To teach effectively, what should I say? �Great. I like having students on the team.� �OK. Rounds start at 8:00 on 7-West.� �Welcome. So, what do you hope to learn during this rotation?� RH RH

34. Set Expectations Response Don't assume students will just catch on Ask about their learning needs Set goals for learning RH RH

35. Examples �What do you hope to learn during this rotation?� �Each admitting day your job will be to perform one H&P.� �Every Friday I meet with the students for feedback.� RH RH

36. Set Expectations Defining a learner�s role builds confidence Using the student�s needs to set objectives increases learning RH RH

37. MicroSkills in Practice - 1 An effective use of MicroSkill 1� Setting Expectations RH RH

38. The Educational Cycle RH RH

39. MicroSkills in Practice - 2 The medical student is presenting a case � RH RH

40. MicroSkill 2 To teach effectively, what should I ask? �That�s the worse case presentation I�ve ever heard. Who taught you how to present like that?� �Did you check for tactile fremitus, egophony, and whispered pectoriloquy?� �Can you summarize the key points of this case for me in one sentence?� RH RH

41. Summarize the Key Points Cue A presentation is unfocused, rambling Response Resist the urge to state your synopsis Ask the learner to summarize the essentials RH RH

42. Summarize the Key Points �What are the essential points of this case?� �Give me a one sentence summary of the case.� RH RH

43. Summarize the Key Points Rationale Creates a clear mental image of the basic clinical problem Discriminates which details are key to making a diagnosis RH RH

44. MicroSkills in Practice - 2 An effective use of MicroSkill 2� Summarize the Key Points RH RH

45. MicroSkills in Practice - 3 The medical student continues� RH RH

46. MicroSkill 3 To teach effectively, what should I say? �Great. Lets read about those and talk about them tomorrow.� �So, what tests should we order?� �Of all those possibilities, what 2 or 3 diagnoses are most likely?� RH RH

47. Narrow the Choices Cue: The learner lists many possible diagnoses RH RH

48. Narrow the Choices Examples �In this case, what three diagnoses are most likely?� �Which diagnoses can we reasonably exclude at this point?� RH RH

49. Narrow the Choices Rationale Students must learn to consider the likelihood of each diagnosis Disease prevalence Context of the case A fundamental step in diagnosis RH RH

50. MicroSkills in Practice - 3 An effective use of MicroSkill 3� Narrow the Choices RH RH

51. MicroSkills in Practice - 4 The medical student continues� RH RH

52. MicroSkills To teach effectively, what should I say? �Ok, lets get a CXR, metabolic panel, UA, cultures, cocci and pertussis serology, and a pulm consult.� �Lets just give her a Z-Pac and see if she gets better.� �What points from the history support the diagnosis of, say, coccidioidomycosis?� RH RH

53. Analyze with Evidence Cue: The student selects 2 or 3 likely diagnoses, and then waits� Response Restrain the urge to blurt out the answer Have the student use case data to discriminate between possibilities RH RH

54. Analyze with Evidence Rationale Use knowledge of disease to compare and contrast Learners reveal their Reasoning Factual knowledge Gaps in understanding RH RH

55. Analyze with Evidence Examples �What points from the history and exam support the diagnosis of _____?� �Of these two diagnoses, which do you think is more likely, and why?� �What diagnosis can you exclude at this point, and why?� RH RH

56. MicroSkills in Practice - 4 An effective use of MicroSkill 4� Analyze with Evidence RH RH

57. The Educational Cycle RH RH

58. Vignette #2 Outline the dialogue Watch for opportunities to teach Ask yourself �What did the students say (or not say) that created an opportunity for teaching?� �How could the teacher use each of these opportunities to teach effectively?� JA JA

60. Small Group Assignment What opportunities for teaching could you identify? How could the teacher use each of these opportunities to teach effectively? Think of some opportunities when you could take some time to teach. JA JA

61. Time Remaining JA JA

62. Discussion What opportunities for teaching could you identify? How could the teacher use each of these opportunities to teach effectively? Think of some opportunities when you could take some time to teach. JA JA

63. MicroSkills in Practice - 5 The medical student is presenting a case� JA JA

64. MicroSkills To teach effectively, what should I say? �What gross incompetence!� �Oh, don�t worry. Those drug rashes are really no big deal.� �That prescription could have caused a drug reaction. It is important to check the chart for allergies whenever prescribing.� JA JA

65. Repair an Error Cue: The learner demonstrates a misunderstanding or error JA JA

66. Examples �That dose of gabapentin is too high for a patient with decreased renal function.� �This may be acute gout, but you can't exclude septic arthritis unless you tap the joint.� JA JA

67. Non-examples �Those lab tests were completely unnecessary.� �You did what!?� JA JA

68. Repair an Err Mistakes left uncorrected will be repeated Learners who become aware of a mistake are especially �teachable� JA JA

69. MicroSkills in Practice - 5 An effective use of MicroSkill 5� Repairing an Error RH RH

70. MicroSkills in Practice - 6 The medical student continues� JA JA

71. MicroSkills To teach effectively, what should I say? �Whoa! This is going to be one expensive urinary tract infection.� �So, what evidence supports routine colon cancer screening in healthy 58 y/o women?� �You identified three needed interventions. This could have an important impact.� JA JA

72. Highlight what was Right Cue: A learner handled a situation very effectively JA JA

73. Examples �You identified poor nutritional status in your assessment, and addressed it in your plan. That is important to wound healing.� �You obtained blood cultures before the first dose of antibiotics. That�s important because failure to identify the pathogen can lead to incorrect therapy. JA JA

74. Non-examples �I agree with you.� �You did that procedure well.� �Great!� JA JA

75. Highlight what was Right Unless reinforced, competencies may never be established Recognizing good performance builds respect JA JA

76. MicroSkills in Practice - 6 An effective use of MicroSkill 6� Highlight the Right RH RH

77. MicroSkills The medical student continues� JA JA

78. MicroSkills in Practice - 7 To teach effectively, what should I say? �Doesn�t that seem like overkill?� �Well, we got a lot of antibiotic resistance out there. You can�t be too careful.� �In treating cystitis, what are the indications for a obtaining a urine culture?� JA JA

79. Pick a Point for Learning Cue: Some aspect of the patient�s condition remains uncertain JA JA

80. Example �A recent meta-analysis raised concern about rosiglitazone. Should we consider stopping this medication?� JA JA

81. Pick a Point for Learning Rationale Integrates learning with patient care Lessons are more memorable Encourages inquiry and the use of best practices JA JA

82. MicroSkills in Practice - 7 An effective use of MicroSkill 7� Pick a Point for Learning RH RH

83. The Educational Cycle JA JA

84. Vignette #3 Outline the interaction Ask yourself �What did the teacher say that was effective?� �What was ineffective?� �What should the teacher do differently next time?� RH RH

85. RH RH

86. Discussion What did the teacher say that was effective? What was ineffective? What should the teacher do differently next time? RHRH

87. Time Remaining RH RH

88. Discussion What did the teacher say that was effective? What was ineffective? What should the teacher do differently next time? RH RH

89. MicroSkills An approach to feedback that you can use RH RH

90. Feedback Learners want to know how they are doing Surveys show they rarely get feedback on their performance RH RH

91. Feedback vs. Evaluation Feedback: Ongoing; provided day-to-day Formative - help learners direct their efforts RH RH

92. The Opening Ask the learner to evaluate their own performance �How do you think it went?� Respond to their self-assessment RH RH

93. The Dialogue Build on positive behavior �You seemed relaxed and at ease.� �You greeted everyone in the room.� � then move to what can be improved RH RH

94. The Dialogue Focus on specifics �You used a term that he didn�t understand.� Not �You didn�t communicate very clearly.� Limit to one or two points RH RH

95. The Dialogue Use non-judgmental language �I don�t think he understood your explanation.� Not �That was a poor job explaining why we are changing his medication.� RH RH

96. The Dialogue When you are subjective, label it as such �I felt that you were uneasy explaining why we changed his medication.� Not �You were struggling.� Acknowledge the learner�s emotions RH RH

97. The Plan Problem solve together to change behavior �What could we do next time that would help you communicate more effectively?� RH RH

98. The Closing End on a positive note �You certainly have a good working relationship with the patient and his family.� Plan future feedback sessions �Let�s talk again on Friday.� RH RH

99. MicroSkills in Practice - 8 The student talks to you after rounds RH RH

100. MicroSkills To teach effectively, what should I say? �So long. Farewell. Auf wiedersehen. Adieu.� �Remember to check those preventive care tracking sheets.� �From your experience, what stands out as important to remember?� RH RH

101. Cue: It�s the end of an educational experience Make Time for Reflection RH RH

102. Examples �What went well?� �What caught your interest?� �Is there anything that you would do differently?� RH RH

103. Make Time for Reflection Rationale Reorganize in memory what was learned Deepen understanding Enhances learning and recall Encourage personal inquiry JA JA

104. MicroSkills in Practice - 8 An effective use of MicroSkill 8� Make Time for Reflection RH RH

105. The Educational Cycle RHRH

106. Feedback Skills The Opening Self evaluation The Dialogue Build on the positive Focus on specifics Use non-judgmental language The Plan Problem solve together The Closing Summarize on a positive note JAJA

107. The MicroSkill-based teacher � Efficient Interactive Learner-centered Patient-focused JA JA

108. and learner� By learning you will teach, by teaching you will learn. Latin Proverb JA JA

109. � does make a difference. For medical students Experiences are formative Will be long remembered JA JA

110. And, finally� Please take a moment to complete the evaluation form for this workshop Thank you � teach well! JA JA

111. JA JA

112. JA JA