A Framework for Effective Clinical Teaching Skills

1. A Framework for Effective Clinical Teaching Skills John (Jack) D. Buckley, MD, MPH Henry Ford Hospital April 9, 2005

2. GOALS • Review our Teaching Duty • Introduce a validated Educational Framework designed to enhance effective teaching skills • Framework Outline • Seminars • Personal Goal Setting • Demonstration

3. Are Good Teachers Simply Born? • Is it genetic and you either have it or you don’t? OR • Can ineffective teachers become better? • Can you make a good teacher even more effective?

4. Traditional Teaching of Clinical Medicine • If you know the material, you can teach it. • See one, do one, teach one • I teach the same way as I was taught. • The ceiling effect

5. “I’m a good teacher. The problem is they aren’tvery good learners.” -Anonymous faculty member

6. “Self-pity and projected blame – the recipe for a well-lived life!” -Parker, The Courage to Teach, 1998

7. How much formal training in teaching skills have you had?

8. Train-the-Trainer Model Stanford Faculty Development Center Clinical Teaching Program Seminar Facilitators Seminar Participants (Faculty & Residents) Learners Institution

9. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • Promoting Understanding and Retention • Evaluation • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

10. Categories of Effective Teaching Skills • Learning Climate • The tone or atmosphere of the clinical teaching setting including whether it is stimulating and whether learners can comfortably identify and address their limitations. • Control of Session • Communication of Goals • Promoting Understanding and Retention • Evaluation • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

11. Categories of Effective Teaching Skills • Learning Climate • Control of Session • The manner in which the teaching interaction is focused and paced as influenced by the teacher’s leadership style. • Communication of Goals • Promoting Understanding and Retention • Evaluation • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

12. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • The establishment and explicit expression of a teacher’s and/or learner’s expectations for the learners. • Promoting Understanding and Retention • Evaluation • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

13. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • Promoting Understanding and Retention • This category describes approaches the teacher can use to: • Explain the content being taught • Have the learner meaningfully interact with that content, thus assisting the learner to understand and retain it. • Evaluation • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

14. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • Promoting Understanding and Retention • Evaluation • The process by which the teacher assesses the learners’ knowledge, skills, and attitudes, based on criteria related to the educational goals. • Feedback • Promoting Self-Directed Learning Stanford Faculty Development Center

15. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • Promoting Understanding and Retention • Evaluation • Feedback • The process by which the teacher provides learners with information about their performance for the purpose of improving their performance. • Promoting Self-Directed Learning Stanford Faculty Development Center

16. Categories of Effective Teaching Skills • Learning Climate • Control of Session • Communication of Goals • Promoting Understanding and Retention • Evaluation • Feedback • Promoting Self-Directed Learning • This form of learning is initiated by the individual learner’s needs, goals, and interests. This category deals with approaches the teacher can use to influence learner motivation and use of resources, thereby fostering self-directed learning. Stanford Faculty Development Center

17. Seminars: The Full Package • Eight sessions • One dedicated to each category • One for reviewing personal / institutional goal setting • Two-hours each • Components • Mini-lecture • Review and Analysis of video • Role Play • Goal Setting

18. Seminar Descriptions cont. • These seminars are NOT: • Rules • A proscriptive method for good teaching • They are intended to: • Increase your awareness of your own teaching skills. • Use the framework to analyze your teaching. • Use the framework to help identify options that may improve your teaching.

19. Does THIS framework actually work? • Clinical Teaching Program - 18 years old • 99 facilitators from over 60 academic medical centers. • Over 2000 participants • 76 peer-reviewed manuscripts

20. Clinical Teacher Model: Assessment Improving Clinical Teaching: Evaluation of a National Dissemination Program. -Skeff KM et al. Arch Intern Med 1992. • Faculty rated seminars as highly useful and would recommend to others. • Pre & Post Seminar Faculty Questionnaires • Rated teaching ability higher after seminars • Pre & Post seminar Housestaff (85%) and Medical Student (15%) Questionnaires • Rated teaching higher

21. Clinical Teacher Model: Assessment Use of faculty development to improve ambulatory care education. -Stratos GA et al. Med Teacher 1997. • 10 Facilitators: faculty development program: 64 ambulatory teachers: 11 western region VA institutions • Participants rated usefulness: 4.8 on a 5 pt Likert • Clinical teaching skills self assessments pre-post intervention: p<.001 improvement in all 7 domains

22. Clinical Teacher Model: Applications Factorial Validation of a Widely Disseminated Educational Framework for Evaluating Clinical Teachers. -Litzelman DK et al. Acad Med 1998. • Reduced the 58 subcomponents to 25 items • Found overlap between descriptors of teacher knowledge and promotion of self directed learning • Provides evidence that the 7 category framework is a valid and useful way to analyze complex teaching activity

23. LEARNING CLIMATE (1) A. DEFINITION B. EDUCATIONAL PURPOSE C. TIMING (initial, ongoing) D. KEY COMPONENTS Stimulation Learner Involvement Respect/Comfort Admission of Limitations

24. LEARNING CLIMATE (2) D. KEY COMPONENTS & SPECIFIC BEHAVIORS 1. STIMULATION TEACHING BEHAVIORS: • show enthusiasm for topic and for learners • show interest through body language • use animated voice • provide conducive physical environment 2. LEARNER INVOLVEMENT TEACHING BEHAVIORS: • look at learners • listen to learners • encourage learners to participate • avoid monopolizing discussion

25. LEARNING CLIMATE (3) D. KEY COMPONENTS & SPECIFIC BEHAVIORS 3. RESPECT/COMFORT TEACHING BEHAVIORS: • use learners' names • acknowledge learners' problems/situation • invite learners to express opinions • state respect for divergent opinions • avoid ridicule, intimidation, or interruption 4. ADMISSION OF LIMITATIONS TEACHING BEHAVIORS: • acknowledge learner limitations • invite learners to bring up problems • admit own errors or limitations • avoid being dogmatic

26. Demonstration: Learning Climate • Participants: • Attending Physician • Fellow • Resident • 4th-year Medical Student • Setting: • Morning Rounds in the Intensive Care Unit

27. STIMULATION show enthusiasm for topic and for learners show interest through body language use animated voice provide conducive physical environment LEARNER INVOLVEMENT look at learners listen to learners encourage learners to participate avoid monopolizing discussion RESPECT/COMFORT use learners' names acknowledge learners' problems/situation invite learners to express opinions state respect for divergent opinions avoid ridicule, intimidation, or interruption ADMISSION OF LIMITATIONS acknowledge learner limitations invite learners to bring up problems admit own errors or limitations avoid being dogmatic Personal Goal Setting: Specific Teaching Behaviors

28. Summary • Effective teaching is more than an art. • Teaching requires a conscious effort, practice, and self-assessment. • A framework can help you improve your teaching skills.