Introduction to Teaching

1. Introduction to Teaching University of Pittsburgh School of Medicine Academy of Master Educators Teaching Residents to Teach Committee Jason Rosenstock MD, CHAIR Jonathan Finder MD, VICE-CHAIR

2. Academy of Master Educators Residents as Teachers Committee Jason Rosenstock MD CHAIR, Assistant Professor of Psychiatry Dir Medical Student Edu Jonathan Finder, MD VICE-CHAIR Associate Professor of Pediatrics Raquel Buranosky, MD,MPH Associate Professor of Medicine PD, Internal Medicine Residency Peter Ferson, MD Professor of Surgery

3. Committee Members James Johnston, MD Professor of Medicine PD, Nephrology Fellowship President, AME Rita M Patel MD Professor & Vice-Chair, Anesthesiology Clinical Procedures UPSOM Course Director Associate Dean for GME Kathleen McIntyre-Seltman, MD Professor of OB/GYN & Reproductive Sciences Advisory Dean, UPSOM Petronilla Vaulx-Smith, MD, PhD Assistant Professor of Psychiatry Basil Zitelli, MD Professor of Pediatrics

4. Introduction to Teaching Goal: To help incoming house staff recognize the importance of teaching understand basic do’s and don’ts be open to further development of teaching skills

5. Orientation Program Introduction to TeachingWhy? • Helps with patient care • Makes you look good • Learners expect it • It’s required • ACGME Competencies • Program/Institutional Requirements

6. Intro to Teaching:The APPLE Curriculum • APPLE Curriculum • Application of Principles and Practice of Learning and Education • Core • Fundamental principles of education • Teaching Opportunities • Assessment/Evaluation/Feedback

7. Conduct of Session • Brief introduction to teaching • Case-Based Scenarios • Reflection (Table Discussion) • Open Discussion • Summary – Teaching Points

8. Agenda • Core • Fundamental principles of education • Teaching Opportunities • Assessment/Evaluation/Feedback

9. Adult Learning Principles • Learners are: • Goal-oriented (Why, What and How) • Autonomous and self-directing • with preexisting resources (life experiences) • Make it relevant, practical & contextual (problem solving) • Be respectful (safe learning environment) • Motivate and reinforce

10. Teachable Moments • Not just a ‘lecture’ • Modeling professional behavior • Daily opportunities • Work rounds • Procedures • Ambulatory settings • Pick your targets (can’t do it all) • Be brief (“teaching on the fly”)

11. What type of teaching useful? • Procedures, Case Management, 5-min talks, Bedside Teaching • Physical Diagnosis Rounds • Lectures, PBL, Simulated Cases, Socratic questioning • MS I & MS II courses

12. Microskills for Clinical Teaching • Get a commitment • Probe for supporting evidence • Teach general rules and think out loud • Tell your learner what he or she did right • Correct the learner’s mistakes Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching

13. SCENARIO #1 • Answer the following questions • How can you use adult learning principles to improve the educational experience? • Identify the teachable moments and critique what you saw

14. Comments? 1. 2. 3. 4.

15. 5 Microskills of Teaching Get a commitment Ask learner to articulate his/her own diagnosis or plan Get him/her to commit to an answer (even if wrong)

16. 5 Microskills of Teaching Probe for supporting evidence Evaluate the learner’s knowledge/reasoning Ask probing questions Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s answer

17. 5 Microskills of Teaching 3. Teach general rules Generalize from the case at hand Give the learner a pearl /take home point Point out how this case is same or different from the general rules

18. 5 Microskills of Teaching 4. Reinforce what was done well Provide positive feedback “Catch them doing something right”

19. 5 Microskills of Teaching 5. Correct errors Provide constructive corrections and feedback Specific Targeted Recommendations for improvement

20. The One Minute Preceptor Choose a single teachable point per encounter Most generalizable (most useful) Most important (don’t miss the life threatening diagnosis) Targeted at learner’s area of weakness Building on previous teachable point Can be diagnosis, management, skill etc

21. Agenda Core Fundamental principles of education Teaching Opportunities Assessment/Evaluation/Feedback

22. Immediate Informal Objective Specific Improvement Formative Information Scheduled Formal Objective Global Grade Summative Judgment Feedbackvs.Evaluation

23. RIME Evaluation Framework • Reporter – Provides data • WBC count 15; chest x-ray infiltrate • Interpreter – Integrates data • Differential diagnosis including pneumonia • Manager – Implements • Treats with antibiotic, arranges hospital admission • Educator – Teaches • Shows how individual data led to diagnosis of pneumonia and how to treat it

24. SCENARIO #2 Answer the following questions: • How would you improve the feedback that was given? • Use the RIME System to assess the learner

25. Comments? 1. 2. 3. 4.

26. Feedback in the Clinical Setting • Observe the learner • Describe a notable aspect of performance • Wait for a response • Recommend a next step to enhance their performance • Arrange for a retry

27. Evaluation of Clinical Learners • Reinforce what they are doing well • Educate about areas in which improvement is possible • Affirm your belief in their ability to follow this advice • Check for their understanding by asking for a plan • Commit to help

28. Teaching Challenges The unmotivated student The unprofessional student Confrontation/Conflict Time constraints Navigating the learner/teacher role

29. Intro to Teaching: Conclusions • It’s important and you’ll do it regularly • Make it relevant, practical • Capitalize on teachable moments • Use microskills (1min teaching!) • Give timely feedback, assess with RIME • Ask for help, more to come

30. So Just Take the Plunge