Teaching When There's No Time To Teach: Strategies & Techniques for the Clinical Setting

1. Teaching When There's No Time To Teach:Strategies & Techniques for the Clinical Setting Amelia Gaglietta, pht Susanne Mak, OT Liliane Asseraf-Pasin, pht Caroline Storr, OT Michèle Hébert, OT Adopted by Linda Snell MD MHPE FRCPC FACP

2. Context P & OT Case- based teaching Learning & teaching Patients Time Learners D. Irby Adopted by Linda Snell MD MHPE FRCPC FACP

3. Who are the learners? • Early student >>> colleagues • Pre-clinical > clinical > intern > practitioner • Different levels of learners (at same level) • Patients Adopted by Linda Snell MD MHPE FRCPC FACP

4. Teachable moment • Anywhere students, teachers and patients collide …and some places they don’t! • In-patient, clinic, rehab centre, home • Patient-triggered • Learner-triggered • Teacher-triggered Adopted by Linda Snell MD MHPE FRCPC FACP

5. A teaching moment can be… • A 5-minute discussion en route to lunch • A case review/discussion • Formal bedside teaching rounds • A mini-lecture or formal class presentation • A moment on the cardioresp team. • … Adopted by Linda Snell MD MHPE FRCPC FACP

6. The Learning Cycle Learning needs Reflection Orientation Evaluation Objectives Feedback Content Strategies &Techniques Adopted by Linda Snell MD MHPE FRCPC FACP

7. And focus on one part of the cycle, one bit of content, or use one strategy or technique When teaching when time is limited …. think of the ‘learning cycle’ Adopted by Linda Snell MD MHPE FRCPC FACP

8. Adult learning principles Students learn best when… • They are actively learning • Their experience is used • It is student-centered • It is based on problems • They can apply what they learn • There is a positive learning environment • They receive feedback Adopted by Linda Snell MD MHPE FRCPC FACP

9. And let the learner guide the learning When teaching when time is limited…. use adult learning principles Adopted by Linda Snell MD MHPE FRCPC FACP

10. Cognitive apprenticeship • Modeling: master teacher demonstrates the skill, thought process or technique • Scaffolding: learner tries part with guidance • Coaching: verbal guidance only • Fading: teacher withdraws, less guidance Adopted by Linda Snell MD MHPE FRCPC FACP

11. To pick your strategy and role related to the learner’s level When teaching when time is limited …. use the concept of cognitive apprenticeship Adopted by Linda Snell MD MHPE FRCPC FACP

12. Directed learner Directed self-learner Self-directed learner Adopted by Linda Snell MD MHPE FRCPC FACP

13. When teaching time is limited…use the concept of self-directed learning • Be a resource: help the student become an independent learner Adopted by Linda Snell MD MHPE FRCPC FACP

14. Peer (and near peer) learning • Peer learning is effective (active, student-centered, cooperative, communication, teamwork) • Peer learning often complementary to learning from teachers Adopted by Linda Snell MD MHPE FRCPC FACP

15. Encourage all learners to teach When teaching when time is limited …. use the concept of peer learning: Adopted by Linda Snell MD MHPE FRCPC FACP

16. Core competencies • Expert clinician • Communication skills • Professionalism and ethics • Interprofessional practice • Health of community, society • Appropriate use of resources • Produce and transmit new knowledge Adopted by Linda Snell MD MHPE FRCPC FACP

17. Teach one competency … other than expert clinician! When teaching when time is limited …. remember the core competencies Adopted by Linda Snell MD MHPE FRCPC FACP

18. The learning cycle Adult learning principles Cog. apprenticeship Self-directed learning Peer-learning Core-competencies Focus on one part Let learner guide Pick your role, strategy Be a resource Use other learners Teach one Recap:Education concepts related to ‘no time’ ... Adopted by Linda Snell MD MHPE FRCPC FACP

19. Questions Mnemonics Frameworks One-item observe & feedback Brainstorm Justify - interpret Short simulations Instructor plays patient ‘Triggers’ Deteriorating case ‘Expand the case’ ‘Clusters’ ‘Prevent’ ‘Where’s the controversy?’ Strategies, techniques and games Adopted by Linda Snell MD MHPE FRCPC FACP

20. Using questions Ask questions of various types to elicit knowledge, comprehension, application, or synthesis: Eg: • Have you seen this before? • When would you use this technique? Adopted by Linda Snell MD MHPE FRCPC FACP

21. Some → Lovers → Try → Positions→ That → They → Can’t → Handle → Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate MnemonicsEg. Carpal Bones: Adopted by Linda Snell MD MHPE FRCPC FACP

22. Short simulations • Practice hands-on procedural or physical exam skills prior to doing it on a real patient. Adopted by Linda Snell MD MHPE FRCPC FACP

23. Delay Gratification • Do not answer all the Qs immediately-all team members look up the answer, then discuss later. Adopted by Linda Snell MD MHPE FRCPC FACP

24. Promoting clinical problem solving What’s the most common teaching strategy used in clinical teaching: • in the clinic discussing a patient? • at the bedside? • reviewing a patient in any setting? Adopted by Linda Snell MD MHPE FRCPC FACP

25. Bloom’s taxonomy Evaluation Synthesis Analysis Application Comprehension Knowledge Adopted by Linda Snell MD MHPE FRCPC FACP

26. Evaluation Synthesis Analysis Application Comprehension Knowledge Choose best? Argue all sides? Alternatives? New approach? Design? Etiology? Use it? Given this patient …? Define? Interpret? Compare/contrast? Who? What? Name? How many? Bloom’s taxonomy Adopted by Linda Snell MD MHPE FRCPC FACP

27. Key messages • The contexts where teaching when time is limited are multiple and varied • Effective teaching strategies used when time is limited can be linked to ‘good’ educational practice • Know the ‘indications’ for their use • When time is not elastic, content is … • Don’t teach too much! Adopted by Linda Snell MD MHPE FRCPC FACP

28. The one(5”) minute teacher 5 microskills for clinical teaching: • Get a commitment: Ask student how they interpreted the situation. Adopted by Linda Snell MD MHPE FRCPC FACP

29. 5 microskills 2. Probe for supporting evidence: • Ask student for their evidence before offering your opinion. (Allows you to find out what they know and identify the gaps.) Adopted by Linda Snell MD MHPE FRCPC FACP

30. 5 microskills 3. Teach general rules and principles: Teach 1 or more general rules targeted to current case but also generalize to other similar cases. Adopted by Linda Snell MD MHPE FRCPC FACP

31. 5 microskills 4. Reinforce what is right: Give feedback that is well timed, expected, case-specific, behavior-focused. Adopted by Linda Snell MD MHPE FRCPC FACP

32. 5 microskills 5. Correct mistakes: Ask the learner what was done right and what they would like to do better. Adopted by Linda Snell MD MHPE FRCPC FACP

33. Adopted by Linda Snell MD MHPE FRCPC FACP