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PGY 1 Retreat 6/3/13

PGY 1 Retreat 6/3/13. Thinking about education How to be a good ward resident- small groups with the Chiefs Changes for next year; administrative issues; misc…………. But first………. Working alone, list the top 10 selling automobiles by the number sold….

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PGY 1 Retreat 6/3/13

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  1. PGY 1 Retreat6/3/13 • Thinking about education • How to be a good ward resident- small groups with the Chiefs • Changes for next year; administrative issues; misc…………..

  2. But first……… • Working alone, list the top 10 selling automobiles by the number sold…..

  3. Now, repeat this exercise, working in small groups with the people sitting near you……..

  4. 1. Ford F-150
Numbers of units sold: 434,585 2. Toyota Camry
Numbers of units sold: 359,241 3. Honda Accord
Numbers of units sold: 331,872 4. Honda Civic
Numbers of units sold: 310,753 5. Chevrolet Silverado 1500
Numbers of units sold: 306,127 6. Nissan Altima
Numbers of units sold: 302,831 7. Toyota Corolla
Numbers of units sold: 286,432 8. Honda CR-V
Numbers of units sold: 281,652 9. Ford Escape
Numbers of units sold: 259,567 10. Ford Focus
Numbers of units sold: 245,922

  5. Giving Feedback • Keith Armitage • Case Western Reserve University

  6. Giving Feedback • Case scenarios

  7. Introduction • Defining feedback • The importance of feedback • Examples of good and bad feedback • Techniques for giving feedback

  8. Feedback is not criticism!! • You are a coach • The ability to reflect……an essential part of modern medical practice

  9. Introduction • Most feedback in medical education is self feedback based on the observation of self and others. • Depends on the ability of the learner to give self feedback. • Most good internists have this ability. • Optimally self feedback is confirmed and augmented by external feedback.

  10. Defining feedback • Rocket science model • “Feedback in the control of a system by reinserting into the system the results of its performance……if the information is able to change the general method and performance, we have a process which may be called learning.” • Humans are more complex; clinical performance is more complicated than rocket science

  11. Defining feedback • Formative • Non-judgmental; presenting information, not judgmental • Rocket science model • Neutral, not “good” vs. “bad” • “coach” • Summative • After the fact, sum of performance, grade • “evaluation,” compared to peers • “judge” • vs. encouragement

  12. The importance of giving feedback • Obligation in all training situations • Learner feels adrift without feedback • Misinterpretation of nonspecific signals • Bi-directional! • Role of providing information/corrective action • Correction of mistakes in the clinical setting • “Vanishing Feedback” • Monthly faculty reminders

  13. Examples of “good” and “bad” feedback • Good • Timely, specific, nonjudgmental, devoid of emotion, private/appropriate setting, given in climate of trust, diagnostic/useful, goal oriented, focused on performance, not personal, supportive, objective, occurrence based, useful • Bad • Vague, public, given in anger, non-timely, personal, “punishment,”

  14. Examples of good and bad feedback, cont • “Your differential diagnosis was O.K., but you might have also considered tuberculosis.” • “Your differential diagnosis was poor/inadequate.”

  15. Techniques for Giving Feedback • The sandwich • Beginning and ending with positive observations • Positive feedback- corrective feedback-positive feedback

  16. Techniques for Giving Feedback, cont. • The Club Sandwich • Reinforce success • Corrective feedback • Affirmation in your belief that the learner can move forward • Plans for moving forward • Commitment to support them in their plans

  17. The Club Sandwich, cont. • I am impressed that you know your patients labs so well • The critical next step is interpreting the labs; for instance, describe the anemia as microcytic, and discuss what this means • I am confident that you can take this next step • Do you have ideas about how to do accomplish this? • I would be happy to help work with you on this issue

  18. Techniques for Giving Feedback, cont. Micro feedback Small opportunities with students as they arise • Capitalize on the moment • Catch them doing something well • Good history- he was a tough guy to talk to • Use a nonjudgmental rule statement • When patient come in with so and so, it is important to ask about • Give the learn a chance to re do their performance • Why don’t you go back and ask about

  19. Techniques for Giving Feedback, cont. • The “tell me how you think you are doing.” • Take advantage of situations as they arise in the clinical setting. • Focused on goals • “Do you want to be the best intern/doctor you could be?” • Turn “negative” feedback into challenge

  20. Techniques for Giving Feedback, cont. • Assess learners level of receptivity to feedback • Encourage learners to ask for feedback • Test your hypothesis about what the problem is • Diagnosing your learners • Avoid overloading • Follow-up is key

  21. Impediments to giving feedback • Time • Inadequate observations • Time to meet • Concern over popularity • “Not wanting to hurt feelings,” damage student teacher relationship

  22. Techniques for Giving Feedback, cont. • Avoid focusing on personality traits, unless they affect clinical care

  23. Impediments to giving feedback • Past experiences that were emotionally difficult; fear that feedback will elicit an emotional reaction • Concerns about the impact of feedback leads to no feedback at all

  24. Impediments to giving feedback • Humiliation • External emotion that can be avoided if the teacher provides nonjudgmental feedback • Embarrassment • Internal emotion, sometimes can’t be avoided, may be motivational • Dealing with tears/anger • Emphasize your willingness to help and their ability to improve

  25. Now that you are a believer in feedback • Feedback is bi-directional • Please take evaluation of your attendings seriously • Cumulative data with comments is returned to attendings • Promotion and tenure

  26. Armitage’s general hints for dealing with feedback/administrative situations • Never begin a conversation in anger or assuming the other person is at fault • If you make the issue patient care, you will (almost) always win • Always make it patient centered • Kick it upstairs

  27. Mindfulness • Paying attention, on purpose, to one’s own mental and physical process during everyday tasks to act with clarity and insight • (the first thing you do at a code…….)

  28. Habits of Mindful Practitioners • Attentive observation • Processing…. • Critical Curiosity • Tolerating and ‘enjoying’ being wrong • Presence • Control of anxiety • Egoless focus on tasks • Tolerating contradictory ideas • Compassion based upon insight

  29. Mindfulness • Understanding your reaction to patients • Incorporating ethics into decision making • Reflection…..! • Being purposely mindful

  30. And Finally- another10 minutes on education • Models of learning • 5 minute preceptor

  31. Reporter Interpreter Manager Educator Diagnosing the learner…. RIME

  32. The One Minute Preceptor • What do you think? • Why do you think that/what else did you consider • What I am thinking • Where do we go from here- positive feedback and next steps

  33. Teaching the 4 C’s of Effective Oral Presentations on Work Rounds

  34. The 4 C’s of effective oral presentationwill only be successful . . . . . . if the resident sets the expectations at the start of a rotation

  35. Remember the 4 C’s • COHERENT • CONCISE • COMPLETE • COMPELLING

  36. COHERENT • Introduction (one sentence!) • Subjective • Vital signs • I/O’s • Physical Exam (pertinent) • New study results • Review of chart (nurses notes, etc) Assessment and Plan:

  37. CONCISE ( 1-2 minutes) • Essential • Pertinent • Uncluttered • The student should be . . . brief and lucid • The student should speak . . . crisply and clearly without notes

  38. The 4 C’s algorithm will be successful only with • APPROPRIATE FEEDBACK • “Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all” - Jack Ende, M.D.

  39. Four steps of clinical teaching • Needs assessment • Teaching to the learner • Feedback • Reinforcement

  40. Teaching Clinical Reasoning“On the Fly”

  41. Key Points to Remember • Teach while you work • Clinical reasoning is most effectively taught as you care for patients together, not in a lecture hall or conference room • Live what you teach • If you don’t “role model” sound clinical reasoning as you discuss all your patients, the students won’t think it’s really important

  42. Bottom Line • Teach as you work and live what you teach! • Be systematic and think out loud • What are the problems? Foreground and background. • What’s the differential? Focus on likelies and high stakes possibles. • Let your differential drive work-up and management

  43. Long term career goals… • Use elective time for scholarly projects • Work with clinical mentors • Meet with your PD to discuss….. • If you are interested in subspecialty training- apply at end of PGY2 year..

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