Introduction to Teaching

1. Introduction to Teaching University of Pittsburgh School of Medicine Academy of Master Educators Teaching Residents to Teach Committee

2. Academy of Master Educators Teaching Residents to Teach Committee Raquel Buranosky, MD,MPH Chair of Committee Associate Professor of Medicine Associate Program Director, Internal Medicine Residency Jason Rosenstock MD Assistant Professor of Psychiatry Director Med Student Education James Johnston, MD Professor of Medicine Program Director, Nephrology Fellowship President, Academy of Master Educators Jonathan Finder, MD Professor of Pediatrics Clinical Director, Pediatric Pulmonology

3. Committee Members, Ctd. Rita M Patel MD Professor & Vice-Chair, Anesthesiology Clinical Procedures UPSOM Course Director Associate Dean for GME Basil Zitelli, MD Professor of Pediatrics Division Chief, Paul C. Gaffney Diagnostic Referral Service Kathleen McIntyre-Seltman, MD Professor of OB/GYN & Reproductive Sciences Advisory Dean, Office of Student Affairs, UPSOM Richard Saladino, MD Professor of Pediatrics Division Chief, Pediatric Emergency Medicine

4. Committee Members, Ctd • David E. Eibling, MD • Professor of Otolaryngology • Helen Westman, MD • Professor of Anesthesiology • Peter Bulova, MD • Associate Professor of Medicine

5. 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

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

7. Conduct of Session • Brief introduction to teaching • Case-Based Scenario • Reflection • Audience-Response System • Summary – Teaching Points

8. Agenda - 1 • Core • Fundamental principles of education • Teaching Opportunities • Assessment/Evaluation/Feedback

9. Adult Learning Principles • Adult learners: • Are goal-oriented (Why, What and How) • Are autonomous and self-directing • Have preexisting resources (life experiences) • Make it relevant, practical & contextual (problem solving) • Be respectful (safe learning environment) • Motivate and reinforce

10. Agenda - 2 • Core • Fundamental principles of education • Teaching Opportunities • Assessment/Evaluation/Feedback

11. “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”)

12. 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 *Students value case-based & bedside teaching over lectures.

13. “The One Minute Preceptor” • 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

14. 1 Minute Preceptor: 1 Get a commitment Ask learner to articulate his/her own diagnosis or plan Get him/her to commit to an answer (even if wrong)

15. One Minute Preceptor 2 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

16. One Minute Preceptor: 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

17. One-Minute Preceptor: 4 Reinforce what was done well Provide positive feedback “Catch them doing something right”

18. One Minute Preceptor: 5 Correct errors Provide constructive corrections and feedback Specific Targeted Recommendations for improvement

19. 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

20. Agenda - 3 Core Fundamental principles of education Teaching Opportunities Assessment/Evaluation/Feedback

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

22. 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

23. Scene - ER • Jim – Medical Student • MS III, midway through rotation • Spent 2 hours with patient and family • Presenting patient with chest pain & anxiety • Rita – Emergency Medicine Resident • Supervising resident

24. (RIME Evaluation) • I think in this scenario the medical student fit into the category of: • Reporter • Interpreter • Manager • Educator

25. Giving Effective Feedback • Feedback : a process of sharing observations and recommendations with a learner – should be formative • Contrasts with evaluation – often summative • Residents almost universally agree that giving and getting feedback is stressful. • best way to reduce that stress is to learn to give feedback effectively

26. Giving Effective Feedback • Well-timed • should be given as soon after the observed behavior as is practical • Based on Firsthand Data • Secondhand data will often lack specificity, or worse, authenticity

27. Giving Effective Feedback • Regulated in Quantity • Too much feedback will be seen as berating. • Elicit the Learner’s Perspective • Listen to what the learner has to say • Descriptive and Nonjudgmental • Be specific about what needs to be changed • you are correcting the behavior, not the person

28. Giving Effective Feedback • Concerned With Decisions and Actions, Rather Than Intentions and Interpretations • Concentrate on WHAT was done or said, rather than WHY • Providing Guidance to Resolve the Problem • Offer suggestions in ways to improve

29. Giving Effective Feedback • Limit to Remediable Behavior • Stay focused on the behavior, even if you feel it originates from a less-than-ideal personality • Remember the Positive! • Positive feedback is based on the criteria just discussed

30. Take Home Points Qualities of Feedback • Expected • Well-timed • Based on Firsthand Data • LIMITED in Quantity • Eliciting the Learner’s Perspective • Descriptive and Nonjudgmental • Concerned With Decisions and Actions

31. Take Home Points • 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

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

33. So Just Take the Plunge