Teaching tips

1. Teaching tips

2. Teaching in residency • PGY-1: Core content • PGY-2: Supervisory roles in MICU, SICU • PGY-3: Supervisory role in ED, teaching workshops and procedural lab • Other: Outside lectures, workshops, ACLS courses

3. Overview • Curriculum development and instructional systems design • Characteristics of adult learners • Using questions and feedback to promote critical thinking • Effective presentation styles • Teaching procedures

4. What is learning? A planned behavior change that has permanence Based on KSA (Knowledge, Skills, and Attitudes)

5. Develop Evaluation Procedures Determine Learning Outcomes Select Media & Methods Develop Instruction Implement Instruction Determine Instructional Strategies Evaluate Instruction

6. Curriculum development and instructional systems design Determine learner outcomes Develop evaluation process Determine instructional strategies Select media and methods Develop instruction Implement instruction Evaluate instruction

7. Objectives Facts: information with arbitrary relationship Concepts: classes of elements with common characteristics Principles: correlational effects, explains WHY Procedures: set of sequential steps performed to accomplish purpose, explains HOW

8. Facts “Overdosing on facts is like giving thyroxine to a tadpole-you get an instant frog, but unfortunately a rather small one” Smith L: Medical education for the 21st century. J Med Educ 60: 106-112, 1985

9. Characteristics of adult learners • Experienced • Oriented by need/problem (WII-FM) • Learners decide content • Concerned for immediate need • Prefer active learning • Skills-oriented • Informal • Self-directed • “Equal” • Intrinsic rewards

10. Information giving and Prescribing • Limit the amount of information given • Give the most important facts first • Stress importance of information to learner’s needs • Avoid jargon • Relate information to the problem at hand • Use repetition for emphasis • Make instructions specific, behavioral, and measurable • Present alternately acceptable treatments or procedures

11. People will remember • 10% of what they read • 20% of what they hear • 30% of what they see • 50% of what they see and hear • 70% of what they say and write • 90% of what they do

12. Six levels of cognitive objectives • Knowledge • Comprehension • Application • Analysis • Synthesis • Evaluation

13. Questioning • Teachers talked 70% of time • Asked questions 4% of time • Wait time of 1.8 sec

14. Questioning “Clinical teachers can make sure that their interactions simulate problem solving by asking questions rather than giving answers. Learners may think they are learning more by being given answers, but actually being asked questions is far more productive”

15. Effective clinical teaching behaviors • Creates positive learning environment • Communicates expectations (avoids assumptions) • Controls session • Uses questions to guide and promote understanding • Provides tangible and constructive feedback • Uses techniques to increase understanding: the FACS model. Focus… Activate… Crystallize… Summarize • Motivates and energizes group with personal commitment and enthusiasm

16. Counterproductive instructor behavior • Discussion stoppers *teacher talks 75% of time *teacher answers 75%of their own questions *teacher “cuts-off” or interrupts students • Providing indirect feedback with “WDY” questions *Why Did You • Feedback focuses on what’s wrong rather than what’s right

17. Helpful instructive behaviors • Guide learning with questions (FPC) *Focus, Probe, Challenge • Ask questions that explore the “why and how” as well as the “what, when, and where” • Give learners time to answer questions or perform procedures (don’t interrupt!)

18. Constructive feedback • Provide useable feedback (not just “you did lousy”) • Limit the quantity of feedback: stick to the main points • Remember the 4 Ps: praise in public, perfect in private • Use the collective we: “we’re still having a little trouble with…”

19. Constructive feedback • Use the praise sandwich: praise…corrective feedback…praise • Use appropriate timing: no distractions, adequate time for discussion, no one freaking out (student or teacher) • Be descriptive and specific: avoid WDY messages, focus on actions, not presumed intentions • Develop several calming responses to defensive reactions from students * “Okay, I’m sure you feel this way now, but lets look down the road…” * “Fine, I can appreciate that, but I want you to know my perspective”

20. Questions (summary) • Avoid discussion stopping behavior • Avoid WDY questions • Use FPC questions • Ask “why and how” as well as “what and when” • Provide constructive feedback • Wait long enough for a response

21. Effective presentation skills • Say what you are going to say, say it, and say it again • Elements of lecture: introduction, body, summation and closure • Paper primacy • Advantages of lectures • Disadvantages of lectures

22. The 10 commandments of slidemaking • Keep it simple • Talk more-show less • Be visually consistent • One message, one slide • Never apologize for a slide

23. The 10 commandments of slidemaking • Design for the back row • Use only readable type face • Make headlines • No red text • Drive 55…. 5 words per line, 5 lines per slide

24. Levels of competency • Unconsciously incompetent • Consciously incompetent “see one” • Consciously competent “do one” • Unconsciously competent “do one more”

25. Teaching procedures • Do not talk about superfluous material (indications...) • Break down the procedure in small parts (demonstrate) • Have learner verbalize parts of procedure • Stop learner if they do something incorrect (with procedures people do NOT learn from their mistakes, they learn their mistakes) • Give enough supervised practice

26. Resources • Whitman N. and Shenk TL. The physician as teacher. Whitman and Associates 1997 (801) 943-1401 • Bland et al. Successful faculty in academic medicine. Essential skills and how to acquire them. 1990 Springer • Irby D. Teaching and learning in ambulatory care settings: A thematic review of the literature. Acad Med 70: 898-931, 1995

27. Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5:339-351, 1994 • Paid attention to my concerns • Highlighted essential points to remember • Explained, demonstrated, practiced climbing maneuvers • Balanced talking and doing • Explained safety system, made efficient use of time, set comfortable pace • Divided time fairly among group

28. Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5:339-351, 1994 • Clarified learner goals and objectives • Explained the plan for the day • Let learner know what to expect • Got to know learner well before teaching • Offered help when the learner was stuck • Provided positive feedback to encourage learners

29. Author Credit – Teaching Tips: Felix Ankel MD Questions

30. 1) Career Planning – Garmel 2) Careers in Academic EM – Sokolove 3) Private Practice Career Options - Holliman 4) Fellowship/EM Organizations – Coates/Cheng 5) CV – Garmel 6) Interviewing – Garmel 7) Contracts for Emergency Physicians – Franks 8) Salary & Benefits – Hevia 9) Malpractice – Derse/Cheng 10) Clinical Teaching in the ED – Wald 11) Teaching Tips – Ankel 12) Mentoring - Ramundo 13) Negotiation – Ramundo 14) ABEM Certifications – Cheng 15) Patient Satisfaction – Cheng 16) Billing, Coding & Documenting – Cheng/Hall 17) Financial Planning – Hevia 18) Time Management – Promes 19) Balancing Work & Family – Promes & Datner 20) Physician Wellness & Burnout – Conrad /Wadman 21) Professionalism – Fredrick 22) Cases for professionalism & ethics – SAEM 23) Medical Directorship – Proctor 24) Academic Career Guide Chapter 1-8 – Nottingham 25) Academic career Guide Chapter 9-16 – Noeller Postresidency Tools of the Trade CD