A Faculty Development Exercise in Clinical Teaching

1. A Faculty Development Exercise in Clinical Teaching Eugene C. Corbett, Jr., MD Subha Ramani, MMEd Elizabeth G. Armstrong, EdD

2. Clinical Teaching Teaching that enables a learner’s clinical performance development, in the care of the patient

3. experiencing 1Identify problems from real life experience Just Do It! 8Present a goal and discuss next steps Activate Prior Knowledge 7Make clear the relevance for practice and encourage commitment to change 2Understand the problems and differences,brainstorm GROWTH doing reflecting 6Select a solutionGive opportunity for personal practical application, e.g. simulators 3Select a specific problem, present data What New Knowledge? Try It Out 5Evaluate consequences of solutions 4Consider alternative solutions thinking

4. Experiencing Why? What next? Doing Reflecting How does it work? What? Thinking

5. Today’s Clinical Teaching Exercise: Create a clinical teaching scenario Try it out Reflect upon it

6. Vignette Creation, Practice & Feedback I Design a clinical teaching scenario role play Within individual group X or Y 20 minutes II 2 Teaching, Observation and Debriefs (20 minutes each) Combined X + Y Group 40 minutes III Large Group Discussion Reflections on clinical teaching, faculty development methods, and implications for teacher beliefs and practice 20 minutes

7. X and Y Groups • X Groups: Communication skills teaching As the clinical teacher, you are about to visit with a patient in the outpatient setting who has come in to discuss their care pertaining to a new diagnosis of cancer. You are working with a third year clerkship student and a pgy2 resident. • Y Groups: Physical examination skills teaching As the clinical teacher, you are about to visit at the bedside with a patient admitted for congestive heart failure. This creates the opportunity to work with your clerkship student, an intern and a pgy3 resident on their physical examination of a patient with mitral valve disease.

8. Clinical Care Performance Competencies Professionalism (many dimensions) Patient engagement & communication skill Scientific knowledge and method Clinical history-taking Mental & physical examination Clinical testing & imaging (select, justify, interpret) Basic clinical procedures Information management (present, record, search, critique) Diagnosis (differential diagnosis, patient problem lists) Intervention (prevention, treat, palliate) Prognosis (anticipate and plan for the future) Placing care in practical context (personal, family, ethnic, economic, health system…) Recommendations for Clinical Skills Curricula, AAMC, 2005, 2008

9. Clinical Teaching Requirements: Clinical expertise Learner levels & needs The Patient Clinical circumstances (setting, time) Clinical focus Curriculum perspective Learner evaluation & feedback Experiential learning theory Teacher self-efficacy

10. Debriefing and Feedback of Teaching

11. Experiencing Just Do It! Discuss scenario Identify problems Activate Prior Knowledge Do role-play Debrief Discuss next steps GROWTH Doing Reflecting Evaluate consequences Get ready for role-play Consider solutions New Knowledge Try It Out Thinking

12. Application of an Interactive Educational Strategy

13. SMART goals • Specific, measurable, attainable, realistic, timely • Ends goals • Impact on patients • Impact on learners: Improved clinical skills, professionalism….. • Means goals • Impact on teachers: • Knowledge, skills or attitude • Immediate or long term THINK: Establish goals

14. Educational frameworks help orient participants to the target goals • One minute preceptor • Stanford clinical teaching model • Create your own • Provide a common language for discussion of teaching and learning for constructive problem solving Educational Frameworks

15. Partner • Commit to learner’s outcomes. • Maintain mutual trust, respect and “safety” (try new things, make mistakes). • Enquire • Ask questions • Challenge learner to: • Look at the situation differently- self, context, assumptions. • Clarify what he / she wants- desired outcomes. • Evaluate • Were outcomes achieved • Reflect (Mirror for the learner / partner) • Encourage self-reflection • Provide feedback. • Identify strategy to get there (Action plan) PAIR: approach to Peer coaching

16. Start with self- reflection • Focus on behaviors • Effectiveness in achieving desired goals • Responses they elicited in learners • Identify MOST effective behaviors first • Why or how these behaviors were effective SHARE: Debriefing and feedback

17. Identify LESS effective teaching behaviors • Why or how these behaviors were not effective • Shared problem solving; brainstorm alternative strategies to use • Plan concrete actions for future similar teaching activities • Reassess adequacy of goals, establish new goals • Use of different teaching strategies/ behaviors SHARE: Debriefing and feedback

18. What do the Observers Track? Participation Skills “Who’s Talking?” “Can they Analyze? Can they Present?” The Group Content Activation “Are they Getting it?” “Who’s Driving the Learning?”

19. Lyman, F. (1981). "The responsive classroom discussion." In Anderson, A. S. (Ed.), Mainstreaming Digest. College Park, MD: University of Maryland College of Education. • Flynn et al. Peer coaching in clinical teaching. Fam Med 1994;26:569-570. • Orlander et al. Co-teaching as a faculty development strategy. Medical Education 2000;34:257-265 • Siddiqui et al. 12 tips to peer observation of teaching. Medical Teacher 2007; 29: 297–300 References