clinical teaching
TRANSCRIPT
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Clinical Teaching in
Physiotherapy
Subhash Khatri
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Goal of Clinical Physiotherapy education is to produce the PT we would like to see if we were sick!
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PTs of tomorrow are taught by teachers
of today using curricula of yesterday!
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It has simply been assumed that
PTs who have graduated from PT
schools/colleges and undergone
postgraduate training can
automatically start teaching the
day after they graduate.
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Overview
Clinical environment Focused on patient Problems, Diagnosis & Management Real life situations Decision making on time Apply theoretical & practical
knowledge Acquire clinical skills
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A teacher is a performer like an
actor; the only difference is that
teacher expects learners to
perform!
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Challenges of Clinical Teaching
1. Time constraints2. Work demands : clinical, research or
administrative 3. Often unpredictable and difficult to prepare for4. Engaging multiple levels of
learners(PG/Interns/IV/III/II/I)
5. Patient related challenges: short hospital stays; patients too sick or unwilling to participate in a teaching encounter
6. Lack of incentives and rewards for teaching7. Physical clinical environment not comfortable for
teaching
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Class room
• Large group
• No patient
• Knowledge
• Theoretical framework
• Teacher student ratio
large
• Passive students
• Less interactive
• Less class room hours
Clinical
• Small group
• Focus on patient
• Application of
knowledge
• Clinical reasoning
• Teacher student ratio
small
• Active students
• More interactive
• More clinical hours
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Skills that make a excellent clinical teacher
1. Share a passion for teaching2. Are clear, organized, accessible, supportive and
compassionate;3. Are able to establish rapport; provide direction and
feedback; exhibit4. Integrity and respect for others5. Demonstrate clinical competence6. Utilize planning and orienting strategies7. Possess a broad repertoire of teaching methods and
scripts8. Engage in self-evaluation and reflection9. Draw upon multiple forms of knowledge, they target
their teaching to the learners’ level of knowledge.
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Challenges in outpatient teaching
1. Busy clinical setting2. Teaching time often short, no time for elaborate teaching3. No control over distribution and organization of time4. Attending to several patients at the same time with multiple
learners5. Brief teacher-trainee interactions6. Patient care demands usually take priority and must be addressed7. Multiple patient problems must be addressed simultaneously, so8. teachers cannot focus on one problem to teach9. Learning and service take place concurrently10. Organic and psychosocial problems are intertwined11. Diagnostic questions often settled by follow up of empiric treatment12. Teacher should be a guide and facilitator than information provider
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Challenges of inpatient teaching
Difficult to set teaching goals, unanticipated events occur frequently
Ward team usually composed of varying levels of learners Patients too sick or unwilling to participate in the teaching
encounter Patient stays are too short to follow natural history of disease Teachers could compromise trainee-patient relationship if they
dominate the encounter Trainees and teachers feel insecure about admitting errors in
front of the patient and the rest of the medical team Tendency by many clinical teachers to lecture rather than
practice interactive teaching Engaging all learners simultaneously can be difficult Teachers need to pay close attention to learner fatigue, boredom
and workload
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Education is not teaching what learners doesn’t know but making
them to behave as they don’t behave!
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Teaching of clinical
Physiotherapy should be
carried out on real
patients with real
problems!
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Teachers should be
encouraged to seek
feedback on their teaching
from peers and
learners!
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Learning styles
Cognitive approach 1. Pragmatists2. Reflectors3. Theorists 4. Activists
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Learning styles
VAK model1. Visual2. Auditory 3. Kinesthetic
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Learning styles
Outcomes of learning1. Superficial learning 2. Deep learning
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Clinical Teaching Models
1. Stanford Faculty Development:- Promoting positive climateControl of sessionCommunication of goalsPromoting understanding and retentionEvalutionFeedbackPromoting self directed learning
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2. Micro skills of Teaching(One-minute preceptor)
Five-step approachGetting commitmentProbing for supportive evidenceTeaching general rulesReinforcementCorrecting mistakes
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3. Dundees model
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Problems with Clinical Teaching
Lack of clear objectives and expectations
Teaching pitched at the wrong level Focus on recall of facts rather than
problem solving Lack of active participation by
learners
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What you say is not important, how
you say is important!
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Don’ts
1. Leave the student alone until asked to supervise2. Correct the student's mistakes in front of patient 3. Fails to set time limit for clinical teaching activities
4. Give general answers to a specific question5. Not approachable6. Difficult person to summon for consultation/help7. Fail to adhere to teaching schedule 8. Ask questions in threatening manner9. Put down them(you don’t know this?)10.Insecurity about up to date knowledge
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Do’s (Practical Tips for clinical teacher)
1. Preparation2. Planning 3. Orientation4. Introduction5. Observation6. Interaction 7. Summarize8. Debrief9. Feedback10.Plan for next interaction
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We will wrap up here!