7/31/2019 Microskills HO

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Micro-Skills

Angkor Hospital for ChildrenFaculty Development Course

5Micro-SkillsforClinicalTeaching

Getacommitment

- toadiagnosis,work-up,treatmentplan- dontjumpinmaketheresidentcommitfirst- canusetoassesstheresidentsthought-process- ifresidentdoesntprocessinformationcorrectly,use

theopportunitytoguide/teach

- provideindividualteachingbasedontheirlevelofknowledgeandskill

Probeforsupportingevidence

- explorethementalprocessbehindtheirdecision- againusetoassesstheresidentslevelofknowledge- dontpassjudgment,butaskfortheresidentsideas- dontquiztheresidentongeneralconcepts(pimp)

thisshouldbeasafe,low-risklearningexperience

Teachgeneralconcepts

- teachingpointswillarisefromtheprevioustwosteps(Ifnot,thepreceptorcanskipthisstep)

- itisnotessentialthatthepreceptorteachsomethingineveryencounter

- youdontwanttoinsult(talkdownto)oroverwhelm(talkovertheheadof)theresident

Reinforcewhatwasdoneright

- someappropriateactionsarepureluckandotherdeliberate

- tobecomeestablished,goodbehavior/decisionsmustberewardedinsomefashionpositivefeedback

buildstheresidentsself-esteem- dontsaytheydidagoodjob,buttellthemspecifically

whattheydidcorrectly

Correctmistakes

-

animportantpartoftheencounterbutonlyonepart- feedbackmustbedonetactfullytobeeffective- chooseanappropriatetimeandplaceassoonas

possibleaftertheevent

- askfortheirownself-evaluationfirst- vague,judgmentalstatementslike,youcouldhave

handledthatcasebetterprovidenoinstructionon

howtomanagethecasebetter

Adaptedfrom:

Neher,J.O.,Gordon,K.C.,Meyer,B.,&Stevens,N.AFive-step"Microskills"ModelofClinicalTeaching.Journalofthe

AmericanBoardofFamilyPractice,1992,5,419-424.

- Whatdoyouthinkisgoingonwiththispatient?

- Whatlaboratorytestsdoyoufeelareindicated?

- Whatwouldyouliketoaccomplishonthisvisit?

- Whydoyouthinkthispatienthasbeennon-

- Whatwerethemajorfindingsthatledtoyourdiagnosis?

- Whydidyouchoosethatparticularmedicationgiventheavailabilityofmanyothers?

- Whatfactorsdidyoutakeintoaccountwhendevelopingyourtreatmentplan?

- Whatelsedidyouconsider?

- Ifthepatienthasacellulitis,incisionanddrainageisnotpossible.Anabscesswhichhas

fluctuancecanbedrained.

- Ihaventencounteredthisconditionbeforeeither.Thebestdermatologyreferenceis___or

inthisclinic,thepersontocheckwithis___.

- Obviously,youconsideredthepatientsfinancesinyourselectionoftherapy.Yoursensitivityto

thiswillcertainlycontributetoimprovinghis

compliance

- Whenprescribingthatmedication,youappropriatelyconsideredthepatients

conditionandtheprolongedhalf-lifeofits

activemetabolitesgiventheirrenal

insufficiency.

- Youcouldberightthatthischildssymptomsareduetoarespiratorytractinfection,but

withoutcheckingtheears,youcouldeasily

overlookanotitismedia.Ataminimum,a

missedearinfectionwillresultinacrankybaby

andperhapsmorephonecallsandunnecessary

visits.Atworst,theinfectioncouldleadto

mastoiditis.Sotrytoincludeanear

examinationoneverypatientwithURI

symptoms

Rememberwedontalwayshavetopresentnewknowledgeforateachinginteractiontobeeffective.

Simplereinforcementofgoodpracticesisoftenenough.