8/2/2019 Teaching Tips for Seniors on-Call

1/2

NaritaJan11

Angkor Hospital for Children

Faculty Development Course

TeachingTipsforSeniorsOn-Call

SetGoals

Macro-expectationsonhowroundswillbeconducted

Mediumwhattocoveronroundsforthatday(whichpatients,etc)

Microwhattofocusonwithspecificpatients

CasePresentations

- Casepresentationsshouldlast5minutesorless- Canoccurinthreeplaces:bedside,corridorormeetingarea- Meetingarea:leastdistractions,mostcomfortable,canusewhiteboard,etc.- Bedside:greateststrengthisthatpatientcanparticipateindiscussion(ifinKhmer!)- Organizedpresentationsflowfromorganizedprogressnotes.Organizedprogressnotesflowfromorganizedthoughtprocesses.

BedsideTeaching- Gotothebedsideonlyforwhatisbesttaughtatthebedside.- Visitsshouldnotexceed5-10minutesperpatientdontdwell!- Keepjuniorsinvolved:Theseniorshouldeitherdemonstrateaskillorobserveajuniorperformingaskill.

- Minimizethenumberofthosethatarejustobserving.- Planyourbedsidevisitbeforeseeingthepatient.- SeetheTwelveTipsattheendofthisoutline.

SharedTeaching

- Avoidthepressuretoteachhalflisteningandhalfjumpingforwardtowhatyoumightteach.Rather Involvejuniorsinsettingtheagendaforrounds Askjuniorswhattheyfindmostinterestingordifficultinapatient

Relaysomeofthequestionsposedbacktothegroup,especiallythosemoresenior

Assignjuniorstoreportbackonparticularquestionsortopics

ExamplesofGoodQuestions

- Dontaskclosed-endedyes-noquestionsbutopen-endedones:

Tossback:Sophal,whatdoyouthink?Anyotherthoughts?Goaroundthecirclesoalljuniorscancontribute.

Feelings:Howdoyoufeelaboutthiscase?Especiallygoodwhendealingwithsocialorpsychologicalissues.

LearnersChoice:Whatisthemostimportantissuetoyouwiththispatient? ProblemList:Listproblems,prioritizeproblems,selectonethegroupwanttodiscuss NextStep:Whatwouldyouliketodonext? Whatif:Whatifthepatientwasacidoticatthispoint?Whatifweculturedoute.coli?

AddressingHeterogeneity

- Oneofthegreatestchallengesisteachingjuniorwithdifferentlevelsofskill/knowledge- Usemoreexperiencedjuniorstoteachapointeitherinoroutsideofrounds- Trickledown:Teachataolderjuniorlevelassumingthelessexperiencedjuniorswillabsorbwhattheyunderstand

- Onanoccasionalbasisseparatenewerjuniorsoutformorefocusedlearning

Thesuccessfulteacherisnolongeronaheight,pumpingknowledgeat

highpressureintopassive

receptaclesheisaseniorstudent

anxioustohelphisjuniors.

-W.Osler

8/2/2019 Teaching Tips for Seniors on-Call

2/2

NaritaJan11

Angkor Hospital for Children

Faculty Development Course

BeSelective

- Teachablemomentsaremorememorablethan90minutesoffacts

- Demonstrateoneortwothingsatthebedside,coveroneortwoitemsfromtheproblemlist,askoneortwo

keyquestionsandthenmoveon.- Dontdoonroundswhatyoucandoalone.X-raysandlabsshouldbegatheredbeforehand.

GiveFeedback

- Toevaluate,onemustobserve.Seniorsandchiefsshouldgivefeedbackonthefollowing: Presentationskills:duringroundsandalsowhenaskingquestions,providingupdates,etc. Charting/progressnotes:includingH&P,dischargesummaries Clinicalskills:interviewing,physicalexamination,diagnositicandtherapeuticprocedures Knowledge:mostimportantistheirinterestinself-directedlearningandmedicaljudgment Organizationalskills:timemanagement,prioritizingtasksTeachingskills:inactionswithpatients,providingpearlstotheteam

Interpersonalskills:dealingwithpatients,colleagues,hospitalstaff

TwelveTipsforBedsideTeaching(simplifiedfromRamani)1. Preparationisakeyelementtoconductingeffective

roundsandincreasingaseniorscomfortatthebedside.2. Planwhatyouwanttoachieveatthebedsideforeach

encountertheskillstodemonstratedorpointstobe

learned.3. Tellthejuniorsyourplansforthesessionandaskthem

ifthereisanythingelsetheydliketoadd.

4. Introduceyourselfandtheteamtothepatient.5. Role-modelthephysician-patientinteractionitisavaluableopportunitytoteachthem

professionalism,interviewingtechniquesandbedsidemannerwhichcantbetaughtwellthroughalecture.

6. Makethesessionjunior-centered.Dontdoallthetalkingbutobservethejuniorsresponsesandtailortheteachingtothem.

7. Challengethejuniorsmindswithouthumiliation,providinggentlecorrectionwhennecessary.

8. Reviewkeylearningpointsforthejuniorsattheendofeachpatientpresentation.9. Leavetimeforquestions,clarifications,assignments,etc.10.

Askthejuniorswhattheyfeltwentwellandwhatdidnt.11. Beareflectiveteacher:thinkaboutthebedsideencounter,evaluateinyourownmindwhatwentwellandwhatwentpoorly,andwhatyouwoulddodifferentlynexttime.

12. Startyourpreparationforthenextencounterwithinsightsfromyourreflectionphase.

ReferencesKroenke.AttendingRounds:GuidelinesforTeachingontheWardsJournalofGeneralInternal

Medicine7,1992.pp68-75.Janicik,etal.Teachingatthebedside:anewmodelMedicalTeacher25(2),2003.pp127-130.

Ramani.TwelvetipstoimprovebedsideteachingMedicalTeacher25(2),2003.pp112-115.

Thedullestofteachersistheonewho

doesnotknowwhattoomit.

O.Holmes

TheAmericanCouncilforGraduate

MedicalEducationandtheWHO

AdvisoryCommitteeonMedical

Trainingrecommendthattraining

programsshouldincreasethe

frequencyofbedsideteachingin

theirclinicalcurriculum.

S.Ramani