The Essentials of Clinical Teaching

7/31/2019 The Essentials of Clinical Teaching

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The Essentials of ClinicalTeaching

Thomas K. Swoboda, MD, MS

Department of Emergency Medicine

LSUHSC - Shreveport


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What is a Teacher?

A teacher

Has knowledge

Has experience

Has a role as teacher, role model,mentor

The natural urge is to share all that

you knowResist this urge!


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Engage the Learner

Focus on the learner

Diagnose the learner

Give the learner appropriatefeedback

Remember that each learner has

different needsKnowledge deficits

Level of knowledge


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Levels of Knowledge

Unconsciously incompetent

Consciously incompetent

Consciously competentUnconsciously competent


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Set the Stage for Learning

Tell the learner what is expected

Make it a safe and supportiveenvironment

Reinforce the need for honesty

State that thinking out loud is

encouraged


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The Microskills of ClinicalTeaching (Neher, et al)

Takes about 5 minutes

Utilizes teachable moments


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Microskill #1

GET A COMMITMENT

When learner waits for your response orasks for your guidance

Elucidate what the learner is thinking

What do you think is going on?

Why do you think the patient is here?

What do you want to do next?Avoid the urge to pipe in or agree or

disagree at this point (gathering info)


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Microskill #2

PROBE FOR SUPPORTING EVIDENCE Need to know why the learner thinks the way

they think

Need to understand the reasoning usedWhat are the findings that led to your conclusion?

What else did you consider?

Why did you rule out X?

Is there anything else that you need to know?

Avoid these:I dont think thats right. Any other ideas?

Wow that is a classic case of X

What are the vitals? What are the meds?


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Microskills #1 and #2

Allow you to generally discern:

What the learner knows

What the learner needs to learn

Allows you to apply your generallearning concepts to teach the learner


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Microskill #3

TEACH GENERAL RULES

Teach specific bits of info based on thecase being discussed

Avoid taking over the case

Keep it short and sweet

Avoid a long didactic session

Hit and runHelps reach a consensus on the patient

evaluation


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Microskill #4

REINFORCE WHAT THE LEARNER DIDRIGHT

Builds on learners self-esteem

Make it behavior specific


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Example of Good Reinforcement

Your H&P were complete and appropriatefor the patients complaint. By puttingtogether the history of syncope with RLQ

pain and getting the additional menstrualhistory, you made the correct diagnosis ofan ectopic pregnancy. Excellent job.

Avoid:

You did a good job with that patient.


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Microskill #5CORRECT MISTAKES Keep this step last Choose appropriate time and place Start by having the learner self-evaluate

Then offer specific observations andsuggestions for improvement

I can understand the difficulty in obtaining a historyfrom this drunk patient, but we should perform acareful physical exam and see if we can get info fromother sources such as Invision.

Avoid:That was not the way to handle that patient.Boy, do you need to read.


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The Teachable Moment

Occur thousands of times in the ED

Every situation offers the chance to teach


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Teachable Moments in the ED

Every case has many teachable moments

Requires attention from the teacher

Use them immediately

Be gentle

Dont tackle too much at one time

Pick the best one

Hit and run- make your point and moveon


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Making the Most of Teachable

Moments

Follow sound learning principles:

Be sensitive to learners needs andissues

At the bedside, be sensitive to patientcare issues

NEVER embarrass the learner


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Identification of Teachable

Moments

Topics can come from: History

Physical Exam

Documentation

Medical Decision Making

Sources can be from: Charts

Presentations Orders and Management Plans

Bedside Evaluation


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Examples from Charts

Documentation of tetnus prophylaxisin wound care

Teach importance of documentation

Discuss indications for passive andactive immunization


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Example from Presentations

Disjointed presentations

Teach how to give an organizedpresentation

Allow the presenter to try to give itimmediately

Formal presentation versus presentation

to a consultant


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Example from Management Plan

Stabilization of patient in acuterespiratory distress

Teach airway evaluation

Discuss evaluation of adequacy ofoxygenation and ventilation

Uses and limitations of pulse ox

Indications for non-invasive ventilationtechniques


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Example from Bedside Evaluation

Observing a pelvic exam

Teach patient comfort measures

Teach techniques to improve exam

findings

Discuss utility of pelvic exam, thelimitations and value of the exam


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Summary

Make it brief Educational hit and run

Use facilitated learning techniques

Avoid didactics

Keep it focusedAddress the learners needs

Give timely feedbackEncourage self-directed learning with

follow-up

Documents

The Essentials of Clinical Teaching