docdayscom.files.wordpress.com · Web view2019. 8. 1. · I think we should aim to formalize the experience more. One of the differences between goals and objectives in Kern’s

Teaching Log

Session #:

8

Date of Session:

November 21, 22

# of hours:

6

Type of education activity (1:1 ambulatory, program meeting, etc.) / Name of education program:

Junior Attending Case review – supervisor Dr. Molla-Ghanbari

Location / hospital*:

TWH

Student’s Initials / # of participants*:

PGY1s x 2, staff preceptor

Education level of student / participants (UG, PG, etc.)*:

PGY1

Positive aspects of session:

First opportunity to perform as an “attending”, where residents reviewed their cases with me

Under the supervision of attending. Was a very different experience in that I had to integrate clinical information/reasoning

For patient care with the aim of teaching residents at the same time.

Difficulties of session:

The challenge was to provide enough feedback/ask enough questions without compromising efficiency and patient care.

Reflection and interpretation of session (analysis):

Reminded me in some ways of Kolb’s experiential learning style wherein

Learners have the “concrete experience” of doing the consult before reflecting on it with the attending. As the

Supervisor, I then tried to “abstract” concepts from the encounter so that students can approach the same case differently

Next time.

Consideration of future strategies for managing similar sessions:

Will be important to balance interruptions for teaching

With letting the learner work through the process herself.

Reviewed:

☐

At Practicum Meeting

☐

With Master Teacher:

Date Discussed:

☐

Not Discussed

* Do not post any details online or electronically which may represent a breach of privacy guidelines

Teaching Log

Session #:

9

Date of Session:

Nov 22,2016

# of hours:

1


Morning report


TWH


2


PGY1s


First session that was unplanned, so had the opportunity to do a “needs assessment” and teach

Ad hoc about a session important to students


Can be difficult as new learner to teach new topics ad hoc. Also harder to structure in systematic

Way (trade off with flexibility)


Was an opportunity to honor adult learning theory’s commitment to

Relevant education. Did a needs assessment which allowed me to identify a topic that was interesting to students, rather

Than just doing something I was comfortable teaching. Also thrives off concept that student swill be more motivated when

They choose/direct session


As I become more comfortable, it will be possible to

Make sessions even more interactive. Early on it is easier to make the session more didactic because it lets me ease into

Teaching a new topic, but I envision opportunities to make it more Socratic going forward

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

10

Date of Session:

Nov 24, 25

# of hours:

6


Junior attending and

Bedside consult review/teaching


TWH


2


PGY1


An opportunity to hone in skills practiced in previous log. On these cases I tried to write less

And consolidate more. Struck a better balance between receiving information and illustrating concepts. Also performed the

Role of JA at bedside


Still finding it difficult to balance my own need for learning (knowledge acquisition, synthesizing case

In my own mind) with facilitating learning in residents


Interesting in many ways how Experiential Learning Cycle was

Occurring for both the students and me. They were learning concepts and applying them, while I was learning a new teaching

Method, tweaking it/experimenting each time, and taking away key principles from the experience


On future occasions I would like to integrate what we

Talk about in case review with the bedside teaching component a bit better (e.g., demonstrate physical exam finding as a group)

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed

Teaching Log

Session #:

11

Date of Session:

Nov 28,29

# of hours:

6


Consult review &

Bedside review


TWH


2


PGY1


Unlike previous 2 experiences, had an interesting challenge from one of learners on one of cases

Involving palliative care of a dying patient. This prompted a larger discussion and some debate among those present


Can be difficult as a teacher to encourage learners to challenge while at the same time ensuring

Patient care/safety is ensured. The resident in this case did not end up agreeing with our goals of care discussion with the

Family (she thought it should be more explicit/direct than implicit than it was), which if not handled properly could make the

Learner feel as if either a) the teacher is incorrect or b) the learner isn’t learning. Neither may be true.


Was an opportunity to really reinforce controversy of topic which

Solidified learning, even if we didn’t all agree on the plan. We had a chance to understand differing perspectives, and how

These can co-exist peacefully in medicine without someone necessarily being right and someone being wrong. As an

Instructor it allowed me to strengthen my own arguments for why I do something and challenge my assumptions.


Consider revisiting the same discussion at next case of

Presentation and then facilitating discussion about whether anyone changed their approach

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed

Teaching Log

Session #:

12

Date of Session:

Dec 1/2

# of hours:

5


Junior Attending &

Bedside Teaching


TWH


2


PGY1x2


This was third week of my first block as JA, so I had a bit more comfort, which allowed me to

Continue to experiment. From an abstract conceptualization perspective, I learned from my earlier experiences that learners

Need to be directed into thinking through problems. Thus instead of teaching them “at the end” what they missed, I tried

To get them to systematically go through the reasoning process with each consult: what is this? Why? What else could it be?

What will I do if I’m wrong?


Learners still sometimes lack experience or knowledge to know what they are missing. Kolb’s

Entire cycle depends to some extent on “concrete experiences” and these are limited for new learners


Still an effective attempt to teach residents the process of delivering

An impression. I could see them becoming more comfortable with differential diagnosis formation because they knew a)

It was necessary and b) I was going to ask them to justify their reasoning. I think this approach facilitate more thorough

Reasoning.


Next time could give learners a chance to test their

Reasoning with hypothetical scenarios. E.g., “what if the CT PE was negative? Now how would you manage this?”

Reviewed:

☐


☐


Teaching Log

Session #:

13

Date of Session:

Dec 5,6

# of hours:

4


Consult review

And Bedside Teaching


TWH


2


PGY1


In my final week as JA, I had the chance to expand on my goal of the previous week by

Attempting to integrate discussion points from the consult review into the bedside teaching/review. For example, on one

Review we discussed how to assess volume status, which we then demonstrated in the physical exam. This was, I felt,

Very reinforcing.


Can be challenging to spend a lot of extra time at bedside due to patient care needs


Opportunity for learners to go through multiple steps in the Experiential Learning framework in a single case. Concrete exper

(initial consult exam) reflection during review on how to assess volume conceptualize new approach to practice test/

Demonstrate new approach


Could revisit these on future days to reinforce principles learned

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

14

Date of Session:

Dec 8/9

# of hours:

4


Bedside teaching and

Consult review


TWH


2


PGY1s


My final JA experience on the block was a chance to consolidate everything I had attempted

Thus far – emphasizing experiential learning, focusing on relevant concepts, and promoting constructive disagreement. In

This final experience I tried to given learners more autonomy. Rather than deciding the plan at the end together, I asked

Learners “what is your plan.” Emphasis was on connecting learning to the act of being a physician.


This approach requires learners be confident enough to provide a plan. It’s important to ask the

Question in a non-interrogative manner so that residents don’t retreat for fear of being wrong


In many ways I found this experience an interesting way to mirror

My own transition into a teacher in my students – i.e., I was teaching them to move from one step (learner) to another

(provider)


The next logical step may involve having residents learn

To teach (e.g., review a consult themselves)

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

15

Date of Session:

Feb 15, 2017

# of hours:

2


Lecture and interactive

session


MSH


10-15


PGY1/PGY2


An early experience to practice formulating my “lecture style” which I try to focus on clinical

Cases that require audience participation, which I feel is critical to effective learning.


Sometimes interactive exercises (e.g., polls, socratic questioning) can detract from rhythm or delay

The time needed to cover key grounds. I wondered if I asked too many questions, leading to tangents when answers weren’t

Forthcoming from audience members. Sometimes it’s necessary to be a bit more didactic


Felt I used some very helpful interaction techniques (e.g., polling of

Who would do what in a given clinical situation, then justifying each option; group ECG readings on screen) that demonstrate

The power of tech and interactive activities for learning


More effective balance between didactic objectives

And audience participation

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Also available online: dfcm.utoronto.ca/landing-page/afgs

Teaching Log

Session #:

16

Date of Session:

# of hours:

4


INTAPT workshop on

Curriculum development


DFCM


5-10


Health care professionals


Very exciting opportunity to practice teaching a workshop on a topic we as a group had spent

Many hours learning (curriculum development) and that was of relevance to our roles as educators.


It is very difficult to keep an audience engaged for 4 hours. In the early half we had lots of interactive

Exercises (e.g., role play) but as the workshop went on, there was increasing pressure to “cover everything we needed to

Cover and our emphasis on interaction faltered, leading to a less effective second half.


A great learning experience that was very instructive with respect

To taking a scholarly approach to education. This was a fairly “meta” session in that we had to design a curriculum for how

To design a curriculum. Integrating a lot of theoretical models and taking a critical look at various educational strategies was

Very informative for our audience and a powerful learning experience for our group


Be very careful about pacing, ensuring that there is a good

Balance between audience participation and didactic teaching throughout the entire workshop.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

17

Date of Session:

March 6

# of hours:

4


First Junior attending with R1, hospital based


TWH


2-3


PGY1s


Opportunity to teach about process (how to “run a list” or prioritize tasks for the day, really

Serves as a “mentoring role”.


Challenging to balance clinical responsibilities with teaching. How to ensure you “teach enough” but

Not so slowly so as to make completing the day’s work impossible


In many ways teaching process at the outset is like a “needs

Assessment” for both he learners and the rotation in that I had to ask my learners what they wanted to get out of the

Rotation while also thinking about what the rotation needed for them.


n/a

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

18

Date of Session:

March 7

# of hours:

4


Procedural hospital learning


TWH


3


PGY2 and 2


Procedural learning – first time demonstrating shoulder injection. As both shoulders needed to

Be done, had chance to “show one” then for resident to “do one”


Always tough to ensure teaching at bedside is not disturbing to pt. Ensure that one explains what they are doing, that they “will be talking a lot about medical stuff”, and ensuring that patients

Have the opportunity to ask questions. Knowing it is a learner’s first time can also be anxiety inducing for pt, so we need to

Be responsive to any concerns


Procedural skills are best taught with educational strategies that

Emphasize hands on learning – in the future I could incorporate a model shoulder.


Use model to demonstrate. Also could consider integrating ultrasound guided techniques as these become increasingly

Adopted.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

19.1

Date of Session:

March 7

# of hours:

4


Didactic/interactive lecture


TWH


3


1-2


Provided overview of approach to anemia in an interactive manner. Encouraged residents

To work through case problems, which I found helpful to illustrate how to order subsequent tests after establishing that a

Pt is anemic


None


Interesting way to integrate clinical teaching with more meta pearsl

About “choosing wisely.” Asking “if you could choose only one next test, what would it be?” was very helpful to illustrate

How critical thinking is both good for patients and the bottom line


Could introduce actual costs of tests

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

19.2

Date of Session:

March 8

# of hours:

4


Ward-based teaching


TWH


2


PGY1


Able to discuss error of premature closure in context of a dysphagia case. Emphasized importance of broad differential even for simple cases so that unexpected presentations

Aren’t missed and that handling more difficult diagnostic cases becomes easier


Premature closure is often unconscious so it’s important to draw students attention to the

Diagnostic decision-making schemes they are using


Showed how teaching “thinking” or “approach” strategies can help miss underappreciated diagnoses


none

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed

Teaching Log

Session #:

20`

Date of Session:

March 8

# of hours:

4


Junior attending


TWH


3


PGY1-2


Second presentation of anemia approach. Refined from previous meant I could more often

Anticipat elearner questions


Learner styles differ and I noticed that one resident has difficult with my classification scheme.

That is, while I often use the MCV to classify anemia and direct further workup, it was difficult for the learner to think of

Anemia in this way because it isn’t physiologically-based. He preferred a “intracorpuscular/extracorpuscular” strategy

Which he felt retained better in his mind


Learning styles can affect engagement and retention. Integrating

Various modalities of instruction can help overcome this barrier


Consider a parallel slide/classification scheme

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

21

Date of Session:

March 16, 2019

# of hours:

3


Didactic lecture

And interactive question period


MSH


20-30


PG1,2, staff physicians


While not a curriculum itself, we asked many of the same questions when planning this session

On physician-assisted death. Got to practice “problem identification” and doing a basic “needs assessment” based on

State of law in Canada


There were multiple affective objectives in this session – namely wanting to stimulate though-provoking dialogue and a greater understanding of the moral qualms regarding MAID.

While this helps stimulate learning, it can also be challenging for participants. It’s important at times to redirect the

Conversation when things get too heated.


Enjoyed the mix of educational strategies from the didactic overview of

The law to the panel discussion on the ethical questions to the case studies for large group participation.


Consider other educational strategies such as

Debate

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

22

Date of Session:

March 17, 2017

# of hours:

4


Junior Attending Role


TWH


3


Ben Kaasa


Neat opportunity to experiment with different learning styles when teaching acid-base. Tra

Traditionally we use formulas, but I added a visual representation of anions/cations to better illustrate the concept of

Anion gap and why we need to consider it whenapproaching acid-base problems


I’m a terrible artist! Nonetheless, even simple drawn illustrations can aid with teaching physiology


Different learners have different needs. Using visual aids in

Cases can broaded the audience that finds lecture useful


Consider prefab slides, though to be fair actively drawing

Can be more engaging for learners.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

23

Date of Session:

March 9, 2019

# of hours:

4


JA with didactic lecture

In AM


TWH


3


Ben Kaasa


Discussed an approach to anemia for third time. This time was able to build on issues with

Previous iterations (e.g., tailored it to inpatient approach which is more exhaustive and more concerned about uncommon but

Serious etiologies)


Information is very dense and it’s a lot to cover


Important to build on previous experiences and improve the talk.

Can get better each time


Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

24

Date of Session:

March 9, 2019

# of hours:

4


JA and Rotation

Feedback


TWH


3


PGY1-2


Another opportunity to provide formative feedback. Really tried to highlight psoitives, but

Also provide meaningful information about how trainees can improve their performance and clinical skills


Challenging when still learning oneself or new to practice to provide feedback.


Thinking about formative feedback as instructive rather than

Purely evaluative. I want my feedback to reinforce good skills and modify areas learners need to work on.


Just need more practice

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

25

Date of Session:

March 10, 2019

# of hours:

4


JA: Clinical Expert


TWH


2


Ben Kaasa


Creative way to teach a difficult topic that requires a lot of memorization (antibiotic classificat-

Ion and use. Used a large 2x2 chart with axes labelled spectrum and class of antibiotics


Still large amount of data. Difficulty to find interactive way to present or teach it. Some learners

Were likely overwhelmed.


I think I was able to present the material in a useful way while

Maintaining audience interaction (as we completed the 2x2 table together)


Given volume, it would be best to provide a handout at

The end so learners have a reference

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

26

Date of Session:

March 18, 2019

# of hours:

1.5


Dealing with Problem

Learner – clinical supervision and formative feedback


TWH


1


PGY1


First experience with a challenging learner demonstrating overconfidence - opportunity to

Develop a strategy for coping with this issue that both a) maintains patient safety and b) corrects learner’s problem behaviour


Learners are not always interested in feedback and on this particular occasion (on call), there was

Limited time to actually give substantial feedback


Rubenstein and Talbot in “Medical Teaching in Ambulatory Care” try to

Contextualize overconfidence attempts to explore underlying cause (e.g., insecurity, narcissism, defensive posturing) so as to

Better remediate the behaviour. In this learner, I think it boiled down to lack of insight into knowledge gap. Therefore, I was

Careful to monitor closely and pose lots of socratic questioning to make him think more deeply about the issue


For overconfident residents as their level of training,

Rubenstein and Talbot make an interesting recommendation to “provde examples that show the learner is performing at his/her level of training, but not higher.” This might temper their self-assessments somewhat, though I wonder if it

Would truly be effective

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

27

Date of Session:

March 19, 2019

# of hours:

2


Clinical teaching


TWH


2


PGY1


A second opportunity to discuss s. aureus bacteremia, but on this occasion was able to apply

The talk to a clinical scenario as this patient had died. Therefore, had an opportunity to teach junior elarns how to fill out a

Death certificate and how to list diagnoses on it.


None


Part of our role as educators is to teach clinical information, but also

To integrate professional responsibilities. “How to fill out a death certificate” is surprisingly challenge and is best attached

To another discussion about the cause of death


Consider writing a sample certificate for illustration

Purposes.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

28

Date of Session:

June 1, 2017

# of hours:

1.5


1:1 procedural training


MSH


1


PGY1


First opportunity to supervise resident actually performing sebaceous cyst removal.


Actually quite challenging. 1. It was sort of “as we go” instruction, which felt hard to control and

Anticipate. 2. It was time consuming given it was my first time supervising and her first time performing


I think procedural skills need to be more structured. Next time I’d like

To talk in length beforehand to outline steps/make process more efficient.


Pre-procedure session and post-procedure debrief

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

29

Date of Session:

March 23, 2018

# of hours:

1


Morning report


TWH


2


PGY1/PGY2


Really fun example of using integration theory to teach a very complicated topic – in this case

Physiology of the lung using the alveolar gas equation so as to conceptually organize approach to hypercapnic and hypoxemic

Respiratory failure


Requires buy-in from learners that learning these “med school formulas” is useful. I tried to

Emphasize the insignificance of memorizing the equation and instead the importance of understanding what it means.


Understanding this formula really helped residents grasp how oxygenation and ventilation differ, clarifying implications for diagnosis of hypercapnia in the setting of normoxemia. It also helped break down the various causes of each type

Of respiratory failure in a way that was physiologically and clinically meaningful (e.g., hypercapnia is frequently due to a

Deficit in the drive to breathe/ventilate and therefore treatment must aim to correct this defect rather than simply “turn on the O2”


Consider alternative strategy for learners less curious about basic science

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

30

Date of Session:

Mar 24, 2018

# of hours:

1


Morning report


TWH


2


PGY1/PGY2 FM


As this was second time giving this talk, I was able to refine my presentation. I used to always

Use the phrase with respect to s.aureus Bactermia: “Think about where it came from and where it’s going.” I used this as a

Way to get residents thinking about source and embolic consequences. On this repeat lesson, I centred my teaching around a stick figure on the board to help residents visually identify these components anatomically in a systematic ‘head-to-toe approach”


None on this occasion


A good example of how visual representations can convey conceptual

Learning strategies (“head to toe”) better than simply listing organ systems without any obvious frame of reference.


Consider using handout/checklist to summarize talk

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

31

Date of Session:

Dec 18, 2018

# of hours:

4


Clinical supervision and chart review


Clinic


4


PGY 1 and 2 in FM


Instead of simply reviewing the day’s cases, I decided to focus on an interactive physical exam

session in neurology. Allowed residents to observe and practice an important skill in a safe environment without fear of

Being embarrassed in front of a patient


Some learners are more hesitant to participate in demonstration or group learning activities


Often residents are asked to “do” and then “review” without little verification that their examination

Techniques are accurate. Was very helpful to be able to correct incorrect techniques on spot by pointing out errors and

Demonstrating the correct approach. This may lead to life-long examination changes for the better


Ensure that those not volunteer to partiicpiate in group

Learning are included in the experience by asking more targeted questions of each learner

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

32

Date of Session:

Mar 11, 2019

# of hours:

4


Supervision of Family Med Residents

In Clinic Setting


Clinic


2


PGY1s in FM


One resident had an encounter where patient was quite unreasonable and rude. Had an

Opportunity to mentor her with respect to modelling professionalism and remaining ‘cool.’ Used this challenging situation as

a chance to explore what professional obligations are (e.g., referral to another provider, timely care) when physician/patient relationship breaks down


None obvious


Importance to emphasizing the “professional” component of the CANMEDS roles, which is especially important when dealing

With challenging patient encounters/unrealistic expectations


I think asking the resident “what would you have done

differently if you could do this encounter over again” might really help get the resident reflecting on how to change practice

Going forward

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

33

Date of Session:

Dec 11, 2018

# of hours:

4


FM Supervision


Clinic


4


PGY1 and PGY2s


In addition to supervising, had opportunity to use technology/audiovisuals to teach

In this case, was a “chest xray review” – very helpful to test residents knowledge on the spot on interpretation – we often

Don’t get enough time in residency to get real in-time feedback on clinical examination/interpretation skills


Tailoring to family medicine residents can be challenging as radiological interpretation is not a core

Skill that is emphasized in postgrad training.


Trying to address the above limitation was very helpful. I focused on

Why it is helpful to develop your own skills in interpretating x-rays. i.e., when on call, before a report is available, improving

Clinical acumen. Also emphasized that this is a ‘chronic skill’ and that the more you challenge yourself, the better you’ll get


We were constrained for time. I’d like to have a full hour session and have residents demonstrate their technique from start to finish rather than focusing on pertinent positives.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

34

Date of Session:

Dec 7, 2018

# of hours:

4


Clinic


Clinic


4


PGY1 and PGY2


In addition to clinical supervision, had an interesting chance to talk a little about how to retain

Things you’ve been taught using effective notes, in this case an online database such as onenote. Demonstrated how I amalgamate all my teaching sessions and handouts into a “online notebook” with tabs for each branch of medicine

That I can easily reference in my day to tday clinical work to really solidify approaches


Everyone learns differently and some may not have the interest or dedication in maintain a record

Of their teaching


Really good opportunity to demonstrate meta-awareness of teaching

As well as reflection. I really value efficiency in learning, and having an easy reference for your notes means you are more likely

To a) remember what you learned by re-accessing it and b) strengthen clinical algorithms each time you use them and c)

More effective teach to others


Consider asking what other elarners do or if they have different experiences with online notes

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

35

Date of Session:

July 6, 2018

# of hours:

4


Direct clinical teaching,

Morning report, team mentorship


CVH


3 – 2 pGY1, 1 fellow


Above


This was my first opportunity to put much of my INTAPT practice in curriculum design into

Place by designing a CTU-style teaching team – the first ever at CVH – to off structured academic learning and leadership

Opportunities for fellows


Really my first time doing this as a staff and was new to facility. Getting the relevant stakeholders on

Board (hospital admin, internal medicine colleagues) to support teaching initiatives, add clinical opportunities, and reduce

Volume was challenging


Chance to used Kern’s model of CD in the real world setting. While not covering particular clinical topics, I still considered this elective

Experience a “curriculum” because there were several structured skills (e.g., presenting, case review, mentoring) that I wanted

Our fellow to experience and develop. Early on, I focused on the first step – “Problem Identification” to conceptualize what was needed in this experience – namely addressing the lack of structured leadership opportunities in clinical education for

Family medicine hospitalists in PGY3 programs. Thus, I pooled all of our residents for the block into one team and helped facilitate an experience wherein the PGY3 was the “junior attending.”


While I based a lot of this program on my own needs assessment at our site, it would have been helpful to consider a more general needs assessment from at the institutional level by looking more into what is already being done by others, for

Example in the internal medicine CTUs. This could have resulted in better integration of the teaching teams and increasing the

Availability of key clinical curriculum topics to all learners irrespective of specialty

Reviewed:

☐


☐


Teaching Log

Session #:

36

Date of Session:

July 9, 2018

# of hours:

4


Teaching Unit as per last log


CVH


3


As before


Had an opportunity for the fellow to begin “Case reviews” with general learners – excellent

Opportunity for her to practice case synthesis and teaching, while also an opportunity for me to supervise not just ‘learners

Learning’ but learners teaching. Really felt like I was coming full circle in my teaching objectives


It can sometimes be hard to keep track of a case clinically, even at my level, when it is going through

Two filters: the junior learner and the fellow.


As noted, I think this was a good chance to really bring to life a key goal of my program: to get our academic fellows teaching.

According to Kern’s model, it is very important to have specific goals when creating curricula or programs and I wanted to make sure that we were providing concrete experiences.


I think we should aim to formalize the experience more. One of the differences between goals and objectives in Kern’s model is that the latter are more easily measurable. Therefore, while getting our fellows to teach is a goal, an objective could be formulated in the “Who will do how much of what by when”. For example: “each fellow will have supervised 4 junior learner case presentations by the end of their 4 week rotation.” This would allow me a way to measure whether

My program is meeting its goals in a quantifiable way, which may help when presenting this model to other organizations (improve buy in).

Teaching Log

Session #:

37

Date of Session:

July 10, 2018

# of hours:

4


Morning report

Supervision, clinical teaching, case review


CVH


As before


As before


Opportunity to try and experiment with different educational strategies to meet program

Objectives. E.g., for physical exam teaching (a psychomotor objective according to Kern), bedside rounds were used rather than a simple lecture, whereas for “cognitive objectives” I would help the fellow lead a didactic/interactive lecture or morning

Report


With a new program, a lot of experimentation with educational strategies can lead to some ideas working less well than others. For example, I tried to have the fellow lead one of the initial

Morning report sessions by herself. She did a great job but there were some gaps in her own knowledge – to be expected – and so I was required to jump in from time to time to redirect the discussion; however, this sometimes change the dynamic

Of her as a supposed teacher, and I’m not sure it worked as well as I thought it would


As Kern notes, it is important to consider what our specific objectives are and then tailoring our educational strategies appropriately.

For example, because I wanted the fellow on our service to demonstrate and hone leadership skills, I tailored her schedule to

Emphasize teaching experiences (e.g., case review in afternoon, morning rounds on insulin teaching in the AM) rather than simply assigning her clinical work.


I would probably like to review more of the morning reports of fellows before presented to ensure there are no gaps in content

Teaching Log

Session #:

38

Date of Session:

July 11, 2018

# of hours:

4


1 hour morning report,

0.5 hour bedside rounds, 2.5 case review


CVH


3


As before


This day was similar to others on the teaching unit and provided more time to reinforce the

Learning activities making up a typical day, including morning report, case review, and bedside teaching


None identified today


Focused on meeting key cognitive objectives of the rotation – did a teaching session on PE and VTE that was interactive, but primarily

Didactic in organization. Benefit of having a team that works together for several weeks is we all get comfortable learning

Together.


None particular to this experience.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

39

Date of Session:

July 12, 2018

# of hours:

4


1 hour morning report,

2 hours case review, 1 hour feedback


CVH


3


As before


This was an important opportunity to give feedback to residents and to receive feedback. As

This was my first time running this teaching unit, it was important that I also have the opportunity to receive feedback for

The rotation and for me as a supervisor.


Difficult to ensure all relevant components are being evaluated. For example, residents need to

Evaluate my performance, the rotation, and themselves. Likewise, I need to do the same for them. Can also be challenging

To expect honest feedback from learners you are supervising. A third challenge is translating the formative feedback we give

Learners into a summative “mark” on their evaluation.


I think the key to making feedback valuable and instructive to be very organized in the approach. We dedicated a 1 hour slot to complete

All of our evaluations. I also made it clear what was being evaluated – them, me, and the rotation. I think one thing I do well is create a very open environment to honest feedback. I preface the conversation by stating “I am new to this as well and we need to make sure the rotation is working for our learners. Please tell me if there is anything I can do better as a supervisor.”

I also aim to do this half-way in the rotation as well so that any problems can be rectified.


Developing a checklist for feedback (e.g., did we meeting objective A,B,C) might help standardize the process and facilitate the learning of effective feedback techniques for the Fellow, who I very much included in the ‘feedback providing’ exercise for

Junior learners. Could also consider a pre-test/post-test approach to key outcomes I’m interested in (e.g., I feel capable performing a case review) at the beginning and end of the rotation to judge whether we are doing what we said we’d do.

Reviewed:

☐


☐


Teaching Log

Session #:

40

Date of Session:

Feb 26, 2019

# of hours:

1


Meeting with education

Director at BH re: educational program design for inpatient teaching unit for learners


Bridgepoint Hospital (BH)


0


n/a


Unique 1-on-1 session with my program lead focused on the development of a learner exper-

Ience. This was a unique chance to really put into practice a lot of what I’ve been working on in my practicum, focusing primarily on a needs assessment of what our learners need.


It was difficult to know exactly what we needed to offer for our learners given that the rehab

Inpatient medicine elective is really a brand new idea. The needs of different learners (e.g., medical students, residents,

Fellows, GIM vs FM etc) also vary.


This was fundamentally a planning and needs assessment sit-down where we started with creating a few concrete goals:

Creating a key topics repository and rotation structure.


The work resulting from this session will now need to be

Tested by asking other stakeholders what their needs are (e.g., administrators, program leads, learners themselves. Will also

Need to create an effective evaluation tool that determines whether we are effectively meeting our goals.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

41

Date of Session:

Mar 1, 2019

# of hours:

2


Informal teaching, case

Review


Hospital/rehab


1


Pgy1


One of first encounters with family medicine resident in a rehab inpatient setting, which

Offers unique challenges to care delivery and learning compared to acute care. As family med residents will practice primarily

In outpatient setting, cueing to what should be done “outside the hospital” was a focus of our teaching


Trying to balance inpatient vs outpatient priorities which tend to blend in a rehabilitation medicine setting (e.g, tranisitioning

From a focus on approach to presentation of the acute issue to maintenance/prevention)


Thinking about the SPICES curriculum, specifically the “C” for community vs hospital-based focused, is a very valuable part of

Teaching in the rehab hospital because many of these patients are chronic inpatients who really need outpatient care. I there=

Fore often ask residents to consider what they’d do for this patient in the office (e.g., vaccines, screening, f/u etc.)


Having a preventative checklist might formalize learning

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

42

Date of Session:

March 5, 2019

# of hours:

3-4


1 hour didactic, 2 hours

Team rounding, 1 hour review


Bridgepoint Hospital


1


PGY1


This was a unique session with my PGY1 wherein we got to do our rounds together, an invaluable experience in my mind that residents don’t get enough of these days.

There is tremendous value in practicing exam skills and contextualizing findings in a ‘door-side’ case review.


Time constraints are always an issue, especially with multiple learners.


Thinking about educational strategies discussed by Kern, psychomotor

Objectives are often overlooked in medicine. We had 2 patients with interesting neurological features and taking the time to

Discuss an approach to motor symptoms before rounding and then testing and observing these findings together improves

Resident experience and technique, but also how they incorporate exam findings into the clinical story.


Perhaps try this on patients the resident hasn’t seen to

Have a more “tabula rasa” test of what she/he has learned.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

43

Date of Session:

March 8, 2019

# of hours:

2


Case rounds 1 hour,

Formal teaching on anemia


BH


1


PGY1


We had several cases of anemia on our roster this week and used some formal teaching as

A way to introduce an algorithmic approach. I then had resident practice algorithm on our actual patients to not only hone

The approach, but result in real-life clinical decision-making


The anemia approach I use for inpatient teaching is a bit more in depth than what might be used

In the outpatient setting, so getting FM residents comfortable using it takes a few repetitions I sometimes find.


Again, another good example of how physiology/basic science can be helpful when integration takes place immediately and

Continuously. For example, we talked about what “reticulocytosis” means and why it matters (i.e., is this patient bleeding, is

This patient hemolyzing?) and trying to understand the physiology of each patient’s anemia.


None come to mind on this occasion

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed



Teaching Log

Session #:

44

Date of Session:

Feb 26

# of hours:

3


Case review x 2 hours,

Rounds x 1 hour teaching on CHF


Bridgepoint hospital


1


PGy1


1. Got to formally use integration principles when teaching CHF, building on my INTAPT

Formulation of CHF (thinking of heart as pump) and dividing CHF into mechanistic categories in a way that lets resident approach new patients with undifferentiated CHF. Got to apply to real-life patient in front of us we discussed at case rounds.

2. Focused on structuring a “consult” in the rehab setting – goals, care concerns, outpatient setting etc.


Physiological/integration approach to CHF can be challenging in patients who have multiple underlying etiologies. In one of our

Our patients, it wasn’t really clear which of the competing causes most needed treatment and a strict algorithm doesn’t

Neatly answer this question


A good opportunity to practice integration theory while also addressing real-life clinical scenarios


None unique to this case.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed


Teaching Log

Session #:

45

Date of Session:

Nov 9, 2018

# of hours:

4


Clinic supervision


MSH


4 PGY1/2


4


Witnessed an encounter where patient was very rude to resident and asked to terminate

Relationship for dubious reason. Observed quite a lot of countertransference from resident and this was a good opportunity

To talk about the interpersonal skills of medicine, and teaching an “affective objective” of conflict resolution


The resident was quite upset and saddened by the patient’s unreasonable conduct and was likely

Not in the best frame of mind for immediate learning


Part of teaching is mentorship and in this case that involves talking

About the patient-physician conflicts in our encounters as well as our professional obligations in terms of promising continuity

Of care/transferring to another physician. I tried to normalize the experience (this will happen again and happens to all of us),

So that we could focus on how to more constructively handle criticism (express understanding without necessarily apologizing, staying calm etc.).


I think it would be helpful to bring the resident back in a few days once things have cooled off. Also, given I am trying to

Impart a psychological/attitudinal change, as Kern notes, a role playing activity demonstrating the preferred approach to this

Kind of encounter might have been more effective than just talking about it.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed

Teaching Log

Session #:

46

Date of Session:

May 7, 2019

# of hours:

4


Family Medicine Supervision


MSH


4


PGY1 and 2


Think I did a good job of handling a difficult encounter with resident who counselled a woman

Who had just had a miscarriage. She was covering and patient wasn’t hers, but at times she seemed to lack the compassion

And interest in the human aspect of the encounter (focused on medical agenda). I was able in a constructive way to re-orient her and discuss the “bigger picture”, as well as the “psychological aspect” of this issue.


It is very difficult to give feedback surrounding a resident’s demeanor/humanism without it coming

Across as a criticism of their personality rather than their conduct. I think in this case I was able to balance the needs to

Emphasize compassion with the medical priorities of the practitioner


Professional identity formation is integral to becoming a family

Physician and I think talking to residents about the humanistic side of medicine is necessary. While it might not seem like

Compassion is something you “can teach,” we can always in fact open ourselves up and learn how to demonstrate more

Interest and attention.


I think formalizing this into an hour long session

With case examples might make a great teaching strategy

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed




© 2016 Department of Family and Community Medicine

Teaching Log

Session #:

47

Date of Session:

May 28, 2019

# of hours:

4


Supervision Clinic


MSH


3


PGY1 and 2


Opportunity to discuss epidemiological statistics and diagnostic performance statistics in setting of real clinical case (e.g., in

This instance, whether to order h. pylori serology as a screening test)


Can be difficult to demonstrate concepts without raw data or baseline stats. I obtained these

From uptodate, but numbers were not easy to get


I think this session emphasizes that much of medicine is transdisciplin-

Ary in that learners apply concepts from multiple disciplines (physiology, gastroenterology, pharmacology) while also

‘becoming’ an expert in the real world of practice, which includes not just basic clinical knowledge, but scientific and judicious

Use of diagnostic tests


Consider having resdients look up stats and bring back

For future sessions on other common tests they use to solifidfy retention

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed




Teaching Log

Session #:

48

Date of Session:

1 June 2019

# of hours:

2


Curriculum developme=

Nt meeting with education lead




1


Staff


Nearing end of my practicum, I have now transitioned to a staff role and have taken on respon

Sibility of leading education on an inpatient medical rehabilitation floor. This session was an opportunity to apply my INTAPT

Workshop principles to early stages of curriculum design


Following Kern’s model, I was easily able to complete stage 1 (problem identification – need for

Systematic educational experience for learners), but it was more difficult to do a target needs assessment as I didn’t know

Much about the learners I’d be receiving other than thy had likely not done this type of medicine for.


I met with the education lead at Bridgepoint to design a curriculum

With daily activities, overarching objectives, and a repository of key clinical areas. Our first meeting was an opportunity

To brainstorm general ideas (identifying problem, proposed educational strategies etc.)


Next steps involve looking into education literature

To determine what else is out there ( who is doing what) and consider adapting it to our site. A primary purpose of this

Curriculum is to introduce systematic rather than opportunistic experiences (i.e., from SPICES curriculum) into the rotation

Such as a dedicated “neurological day” wherein learners have a day to practice integrated care of neuro patients from physical exam to therapy to discharge planning)

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed




Teaching Log

Session #:

49

Date of Session:

June 5, 2019

# of hours:

4


Supervision and panel

Judge for PGY2 research projects


MSH


10 PGY2s


PGY2


A really fun and novel experience for me sitting on a panel evaluating scholarly work of our

PGY2s. First chance to evaluate and critique educational/academic/research projects


I found it really challenging to critique projects, especially rom a research perspective, as I am not

A researcher. On occasion, advanced stats and design methodology were difficult for me gauge/comment on


While not a researcher, I felt I still had insight to offer on

Clinical relevance, data analysis, and applicability of data


Would benefit from further independent study in

Methodology/stats prior to judging again

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed




Teaching Log

Session #:

50

Date of Session:

June 11, 2019

# of hours:

2


Interprofessional

Education Activity




TBD


Interprofessional staff


Working at Bridgepoint, I am aware of several issues regarding MD-RN communication.

As education lead, I decided to sit down and create a presentation addressing some key gaps perceived by physicians and

Their solutions.


I had done this before realizing other members of the hospital were working on similar parallel

Projects. Good reminded to always consider relevant stakeholders and ask, “what is already being done.”


I’m looking to build on the above and perhaps merge my work into or

Join other parallel projects with aim of operationalizing the proposed improvements (i.e., actual quality improvement)


Definitely need to assess current work being done and all

Stakeholders. Would benefit from a formal course in quality improvement.

Reviewed:

☐


☐


Date Discussed:

☐

Not Discussed




Documents

docdayscom.files.wordpress.com · Web view2019. 8. 1. · I think we should aim to formalize the experience more. One of the differences between goals and objectives in Kern’s