PROFESSIONAL DEVELOPMENT October 3, 2013 Dr. V. Antao MD, CCFP FCFP, MHSc, Dr. G. Mand MBBS, CCFP,...

PROFESSIONAL DEVELOPMENTOctober 3, 2013

Dr. V. Antao MD, CCFP FCFP, MHSc, Dr. G. Mand MBBS, CCFP, Dr. J. McCabe, MD, CCFP, Dr.

Yves Talbot and Dr. Yee-Ling Chang were involved in the creation of this session.

STRATEGIES FOR EFFECTIVE TEACHING IN AMBULATORY CARE

• This set of slides is adapted for DFCM Open. You can download these slides at www.dfcmopen.com/item/basics-effective-teaching.

“ The mediocre teacher tells. The good teacher explains. The superior teacher

demonstrates. The great teacher inspires.”

~William Arthur Ward

TEACHING STRATEGIES

OBJECTIVES

• Acquire an increased awareness of challenges in ambulatory care

• Review the One Minute Preceptor Model as a teaching strategy

• Review other common teaching strategies and teaching methods

OBJECTIVES

• Be familiar with some resources available to clinician teachers to address common teaching challenges

CHALLENGES IN TEACHING

• Reflect on your own experience:

• How do you teach?

• What challenges do you face teaching in your office?

ONE MINUTE CLINICAL PRECEPTOR

• Focuses teaching on learners reasoning• Based on 5 Microskills

1. Get a Commitment 2. Probe for evidence3. Teach general rules4. Provide feedback5. Correct mistakes

Neher J et al., A Five Step Microskills Model of Clinical Teaching. J. Am Board of Fam Practice, 5:419-24, 1992

GET A COMMITMENT

• What do you think is going on with this pt?• What investigations are indicated ?• What do you think needs to be

accomplished on this visit?

* resist asking data gathering questions at this time

PROBE FOR SUPPORTING EVIDENCE

• What are the major findings that lead to your conclusion ?

• What else did you consider ?• What made you choose this particular

treatment ?

• * “thinking out loud” rather than grilling

TEACH GENERAL RULES

• Keep it brief and focused on identified issues

• Instruction is more memorable when offered as a general rule

REINFORCE WHAT WAS DONE RIGHT

• Be specific• General praise does not reinforce a

particular behaviour

CORRECT ERRORS

• Consider appropriate time and place• Start with learner self evaluation• Consider language

“ Who dares to teach must never cease to learn.”

~John Cotton Dana

TEACHING STRATEGIES

COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE

1) Orienting learner2) Prioritizing or assessing learning needs3) Problem-oriented learning4) Priming *5) Pattern recognition6) Teaching in the patient’s presence*

Heidenreich C et al., Pediatrics 105:231-237,2000

COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE

7) Limiting teaching points *8) Reflective modelling9) Questioning10) Feedback11) Teacher/learner reflection

Heidenreich C et al., Pediatrics 105:231-237,2000

PRIMING

• Orientation of learner to pt. and tasks before entering room 1-2 min

1. Tasks

2. Attending role

3. Patient

4. Product

TEACHING IN THE PATIENT’S PRESENCE

• Learner presents findings to preceptor in front of patient– Increases preceptor time with patient– Enables direct verification of history/findings– Enables direct observation– Saves time

LIMITING TEACHING POINTS

• Focus on a few main points, less teaching, more learning

• General rules more memorable, more transferable

• At end of clinic, address other issue in more detail

• At next session review unresolved issues

CONCLUSIONS/SUMMARY

• There are numerous challenges associated with clinical teaching

• Effective teaching strategies may be used in ambulatory care

• A learner centred model of teaching is the One-Minute Preceptor (OMP)

REFLECTIVE EXERCISE

• Implement a Method/Strategy• -consider using the sample LOG

– Why did you chose this method?– Why was approach effective/ineffective?– What would you do differently next time? and

why?

TEACHING LOG

This is a teaching log created by Dr. Helen Batty and used in the Academic Fellowship Program.

EFFECTIVENESS OF TEACHING IMPROVEMENT INTERVENTIONS

Effective Teaching Interventions:

• Workshops• Teaching Evaluations with Consultation• Faculty development fellowship programs

• Wilkerson L et al., Strategies for Improving Teaching practices: A Comprehensive Approach to Faculty Development. Academic Medicine1998

RESOURCES

• Local undergrad/postgrad/PD representatives• Rubenstein W, Talbot Y. Medical Teaching in Ambulatory

Care, 2003• Neher J et al., A five Step Microskills Model of Clinical

Teaching. J. Am. Board. of Fam. Prac. 5:419-421,1992• Aagard E et al., Effectiveness of the One minute

Preceptor Model for Diagnosing the Patient and Learner: Proof of Comcept. Academic medicine 79:42-49,2004

TEACHING STRATEGIES

• Case discussion• Case review• Direct observation• Chart review• Chart stimulated recall• Criterion chart review• Role play• Short didactic presentation

Rubenstein W, Talbot Y Medical Teaching in Ambulatory Care

2003

“ If you have knowledge, let others light their candle at it.”

~Margaret Fuller

TEACHING STRATEGIES

Thank You