A Framework for A Framework for Effective Clinical Effective Clinical Teaching SkillsTeaching SkillsJohn (Jack) D. Buckley, MD, John (Jack) D. Buckley, MD,

MPHMPH

Henry Ford HospitalHenry Ford Hospital

April 9, 2005April 9, 2005

GOALSGOALS

Review our Teaching DutyReview our Teaching Duty Introduce a validated Educational Introduce a validated Educational

Framework designed to enhance Framework designed to enhance effective teaching skillseffective teaching skills Framework OutlineFramework Outline SeminarsSeminars Personal Goal SettingPersonal Goal Setting

DemonstrationDemonstration

Are Good Teachers Are Good Teachers Simply Born?Simply Born?

Is it genetic and you either have it or Is it genetic and you either have it or you don’t? you don’t?

OROR Can ineffective teachers become Can ineffective teachers become

better?better? Can you make a good teacher even Can you make a good teacher even

more effective?more effective?

Traditional Teaching of Traditional Teaching of Clinical MedicineClinical Medicine

If you know the material, you can If you know the material, you can teach it. teach it.

See one, do one, teach oneSee one, do one, teach one I teach the same way as I was I teach the same way as I was

taught.taught. The ceiling effectThe ceiling effect

““I’m a good teacher.I’m a good teacher. The problem is they The problem is they

aren’taren’t

very good learners.”very good learners.” -Anonymous faculty member-Anonymous faculty member

““Self-pity and projected Self-pity and projected blame – the recipe for a blame – the recipe for a

well-lived life!”well-lived life!”

-Parker, -Parker, The Courage to TeachThe Courage to Teach, 1998, 1998

How much formal How much formal training in teaching training in teaching skills have you had?skills have you had?

Train-the-Trainer ModelTrain-the-Trainer Model

Stanford Faculty Development Center

Clinical Teaching Program

Seminar Facilitators

Seminar Participants(Faculty & Residents)

Learners Institution

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and Promoting Understanding and

RetentionRetention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate The tone or atmosphere of the clinical teaching The tone or atmosphere of the clinical teaching

setting including whether it is stimulating and setting including whether it is stimulating and whether learners can comfortably identify and whether learners can comfortably identify and address their limitations.address their limitations.

Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session

The manner in which the teaching interaction The manner in which the teaching interaction is focused and paced as influenced by the is focused and paced as influenced by the teacher’s leadership style.teacher’s leadership style.

Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals

The establishment and explicit expression of a The establishment and explicit expression of a teacher’s and/or learner’s expectations teacher’s and/or learner’s expectations forfor the the learners. learners.

Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention

This category describes approaches the teacher This category describes approaches the teacher can use to:can use to:

Explain the content being taughtExplain the content being taught Have the learner meaningfully interact with Have the learner meaningfully interact with

that content, thus assisting the learner to that content, thus assisting the learner to understand and retain it.understand and retain it.

EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation

The process by which the teacher The process by which the teacher assesses the learners’ knowledge, skills, assesses the learners’ knowledge, skills, and attitudes, based on criteria related and attitudes, based on criteria related to the educational goals.to the educational goals.

FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

Stanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback

The process by which the teacher The process by which the teacher provides learners with information about provides learners with information about their performance for the purpose of their performance for the purpose of improving their performance.improving their performance.

Promoting Self-Directed LearningPromoting Self-Directed LearningStanford Faculty Development CenterStanford Faculty Development Center

Categories of Effective Categories of Effective Teaching SkillsTeaching Skills

Learning ClimateLearning Climate Control of SessionControl of Session Communication of GoalsCommunication of Goals Promoting Understanding and RetentionPromoting Understanding and Retention EvaluationEvaluation FeedbackFeedback Promoting Self-Directed LearningPromoting Self-Directed Learning

This form of learning is initiated by the This form of learning is initiated by the individual learner’s needs, goals, and individual learner’s needs, goals, and interests. This category deals with interests. This category deals with approaches the teacher can use to influence approaches the teacher can use to influence learner motivation and use of resources, learner motivation and use of resources, thereby fostering self-directed learning.thereby fostering self-directed learning.

Stanford Faculty Development CenterStanford Faculty Development Center

Seminars: The Full Seminars: The Full PackagePackage

Eight sessionsEight sessions One dedicated to each categoryOne dedicated to each category One for reviewing personal / institutional One for reviewing personal / institutional

goal settinggoal setting Two-hours eachTwo-hours each

ComponentsComponents Mini-lectureMini-lecture Review and Analysis of videoReview and Analysis of video Role PlayRole Play Goal SettingGoal Setting

Seminar Descriptions Seminar Descriptions cont.cont.

These seminars are These seminars are NOTNOT:: RulesRules A proscriptive method for good teachingA proscriptive method for good teaching

They are intended to:They are intended to: Increase your awareness of your own Increase your awareness of your own

teaching skills.teaching skills. Use the framework to analyze your Use the framework to analyze your

teaching.teaching. Use the framework to help identify options Use the framework to help identify options

that may improve your teaching. that may improve your teaching.

Does THIS framework Does THIS framework actually work?actually work?

Clinical Teaching Program - 18 Clinical Teaching Program - 18 years oldyears old

99 facilitators from over 60 99 facilitators from over 60 academic medical centers.academic medical centers.

Over 2000 participantsOver 2000 participants 76 peer-reviewed manuscripts76 peer-reviewed manuscripts

Clinical Teacher Model: Clinical Teacher Model: AssessmentAssessment

Improving Clinical Teaching: Evaluation of a Improving Clinical Teaching: Evaluation of a National Dissemination Program.National Dissemination Program.-Skeff KM et al. -Skeff KM et al. Arch Intern MedArch Intern Med 1992. 1992.

Faculty rated seminars as highly useful Faculty rated seminars as highly useful and would recommend to others.and would recommend to others.

Pre & Post Seminar Faculty QuestionnairesPre & Post Seminar Faculty Questionnaires Rated teaching ability higher after Rated teaching ability higher after

seminarsseminars Pre & Post seminar Housestaff (85%) and Pre & Post seminar Housestaff (85%) and

Medical Student (15%) QuestionnairesMedical Student (15%) Questionnaires Rated teaching higherRated teaching higher

Clinical Teacher Model: Clinical Teacher Model: AssessmentAssessment

Use of faculty development to improve Use of faculty development to improve ambulatory ambulatory

care education. -care education. -Stratos GA et al. Stratos GA et al. Med Teacher Med Teacher 1997.1997.

10 Facilitators: faculty development program: 10 Facilitators: faculty development program: 64 ambulatory teachers: 11 western 64 ambulatory teachers: 11 western region VA institutionsregion VA institutions

Participants rated usefulness: 4.8 on a 5 pt Participants rated usefulness: 4.8 on a 5 pt Likert Likert

Clinical teaching skills self assessments pre-Clinical teaching skills self assessments pre-post intervention: p<.001 improvement in all post intervention: p<.001 improvement in all 7 domains7 domains

Clinical Teacher Model: Clinical Teacher Model: ApplicationsApplications

Factorial Validation of a Widely Disseminated Factorial Validation of a Widely Disseminated Educational Framework for Evaluating Educational Framework for Evaluating Clinical Teachers. Teachers. -Litzelman DK et al. -Litzelman DK et al. Acad MedAcad Med

1998.1998.

Reduced the 58 subcomponents to 25 itemsReduced the 58 subcomponents to 25 items Found overlap between descriptors of Found overlap between descriptors of

teacher knowledge and promotion of self teacher knowledge and promotion of self directed learningdirected learning

Provides evidence that the 7 category Provides evidence that the 7 category framework is a valid and useful way to framework is a valid and useful way to analyze complex teaching activityanalyze complex teaching activity

LEARNING CLIMATE LEARNING CLIMATE (1)(1)

A. DEFINITION

B. EDUCATIONAL PURPOSE

C. TIMING (initial, ongoing)

D. KEY COMPONENTS Stimulation Learner Involvement Respect/Comfort Admission of Limitations

LEARNING CLIMATE LEARNING CLIMATE (2)(2)D. KEY COMPONENTS & SPECIFIC BEHAVIORS

1. STIMULATION TEACHING BEHAVIORS:

• show enthusiasm for topic and for learners

• show interest through body language

• use animated voice• provide conducive physical

environment

2. LEARNER INVOLVEMENT TEACHING BEHAVIORS:

• look at learners• listen to learners• encourage learners to participate• avoid monopolizing discussion

LEARNING CLIMATE LEARNING CLIMATE (3)(3) D. KEY COMPONENTS & SPECIFIC BEHAVIORS

3. RESPECT/COMFORT TEACHING BEHAVIORS:

• use learners' names• acknowledge learners'

problems/situation• invite learners to express opinions• state respect for divergent opinions• avoid ridicule, intimidation, or

interruption

4. ADMISSION OF LIMITATIONS TEACHING BEHAVIORS:

• acknowledge learner limitations• invite learners to bring up problems• admit own errors or limitations• avoid being dogmatic

Demonstration: Learning Demonstration: Learning ClimateClimate

Participants:Participants: Attending PhysicianAttending Physician FellowFellow ResidentResident 44thth-year Medical Student-year Medical Student

Setting:Setting: Morning Rounds in the Intensive Care Morning Rounds in the Intensive Care

UnitUnit

Personal Goal Setting: Specific Personal Goal Setting: Specific Teaching BehaviorsTeaching Behaviors

STIMULATION show enthusiasm for topic

and for learners show interest through

body language use animated voice provide conducive

physical environmentLEARNER

INVOLVEMENT look at learners listen to learners encourage learners to

participate avoid monopolizing

discussion

RESPECT/COMFORT use learners' names acknowledge learners'

problems/situation invite learners to express

opinions state respect for divergent

opinions avoid ridicule, intimidation,

or interruptionADMISSION OF

LIMITATIONS acknowledge learner

limitations invite learners to bring up

problems admit own errors or

limitations avoid being dogmatic

SummarySummary

Effective teaching is more than an Effective teaching is more than an art.art.

Teaching requires a conscious effort, Teaching requires a conscious effort, practice, and self-assessment.practice, and self-assessment.

A framework can help you improve A framework can help you improve your teaching skills. your teaching skills.