Improving Teaching and Learning in Clinical Settings_hossam Hamdy

7/31/2019 Improving Teaching and Learning in Clinical Settings_hossam Hamdy

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ImprovingImproving

Teaching and LearningTeaching and Learningin Clinical Settingsin Clinical Settings

Professor Hossam HamdyProfessor Hossam HamdyUniversity of SharjahUniversity of Sharjah


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AimAim

What is Clinical Teaching

Barriers to effective Clinical Teaching

Strategies to improve Clinical Teaching


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Triad Interactive Learning inTriad Interactive Learning inthe Clinical Contextthe Clinical Context

ContentTeacher Patient

StudentContext


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THE PHYSICIAN ASTHE PHYSICIAN ASTEACHERTEACHER

It is still supposed that because a manIt is still supposed that because a manis an accomplished physician, he is anis an accomplished physician, he is anexcellent teacher.excellent teacher.

Abraham Flexner, 1910Abraham Flexner, 1910


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BASICBASIC QUESTIONSQUESTIONS

Is training others an integral part of theIs training others an integral part of theresponsibilities of a Physician/Surgeon?responsibilities of a Physician/Surgeon?

Does the institution recognize it andDoes the institution recognize it andreward education training?reward education training?


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Barriers to Effective ClinicalBarriers to Effective ClinicalTeachingTeaching A global ConcernA global Concern

Time lack for clinicians.

Insufficient space to teach.Crowded outpatients.

Increasing number of super-specialist clinics.


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Barriers to Effective ClinicalBarriers to Effective ClinicalTeachingTeaching (cont/(cont/ --))

Lack of patients and inpatient beds.

Lack of consistency in what is taught.Lack of organization in what is taughtbetween teachers.


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Barriers to Effective ClinicalBarriers to Effective Clinical

TeachingTeaching (cont/(cont/ --))

Teaching is not considered part ofservice commitment not recognized

by the institutions

Lack of knowledge and skills aboutteaching methods.


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The Clinical ContextThe Clinical Context

More shift from Hospital setting toMore shift from Hospital setting toAmbulatory settings.Ambulatory settings.

Diminish the significance of bedsideDiminish the significance of bedsideteachingteaching short length of stayshort length of stay ..


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The Clinical ContextThe Clinical Context(cont/(cont/ --))

Hospital populated with critically ill and earlyHospital populated with critically ill and earlypostpost --operativeoperative patients.patients.

Early diagnosisEarly diagnosis no or little physical signs.no or little physical signs.


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Key Clinical CompetenciesKey Clinical CompetenciesWhat are the key clinical competencies you asWhat are the key clinical competencies you asa clinical teacher want to ensure that thea clinical teacher want to ensure that thestudents have accomplishedstudents have accomplished

Good communication and data gathering (history andGood communication and data gathering (history andphysical examinationphysical examination

Clinical reasoningClinical reasoning

Decision Making, investigation and treatmentDecision Making, investigation and treatment

EBMEBM

Ethics and professionalismEthics and professionalism

Patient SafetyPatient Safety


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ADULT LEARNING PRINCIPLEAdults learn best when the educationalAdults learn best when the educationalexperience ensures that:experience ensures that:

The content is relevant and has meaning and purposefor everyday issues.

The learner is actively involved.

Objectives are defined and goals set.

Positive feedback is given.

Reflection on the learning experience is encouraged.


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Effective Clinical TeachingEffective Clinical Teaching

Be available (on time) and approachable.

Introduce yourself and know their names.

Pre select patients/ Ask permission

Ensure respect for patients comfort anddignity

Planning set


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Clarify expectations and goals appropriate

to the setting, patient problems and studentlevel prior knowledge

Clinical TeachingClinical TeachingPlanning set (cont/(cont/ --))


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Teach from clinical cases.

Go to the bedside or exam room

Use questions to diagnose patient & learners.

Train the students how to take a focusedhistory and physical examination

TeachingTeaching DialogueDialogue

Clinical TeachingClinical Teaching


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Role modelRole model

Focus the teaching on data gathering by or Focus the teaching on data gathering by or about the patientabout the patient critical player critical player

Promote student clinical reasoning skills..Promote student clinical reasoning skills..

TeachingTeaching DialogueDialogue (cont/(cont/ --))

Clinical TeachingClinical Teaching


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Context specificity.Context specificity.

Prior knowledge & netPrior knowledge & net --working.working.

Schemata and script concordance.Schemata and script concordance.

NonNon --Analytical ReasoningAnalytical ReasoningPattern recognition


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Analytical ReasoningAnalytical Reasoning

Cues form c/oCues form c/o durationduration

Early hypothesis generationEarly hypothesis generationTesting and reTesting and re --testing hypothesistesting hypothesisRanking and reRanking and re --ranking hypothesisranking hypothesis


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PrePre --testtest

ProbabilityProbabilityTESTTEST PostPost --testtest

ProbabilityProbability

Clinical ReasoningClinical Reasoning

Each question in the history and each physicalexamination is a diagnostic test.

EBM Approach


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Combined Model of ClinicalCombined Model of ClinicalReasoningReasoning

PatientPresents

HypothesesTested

Non-analytic Interactive Analytic

CaseRepresentation


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Increase the student base of scenarios,Increase the student base of scenarios,scripts and mental images.scripts and mental images.

Students should be guided to relateStudents should be guided to relatenovel experience with past experiencesnovel experience with past experiencesAnchor protoAnchor proto --type in their memorytype in their memory ..

Clinical Teaching TipsClinical Teaching Tips


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Clinical Teaching TipsClinical Teaching Tips (cont/(cont/ --))

Implicit / Tacit Explicit

Key features of disease

Relevant informationfocused history & physical exam.

Model Professional Thinking and Decision MakingPreceptor Thinking Out Loud


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Clinical Teaching TipsClinical Teaching Tips (cont/(cont/ --))

Priority in investigations and treatment.

Review diagnostic probabilitiesand rationale for diagnosis andtreatment.

Model Professional Thinking and Decision Making

Preceptor Thinking Out Loud


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The Effective Clinical TeacherThe Effective Clinical Teacher (D. Newbie)(D. Newbie)

1. Encourages active student participationrather than passive observation

2. Emphasis on teaching of applied problem

solving

3. Integrates clinical medicine with basic

science4. Close observation of students during

interview/examination rather than side-roomcase presentation


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The Effective Clinical Teacher (D. Newbie)The Effective Clinical Teacher (D. Newbie)

5. Provides adequate opportunity for students to practice skills

6. Provides good role-model for interpersonal

relationships with patients

7. Teaching patient-oriented rather than

disease-orientated8. Demonstrates a positive attitude towards

teaching


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The Effective Clinical TeacherThe Effective Clinical Teacher

Most important being willing to teachand be enthusiastic about it


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Thank YouThank You

Documents

Improving Teaching and Learning in Clinical Settings_hossam Hamdy