Introduction to Teaching

Introduction to Introduction to TeachingTeaching

University of PittsburghUniversity of Pittsburgh School of MedicineSchool of Medicine

Academy of Master EducatorsAcademy of Master EducatorsTeaching Residents to Teach CommitteeTeaching Residents to Teach Committee

Jason Rosenstock MD, CHAIRJason Rosenstock MD, CHAIR Jonathan Finder MD, VICE-CHAIRJonathan Finder MD, VICE-CHAIR

Academy of Master Educators Residents as Teachers Committee

Jason Rosenstock MD– CHAIR, Assistant

Professor of Psychiatry

– Dir Medical Student Edu

Jonathan Finder, MD– VICE-CHAIR– Associate Professor

of Pediatrics

Raquel Buranosky, MD,MPH– Associate

Professor of Medicine

– PD, Internal Medicine Residency

Peter Ferson, MD– Professor of

Surgery

Committee Members

James Johnston, MD– Professor of Medicine – PD, Nephrology

Fellowship– President, AME

Rita M Patel MD– Professor & Vice-Chair,

Anesthesiology– Clinical Procedures

UPSOM Course Director– Associate Dean for GME

Kathleen McIntyre-Seltman, MD– Professor of OB/GYN &

Reproductive Sciences– Advisory Dean, UPSOM

Petronilla Vaulx-Smith, MD, PhD– Assistant Professor of

Psychiatry Basil Zitelli, MD

– Professor of Pediatrics

Introduction to TeachingGoal:To help incoming house staff 1) recognize the importance of

teaching2) understand basic do’s and don’ts3) be open to further development of

teaching skills

Orientation ProgramOrientation Program Introduction to Teaching Introduction to Teaching

Why?Why?

Helps with patient careHelps with patient care Makes you look goodMakes you look good Learners expect itLearners expect it

It’s requiredIt’s required– ACGME CompetenciesACGME Competencies– Program/Institutional RequirementsProgram/Institutional Requirements

Intro to Teaching:Intro to Teaching:The The APPLEAPPLE Curriculum Curriculum

APPLEAPPLE Curriculum Curriculum – AApplication of pplication of PPrinciples and rinciples and PPractice ractice

of of LLearning and earning and EEducationducation CoreCore

– Fundamental principles of educationFundamental principles of education– Teaching OpportunitiesTeaching Opportunities– Assessment/Evaluation/FeedbackAssessment/Evaluation/Feedback

Conduct of SessionConduct of Session

Brief introduction to teachingBrief introduction to teaching Case-Based ScenariosCase-Based Scenarios Reflection (Table Discussion)Reflection (Table Discussion) Open DiscussionOpen Discussion Summary – Teaching PointsSummary – Teaching Points

Agenda CoreCore


Adult Learning Adult Learning PrinciplesPrinciples

Learners are: Learners are: – Goal-oriented (Why, What and How)Goal-oriented (Why, What and How)– Autonomous and self-directingAutonomous and self-directing– with preexisting resources (life experiences)with preexisting resources (life experiences)

Make it relevant, practical & contextual Make it relevant, practical & contextual (problem solving)(problem solving)

Be respectful (safe learning Be respectful (safe learning environment) environment)

Motivate and reinforceMotivate and reinforce

Teachable Moments Not just a ‘lecture’ Modeling professional behavior Daily opportunities

– Work rounds– Procedures– Ambulatory settings

Pick your targets (can’t do it all) Be brief (“teaching on the fly”)

What type of teaching What type of teaching useful?useful?

010203040506070

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A B C DHigh ------------------------------------------------Low

MS Resident Prog Dir

A.A. Procedures, Procedures, Case Case Management, Management, 5-min talks, 5-min talks, Bedside Bedside TeachingTeaching

B.B. Physical Physical Diagnosis Diagnosis RoundsRounds

C.C. Lectures, PBL, Lectures, PBL, Simulated Simulated Cases, Socratic Cases, Socratic questioningquestioning

D.D. MS I & MS II MS I & MS II coursescourses

Microskills for Clinical Microskills for Clinical TeachingTeaching

1.1. Get a commitmentGet a commitment2.2. Probe for supporting evidenceProbe for supporting evidence3.3. Teach general rules and think Teach general rules and think

out loudout loud4.4. Tell your learner what he or she Tell your learner what he or she

did rightdid right5.5. Correct the learner’s mistakesCorrect the learner’s mistakes

Irby, 1997 The One-Minute Preceptor: Microskills for Clinical Teaching

SCENARIO #1 Answer the following questions1.1. How can you use adult learning How can you use adult learning

principles to improve the principles to improve the educational experience?educational experience?

2.2. Identify the teachable moments Identify the teachable moments and critique what you sawand critique what you saw

Comments?

1. 2.3.4.

5 Microskills of Teaching

1. Get a commitment– Ask learner to articulate his/her

own diagnosis or plan– Get him/her to commit to an

answer (even if wrong)


2. Probe for supporting evidence– Evaluate the learner’s

knowledge/reasoning– Ask probing questions

Ask why he/she thinks so Ask “what if …” scenarios Broader / deeper than learner’s answer

5 Microskills of Teaching3. Teach general rules

• Generalize from the case at hand• Give the learner a pearl /take home

point• Point out how this case is same or

different from the general rules


4. Reinforce what was done well• Provide positive feedback• “Catch them doing something right”


5. Correct errors• Provide constructive corrections and

feedback Specific Targeted Recommendations for improvement

The One Minute PreceptorChoose a single teachable point per

encounter– Most generalizable (most useful)– Most important (don’t miss the life

threatening diagnosis)– Targeted at learner’s area of weakness– Building on previous teachable point– Can be diagnosis, management, skill etc

Agenda CoreCore


FeedbackFeedback vs.vs. EvaluationEvaluation ImmediateImmediate InformalInformal ObjectiveObjective SpecificSpecific Improvement Improvement FormativeFormative InformationInformation

ScheduledScheduled FormalFormal ObjectiveObjective GlobalGlobal GradeGrade SummativeSummative JudgmentJudgment

RIMERIME Evaluation Evaluation FrameworkFramework RReporter eporter – Provides data– Provides data

– WBC count 15; chest x-ray infiltrateWBC count 15; chest x-ray infiltrate IInterpreternterpreter – Integrates data – Integrates data

– Differential diagnosis including pneumoniaDifferential diagnosis including pneumonia MManager anager – Implements– Implements

– Treats with antibiotic, arranges hospital admissionTreats with antibiotic, arranges hospital admission EEducator ducator – Teaches – Teaches

– Shows how individual data led to diagnosis of Shows how individual data led to diagnosis of pneumonia and how to treat itpneumonia and how to treat it

SCENARIO #2

Answer the following questions:

1.1. How would you improve the How would you improve the feedback that was given? feedback that was given?

2.2. Use the RIME System to assess Use the RIME System to assess the learnerthe learner

Comments?

1. 2.3.4.

Feedback Feedback in thein the Clinical Clinical SettingSetting

Observe the learnerObserve the learner Describe a notable aspect of Describe a notable aspect of

performanceperformance Wait for a responseWait for a response Recommend a next step to Recommend a next step to enhance their performanceenhance their performance Arrange for a retryArrange for a retry

Evaluation Evaluation ofof Clinical Clinical LearnersLearners Reinforce what they are doing wellReinforce what they are doing well Educate about areas in which Educate about areas in which

improvement is possibleimprovement is possible Affirm your belief in their ability to Affirm your belief in their ability to

follow this advicefollow this advice Check for their understanding by Check for their understanding by

asking for a planasking for a plan Commit to helpCommit to help

Teaching Challenges The unmotivated student The unprofessional student Confrontation/Conflict Time constraints Navigating the learner/teacher

role

Intro to Teaching: Conclusions

It’s important and you’ll do it regularly Make it relevant, practical Capitalize on teachable moments Use microskills (1min teaching!) Give timely feedback, assess with

RIME Ask for help, more to come

So Just Take the Plunge

Documents

Introduction to Teaching