Teaching tips. Society for Academic Emergency Medicine Teaching in residency u PGY-1: Core content u PGY-2: Supervisory roles in MICU, SICU u PGY-3: Supervisory

Teaching tips

Society for Academic Emergency Medicine

Teaching in residency

PGY-1: Core content PGY-2: Supervisory roles in MICU, SICU PGY-3: Supervisory role in ED, teaching

workshops and procedural lab Other: Outside lectures, workshops, ACLS

courses


Overview

Curriculum development and instructional systems design

Characteristics of adult learners Using questions and feedback to promote critical

thinking Effective presentation styles Teaching procedures


What is learning?

A planned behavior change that has permanence Based on KSA (Knowledge, Skills, and Attitudes)


Determine

Learning

Outcomes

Develop

Evaluation

Procedures

Determine

Instructional

Strategies

Select

Media &

Methods

Develop

Instruction

Implement

Instruction

Evaluate

Instruction


Curriculum development and instructional systems design

Determine learner outcomes Develop evaluation process Determine instructional strategies Select media and methods Develop instruction Implement instruction Evaluate instruction


Objectives

Facts: information with arbitrary relationship Concepts: classes of elements with common

characteristics Principles: correlational effects, explains WHY Procedures: set of sequential steps performed to

accomplish purpose, explains HOW


Facts

“Overdosing on facts is like giving thyroxine to a tadpole-you get an instant frog, but unfortunately a rather small one”

Smith L: Medical education for the 21st century. J Med Educ 60: 106-112, 1985


Characteristics of adult learners

Experienced Oriented by need/problem (WII-FM) Learners decide content Concerned for immediate need Prefer active learning Skills-oriented Informal Self-directed “Equal” Intrinsic rewards


Information giving and Prescribing Limit the amount of information given Give the most important facts first Stress importance of information to learner’s needs Avoid jargon Relate information to the problem at hand Use repetition for emphasis Make instructions specific, behavioral, and measurable Present alternately acceptable treatments or procedures


People will remember

10% of what they read 20% of what they hear 30% of what they see 50% of what they see and hear 70% of what they say and write 90% of what they do


Six levels of cognitive objectives

Knowledge Comprehension Application Analysis Synthesis Evaluation


Questioning

Teachers talked 70% of time Asked questions 4% of time Wait time of 1.8 sec


Questioning

“Clinical teachers can make sure that their interactions simulate problem solving by asking questions rather than giving answers. Learners may think they are learning more by being given answers, but actually being asked questions is far more productive”


Effective clinical teaching behaviors

Creates positive learning environment Communicates expectations (avoids assumptions) Controls session Uses questions to guide and promote understanding Provides tangible and constructive feedback Uses techniques to increase understanding: the FACS

model. Focus… Activate… Crystallize… Summarize Motivates and energizes group with personal

commitment and enthusiasm


Counterproductive instructor behavior

Discussion stoppers *teacher talks 75% of time

*teacher answers 75%of their own questions

*teacher “cuts-off” or interrupts students

Providing indirect feedback with “WDY” questions *Why Did You

Feedback focuses on what’s wrong rather than what’s right


Helpful instructive behaviors

Guide learning with questions (FPC)*Focus, Probe, Challenge

Ask questions that explore the “why and how” as well as the “what, when, and where”

Give learners time to answer questions or perform procedures (don’t interrupt!)


Constructive feedback

Provide useable feedback (not just “you did lousy”) Limit the quantity of feedback: stick to the main

points Remember the 4 Ps: praise in public, perfect in private Use the collective we: “we’re still having a little

trouble with…”


Constructive feedback

Use the praise sandwich: praise…corrective feedback…praise Use appropriate timing: no distractions, adequate time for

discussion, no one freaking out (student or teacher) Be descriptive and specific: avoid WDY messages, focus on

actions, not presumed intentions Develop several calming responses to defensive reactions

from students* “Okay, I’m sure you feel this way now, but lets look down the road…”

* “Fine, I can appreciate that, but I want you to know my perspective”


Questions (summary)

Avoid discussion stopping behavior Avoid WDY questions Use FPC questions Ask “why and how” as well as “what and when” Provide constructive feedback Wait long enough for a response


Effective presentation skills

Say what you are going to say, say it, and say it again Elements of lecture: introduction, body, summation

and closure Paper primacy Advantages of lectures Disadvantages of lectures


The 10 commandments of slidemaking

Keep it simple Talk more-show less Be visually consistent One message, one slide Never apologize for a slide


The 10 commandments of slidemaking

Design for the back row Use only readable type face Make headlines No red text Drive 55…. 5 words per line, 5 lines per slide


Levels of competency

Unconsciously incompetent Consciously incompetent “see one” Consciously competent “do one” Unconsciously competent “do one more”


Teaching procedures

Do not talk about superfluous material (indications...)

Break down the procedure in small parts (demonstrate)

Have learner verbalize parts of procedure Stop learner if they do something incorrect (with

procedures people do NOT learn from their mistakes, they learn their mistakes)

Give enough supervised practice


Resources

Whitman N. and Shenk TL. The physician as teacher. Whitman and Associates 1997 (801) 943-1401

Bland et al. Successful faculty in academic medicine. Essential skills and how to acquire them. 1990 Springer

Irby D. Teaching and learning in ambulatory care settings: A thematic review of the literature. Acad Med 70: 898-931, 1995


Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5:339-351, 1994

Paid attention to my concerns Highlighted essential points to remember Explained, demonstrated, practiced climbing

maneuvers Balanced talking and doing Explained safety system, made efficient use of

time, set comfortable pace Divided time fairly among group


Kahn EM, Yardely NJ. Relationships of client attributes and guides: techniques to client satisfaction at a climbing school. J Wilderness Med 5:339-351, 1994

Clarified learner goals and objectives Explained the plan for the day Let learner know what to expect Got to know learner well before teaching Offered help when the learner was stuck Provided positive feedback to encourage learners


Author Credit – Teaching Tips: Felix Ankel MD

Questions


Postresidency Tools of the Trade CD

1) Career Planning – Garmel

2) Careers in Academic EM – Sokolove

3) Private Practice Career Options - Holliman

4) Fellowship/EM Organizations – Coates/Cheng

5) CV – Garmel

6) Interviewing – Garmel

7) Contracts for Emergency Physicians – Franks

8) Salary & Benefits – Hevia

9) Malpractice – Derse/Cheng

10) Clinical Teaching in the ED – Wald

11) Teaching Tips – Ankel

12) Mentoring - Ramundo

13) Negotiation – Ramundo

14) ABEM Certifications – Cheng

15) Patient Satisfaction – Cheng

16) Billing, Coding & Documenting – Cheng/Hall

17) Financial Planning – Hevia

18) Time Management – Promes

19) Balancing Work & Family – Promes & Datner

20) Physician Wellness & Burnout – Conrad /Wadman

21) Professionalism – Fredrick

22) Cases for professionalism & ethics – SAEM

23) Medical Directorship – Proctor

24) Academic Career Guide Chapter 1-8 – Nottingham

25) Academic career Guide Chapter 9-16 – Noeller

Documents

Teaching tips. Society for Academic Emergency Medicine Teaching in residency u PGY-1: Core content u PGY-2: Supervisory roles in MICU, SICU u PGY-3: Supervisory