Peds_EM_Tch_Strat_RAT_July_04

Pediatric Emergency MedicineFellowship OrientationBedside Teaching Workshop : 

Pediatric Emergency MedicineFellowship OrientationBedside Teaching Workshop July 13, 2004 Deb Simpson, PhD Director, Office of Educational Services Professor, Family and Community Medicine

Objectives : 

Objectives Describe effective clinical teacher Behavior/Skills Knowledge Incorporate proven teaching strategies into your bedside teaching Orienting learner 1-2 focal teaching points/interaction Feedback Engage in self-assessment teaching ACGME – PBL & I

ACGME: Practice Based-Learning & Improvement: Teaching : 

ACGME: Practice Based-Learning & Improvement: Teaching Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: facilitate the learning of students and other health care professionals http://www.acgme.org/outcome/comp/compFull.asp

AAMC Sr. GQOf all the teaching you received on clinical clerkships, estimate the overall % provided by resident physicians and fellows. : 

AAMC Sr. GQOf all the teaching you received on clinical clerkships, estimate the overall % provided by resident physicians and fellows. Mean EM, FM, IM, Ob/Gyn, Neuro, Peds, Psych, Radiology, Surg Preliminary Data 2004

Agenda: Work - shop : 

Agenda: Work - shop Characteristics of Effective CT Teaching Strategies IIo TK Orient the learner “1-2 Focal Teaching Points” ACGME Competencies Feedback Self-Assessment

Needs Assessment: Your CT : 

Needs Assessment: Your CT Experience as Clinical Teacher What do well? What struggled with?

Characteristics/Behaviors of Effective Clinical Teachers : 

Characteristics/Behaviors of Effective Clinical Teachers . . . . . . .

Slide 8: 

Form Used by Peds Students and Residents to Evaluate Teaching

Slide 9: 

NOW Goal SELF- ASSESSMENT

WHAT DOES AN EXPERT CLINICAL TEACHER KNOW? : 

WHAT DOES AN EXPERT CLINICAL TEACHER KNOW? Clinical Knowledge General concepts/principles about medicine H & P Examine baby Disease specific Clinical Knowledge is linked to: Educational Principles & Objectives Learners Methods/Strategies Resources Knowledge organized as “Scripts”

Teaching SCRIPTS : 

Teaching SCRIPTS Script Like a script for a play/movie Built based on knowledge & experience (repetition) By Allowing us to: Anticipate what will happen Teaching Points! Revise/elaborate behavior/script based on what actually occurred

Example of a Script : 

Example of a Script Birthday Script: How proceed, expectations.. Content and Procedural knowledge You walk into a room and see What’s going on? Suppose you now see: Suppose you now see friends running in:

Example of Clinical Scripts : 

Example of Clinical Scripts Peds ED 2 yr presents with marble/pea up its nose

TK - Learner: Scripts Common Errors - Teach Points : 

TK - Learner: Scripts Common Errors - Teach Points July - JMS 6 mo old with vomiting and diarrhea Hx PE Presentation Errors? ? 1-2 Focal Tch Points PGY 1 – July?

TK #1: Pediatric Scripts : 

TK #1: Pediatric Scripts N = 80 academic pediatricians at COMSEP Vignette: It is July and you are about to hear Becky (M3) present the hx of a 3/yo child admitted to your floor from ER during an acute exacerbation of “asthma” 2 QUESTIONS What are common error you expect in hx? What teaching points will you make? Marcdante K, Simpson D. Peds 1999;104(1):S148-150.

Results – Peds Scripts : 

Results – Peds Scripts > 87% Errors Hx of acute illness is disorganized / incomplete Failure to obtain fam, soc, envir Hx Difficulty assessing severity of illness >85% Teach Points How organize /structure presentation What pertinent Hx to include How to assess severity of asthma

Internal Summary: Expert Teacher’s Knowledge : 

Internal Summary: Expert Teacher’s Knowledge Scripts evoked by common errors Scripts contain objectives (1-2 key) Objectives linked to: educational principles, teaching methods, resources

TK #2: EDUCATIONAL PRINCIPLES : 

TK #2: EDUCATIONAL PRINCIPLES Ebbinghaus’ Learning Curve Support Challenge Learning

Support/Challenge : 

Support/Challenge Challenge High Low Support High RETREAT GROWTH STASIS CONFIRMATION

SUPPORT & CHALLENGE : 

SUPPORT & CHALLENGE Challenges ambiguity about role & expectations learner competence pace of ED setting diversity/complexity of patients Supports Respect/Valued Structure Defined outcomes Orientation personal atmosphere “ok” to make mistake ADL’s

TK: #3 Methods : 

TK: #3 Methods Efficient/Effective Clinical Teaching Methods Lecturettes, PBL, ?ing, feedback, etc. Priming? TIPP? “Aunt Minnie?”, e-learning Resources (for learner) PDA based textbook, references, WWW - EBM People

Teacher Knowledge: Methods : 

Teacher Knowledge: Methods Orient the learner To You & ADL-Learner To Patient: Priming Anticipate learner errors via scripts “1-2 Focal Teaching Points” ACGME Competencies Feedback

Key Points in Orienting Learner : 

Key Points in Orienting Learner Teacher Knowledge Re: Learners Anxieties?

Key Points in Orienting Learner : 

Key Points in Orienting Learner ADL’s When arrive Typical day Call schedule Breaks Where store materials During ED What to expect from you What you expect from them

TK: Orienting Learner to Patient: PRIMING : 

TK: Orienting Learner to Patient: PRIMING Teacher directed Brief (< 1 min) orientation of learner immediately prior to entering pt’s rm. Tasks Your Role Patient Product

Practice! 1 minute Prime : 

Practice! 1 minute Prime July - JMS 6 mo old with vomiting and diarrhea Hx, PE, Presentation Errors? ? 1-2 Focal Tch Points

Your Teaching Objectives : 

Your Teaching Objectives SCRIPTS: Increase Your TK ACGME Competencies

TK #5: Objectives Linked to Errors : 

TK #5: Objectives Linked to Errors ACGME Competencies as Teaching Foci As teachers list the competencies List the objectives for: Professionalism? Systems based Practice? Incorporate into Your DAILY teaching (What would a resident say?)

ACGME Competencies : 

ACGME Competencies Patient Care Medical Knowledge Practice-based Learning & Improvement (PBL-I) Interpersonal & Communication Skills Professionalism Systems-based Practice (SBP)

Why use these? : 

Why use these? ACGME competencies implemented as of July 1, 2003 Patient Care, Medical Knowledge and Interpersonal Skills & Communication “understood” Systems-based Practice not well understood Professionalism - hard to teach

System based practice : 

System based practice ACGME “definition” Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is optimal value.

ACGME Objectives : 

ACGME Objectives Residents are expected to: Understand how patient care and other practices affect other HC professionals, the HC organization and the larger society and how these elements of the system affect their own practice Know how types of practice and delivery systems differ, including methods of controlling costs and allocating resources

Objectives (continued) : 

Objectives (continued) Practice cost effective health care and resource allocation that does not compromise quality Advocate for quality care and assist patients dealing with system complexities Know how to partner with HC managers and provides to assess, coordinate and improve care and know how these activities can affect system performance

System Based Practice Adapted from multiple sources : 

System Based Practice Adapted from multiple sources TACTICS Teamwork Advocacy Coordination Technology Use Improvement Cost Effectiveness Safety ? 2004 Department of Pediatrics – Medical College of Wisconsin

Professionalism : 

Professionalism ACGME definition Residents must demonstrate a commitment to carrying out professional activities, adherence to ethical principles and sensitivity to a diverse population

Professionalism : 

Professionalism ABIM publication (I-HEAARD) Integrity-Honesty Excellence Altruism Accountability Respect Duty ? 2004 Department of Pediatrics – Medical College of Wisconsin

Practice: APPLYING Your Teaching Objectives : 

Practice: APPLYING Your Teaching Objectives Professionalism I-HEAARD Systems Based Practice TACTICS TK: Practice + FB

Practice: APPLYING Your Teaching Objectives : 

Practice: APPLYING Your Teaching Objectives Draft 1-2 Teaching Objectives that include: Professionalism – I-HEAARD SBP – TACTICS Draft a 1-minute script re: how you would teach that objective to the 6 mo old with vomiting and diarrhea M3 July PGY 1 July

Teacher Knowledge : 

Teacher Knowledge Teaching Strategies: Feedback

Why is teaching/correcting competencies difficult? : 

Why is teaching/correcting competencies difficult? We use correction strategies that minimize exposing errors Ende J, Pomerantz A, Erickson F. Acad Med 1995, 70(3): 224-229. Aseptic RoutineJulian LeviInk, pencil, and pastel drawing, 1943

TK: FEEDBACK: ENDE’s 3 Correction Strategies 1995 Acad Med : 

TK: FEEDBACK: ENDE’s 3 Correction Strategies 1995 Acad Med Used when learners either don’t answer ?’s or offer wrong /inappropriate answers Silence (Opportunity Spaces for Revisions) Hints (FU ?’s with clues) Yes, But... (Treat wrong answers as possible, but in need of further consideration)

FEEDBACK: Indirect FB Ende - 1995, Acad Med + 1983 JAMA : 

FEEDBACK: Indirect FB Ende - 1995, Acad Med + 1983 JAMA Why? preserve L’s self-confidence and esteem T/L (future colleague) active “discovery” learning increase responsibility of learner for patient Outcome L’s don’t recognize corrections as FB Assume they are correct

Practice: Teaching is a Performing Art : 

Practice: Teaching is a Performing Art Practice – Pilot Your Script Critical Analysis: What worked, didn’t Revise Practice – Feedback to Teacher TK: Expand repertoire of scripts via practice with feedback and reflection (PBL & I)

Continuing Opps to Enhance Repertoire : 

Continuing Opps to Enhance Repertoire

Online CT Modules : 

Online CT Modules http://coursesites.blackboard.com

Clinical Teaching Basics : 

Clinical Teaching Basics

Objectives : 

Objectives Describe effective clinical teacher Behavior/Skills Knowledge Incorporate proven teaching strategies into your bedside teaching Orienting learner 1-2 focal teaching points/interaction Feedback Engage in self-assessment teaching ACGME – PBL & I

Slide 49: 

The hardest conviction to get into the mind of the beginner is that education upon which she is engaged is not a college course, not a medical course, but a life course… Sir. William Osler

What is teaching? : 

What is teaching? Teaching is more than talking to students and listening to them respond. Teaching is a process of design, interaction, evaluation, and redesign. Lee Shulman, PhD President Carnegie Foundation for Advancement of Teaching

References : 

References Brookfield SD. Becoming a Critically Reflective Teacher 1995:Jossey-Bass; San Francisco. Ende J, Pomerantz A, Erickson F. Preceptor’s Strategies for Correcting Residents in an Ambulatory Care Medicine Setting Acad Med 1995:70(3):224-229. Krippendorf R, Simpson D, Schiedermayer D. Promoting Reflective Teaching with Personal Digital Assistants. Acad Med 1999;74(5):577. Heidenreich C, Lye P, Simpson D, Lourich M. The Search for Effective and Efficient Ambulatory Teaching Methods Through the Literature. Pediatrics 2000;105:231=237.

References : 

References Marcdante KW, Simpson DE. How Pediatric Educators Know What to Teach: The Use of Teaching Scripts. Pediatrics 1999;104(1)S148-150. Pinsky L, Monson D, Irby D. How Excellent Teachers are Made: Reflecting on Success to Improve Teaching Advances in Health Sciences Educ 1998;3:207-215. Pinksy LE, Irby DM, If at First You Don’t Succeed: Using Failure to Improve Teaching Acad Med 1997;72:973-976. Smith CS, Irby D. The Roles of Experience and Reflection in Ambulatory Care Education. Acad Med 1997;72(1):32-35 Vella J, Berardinelli P, Burrow J. How Do They Know They Know. Jossey Bass; San Francisco