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PROFESSIONAL DEVELOPMENTOctober 3, 2013
Dr. V. Antao MD, CCFP FCFP, MHSc, Dr. G. Mand MBBS, CCFP, Dr. J. McCabe, MD, CCFP, Dr.
Yves Talbot and Dr. Yee-Ling Chang were involved in the creation of this session.
STRATEGIES FOR EFFECTIVE TEACHING IN AMBULATORY CARE
• This set of slides is adapted for DFCM Open. You can download these slides at www.dfcmopen.com/item/basics-effective-teaching.
“ The mediocre teacher tells. The good teacher explains. The superior teacher
demonstrates. The great teacher inspires.”
~William Arthur Ward
TEACHING STRATEGIES
OBJECTIVES
• Acquire an increased awareness of challenges in ambulatory care
• Review the One Minute Preceptor Model as a teaching strategy
• Review other common teaching strategies and teaching methods
OBJECTIVES
• Be familiar with some resources available to clinician teachers to address common teaching challenges
CHALLENGES IN TEACHING
• Reflect on your own experience:
• How do you teach?
• What challenges do you face teaching in your office?
ONE MINUTE CLINICAL PRECEPTOR
• Focuses teaching on learners reasoning• Based on 5 Microskills
1. Get a Commitment 2. Probe for evidence3. Teach general rules4. Provide feedback5. Correct mistakes
Neher J et al., A Five Step Microskills Model of Clinical Teaching. J. Am Board of Fam Practice, 5:419-24, 1992
GET A COMMITMENT
• What do you think is going on with this pt?• What investigations are indicated ?• What do you think needs to be
accomplished on this visit?
* resist asking data gathering questions at this time
PROBE FOR SUPPORTING EVIDENCE
• What are the major findings that lead to your conclusion ?
• What else did you consider ?• What made you choose this particular
treatment ?
• * “thinking out loud” rather than grilling
TEACH GENERAL RULES
• Keep it brief and focused on identified issues
• Instruction is more memorable when offered as a general rule
REINFORCE WHAT WAS DONE RIGHT
• Be specific• General praise does not reinforce a
particular behaviour
CORRECT ERRORS
• Consider appropriate time and place• Start with learner self evaluation• Consider language
“ Who dares to teach must never cease to learn.”
~John Cotton Dana
TEACHING STRATEGIES
COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE
1) Orienting learner2) Prioritizing or assessing learning needs3) Problem-oriented learning4) Priming *5) Pattern recognition6) Teaching in the patient’s presence*
Heidenreich C et al., Pediatrics 105:231-237,2000
COMMON AMBULATORY TEACHING METHODS DISTILLED FROM THE LITERATURE
7) Limiting teaching points *8) Reflective modelling9) Questioning10) Feedback11) Teacher/learner reflection
Heidenreich C et al., Pediatrics 105:231-237,2000
PRIMING
• Orientation of learner to pt. and tasks before entering room 1-2 min
1. Tasks
2. Attending role
3. Patient
4. Product
TEACHING IN THE PATIENT’S PRESENCE
• Learner presents findings to preceptor in front of patient– Increases preceptor time with patient– Enables direct verification of history/findings– Enables direct observation– Saves time
LIMITING TEACHING POINTS
• Focus on a few main points, less teaching, more learning
• General rules more memorable, more transferable
• At end of clinic, address other issue in more detail
• At next session review unresolved issues
CONCLUSIONS/SUMMARY
• There are numerous challenges associated with clinical teaching
• Effective teaching strategies may be used in ambulatory care
• A learner centred model of teaching is the One-Minute Preceptor (OMP)
REFLECTIVE EXERCISE
• Implement a Method/Strategy• -consider using the sample LOG
– Why did you chose this method?– Why was approach effective/ineffective?– What would you do differently next time? and
why?
TEACHING LOG
This is a teaching log created by Dr. Helen Batty and used in the Academic Fellowship Program.
EFFECTIVENESS OF TEACHING IMPROVEMENT INTERVENTIONS
Effective Teaching Interventions:
• Workshops• Teaching Evaluations with Consultation• Faculty development fellowship programs
• Wilkerson L et al., Strategies for Improving Teaching practices: A Comprehensive Approach to Faculty Development. Academic Medicine1998
RESOURCES
• Local undergrad/postgrad/PD representatives• Rubenstein W, Talbot Y. Medical Teaching in Ambulatory
Care, 2003• Neher J et al., A five Step Microskills Model of Clinical
Teaching. J. Am. Board. of Fam. Prac. 5:419-421,1992• Aagard E et al., Effectiveness of the One minute
Preceptor Model for Diagnosing the Patient and Learner: Proof of Comcept. Academic medicine 79:42-49,2004
TEACHING STRATEGIES
• Case discussion• Case review• Direct observation• Chart review• Chart stimulated recall• Criterion chart review• Role play• Short didactic presentation
Rubenstein W, Talbot Y Medical Teaching in Ambulatory Care
2003
“ If you have knowledge, let others light their candle at it.”
~Margaret Fuller
TEACHING STRATEGIES
Thank You