A faculty development exercise in clinical teaching
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A Faculty Development Exercise in Clinical Teaching. Eugene C. Corbett, Jr., MD Subha Ramani, MMEd Elizabeth G. Armstrong, EdD . Clinical Teaching. Teaching that enables a learner’s clinical performance development, in the care of the patient. experiencing.

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A faculty development exercise in clinical teaching

A Faculty Development Exercise in Clinical Teaching

Eugene C. Corbett, Jr., MD

Subha Ramani, MMEd

Elizabeth G. Armstrong, EdD


Clinical teaching

Clinical Teaching

Teaching that enables a learner’s

clinical performance development,

in the care of the patient


A faculty development exercise in clinical teaching

experiencing

1Identify problems from real life experience

Just Do It!

8Present a goal and discuss next steps

Activate Prior Knowledge

7Make clear the relevance for practice and encourage commitment to change

2Understand the problems and differences,brainstorm

GROWTH

doing

reflecting

6Select a solutionGive opportunity for personal practical application, e.g. simulators

3Select a specific problem, present data

What New

Knowledge?

Try It Out

5Evaluate consequences of solutions

4Consider alternative solutions

thinking


A faculty development exercise in clinical teaching

Experiencing

Why?

What next?

Doing

Reflecting

How does it work?

What?

Thinking


Today s clinical teaching exercise

Today’s Clinical Teaching Exercise:

Create a clinical teaching scenario

Try it out

Reflect upon it


A faculty development exercise in clinical teaching

Vignette Creation, Practice & Feedback

I

Design a clinical teaching scenario role play

Within individual group X or Y

20 minutes

II

2 Teaching, Observation and Debriefs

(20 minutes each)

Combined X + Y Group

40 minutes

III

Large Group Discussion

Reflections on clinical teaching, faculty development methods, and implications for teacher beliefs and practice

20 minutes


X and y groups

X and Y Groups

  • X Groups: Communication skills teaching

    As the clinical teacher, you are about to visit with a patient in the outpatient setting who has come in to discuss their care pertaining to a new diagnosis of cancer. You are working with a third year clerkship student and a pgy2 resident.

  • Y Groups: Physical examination skills teaching

    As the clinical teacher, you are about to visit at the bedside with a patient admitted for congestive heart failure. This creates the opportunity to work with your clerkship student, an intern and a pgy3 resident on their physical examination of a patient with mitral valve disease.


Clinical care performance competencies

Clinical Care Performance Competencies

Professionalism (many dimensions)

Patient engagement & communication skill

Scientific knowledge and method

Clinical history-taking

Mental & physical examination

Clinical testing & imaging (select, justify, interpret)

Basic clinical procedures

Information management (present, record, search, critique)

Diagnosis (differential diagnosis, patient problem lists)

Intervention (prevention, treat, palliate)

Prognosis (anticipate and plan for the future)

Placing care in practical context (personal, family, ethnic, economic, health system…)

Recommendations for Clinical Skills Curricula, AAMC, 2005, 2008


Clinical teaching requirements

Clinical Teaching Requirements:

Clinical expertise

Learner levels & needs

The Patient

Clinical circumstances (setting, time)

Clinical focus

Curriculum perspective

Learner evaluation & feedback

Experiential learning theory

Teacher self-efficacy


Debriefing and feedback of teaching

Debriefing and Feedback of Teaching


A faculty development exercise in clinical teaching

Experiencing

Just Do It!

Discuss scenario Identify problems

Activate Prior Knowledge

Do role-play Debrief Discuss next steps

GROWTH

Doing

Reflecting

Evaluate consequences

Get ready for role-play

Consider solutions

New

Knowledge

Try It Out

Thinking


A faculty development exercise in clinical teaching

Application of an Interactive Educational Strategy


Think establish goals

  • SMART goals

    • Specific, measurable, attainable, realistic, timely

  • Ends goals

    • Impact on patients

    • Impact on learners: Improved clinical skills, professionalism…..

  • Means goals

    • Impact on teachers:

      • Knowledge, skills or attitude

      • Immediate or long term

THINK: Establish goals


Educational frameworks

  • Educational frameworks help orient participants to the target goals

    • One minute preceptor

    • Stanford clinical teaching model

    • Create your own

  • Provide a common language for discussion of teaching and learning for constructive problem solving

Educational Frameworks


Pair approach to peer coaching

  • Partner

    • Commit to learner’s outcomes.

    • Maintain mutual trust, respect and “safety” (try new things, make mistakes).

  • Enquire

    • Ask questions

    • Challenge learner to:

      • Look at the situation differently- self, context, assumptions.

      • Clarify what he / she wants- desired outcomes.

  • Evaluate

    • Were outcomes achieved

  • Reflect (Mirror for the learner / partner)

    • Encourage self-reflection

    • Provide feedback.

    • Identify strategy to get there (Action plan)

PAIR: approach to Peer coaching


Share debriefing and feedback

  • Start with self- reflection

  • Focus on behaviors

    • Effectiveness in achieving desired goals

    • Responses they elicited in learners

  • Identify MOST effective behaviors first

    • Why or how these behaviors were effective

SHARE: Debriefing and feedback


Share debriefing and feedback1

  • Identify LESS effective teaching behaviors

    • Why or how these behaviors were not effective

    • Shared problem solving; brainstorm alternative strategies to use

  • Plan concrete actions for future similar teaching activities

    • Reassess adequacy of goals, establish new goals

    • Use of different teaching strategies/ behaviors

SHARE: Debriefing and feedback


A faculty development exercise in clinical teaching

What do the Observers Track?

Participation

Skills

“Who’s Talking?”

“Can they Analyze? Can they Present?”

The Group

Content

Activation

“Are they Getting it?”

“Who’s Driving the Learning?”


References

  • Lyman, F. (1981). "The responsive classroom discussion." In Anderson, A. S. (Ed.), Mainstreaming Digest. College Park, MD: University of Maryland College of Education.

  • Flynn et al. Peer coaching in clinical teaching. Fam Med 1994;26:569-570.

  • Orlander et al. Co-teaching as a faculty development strategy. Medical Education 2000;34:257-265

  • Siddiqui et al. 12 tips to peer observation of teaching. Medical Teacher 2007; 29: 297–300

References


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