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Teaching Residents to be Teachers

Shannon U. Waterman, MD – Swedish Family Medicine Cherry Hill Kimberly Collins, MD – University of Washington Family Medicine Residency. Teaching Residents to be Teachers. Family Medicine Residency Network Webinar | February 7, 2018. Residents as Teachers.

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Teaching Residents to be Teachers

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  1. Shannon U. Waterman, MD – Swedish Family Medicine Cherry Hill Kimberly Collins, MD – University of Washington Family Medicine Residency Teaching Residents to be Teachers Family Medicine Residency Network Webinar | February 7, 2018

  2. Residents as Teachers WWAMI Network Faculty Development Webinar Series February 7th, 2018 Shannon U Waterman, MD

  3. POLLIn your own residency, what training did you have to be an effective teacher?

  4. Residents as Teachers • Students (preclinical, clerkship, sub-i) • Peers • Patients • Faculty • Public 20-25% of resident work

  5. ACGME Residents are expected to develop skills and habits to be able to meet the following goals: • IV.A.5.c).(8) participate in the education of patients, families, students, residents and other health professionals. (Outcome, PBLI)

  6. AAFP - Curriculum Guidelines: Residents as Teachers and Precepting in Postgraduate Practice At the completion of residency training, a family medicine resident should be able to:  Recognize the value of—and incorporate opportunities for—teaching a variety of learners (e.g., students, residents, colleagues, patients) regarding the clinical practice of medicine (Prof)  Demonstrate effective teaching skills and strategies to actively engage learners in a variety of clinical settings (e.g., hospital, clinic, bedside, nursing home) and academic/didactic settings in a manner appropriate to the size and needs of the audience (PBLI, Comm)

  7. AAFP - Curriculum Guidelines: Residents as Teachers and Precepting in Postgraduate Practice  Assess learners in a developmentally appropriate manner using a standardized framework to provide both summative and formative evaluation (PBLI)  Effectively provide direct positive and constructive feedback to learners in a timely manner and be able to navigate individual barriers to the feedback process (PBLI, Comm)  Strategize incorporating learners into clinical and non-clinical learning environments while emphasizing maintenance of excellent patient care and clinical efficiency (PBLI, SBP) http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint290B_Postgraduate.pdf

  8. AAFP – Value of Teaching • Teaching is an important skill for physicians, and experience improves this skill, as well as solidifying knowledge of the content being taught. • Teaching students increases student choice of family medicine and develops future colleagues. • Incorporating teaching into a physician’s career increases job satisfaction and reduces burn out. • Having a better understanding of teaching and learning makes people better learners themselves. • Patients admire physicians who are teachers. • Learning how to teach makes physicians better patient educators. http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint290B_Postgraduate.pdf

  9. How does your program teach residents to teach? “Oh no - we don’t have a formal teaching curriculum!”

  10. Swedish Cherry Hill ExperienceSeattle 6 site 14/12/12 • Intern Orientation (feedback, teaching MS3/4, PRIME, supervision) • Senior Orientation R2/R3 (feedback 2.0, PRIME, 5 Microskills, supervision) • FMS Senior (peer R2/3 mentorship - “pearls,” chalk talks, case review, bedside teaching) and clinic preceptor for UW clerkship students • EBM Talk (R2, 15 min, PICO format) • “Bread & Butter” talk (R3, 45 min) • Grand Rounds (Paired R3s, 50 min. Two+ advising sessions – evidence & presentation itself.)

  11. Teaching Resources for Programs • Mount Sinai curriculum • Stanford Pediatrics Residency example • AAIM (proprietary) • NDRL – UW’s online resource for faculty

  12. Mount Sinai -The Resident Teaching Development Program http://www.jacksonhealth.org/library/residents-fellows/sample-handout-teaching.pdf

  13. Mount Sinai - Resident Teaching Development Program

  14. Stanford Pediatrics Residents as Teachers

  15. Stanford Pediatric Required Teaching Senior Rotation (4 week) • Preparation and planning for teaching • Learning Styles • Teaching in large groups • Teaching in small groups • Bedside teaching • Teaching in the context of clinical care • One-on-one teaching based on direct observation • Feedback and Evaluation • Curriculum design and evaluation • Reflection and self-assessment

  16. Curriculum (proprietary) Oral Presentation Progress Notes Physical Examination New Patients Clinical Reasoning Professionalism Conflict Resolution RIME Feedback Interns as Teachers

  17. POLL Are there other topics you tackle in your teaching curriculum which I’ve not listed previously? Ex: Conflict resolution, Ethics, boundaries. Others?

  18. Teaching Resources for Individual Chief or Teaching Fellow • ACP Teaching Series • STFM Faculty For Tomorrow Workshop for Residents - Annual Spring Conference • STFM Residency Faculty Fundamentals Certificate Program (possibly for 4th year chief)

  19. Residency Faculty Fundamentals Certificate Program – NEW! • 25 hours, self-led • Core faculty development topics • 12 months to complete • Pass final test • $999 for STFM members • $1450 for non-members

  20. POLLS • What % of your residents have become medical school or residency faculty? 2) What % of your residents become community preceptors?

  21. Multiple Options • Informal curriculum – label it • Formal curriculum – series, ½ or whole day workshops , STFM conference • 4th Year Chief position • Teaching AOC

  22. 4th Year Chief position Benefits • Relieve 3rd yr chief(s) of administrative duties • Offers focused teaching experience, pipeline • Internal candidate knows curriculum, operations, EMR, clinic flow Challenges • Funding – program, institution • Recruitment – unpredictable year to year • “Neither, nor” – liminal, betwixt and between, potential isolation. Poor orientation to new role. • Administrative black hole – jeopardizes pipeline

  23. N= 90 medical students • 6 Medical Schools across Ontario, Canada J Grad Med Educ. 2014 Dec; 6(4): 694–697.

  24. Residents Teaching Techniques J Grad Med Educ. 2014 Dec; 6(4): 694–697.

  25. Residents Teacher Qualities J Grad Med Educ. 2014 Dec; 6(4): 694–697.

  26. Developing Future Family Medicine Educators:   The Creation of a Clinician-Educator Area of Concentration for Residents Kimberly Collins MD, Tara Simpson MD, Adam Nishimura MD University of Washington Family Medicine Residency

  27. Background • There is a shortage of qualified family medicine faculty in our country.1 • Approximately 68% of family medicine residencies are currently recruiting one or more faculty.2 • There is a need for training during residency on faculty development skills.1 1. Cullison S. Time to change our paradigm for faculty recruitment; old rules are failing us: we need to recruit new faculty before they graduate. Fam Med 2015;47(3):235-7. 2. Quick Hitter Question Data from AFMRD Annual Meeting, 2016.

  28. Background • All residents currently participate in teaching on our inpatient service, in clinic, and during didactics • Previously R3 residents taught medical students in the Intro to Clinical Medicine I course • With reform of the med student curriculum this opportunity was no longer available in 2015-16

  29. A Clinician-Educator Area of Concentration • We wondered if we could expand the resident experience in clinical and didactic teaching • Provide more experiences in clinical and didactic teaching for residents

  30. Audience Poll • Do you have an AOC for resident teaching or a teaching track within your residency? • Answer: Yes or No

  31. Audience Poll • Do you have a fourth year teaching fellowship or other opportunity available at your residency? • Answer: Yes or No

  32. A Clinician-Educator Area of Concentration Overarching Goals of the AOC: • To improve residents’ skills as educators by providing access to focused training and enhanced opportunities to educate medical students and colleagues • To prepare interested residents for a career in family medicine teaching

  33. A Clinician-Educator Area of Concentration • Practicalities of setting up an AOC: • Goals and objectives • Requirements • Teaching experiences

  34. A Clinician-Educator Area of Concentration Requirements (based on AFMRD*): • At least 2 months or 200 hours of training in the AOC. • At least one of each type of teaching experience: longitudinal, one-time, didactic, and direct clinical. • A scholarly project completed in the AOC, presented and evaluated locally. Presentation at the state and/or national level is encouraged. • Attendance at a national CME meeting in the AOC. • Journal club (critical appraisal) presentation of an article. • Successful completion of the residency program itself. *http://glfhc.org/residency/wp-content/assets/sites/7/2017/07/AFMRD-AOC_individual_guidelines.pdf

  35. A Clinician-Educator Area of Concentration

  36. A Clinician-Educator Area of Concentration • Clinical Teaching Experiences • Foundations of Clinical Medicine hospital tutorial groups • Community Health Advancement Program (CHAP) • Primary Care Practicum • Family Medicine Service • Didactic Teaching Experiences • Resident Didactics/R1 Core Skills Didactics • Family Medicine Interest Group • Underserved Pathway • Foundations of Clinical Medicine Course • OSCE Observer • Family Medicine Clerkship Clinical Reasoning Webinars • Faculty Development (EOQ) Meetings

  37. A Clinician-Educator Area of Concentration • Our first resident: • Tara Simpson, current R3

  38. A Clinician-Educator Area of Concentration

  39. A Clinician-Educator Area of Concentration

  40. A Clinician-Educator Area of Concentration • Adam Nishimura, current R2 • Innovative didactic teaching methods in Core Skills • Flipped classroom • Video Teaching: https://youtu.be/oiZlG51sAmU

  41. Poll: Can you provide some examples of teaching experiences, either longitudinal or didactic, that already exist or could be created within your residency? (Take about 5 mins)

  42. Next Steps • Developing an educational program over the 3 years on topics such as how to give feedback, precepting skills, teaching evidence-based medicine skills • Offering the experience to other incoming R1s and R2s • Collecting data and feedback on whether the AOC increases resident’s confidence in teaching and/or increases interest in a career in academic medicine

  43. A Clinician-Educator Area of Concentration • Questions

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