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R esident E ducator D evelopment. The RED Program A Residents-as-Teachers Curriculum Developed by Heather A. Thompson, MD. The RED Program. Team Leadership How to Teach at the Bedside The Microskills Model: Teaching during Oral Presentations How to Teach EBM The Ten Minute Talk

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r esident e ducator d evelopment

ResidentEducatorDevelopment

The RED Program

A Residents-as-Teachers Curriculum

Developed by Heather A. Thompson, MD

the red program
The RED Program
  • Team Leadership
  • How to Teach at the Bedside
  • The Microskills Model: Teaching during Oral Presentations
  • How to Teach EBM
  • The Ten Minute Talk
  • Effective Feedback
  • Professionalism
  • Patient Safety and Medical Errors
the microskills model clinical teaching during oral presentations

The Microskills Model:Clinical Teaching DuringOral Presentations

Resident Educator Development (RED) Program

what is the microskills model
What is the Microskills Model?
  • A 5 step process of clinical teaching
  • Can be used during oral presentations, bedside or sit-down rounds, or any other case-based discussion
  • Originated in the business literature and was applied to clinical medicine as a model for enhancing education

Neber, J.O., Gordon, K.C., Meyer, B., and Stevens, N. “A Five Step Microskills Model of Clinical Teaching” J Am Board of Family Practice 5:419-424, 1992.

is there data
Is there data?
  • Faculty members who had completed training in the Microskills model had improved scores on feedback

--Journal of Gen Int Med 17(10) 779-87 Oct 2002

  • Randomized trial of Microskills training vs. no training in surgical residents: Improved scores on an OSTE station

--Academic Medicine 73(6) 696-700 June 1998

the 5 steps
The 5 Steps
  • Get a commitment
  • Probe for Supporting Evidence
  • Teach General Rules
  • Reinforce what was done right
  • Correct Mistakes
get a commitment
Get a commitment
  • After presenting the facts of a case to you, the learner may stop and wait for your response.
  • Instead of telling them the answer, ask them to state what he or she thinks about the issues presented by the data.
get a commitment1
Get a commitment
  • Examples—
    • “What do you think is going on with the patient?”
    • “How can you tie all of this together?”
    • “What would you like to accomplish with this hospital stay (or clinic visit)?”
    • NOT: “This is obviously a case of viral meningitis.”
probe for supporting evidence
Probe for Supporting Evidence
  • After committing him or herself on the presenting problem, the learner may look to you to either confirm or refute the opinion.
  • Before doing that, ask the learner for evidence that he or she feels supports the opinion.
probe for supporting evidence1
Probe for Supporting Evidence
  • An alternative approach is to ask the presenter to expand the differential diagnosis of the patient’s presenting complaint, physical findings, or data.
probe for supporting evidence2
Probe for Supporting Evidence
  • “I am interested in how you came to that diagnosis.”
  • “What were the major findings that led to your conclusion?”
  • “What other things did you consider regarding the patient’s abdominal pain?”
  • “What else might be causing the (pleural effusion, elevated LFT’s…)?”
  • “What further questions are arising in your mind?”
probe for supporting evidence3
Probe for Supporting Evidence
  • NOT: “List all of the possible causes of post op fever.”
  • NOT: “I don’t believe this is consistent with acute pancreatitis. Don’t you have any other ideas?”
  • NOT: “What was their last creatinine?”
  • NOT: “What if the patient had just immigrated from Somalia?” (read my mind questions)
teach general rules
Teach General Rules
  • You have ascertained from what the learner revealed that there is a knowledge gap.
  • At this point, provide general rules, concepts, or considerations targeted to the learner’s level.
teach general rules1
Teach General Rules
  • Example: “Patients with cystitis usually have pain with urination, frequency, urgency, and a positive UA. However, fever, flank pain, nausea and vomiting would be unusual, and this usually indicates the presence of pyelonephritis.”
  • NOT: “This patient needs IV antibiotics!” “The last time I saw this condition…”
reinforce what was done right
Reinforce what was done right
  • The learner may or may not realize that their plan of action was effective and will have a positive impact.
  • Focus on the specific deed and the effect it had.
reinforce what was done right1
Reinforce what was done right
  • “You considered the cost of the medication and the schedule of dosing in your selection of an antibiotic. This will contribute to improving this patient’s compliance.”
  • NOT: “Good job.” “Strong intern.”
correct mistakes
Correct Mistakes
  • In the case where the learner’s work has demonstrated mistakes, this needs to be discussed as soon as possible.

--What went wrong and why

--How to avoid or correct the error in the future

correct mistakes1
Correct Mistakes
  • “You may be right to attribute this patient’s altered mental status to the UTI. However, given the history of a recent fall in a patient on Warfarin, a head CT really should be done to rule out bleed or subdural hematoma.”
  • NOT: “Why didn’t you get a head CT?!” “You never want to miss __________”
view video clips
View Video Clips
  • “Pre-Microskills”: Med student and resident discussing case in clinic.
  • “Post-Microskills”: same scenario only incorporating some of the Microskills steps.
practice the microskills model
Practice the Microskills Model
  • Split into pairs.
  • One person plays the resident; the other, the medical student.
  • Go through the case scenarios.
  • Use the 5 Steps to help educate your student.
group discussion
Group Discussion
  • Describe your clinical scenario and the discussion that followed.
  • What went well? What did you like about the Microskills model?
  • What didn’t go well? Any pitfalls to avoid?
in summary microskills
In summary: Microskills
  • Get a commitment
  • Probe for Supporting Evidence
  • Teach General Rules
  • Reinforce what was done right
  • Correct Mistakes