8 strategies for effective teaching · 2006-11-13 · 8 strategies for effective teaching charles...

8 Strategies for Effective Teaching8 Strategies for Effective TeachingCharles J. Hatem, M.D.Charles J. Hatem, M.D.

Harold Amos Professor of MedicineHarold Amos Professor of MedicineHarvard Medical SchoolHarvard Medical School

Director of Faculty Programs in Medical EducationDirector of Faculty Programs in Medical EducationThe Shapiro Institute of Education and Research at Beth Israel DThe Shapiro Institute of Education and Research at Beth Israel Deaconess eaconess

Medical Center and Harvard Medical SchoolMedical Center and Harvard Medical School

Director of Medical EducationDirector of Medical EducationMount Auburn HospitalMount Auburn Hospital

Director, The Academy Center for Teaching and LearningDirector, The Academy Center for Teaching and Learning

September 13, 2006September 13, 2006

[email protected]@mah.harvard.edu

mailto:[email protected]

8 Strategies for Effective Teaching8 Strategies for Effective Teaching

Because of copyright restrictions, the following slides contain the text of this discussion without many of the images.

““Teaching is a messy, indeterminate, Teaching is a messy, indeterminate, inscrutable, often intimidating, and highly inscrutable, often intimidating, and highly uncertain taskuncertain task.”.”

Richard Elmore*Richard Elmore*

*Christensen CR, Garvin D, Sweet A. *Christensen CR, Garvin D, Sweet A. Education for Judgment, The Artistry of Discussion LeadershipEducation for Judgment, The Artistry of Discussion Leadership. Harvard Business . Harvard Business School Press, 1991. Forward, School Press, 1991. Forward, xixi..

“Teaching can be “Teaching can be compared to selling compared to selling commodities. No one commodities. No one can sell unless can sell unless someone buys…[yet] someone buys…[yet] there are teachers there are teachers who think they have who think they have done a good day’s done a good day’s teaching irrespective teaching irrespective of what pupils have of what pupils have learned.”*learned.”*

*Dewey *Dewey How We ThinkHow We Think, quoted by David Garvin in, quoted by David Garvin inChristensen CR, Garvin D, Sweet A. Christensen CR, Garvin D, Sweet A. Education for Education for Judgment, The Artistry of Discussion LeadershipJudgment, The Artistry of Discussion Leadership. . Harvard Business School Press, 1991. page 5.Harvard Business School Press, 1991. page 5.

Clinical TeachingClinical TeachingGoals of Session:Goals of Session:–– To discuss principles of adult learning and To discuss principles of adult learning and

their application to clinical teaching and their application to clinical teaching and learning;learning;

–– To review 8 essential strategies to achieve To review 8 essential strategies to achieve excellence in clinical teaching, andexcellence in clinical teaching, and

–– To share insights/techniques amongst To share insights/techniques amongst ourselves about effective clinical teaching and ourselves about effective clinical teaching and learning.learning.

Clinical TeachingClinical Teaching

OverviewOverview

Need to accommodate theseNeed to accommodate these challenges:challenges:

Different interestsDifferent interestsDifferent levelsDifferent levelsTimeTime

8 Strategies for Effective Clinical Teaching8 Strategies for Effective Clinical TeachingStrategy #1: Remember the ultimate goal of medical educationStrategy #1: Remember the ultimate goal of medical education

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.

Knows

Shows how

Knows how

Does

Pro

fess

iona

l aut

hent

icity

Pro

fess

iona

l aut

hent

icity

Cognition

Behaviour

After, After, CeesCees van van derder VleutenVleuten

The care of patients

Competency-based training

8 Strategies for Effective Clinical Teaching8 Strategies for Effective Clinical Teaching

Strategy #2 Strategy #2

remember the remember the following following assumptionsassumptionsabout adults about adults as learners*as learners*

*Stephen *Stephen LiebLieb. Accessed 9/16/2006. Accessed 9/16/2006http://http://honolulu.hawaii.edu/intranet/comhonolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/mittees/FacDevCom/guidebk/teachtip/adultsadults--2.htm2.htm

Adults,Adults,–– Are autonomous and Are autonomous and

selfself--directeddirected–– Have accumulated a Have accumulated a

foundation of life foundation of life experiences and experiences and knowledgeknowledge

–– Are goal directedAre goal directed–– Are relevancyAre relevancy--orientedoriented–– PracticalPractical–– Need to be shown Need to be shown

respectrespect And

http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm





remember the remember the following principles following principles about learning about learning

Knowledge is Knowledge is constructed, not constructed, not accumulatedaccumulated

Ende J. What If OslerWere One of Us? JGIM. April 1997 (Supp.2); 12:S411-48.

Wang, K. et al. N Engl J Med 2003;349:2128-2135

Electrocardiograms Showing ST-Segment Elevation in Various Conditions

V1

V2

V3

II

80 year-old woman with pericarditis

Wang, K. et al. N Engl J Med 2003;349:2128-2135

Electrocardiograms Showing ST-Segment Elevation in Various Conditions

LVH

LB3

Acute pericarditis

Pseudoinfarctpattern with hyperkalemia

Acute anteroseptalMI

Acute anteroseptalMI & RB3

Brugadasyndrome



remember the remember the following principles following principles about learning about learning

Knowledge is Knowledge is constructed, not constructed, not accumulatedaccumulated

Expertise depends on Expertise depends on experience with casesexperience with cases

Students learn when they Students learn when they are involvedare involved

Learning is both a Learning is both a personal and a social personal and a social processprocess

Ende J. What If Osler Were One of Us?JGIM. April 1997 (Supp.2); 12:S411-48.

John Dewey

8 Strategies for8 Strategies for Effective Clinical TeachingEffective Clinical Teaching

Strategy #3Strategy #3

Find outFind outwhere inwhere inthe worldthe worldthe learnersthe learnersare ‘at’ are ‘at’

Cognitively

Stylistically

Developmentally

Personally Fiona Lake & Gerard Ryan. Teaching on the run tips 2: educational guides for teaching in a clinical setting. MJA;180:May 17, 2004



Use the followingUse the followingtemplatetemplate

Learning community

Safety__________________________

Microskills of teaching

Educational contract___________________________________________

Knowing the learner

Stephen Stephen KufflerKuffler19131913--19801980

Know the learnerKnow the learner

Know the Know the learnerlearner

RanjanaRanjanaSrivastavaSrivastava, MBBS, MBBSA Foreign ConceptA Foreign ConceptAnn Intern Med.Ann Intern Med.2004;140:10572004;140:1057--1058.1058.




Learning community

Safety__________________________



Knowing the learner

Feedback

Roles/Content

Needs & Expectations

Modified from Pratt D, Magill M.

Essential for feedback & evaluation of learner & program

J Med Educ.1983;59:452




Learning community

Safety____________________



Knowing the learner

What do you think?

Why?

Teach general principles.

What are your major questions at this point?

Reinforce what’s right.

Correct mistakes.

How can I be of most help to you?

*Modified from: *Modified from: NeherNeher JO, Gordon KC, Meyer B, Stevens N. JO, Gordon KC, Meyer B, Stevens N. A fiveA five--step “step “microskillsmicroskills” ” model of clinical teachingmodel of clinical teaching. J Am Board . J Am Board FamFam PractPract. Jul. Jul--Aug; 5(4);419Aug; 5(4);419--24.24.

Active listening

8 Strategies for 8 Strategies for Effective Clinical Effective Clinical TeachingTeaching

Strategy #4Strategy #4Use the followingUse the followingtemplatetemplate

Learning community

Safety_____________________

SNAPPS model

Educational contract_________________________________

Knowing the learner

Narrows the differentialdiagnosis

Analyses the differential diagnosis

Probes (asks the teacher about areas not understood)

Plans management

Selects an issue for self-directed learning

Summarizes the case

“SNAPPS” model*

* Wolpaw T, Wolpaw D, Papp K. SNAPPS: a learner centered approach for outpatient education. Acad Med 2003;78:893-898.




Learning community

Safety__________________________



Knowing the learner

Maslow’shierarchy

Osler’s frequent salutation: “fellow students”

www.gurutoyou.com/images/pyramid.gif



Use questionsUse questionseffectivelyeffectively

Evaluation

Synthesis

Analysis

Application

Understanding

Knowledge

Bloom’s Taxonomy

In 1956, Benjamin Bloom headed a group of educational psychologists who developed a classification of levels of intellectual behavior important to learning.

He found 95 % of test questions only required recall of information.




Hierarchy of knowledge and examples of questions to Hierarchy of knowledge and examples of questions to determine the learner’s knowledge*determine the learner’s knowledge*

**Adapted from Peyton and Adapted from Peyton and AlleryAllery; and Douglas et al. see; and Douglas et al. see Fiona R LakeFiona R Lake, , Alistair W Vickery &Alistair W Vickery &Gerard RyanGerard Ryan Teaching on the run tips 7: effective use of questions Teaching on the run tips 7: effective use of questions MJA 2005; 182 (3):126-127

Evaluation

Synthesis

Analysis

Comprehension

Facts

How well have you managed this patient?What have you learned?

What do these findings mean?

In this patient what is the Dx? Rx? Likely outcome?

What are the causes? Effects? What do you understand by…?

What is the name of…? Where…?

8 Strategies for Effective Teaching8 Strategies for Effective Teaching



Hierarchy of knowledge and examples of questions to Hierarchy of knowledge and examples of questions to determine the learner’s knowledge*determine the learner’s knowledge*

**Adapted from Peyton and Adapted from Peyton and AlleryAllery; and Douglas et al. see; and Douglas et al. see Fiona R LakeFiona R Lake, , Alistair W Vickery &Alistair W Vickery &Gerard RyanGerard Ryan Teaching on the run tips 7: effective use of questions Teaching on the run tips 7: effective use of questions MJA 2005; 182 (3):126-127

Evaluation

Synthesis

Analysis

Comprehension

Facts

How well have you managed this patient?What have you learned?

What do these findings mean?

In this patient what is the Dx? Rx? Likely outcome?

What are the causes? Effects? What do you understand by…?

What is the name of…? Where…?

Isidor Rabi: Nobel Laureate Physics, 1944

Of his mother he said: “She wasn’t so much interested in what he had learned that day, but she always inquired, ‘Did you ask a good question today?’ ‘Asking good questions,’ Rabi said, ‘made me become a scientist.’”




“Research data: teachers wait less than 1 second for students to respond. By prolonging wait-time to at least 3 seconds, students’ responses become 3-7 times longer and contain more logical arguments and speculative thinking.” (Penciner R. Clinical Teaching in a busy emergency department: strategies for success. Can J Emerg Med. July, 2002; 4)


Strategy # 6Strategy # 6

Remember the Remember the three beneficiaries three beneficiaries of clinical teachingof clinical teaching

The patient’s voice is The patient’s voice is heard:heard:

“I am Luis Alejandro “I am Luis Alejandro Velasco…”Velasco…”




The The houseofficerhouseofficer/student’s /student’s voice is heard:voice is heard:

at the bedsideat the bedsideas fellowas fellow--student student as fellowas fellow--teacherteacher




The faculty’s voice is heard:The faculty’s voice is heard:

as role model/ as role model/ hidden curriculumhidden curriculum

stimulating the stimulating the ‘curiosity gene’‘curiosity gene’

Faith Fitzgerald, M.D.Faith Fitzgerald, M.D.



reflect, reflect, reflect, reflect, reflectreflect



Daniel Federman, M.D.

Be Kind

Think out loud

Stick to the basics

Follow some really good advice

8 Strategies for More Effective Teaching8 Strategies for More Effective Teaching

Remember:Remember:1.1. ultimate goal of medical educationultimate goal of medical education2.2. assumptions about adults as learners and the assumptions about adults as learners and the

principles about learningprinciples about learning3.3. where the learners are ‘at’where the learners are ‘at’4.4. the basic templates of teachingthe basic templates of teaching5.5. the taxonomy of effective questions the taxonomy of effective questions 6.6. the beneficiaries of clinical teachingthe beneficiaries of clinical teaching7.7. the role of reflective practicethe role of reflective practice8.8. Federman’sFederman’s advice!advice!

Coda Coda (in 6 parts)(in 6 parts)

[in music]”…a coda is required to ‘look back’ on the main body, allow listeners to ‘take it all in’, and ‘create a sense of balance.’”Charles Burkart/Wikipedia

http://images.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/en/6/63/Coda_sign.png&imgrefurl=http://en.wikipedia.org/wiki/Coda_(music)&h=42&w=40&sz=1&hl=en&start=4&tbnid=0QFZZdCLVzYM2M:&tbnh=42&tbnw=40&prev=/images%3Fq%3Dcoda%2Bmusic%2Bsign%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DRNWG,RNWG:2004-12,RNWG:en%26sa%3DX

Coda: Part 1

Good teaching is as much passion as it is about reason. Richard Leblanc

t

T

“We must acknowledge “We must acknowledge again that the most again that the most important, indeed, the important, indeed, the only, thing we have to only, thing we have to offer our students is offer our students is ourselves.”*ourselves.”*

**TostesonTosteson D.C. D.C. Learning in medicine.Learning in medicine.N Engl J Med 1979; 301:690-694.

Daniel C. Tosteson, M.D.

Dean, HMS 1977-1997

Coda: Part 2

Charles HandyCharles Handy

“…three old“…three old--fashioned fashioned wordswords——curiosity, curiosity, forgiveness, and forgiveness, and lovelove——still lie at the still lie at the heart of all learning.”heart of all learning.”

Handy: Waiting for the Mountain to Move. Reflections on Work & Life. Jossey-Bass, 1999

Coda: Part 3

Coda: Part 4 Take Risks/Have FunTake Risks/Have Fun

www.llywelyn.net/images/authors/thurber.jpg

James Thurber

“You might as well fall flat on your face as lean over too far backward.”

Coda: Part 5Coda: Part 5

Stanley Joel Reiser is the Griff T. Ross Professor and Director of the Program on Humanities and Technology in Health Care at the University of Texas Health Science Center, Houston.

What is Empathy and Can It Be Taught? Howard Spiro (ed.)

Coda: Part 6Coda: Part 6“The last word belongs to Eli, who wrote in his best, “The last word belongs to Eli, who wrote in his best,

55--yearyear--old printing, his advice to new teachers.”*old printing, his advice to new teachers.”*

4 4 ImprtintImprtint Things for Things for NooNoo TeechrsTeechrs to Memberto Member

1.1. SumtimsSumtims therther are no rite are no rite ansersansers..2.2. Its Its eeziereezier with a buddy.with a buddy.3.3. AlweesAlwees smile.smile.4.4. WhanWhan yoryor braenbraen gets gets hevyhevy be be shersher to to empteempte

sum and sum and thnthn play and get sum rest.play and get sum rest.

*Wassermann S. *Wassermann S. This Teaching Life.This Teaching Life. Teachers College Press, 2004.Teachers College Press, 2004.

8 strategies for effective teaching · 2006-11-13 · 8 strategies for effective teaching charles...

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