c hief r esident i mmersion t raining landon center on aging university of kansas school of medicine...
TRANSCRIPT
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Chief Resident Immersion TrainingLandon Center on Aging
University of Kansas School of Medicine
Clinical Teaching:The 1 Minute Preceptor
Mary McDonald, MDKUMC – Dept of Family Medicine,
Division of Geriatric Med and Palliative Care
Chief Resident Immersion TrainingLandon Center on Aging
University of Kansas School of Medicine
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Types of TeachingPimpingLectureApprenticeshipMentorship
Venues for Teaching
Inpatient vs Outpatient
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
PimpingOften occurs on rounds
Both teacher and learner are active Patient-specific or hypothetical
Warning: Fine line between educational quizzing and emotional belittlement
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
LectureTeacher active but learner is passive
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
ApprenticeshipTeacher passive but learner activeCan occur on teaching rounds
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
PreceptorshipTeacher active and learner passiveOccurs in bedside teaching
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Case PresentationPresenting in Front of the Patient
PROs CONs
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Bedside Presentations*Patients reported:
Doctors spent more time with them (10 vs. 6 min) Perceptions of their care were slightly more
favorable Doctors were more likely to explain problems
adequately
*Lehman L, N Eng J Med 1997:336:1150
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Bedside Presentations*Bedside presentation patients reported: Did not provoke worry (88%) The practice should continue (82%) Helped them understand their illness (51%) Too much confusing medical terminology (46%) Perceived that the purpose of rounds was to
teach and not to provide care (94%)
*Lehman L, N Eng J Med 1997:336:1150
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Improving Bedside Presentations* Patients should be given the opportunity to
say more All physicians in room should introduce
themselves Physicians should be more attentive to the
presentations There should be fewer physicians in the room
*Lehman L, N Eng J Med 1997:336:1150
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Improving Bedside Presentations* The physicians should respect the patients
privacy more Physicians should ask permission to present
at the bedside Physicians should be seated during the
presentation
*Lehman L, N Eng J Med 1997:336:1150
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
How is teaching in an outpatient setting different?
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1-8Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Teaching in the Clinic
In-depth LecturesSeminarsFormal Educational SessionsExtensive Discussion
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1-9Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Efficient and effective ambulatory care teaching requires that both the student and preceptor accept the limitations of the outpatient setting.
Extensive discussions of differential diagnosis, pathophysiology and psychosocial problems are not possible nor necessarily desirable.
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Pitfalls in Clinical Case-Based Teaching “Taking over” the case Inappropriate lectures Insufficient “wait-time”: 3-5 sec Pre-programmed answers
What do you think is going on? Could it be an ulcer?
Rapid reward Effectively shuts down the student’s thinking
Pushing past ability Persist in carrying the students beyond their understanding
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
The “One Minute Preceptor” teaching model was developed at the Department of Family Medicine at the University of Washington, Seattle.
See: Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A five-step "microskills" model of clinical teaching. Journal of the American Board of
Family Practice, 5, 419-424.
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
The One-Minute Preceptor
1. Get a commitment
2. Probe for supporting evidence
3. Reinforce what is right
4. Give guidance about errors or omissions
5. Teach general principles
6. Conclusion
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Commitment Why?
Learner becomes more active in teaching encounter Allows you to assess how learner has processed
information presented Even if answer is incorrect, learning has occurred
Example What do you think is going on here? What would you like to do next?
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Probe for Evidence
Why? Uncovers learners reasoning process for arriving
at the conclusion (Not a lucky guess)
Example “What factors support your diagnosis?” “Why did you choose that treatment?”
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Reinforce What Was RightWhy?
Behavior specific feedback will promote and encourage desirable clinical behaviors.
Example “I liked that your differential took into
account the patient’s age, recent exposures, & symptoms.”
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Give Guidance About Errors or Omissions
Why? Behavior specific constructive feedback
discourages incorrect behaviors and corrects misconceptions.
Example “During the ear exam the patient seemed
uncomfortable. Let’s go over holding the otoscope.”
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Teach General RulesWhy?
Helps learner effectively generalize knowledge gained from this specific case to other clinical situations
Example “Remember 10-15% people are carriers of
strep, which can lead to false positive strep tests.”
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
ConclusionWhy?
Helps control time and sets clear agenda and roles for remainder of encounter
Example …“Let’s go back in the room and I’ll show
you how to get a good throat swab. Tell me when we have the results, and I’ll watch you go over the treatment plan.”
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Chief Resident Immersion Training
Landon Center on AgingUniversity of Kansas School of Medicine
Adapted from Materials…… Effective Clinical Teaching, Rohan Jeyarajah, MD and Hari
Raja, MD Lehman LS,et.al. The effect of bedside case presentations on
patients’ perception of their medical care. NEJM 1997;336:1150.
The “One Minute Preceptor”:Time Efficient Teaching in Clinical Practice. Preceptor Development Program, developed by MAHEC. Funded by HRSA Family Medicine Training Grant # 1D15PD50119-01
The One-Minute Preceptor &The One-Minute Observation Effective & Efficient
Outpatient Clinical Teaching. JHUSOM Department of Neurology, December 21, 2006