Improving Medical Education

Skills

Many Family Medicine graduates teach…

• D6 students• New doctors who do not have post-graduate

training• Other healthcare staff• Patients

Objectives of workshop

• To discuss the role of the preceptor (clinical teacher and supervisor)• To learn about one way to teach while caring for

patients: “The one minute lecture”

The Preceptor

What is a preceptor?

What is a preceptor?

• A preceptor is an expert who gives training to a student• The Preceptor is a ROLE MODEL – • The preceptor shows the interns how to be a good

doctor• The MOST important quality is to be a good doctor

Preceptor

•Most of the learning will be at the patient’s bedside so ….

•The preceptor does… “Bedside Teaching”

What Is Bedside Teaching?

• Bedside teaching is the process of active learning in the presence of a patient

Who Participates in Bedside Teaching?

TeacherLearnerPatient

Who is ...

•Teacher (preceptor, intern, patient)

•Learner (preceptor, student, resident, patient)

•Patient

What Can The Preceptor Teach at the Bedside?

•Focused history taking •Physical exam skills•Patient management

We Also Teach ..

•How to be a good physician•How to care for our patients - how to talk to our patients, how to respond to our patients •How to teach – interns, patients •How to give feedback

The Preceptor Should

• Observe the learner working at the bedside, taking the history, doing the examination• Provide feedback to the learner, compliment what

was well done, correct any errors, offer alternate approaches• This should be done when you first meet and often

after that

All learners learn by doing

• Usually the learner will see the patient first, then present the history and examination findings to the preceptor

• The preceptor should interact • Talk to the patient and be sure the learner has the right

information• Ask the learner to show how they examine the patient

All learners learn by doing

• The preceptor should have the learner provide the diagnosis, and the plan for tests and treatments

• The preceptor should have the learner explain why they made the specific diagnosis or plan

• The preceptor should provide feedback, compliment what was good, correct any mistakes

All learners learn by doing

•BUT learners need guidance and supervision

• The preceptor should supervise their work

• The preceptor should review their ‘work’ regularly and

• The preceptor should provide feedback

Culture of Learning

• A preceptor is a teacher but you can also learn by interacting with others in a respectful way• The Preceptor has clinical experience and decision

making skills, the learner will have theoretical and book knowledge, they may teach each other• The Preceptor should promote a “culture of

learning together to help the patient”

THE ONE MINUTE LECTURE:

Take every chance to teach in the clinical setting!

General Objective

• Develop an approach to “The one minute lecture”

Specific Objectives

• Define “The one minute lecture”• Identify situations where “The one minute lecture”

can work• Identify teaching skills needed for “The one minute

lecture”• Identify barriers to “The one minute lecture” • Identify benefits of “The one minute lecture”• Practice

Introduction

• Many different teaching formats• Lectures, workshops, self-directed learning, bedside

teaching session• Can be in a classroom or at the hospital or clinic

Introduction

• With teaching in classroom • Teacher has control: pre-determined setting, objectives,

duration, audience• Advanced time for preparation for teacher, sometimes

for the student• Protected time for student and teacher: uninterrupted,

time for questions and answers, time for detail and discussion

Introduction

• With teaching in clinical setting• Residents and students with us most of the time• Teaching and learning done through working together

on patient care• Role modeling (learners watch us and how we work) • Cannot control what happens• Many interruptions

Introduction

• Clinical teaching is important for teaching skills beyond the medical expert• It is important to teach doctors how to be• Educator• Manager• Researcher• Community leader• Communicator• Professional

Definition

What is a one minute lecture?

Definition: Clinical teaching that…

• Is spontaneous (no advance preparation)• Is based on what clinical work you are doing at that

moment• Has defined objectives and duration (may be very

brief)• SHOULD BE USED OFTEN

Very effective as a teaching method in…• All clinical settings- Inpatient and Outpatient• Situations where plans are changed without

warning

What teaching skills do you need for the “one minute lecture” ?

Teaching skills

• Spontaneity and enthusiasm• Flexibility and open to questions•Resourcefulness•Approachability•Patience•Ability to recognize a teaching moment

What are some things that make the “one minute lecture” difficult? (Barriers)

Barriers

• We don’t always think about it• We can turn any part of patient care into an education

opportunity

• We don’t have time to prepare in advance• Tests our knowledge, organization

• We don’t always have time• Teaching slows down our day, slows patient care

• We have trouble only teaching a little bit about something• We feel we have to teach everything about the case, but we

can just choose one thing

What are some benefits of the “one minute lecture?”

Benefits: For the teacher, an opportunity to…

• Share clinical expert skills • Role model beyond medical expert (educator,

manager, professional, collaborator, communicator, health advocate, community leader)• Have fun with very interesting cases• Challenge and develop their teaching skills

Benefits: For the teacher, an opportunity to…• Show enthusiasm and caring for the learner• Observe the skills of the learner• Give feedback to their learners in many different

settings

Benefits: For the learner, an opportunity to…

• Feel rewarded for their work by receiving many teaching sessions• Interact with the teacher on a one to one basis• Receive feedback on many clinical issues• Discuss issues at their level of training

Goal

• Creates a partnership between teacher and student that leads to better patient care

TEAM CHALLENGE

• Each team will be given a case• Within that case the team should identify:• Potential “One minute lectures”/teaching topics• Barriers to teaching• Teaching skills needed• Benefits to the students/teachers

• Teams will present their results to the group

Case # 1

• You are working with a medical student• The student has just admitted a 6 month old baby

from the emergency department with severe meningitis• You need to perform a lumbar puncture • The family is very worried

Case # 2

• You are supervising a first year FMSP resident in your outpatient clinic• The resident has assessed a patient for a post

partum visit• The resident reviews the case with you and tells

you that the patient is very depressed and wishes to commit suicide

Case # 3

• You are working with a physician assistant• You are reviewing how to examine for ascites on a

patient with liver failure• While you are examining the patient, he has a

seizure

CASE # 4

• You are working with a first year FMSP resident• It has been very quiet lately with very few new

admissions • You go to see a patient who will be discharged

today after admission for heart failure from valvular heart disease and hypertension • The family also wishes to talk with you

Case # 5

• You are starting your Outpatient Department clinic with a D6 medical student• The nurse on the ward calls you because one of

your patients is very sick with hypotension (BP 70/30), dyspnea, and fever

CASE # 6

• You are working with a second year FMSP resident• You are waiting to go into the OR for an elective

case of repair of an inguinal hernia• The nurse tells you that the case will be delayed for

20 minutes

Approach To The One Minute Lecture• Take every opportunity to teach• Recognize that any situation has the potential for

teaching and learning• Decide how much time you can spare• Pick one brief, well defined teaching issue,

(recognize that it does not have to be all inclusive)

• Who is your audience “what are they ready for?”• What about your patient/family “what are they

ready for?”• Get the cooperation of the patient as a partner and

active participant

• Tell your learners it will be a teaching moment (example: “Now we will take a moment to review the medications we use for hypertension”)• Apply the usual basics of good bedside teaching…

make it interactive, lots of questions, summarize the major teaching points• Give learners some follow up topics to study

• Have fun! Your students will appreciate your efforts, and you will enjoy your role as teacher

• WE LEARN BY DOING TOGETHER- learn from your students!!