Supreeya Wongtra-ngan,MD.,MHPEd

4 สิ�งหาคม 2548เรี�ยนท่�านคณบดี�

ผมเขี�ยนบ�นท่�กน��ดี�วยความเป็�นห�วงค�ณภาพขีองน�กศึ�กษาป็#ท่�$ ๖ในป็'จจ�บ�น ซึ่�$งผมเพ�$งสิอบไป็เม+$อเรี,วๆน�� เขีาสิามารีถตอบค0าถามเก�$ยวก�บโรีคและการีว�น�จฉั�ยแยกโรีคต�างๆไดี� แต�ไม�สิามารีถรีวบรีวมขี�อม6ลจากผ6�ป็7วย การีซึ่�กป็รีะว�ต�และการีตรีวจรี�างกายก,ท่0าไดี�แย� อาการีและอาการีแสิดีงหลายอย�างถ6กขี�ามไป็ เน�นแต�การีสิ+บค�นท่างห�องป็ฏิ�บ�ต�การี แสิดีงให�เห,นว�าเขีาขีาดีท่�กษะในท่างคล�น�ก ไม�สิามารีถน0าขี�อม6ลมาป็รีะกอบก�บความรี6�ท่างท่ฤษฎี�เพ+$อใช้�ในการีแก�ป็'ญหาผ6�ป็7วย

ผมแน�ใจว�าเก�ดีจากการีท่�$ม�เวลาน�อยในช้��นคล�น�ก จ�งขีอให�คณะฯขียายเวลาเรี�ยนออกไป็อ�กหน�$งป็#เพ+$อเพ�$มพ6นท่�กษะท่างคล�น�กมากขี��น

ขีอแสิดีงความน�บถ+ออย�างย�$ง

นพ.เพ�$มพ6น เต,มล�น

What is Clinical Teaching?

Where does it take place?

When does it take place?

• Bedside teaching• OPD, OR, LR• Ward rounds• Independent patient contact• Simulation, Role play• Case discussion• Home visit• etc

ผ6�เรี�ยนขีองเรีาค+อใครี

Principles of learning

Learning climateInternal motivationMeaningful learningLearning objectiveIdentify resourcesPracticeReinforcement

The Learning Pyramid

Lecture

Reading

Audiovisual

Demonstration

Group discussion

Practice by doing

Teach others

5%

10%20%

30%

50%

75%

80%

National Training Laboratories, Bethel, Main,USA

AverageRetention Rate

• Be enthusiastic

• Interested in the well-being of students

• Prepare for your teaching

• Authentic medical problems

• How to improve teaching and students’

learning

Ronald J Markert, 2001

CLINICAL COMPETENCIES

Factual Knowledge

Technical Skill

Problem Solving Skill

Communication Skill

Manners & Etiquette

Recall

Comprehension

Application

Analysis

Synthesis

Evaluation

Cognitive domain

Bloom 1956

CLINICAL COMPETENCIES

Factual KnowledgeTechnical SkillProblem Solving SkillCommunication SkillManners & Etiquette

Perception

Set

Guided response

Mechanism

Complex overt response

Psychomotor domain

Simpson

Clear understanding of the task

Supervised practiceDirect experienceRepetitionPersistence

ผ6�ป็7วยน��นสิ0าค�ญไฉัน???

In what may be called the natural method of teaching the student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.

Sir William Osler,1904

Be on timeInsist that students arrive on time

Plan the clinical teaching session

Involve the patientsInform the charge nurseInvolve all the studentsInsist on a standard format

Use a problem –solving approach

Conduct discussion away from the patientDo not try to do too much

 

  การีเตรี�ยมพรี�อม 

ป็รีะเม�นผล การีท่ดีลองฝึ?กป็ฏิ�บ�ต� 

สิรี�ป็ขี�อสิ0าค�ญหล�งพบผ6�ป็7วย สิรี�ป็ขี�อสิ0าค�ญก�อนนศึ.พบผป็.

(Debriefing)(Briefing) 

ช้�วงพบผ6�ป็7วย 

Clinical learning cycle

Briefing Briefing patient students

Debriefing Clinical

Session practice

Including

the Patient

Briefing the patient Explaining the purpose Seeking co-operation Negotiating roles Preparing patient

Briefing students Providing a framework Generating ideas

Clinical practice Modelling appropriate

behaviors Using questions

Debriefing Analysis discoveries Discussing insights

CLINICAL COMPETENCIES

Factual KnowledgeTechnical SkillProblem Solving

SkillCommunication SkillManners & Etiquette

You are driving a car.

On one big storm night.

You are passing a station.

There are three people who are waiting for the bus

One doctor who saved your life before.

One guy/lady who is someone you have been dreaming to get married to.

One old lady who is dying.

You can only take one passenger, which one you will choose? Please explain your reason.

" Give the car key to the doctor, let the doctor take the old lady to the hospital and I stay to wait for the bus with the lady of my ream!"

Everyone I know think the above answer is the best answer, but there is no one (including myself) can think of this answer first.

Is that because we never want to give up any advantage we held in our hands (the car key)? Sometimes, we would gain more if we were able to give up our stubbornness, limitations, and advantage.

CLINICAL COMPETENCIES

Factual KnowledgeTechnical SkillProblem Solving SkillCommunication SkillManners & Etiquette

• Informed consent

• Confidentiality

• Truth telling

• Maternal-fetal conflict

• Quality end of life care

• Conflict of interest

• etc

Objective

Learning experience

Learner

Evaluation

Education cycle

• Multiple choice question• Modified essay question• Short/ Long case• Case report• Structured oral exam• Objective Structured Clinical Examination (OSCE)• OSLER• Direct observation: check list, rating scale• Standardized patient

To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all

Osler 1903

Good night