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Teaching When There's No Time To Teach:Strategies & Techniques for the Clinical Setting

Amelia Gaglietta, phtSusanne Mak, OTLiliane Asseraf-Pasin, phtCaroline Storr, OTMichèle Hébert, OT

Adopted by Linda Snell MD MHPE FRCPC FACP

Case-based

teaching

P & OT

Patients

Learners

Learning &teaching

D. Irby

Context

Time

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Who are the learners?

• Early student >>> colleagues– Pre-clinical > clinical > intern >

practitioner– Different levels of learners (at same level)

• Patients

Adopted by Linda Snell MD MHPE FRCPC FACP

Teachable momentAnywhere students, teachers and patients

collide …and some places they don’t!

• In-patient, clinic, rehab centre, home Patient-triggered Learner-triggered Teacher-triggered

Adopted by Linda Snell MD MHPE FRCPC FACP

A teaching moment can be…• A 5-minute discussion en

route to lunch• A case review/discussion• Formal bedside teaching

rounds• A mini-lecture or formal

class presentation• A moment on the

cardioresp team.• …

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EvaluationObjectives

Learningneeds

The Learning Cycle

Feedback

OrientationReflection

Strategies &Techniques

Content

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When teaching when time is limited …. think of the ‘learning cycle’

And focus on one part of the cycle, one bit of content, or use one strategy or

technique

Adopted by Linda Snell MD MHPE FRCPC FACP

Adult learning principlesStudents learn best

when… • They are actively learning• Their experience is used • It is student-centered • It is based on problems • They can apply what they learn • There is a positive learning

environment • They receive feedback

Adopted by Linda Snell MD MHPE FRCPC FACP

When teaching when time is limited…. use adult learning principles

And let the learner guide the learning

Adopted by Linda Snell MD MHPE FRCPC FACP

Cognitive apprenticeship

• Modeling: master teacher demonstrates the skill, thought process or technique

• Scaffolding: learner tries part with guidance

• Coaching: verbal guidance only• Fading: teacher withdraws, less

guidance

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When teaching when time is limited …. use the concept of cognitive apprenticeship

To pick your strategy and role related to the learner’s level

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Directed learner

Directed self-learner

Self-directed learner

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When teaching time is limited…use the concept of self-directed learning

Be a resource: help the student become an independent learner

Adopted by Linda Snell MD MHPE FRCPC FACP

Peer (and near peer) learning

Peer learning is effective (active, student-centered, cooperative,

communication, teamwork)

Peer learning often complementary to learning from teachers

Adopted by Linda Snell MD MHPE FRCPC FACP

When teaching when time is limited …. use the concept of peer learning:

Encourage all learners to teach

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Core competencies• Expert clinician• Communication skills• Professionalism and ethics• Interprofessional practice• Health of community, society • Appropriate use of resources• Produce and transmit new

knowledge

Adopted by Linda Snell MD MHPE FRCPC FACP

When teaching when time is limited …. remember the core competencies

Teach one competency … other than expert clinician!

Adopted by Linda Snell MD MHPE FRCPC FACP

Recap:Education concepts related to ‘no time’ ...

• The learning cycle• Adult learning

principles• Cog. apprenticeship

• Self-directed learning• Peer-learning• Core-competencies

Focus on one part Let learner guide Pick your role,

strategy Be a resource Use other learners Teach one

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Strategies, techniques and games

• Questions• Mnemonics• Frameworks• One-item

observe & feedback

• Brainstorm• Justify - interpret • Short

simulations

• Instructor plays patient

• ‘Triggers’• Deteriorating

case• ‘Expand the case’• ‘Clusters’• ‘Prevent’• ‘Where’s the

controversy?’

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Using questionsAsk questions of various

types to elicit knowledge, comprehension, application, or synthesis:

Eg: • Have you seen this

before?• When would you use this

technique?

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Mnemonics Eg. Carpal Bones:

• Some → • Lovers → • Try → • Positions→ • That → • They → • Can’t → • Handle →

ScaphoidLunateTriquetrumPisiformTrapeziumTrapezoidCapitateHamate

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Short simulations

• Practice hands-on procedural or physical exam skills prior to doing it on a real patient.

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Delay Gratification

• Do not answer all the Qs immediately-all team members look up the answer, then discuss later.

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Promoting clinical problem solving

What’s the most common teaching strategy used in clinical teaching:

• in the clinic discussing a patient?• at the bedside?• reviewing a patient in any

setting?

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Bloom’s taxonomyEvaluation Synthesis Analysis

ApplicationComprehension

Knowledge

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Bloom’s taxonomyEvaluationSynthesis AnalysisApplicationComprehension

Knowledge

Choose best? Argue all sides? Alternatives? New approach? Design? Etiology? Use it? Given this patient …? Define? Interpret?Compare/contrast? Who? What? Name? How many?

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Key messages• The contexts where teaching when time is

limited are multiple and varied • Effective teaching strategies used when time

is limited can be linked to ‘good’ educational practiceKnow the ‘indications’ for their use

• When time is not elastic, content is …Don’t teach too much!

Adopted by Linda Snell MD MHPE FRCPC FACP

The one(5”) minute teacher5 microskills for clinical teaching:

1. Get a commitment:

Ask student how they interpreted the situation.

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5 microskills2. Probe for supporting

evidence: • Ask student for their

evidence before offering your opinion.

(Allows you to find out what they know and identify the gaps.)

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5 microskills

3. Teach general rules and principles:

Teach 1 or more general rules targeted to current case but also generalize to other similar cases.

Adopted by Linda Snell MD MHPE FRCPC FACP

5 microskills4. Reinforce what is right:

Give feedback that is well timed, expected, case-specific, behavior-focused.

Adopted by Linda Snell MD MHPE FRCPC FACP

5 microskills5. Correct mistakes:

Ask the learner what was done right and what they would like to do better.

Adopted by Linda Snell MD MHPE FRCPC FACP