Principles of Good Practice in Clinical Teaching

1
Principles of Good Practice in Clinical Teaching

• William Brady, MD
• Associate Professor of Medicine
• Temple University School of Medicine

2
Health Sciences Summer Teaching Institute

• Reaching All Students
• Clinical Teaching
• Feedback and Assessment
• Effective Lectures and Small Groups

3
Goals

• Describe adult learning theory and how it relates
  to health science students on clinical rotations
• Highlight the role of constructing knowledge for
  your learners and describe the steps for
  accomplishing it
• Review some techniques for creating a supportive
  learning environment for your learners

4
Learning Goals on Clinical Rotations

• Health science students should

5
Learning Goals on Clinical Rotations

• Health science students should
• Broaden knowledge base
• Master reporting
• Learn how to interpret
• Begin to manage

6
Blooms Taxonomy of Educational Objectives in the
Cognitive Domain
7
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

8
Knowledge

• Recall, or recognition of terms, ideas,
  procedure, theories, etc.
• Pneumonia is an infection of the lung.
• Patients with pneumonia commonly have a cough.
• Patients with pneumonia commonly have fever.
• Patients with pneumonia commonly have an abnormal
  lung exam and an infiltrate in the lungs on chest
  X-ray.

9
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

10
Comprehension

• Translate, interpret, extrapolate, but not see
  full implications or transfer to other
  situations, closer to literal translation.
• Pneumonia is an infection of the lung associated
  with a cough, fever, an abnormal lung exam, and
  an infiltrate on chest X-ray.

11
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

12
Application

• Apply abstractions, general principles, or
  methods to specific concrete situations.
• Mr. Smith tells me that he has a cough. On exam,
  I see he has a fever and an abnormal lung exam.
  He has an infiltrate on his chest X-ray. I think
  Mr. Smith has pneumonia.

13
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

14
Analysis

• Separation of a complex idea into its constituent
  parts and an understanding of organization and
  relationship between the parts. Includes
  realizing the distinction between hypothesis and
  fact as well as between relevant and extraneous
  variables.
• Mr. Smith has evidence of inflammation and a
  lesion localized to his right middle lobe. The
  likely diagnosis is pneumonia.

15
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

16
Synthesis

• Creative, mental construction of ideas and
  concepts from multiple sources to form complex
  ideas into a new, integrated, and meaningful
  pattern subject to given constraints.
• Mr. Jones appears to have pneumonia, but does not
  have the classic X-ray findings. I think that
  because he is dehydrated and immunosuppressed
  from his recent chemotherapy, he is unable to
  mount the normal response to pneumonia that would
  produce the typical X-ray.

17
Example of the Taxonomy

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

18
Evaluation

• To make a judgment of ideas or methods using
  external evidence or self-selected criteria
  substantiated by observations or informed
  rationalizations.
• Although the patient who has just had
  chemotherapy, is dehydrated because he has been
  vomiting, and has problems with his immune system
  may not exhibit the classic exam or chest X-ray
  of pneumonia, the competent internist who is
  unable to recognize his pneumonia has committed
  malpractice.

19
Blooms Taxonomy of Educational Objectives in the
Cognitive Domain
20
Knowledge is not accumulated,
21
knowledge is constructed.
22
Steps in the Construction of Knowledge
23
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner

24
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner
• Targeted teaching

25
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner
• Targeted teaching
• Identification of areas for further learning

26
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner
• Targeted teaching
• Identification of areas for further learning

27
Assessing Your Learner
28
Assessing Your Learner

• Beginning of rotation
• Prior experience
• Goals for the rotation
• Career interests
• In individual teaching encounters

29
Assessing Your Learner in Individual Teaching
Encounters

• Get a commitment
• Probe for level of knowledge and understanding,
  e.g.
• Why do you think it is that?
• What else could it be?
• How is this situation different than the last
  patient we saw with the same symptoms?

30
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner
• Targeted teaching
• Identification of areas for further learning

31
Give Feedback

• Correct mistakes
• Reinforce what was right

32
Steps in the Construction of Knowledge

• Assessment of the current knowledge of the
  learner
• Targeted teaching
• Identification of areas for further learning

33
Identifying Areas for Future Learning

• On rounds
• In feedback

34
Hints for Improving the Learning Environment

• Set expectations
• Eliminate competition
• Give the learner time to think
• Involve everyone
• Be willing to show your own deficiencies

35
Modeling Clinical Reasoning Skills

• Application, analysis, and synthesis are the
  primary learning objectives for health science
  students on clinical rotations,
• So make clinical reasoning an explicit part of
  their learning experience.
• Think out loud!

36
Modeling Clinical Reasoning Skills

• Application, analysis, and synthesis are the
  primary learning objectives for health science
  students on clinical rotations,
• So make clinical reasoning an explicit part of
  their learning experience.
• Think out loud!

37
Summary

• Application, analysis, and synthesis are the main
  learning objectives for health science students
  on clinical rotations.
• Knowledge is constructed, not accumulated.
• Probing your learners for their level of
  knowledge and understanding helps target your
  teaching.
• The teacher helps create the ideal learning
  environment.
• Clinical reasoning should be modeled.

38
Acknowledgements

• Blooms taxonomy
• Center for Teaching and Learning,UNC Charlotte
• http//teaching.uncc.edu/resources/best-practice-a
  rticles/goals-objectives/blooms-taxonomy
• Clinical teaching
• Ende, J. What if Osler were one of us?
  Inpatient teaching today J Gen Intern Med. 1997
  April 12(S2) S41S48