Clinical Teaching

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Clinical Teaching

• Jennifer Welsh, MD
• David Power, MD, MPH

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Clinical Teaching

• The microskills model is an easy to use, quick,
  well-studied way to improve your teaching skills.
• Used in family medicine settings around the
  country
• You can use the steps you need based on available
  time and your students needs.

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Microskills Model of Clinical Teaching 5 Steps

• Get a commitment
• Probe for supporting evidence, then
• Teach general principles
• Reinforce what was done right
• Correct mistakes

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Microskill 1 Get a Commitment-Examples

• For senior students and junior residents
• What do you think is going on?
• What would you like to accomplish on this
  visit?
• Why do you think this patient has been
  non-compliant?
• For junior students
• Do you have ideas about what could be causing
  this patients symptoms?
• What do you think is the patients main
  concern?
• Not Whats the family history? Anything else
  I should know?

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Microskill 2 Probe for Supporting Evidence

• Examples
• What were the main findings that led to your
  diagnosis?
• Im interested in understanding how you have
  come to this conclusion.
• Why did you choose that medication given the
  availability of others?
• Not
• Name the 6 most likely causes of _______.
• Dont you have any other ideas?

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Microskill 3 Teach General Principles - Examples

• Typically there are two main treatment options
• The important factors to consider are...
• Not
• Ive always done it that way.
• This patient needs Lasix.

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Microskill 4 Reinforce What Was Done Right

• You did a really good job of prioritizing that
  patients long list of problems at todays
  visit.
• You were conscious of the patients financial
  situation and the cost in selecting the most
  appropriate antibiotic. This will help the
  patient be compliant with medication.
• Not
• Good job!

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Microskill 5 Correct Mistakes

• You may be right that this childs symptoms are
  due to a URI. But without checking the ears, you
  may be overlooking an otitis media.
• There are more cost-effective approaches to
  treating ___________.
• Not
• Good job.
• Why dont you read about that later.
• That whole case was handled badly.

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Clinical Teaching

• Now that youve seen the microskills, its time
  to put them in action. The steps are
• Get a commitment
• Probe for supporting evidence, then
• Teach general principles
• Reinforce what was done right
• Correct mistakes