Teaching tips

1
Teaching tips
2
Teaching in residency

• PGY-1 Core content
• PGY-2 Supervisory roles in MICU, SICU
• PGY-3 Supervisory role in ED, teaching workshops
  and procedural lab
• Other Outside lectures, workshops, ACLS courses

3
Overview

• Curriculum development and instructional systems
  design
• Characteristics of adult learners
• Using questions and feedback to promote critical
  thinking
• Effective presentation styles
• Teaching procedures

4
What is learning?

• A planned behavior change that has permanence
• Based on KSA (Knowledge, Skills, and Attitudes)

5
(No Transcript)
6
Curriculum development and instructional systems
design

• Determine learner outcomes
• Develop evaluation process
• Determine instructional strategies
• Select media and methods
• Develop instruction
• Implement instruction
• Evaluate instruction

7
Objectives

• Facts information with arbitrary relationship
• Concepts classes of elements with common
  characteristics
• Principles correlational effects, explains WHY
• Procedures set of sequential steps performed to
  accomplish purpose, explains HOW

8
Facts

• Overdosing on facts is like giving thyroxine to
  a tadpole-you get an instant frog, but
  unfortunately a rather small one
• Smith L Medical education for the 21st
  century. J Med Educ 60 106-112, 1985

9
Characteristics of adult learners

• Experienced
• Oriented by need/problem (WII-FM)
• Learners decide content
• Concerned for immediate need
• Prefer active learning
• Skills-oriented
• Informal
• Self-directed
• Equal
• Intrinsic rewards

10
Information giving and Prescribing

• Limit the amount of information given
• Give the most important facts first
• Stress importance of information to learners
  needs
• Avoid jargon
• Relate information to the problem at hand
• Use repetition for emphasis
• Make instructions specific, behavioral, and
  measurable
• Present alternately acceptable treatments or
  procedures

11
People will remember

• 10 of what they read
• 20 of what they hear
• 30 of what they see
• 50 of what they see and hear
• 70 of what they say and write
• 90 of what they do

12
Six levels of cognitive objectives

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

13
Questioning

• Teachers talked 70 of time
• Asked questions 4 of time
• Wait time of 1.8 sec

14
Questioning

• Clinical teachers can make sure that their
  interactions simulate problem solving by asking
  questions rather than giving answers. Learners
  may think they are learning more by being given
  answers, but actually being asked questions is
  far more productive

15
Effective clinical teaching behaviors

• Creates positive learning environment
• Communicates expectations (avoids assumptions)
• Controls session
• Uses questions to guide and promote understanding
• Provides tangible and constructive feedback
• Uses techniques to increase understanding the
  FACS model. Focus Activate Crystallize
  Summarize
• Motivates and energizes group with personal
  commitment and enthusiasm

16
Counterproductive instructor behavior

• Discussion stoppers
• teacher talks 75 of time
• teacher answers 75of their own questions
• teacher cuts-off or interrupts students
• Providing indirect feedback with WDY questions
• Why Did You
• Feedback focuses on whats wrong rather than
  whats right

17
Helpful instructive behaviors

• Guide learning with questions (FPC)
• Focus, Probe, Challenge
• Ask questions that explore the why and how as
  well as the what, when, and where
• Give learners time to answer questions or perform
  procedures (dont interrupt!)

18
Constructive feedback

• Provide useable feedback (not just you did
  lousy)
• Limit the quantity of feedback stick to the main
  points
• Remember the 4 Ps praise in public, perfect in
  private
• Use the collective we were still having a
  little trouble with

19
Constructive feedback

• Use the praise sandwich praisecorrective
  feedbackpraise
• Use appropriate timing no distractions, adequate
  time for discussion, no one freaking out (student
  or teacher)
• Be descriptive and specific avoid WDY messages,
  focus on actions, not presumed intentions
• Develop several calming responses to defensive
  reactions from students
• Okay, Im sure you feel this way now, but lets
  look down the road
• Fine, I can appreciate that, but I want you to
  know my perspective

20
Questions (summary)

• Avoid discussion stopping behavior
• Avoid WDY questions
• Use FPC questions
• Ask why and how as well as what and when
• Provide constructive feedback
• Wait long enough for a response

21
Effective presentation skills

• Say what you are going to say, say it, and say it
  again
• Elements of lecture introduction, body,
  summation and closure
• Paper primacy
• Advantages of lectures
• Disadvantages of lectures

22
The 10 commandments of slidemaking

• Keep it simple
• Talk more-show less
• Be visually consistent
• One message, one slide
• Never apologize for a slide

23
The 10 commandments of slidemaking

• Design for the back row
• Use only readable type face
• Make headlines
• No red text
• Drive 55. 5 words per line, 5 lines per slide

24
Levels of competency

• Unconsciously incompetent
• Consciously incompetent see one
• Consciously competent do one
• Unconsciously competent do one more

25
Teaching procedures

• Do not talk about superfluous material
  (indications...)
• Break down the procedure in small parts
  (demonstrate)
• Have learner verbalize parts of procedure
• Stop learner if they do something incorrect (with
  procedures people do NOT learn from their
  mistakes, they learn their mistakes)
• Give enough supervised practice

26
Resources

• Whitman N. and Shenk TL. The physician as
  teacher. Whitman and Associates 1997 (801)
  943-1401
• Bland et al. Successful faculty in academic
  medicine. Essential skills and how to acquire
  them. 1990 Springer
• Irby D. Teaching and learning in ambulatory care
  settings A thematic review of the literature.
  Acad Med 70 898-931, 1995

27
Kahn EM, Yardely NJ. Relationships of client
attributes and guides techniques to client
satisfaction at a climbing school. J Wilderness
Med 5339-351, 1994

• Paid attention to my concerns
• Highlighted essential points to remember
• Explained, demonstrated, practiced climbing
  maneuvers
• Balanced talking and doing
• Explained safety system, made efficient use of
  time, set comfortable pace
• Divided time fairly among group

28
Kahn EM, Yardely NJ. Relationships of client
attributes and guides techniques to client
satisfaction at a climbing school. J Wilderness
Med 5339-351, 1994

• Clarified learner goals and objectives
• Explained the plan for the day
• Let learner know what to expect
• Got to know learner well before teaching
• Offered help when the learner was stuck
• Provided positive feedback to encourage learners

29
Author Credit Teaching Tips Felix Ankel MD

• Questions

30
Postresidency Tools of the Trade CD

• 13) Negotiation Ramundo
• 14) ABEM Certifications Cheng
• 15) Patient Satisfaction Cheng
• 16) Billing, Coding Documenting Cheng/Hall
• 17) Financial Planning Hevia
• 18) Time Management Promes
• 19) Balancing Work Family Promes Datner
• 20) Physician Wellness Burnout Conrad /Wadman
• 21) Professionalism Fredrick
• 22) Cases for professionalism ethics SAEM
• 23) Medical Directorship Proctor
• 24) Academic Career Guide Chapter 1-8
  Nottingham
• 25) Academic career Guide Chapter 9-16 Noeller

• 1) Career Planning Garmel
• 2) Careers in Academic EM Sokolove
• 3) Private Practice Career Options - Holliman
• 4) Fellowship/EM Organizations Coates/Cheng
• 5) CV Garmel
• 6) Interviewing Garmel
• 7) Contracts for Emergency Physicians Franks
• 8) Salary Benefits Hevia
• 9) Malpractice Derse/Cheng
• 10) Clinical Teaching in the ED Wald
• 11) Teaching Tips Ankel
• 12) Mentoring - Ramundo