Practice and EvidenceBased Tips for Teaching in the Inpatient Environment

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Practice and Evidence-Based Tips for Teaching in
the Inpatient Environment

• Michael G. Ison, MD MS
• Divisions of Infectious Diseases Organ
  Transplantation

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Overview

• Roles Goals of Physician-Educators
• 1-Minute Clinical Preceptor
• Tips

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Roles Goals of Physician-Educators

• Manage the fast pace of patient care delivery
• Integrate learners into the patient care practice
• Deliver effective clinical teaching
• Assure high quality of care
• Evaluate the learners performances
• Providing feedback to the learner

Bowen JL. N Eng J Med. 20063552217-2225.
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One Minute Preceptor

• Developed for the outpatient arena
• Now applicable to inpatient and consultative care
  because of
• Decreased length of stay
• Work hour limitations
• There is more time to teach on the ward, but
• Multiple learners
• Multiple skill sets

Bowen JL, et al. Teach Learning Med.
20061835-41.
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One Minute Preceptor

• 5 Microskills
• Get a commitment
• What do YOU think is going on?
• Probe for supporting evidence
• Why is that the diagnosis, treatment?
• Teach general rules
• Provide positive reinforcement
• Correct mistakes

Neher JO, et al. Clin Teach. 19925419-424.
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One Minute Preceptor

• Advantages
• Time efficient
• Learner-centered
• Integrates learner assessment into each encounter

Bowen JL, et al. Teach Learning Med.
20061835-41.
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One Minute Preceptor
Bowen JL, et al. Teach Learning Med.
20061835-41.
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Tips Getting Started

• Get to know your learner
• Allows focused mentoring
• Allows you to modulate your expectations
• Provide an overview and orientation
• Sets expectations
• Discussed the unique features of your specialty
• Essential reading should be provided

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Tips Be a Model

• Be a good role model
• Wash you hands
• Wear a clean coat
• Be courteous, even when others arent
• Avoid Negativity
• If you order it, look at it
• Look at all radiology with a radiologist
• Review unusual or unexpected findings in the
  laboratory
• If there is a biopsy, you must look at it

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Tips Using the Literature

• Integrate the medical literature
• Have a file with important review articles and
  guidelines
• Provide firm data about your thoughts or
  recommendations
• Primarily review the classic data and put it
  into context
• Try to find an appropriate article for each case
• Encourage integration of data into note
• Consider e-mailing literature to team

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Tips Daily Rounds Teaching

• Organization of day
• Allow learner to have appropriate degree of
  independence
• Ask the trainee how they want rounds and teaching
  done
• Make a plan at the beginning of rounds
• Perform teaching in real time
• May take longer but keeps the learning in context

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Practical Tips for Teaching on the Inpatient
Service

• Jay Paparello, MD
• Division of Nephrology

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Education

• From the literature
• Teaching in Your Office, Alguire, et al.
• What makes a good teacher ?

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Teaching in Your Office, Alguire, et al.

• Communicating Expectations
• Stimulating interest enthusiastically
• Interacting skillfully with your patients
• Involving the learner in the teaching process
• Role modeling of the desired behaviors

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Communicating Expectations

• Define roles of the learners on the team
• More important that they feel needed, Slotnick
  even relates it to Maslows Hierarchy of Needs
  (Affiliation)
• As early as possible
• What are the learners goals
• OK to ask what they are interested in
• Helps define goals
• Shows interest in them

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Stimulating Interest Enthusiastically

• Be positive
• Dont be negative
• Love what you do, and want to do it.
• The most esoteric case has a differential of
  common things Make it relevant

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Interacting skillfully with your patients

• From Dr. Ison
• Be a good role model
• Respect for the patient, your team, staff
• If you dont know something, investigate

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Involve the learner in the teaching process

• Active learning is allows for better retention
  than passive learning
• Passive learning 10 recall
• Active Learning 25-30 recall
• Small group sessions with students reveal when
  the are questioned, they appreciate the attention
• Show respect
• Ask questions to encourage thought, not to demean
  or embarrass

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Role modeling of the desired behaviors

• Respect for patients
• Gain understanding of the patients perspective
• Use the learner to go back and reinforce the
  teams message
• Any questions about dialysis
• OK to acknowledge difficult patients/situations
• That was tough, anything we could have done
  better.

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Role modeling of the desired behaviors

• Use the literature
• A flash drive can hold a lot of papers
• Older papers provide some distinction and
  tradition
• New papers make the topic current

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A few points

• Overall attention declines after 45 minutes
• An adult can put 3 major facts an hour into long
  term memory

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From the literature

• How Doctors Learn The role of Clinical Problems
  across the Medical School to Practice Continuum,
  Slotnick, 1996
• Practical (a problem that will be faced in the
  future) Make the esoteric relevant
• This is a dialysis patient, what do you think
  the bicarbonate concentration is in the dialysate
  ?
• Participation (involve the learner)
• Active More recall
• Time efficient (Ruthlessly exclude the
  extraneous)
• Recognize other demands on learners time.
• If were looking at U/As, use the time
• Disband the entourage if not needed

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From others

• The Teaching moment - Keep it a moment
• Recognize the right time to reinforce a point
• Taking time to teach in a non-distracted way

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Provide regular feedback

• Dont be afraid to acknowledge something done
  well
• Give them a sandwich
• What was done right
• What was done wrong
• What to do next time

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Nephrology Rotation

• Unique in broad overlap with general medicine,
  but we will limit exposure to more technical
  aspects (such as dialysis, CVV) unless requested.
• Scheduled lectures attending with however many
  people are rotating on service (individualized
  attention)
• Enthusiastic faculty who like to teach

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From Parker Palmer

• Every teacher is unique, and should have their
  own style (dont emulate someone else, be
  yourself)
• Hirschtick, DeSantis at firm conference
• Recognize your audience, and their goals

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Questions?