Angkor Hospital for Children Faculty Development Course

Narita Jan11

Set Goals Macro - expectations on how rounds will be conducted Medium what to cover on rounds for that day (which patients, etc) Micro what to focus on with specific patients Case Presentations - Case presentations should last 5 minutes or less - Can occur in three places: bedside, corridor or meeting area - Meeting area: least distractions, most comfortable, can use whiteboard, etc. - Bedside: greatest strength is that patient can participate in discussion (if in Khmer!) - Organized presentations flow from organized progress notes. Organized progress notes flow from organized thought processes. Bedside Teaching - Go to the bedside only for what is best taught at the bedside. - Visits should not exceed 5-10 minutes per patient dont dwell! - Keep juniors involved: The senior should either demonstrate a skill or observe a junior performing a skill. - Minimize the number of those that are just observing. - Plan your bedside visit before seeing the patient. - See the Twelve Tips at the end of this outline. Shared Teaching - Avoid the pressure to teach half listening and half The successful teacher is no longer jumping forward to what you might teach. Rather on a height, pumping knowledge at Involve juniors in setting the agenda for rounds high pressure into passive Ask juniors what they find most interesting or difficult receptacles he is a senior student in a patient anxious to help his juniors. Relay some of the questions posed back to the group, - W. Osler especially those more senior Assign juniors to report back on particular questions or topics Examples of Good Questions - Dont ask closed-ended yes-no questions but open-ended ones: Tossback: Sophal, what do you think? Any other thoughts? Go around the circle so all juniors can contribute. Feelings: How do you feel about this case? Especially good when dealing with social or psychological issues. Learners Choice: What is the most important issue to you with this patient? Problem List: List problems, prioritize problems, select one the group want to discuss Next Step: What would you like to do next? What if: What if the patient was acidotic at this point? What if we cultured out e. coli? Addressing Heterogeneity - One of the greatest challenges is teaching junior with different levels of skill/knowledge - Use more experienced juniors to teach a point either in or outside of rounds - Trickle down: Teach at a older junior level assuming the less experienced juniors will absorb what they understand - On an occasional basis separate newer juniors out for more focused learning

Teaching Tips for Seniors On-Call

Angkor Hospital for Children Faculty Development Course

Narita Jan11

Be Selective - Teachable moments are more memorable than 90 The dullest of teachers is the one who minutes of facts does not know what to omit. - Demonstrate one or two things at the bedside, cover O. Holmes one or two items from the problem list, ask one or two key questions and then move on. - Dont do on rounds what you can do alone. X-rays and labs should be gathered beforehand. Give Feedback - To evaluate, one must observe. Seniors and chiefs should give feedback on the following: Presentation skills: during rounds and also when asking questions, providing updates, etc. Charting/progress notes: including H&P, discharge summaries Clinical skills: interviewing, physical examination, diagnositic and therapeutic procedures Knowledge: most important is their interest in self-directed learning and medical judgment Organizational skills: time management, prioritizing tasks Teaching skills: inactions with patients, providing pearls to the team Interpersonal skills: dealing with patients, colleagues, hospital staff Twelve Tips for Bedside Teaching (simplified from Ramani) The American Council for Graduate 1. Preparation is a key element to conducting effective Medical Education and the WHO rounds and increasing a seniors comfort at the bedside. Advisory Committee on Medical 2. Plan what you want to achieve at the bedside for each Training recommend that training encounter the skills to demonstrated or points to be programs should increase the learned. frequency of bedside teaching in 3. Tell the juniors your plans for the session and ask them their clinical curriculum. if there is anything else theyd like to add. S. Ramani 4. Introduce yourself and the team to the patient. 5. Role-model the physician-patient interaction it is a valuable opportunity to teach them professionalism, interviewing techniques and bedside manner which cant be taught well through a lecture. 6. Make the session junior-centered. Dont do all the talking but observe the juniors responses and tailor the teaching to them. 7. Challenge the juniors minds without humiliation, providing gentle correction when necessary. 8. Review key learning points for the juniors at the end of each patient presentation. 9. Leave time for questions, clarifications, assignments, etc. 10. Ask the juniors what they felt went well and what didnt. 11. Be a reflective teacher: think about the bedside encounter, evaluate in your own mind what went well and what went poorly, and what you would do differently next time. 12. Start your preparation for the next encounter with insights from your reflection phase. References Kroenke. Attending Rounds: Guidelines for Teaching on the Wards Journal of General Internal Medicine 7, 1992. pp 68-75. Janicik, et al. Teaching at the bedside: a new model Medical Teacher 25(2), 2003. pp127-130. Ramani. Twelve tips to improve bedside teaching Medical Teacher 25(2), 2003. pp112-115.