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Thomas K. Swoboda, MD, MS Department of Emergency Medicine LSUHSC - Shreveport
Microskills of Clinical Teaching The Teachable Moment Examples
role model.What is a Teacher? A teacher… – Has knowledge – Has experience – Has a role as teacher. mentor The natural urge is to share all that you know – Resist this urge! .
Engage the Learner Focus on the learner Diagnose the learner Give the learner appropriate feedback Remember that each learner has different needs – Knowledge deficits – Level of knowledge .
Levels of Knowledge Unconsciously incompetent Consciously incompetent Consciously competent Unconsciously competent .
Set the Stage for Learning Tell the learner what is expected Make it a safe and supportive environment Reinforce the need for honesty State that “thinking out loud” is encouraged .
The Microskills of Clinical Teaching (Neher. et al) Takes about 5 minutes Utilizes teachable moments .
Microskill #1 GET A COMMITMENT – When learner waits for your response or asks for your guidance – Elucidate what the learner is thinking What do you think is going on? Why do you think the patient is here? What do you want to do next? – Avoid the urge to pipe in or agree or disagree at this point (gathering info) .
Any other ideas? Wow… that is a classic case of “X” What are the vitals? What are the meds? .Microskill #2 PROBE FOR SUPPORTING EVIDENCE – Need to know why the learner thinks the way they think – Need to understand the reasoning used What are the findings that led to your conclusion? What else did you consider? Why did you rule out “X”? Is there anything else that you need to know? – Avoid these: I don’t think that’s right.
Microskills #1 and #2 Allow you to generally discern: – What the learner knows – What the learner needs to learn – Allows you to apply your general learning concepts to teach the learner .
Microskill #3 TEACH GENERAL RULES – Teach specific bits of info based on the case being discussed – Avoid taking over the case – Keep it short and sweet Avoid a long didactic session “Hit and run” – Helps reach a consensus on the patient evaluation .
Microskill #4 REINFORCE WHAT THE LEARNER DID RIGHT – Builds on learner’s self-esteem – Make it behavior specific .
” .” Avoid: – “You did a good job with that patient. Excellent job. By putting together the history of syncope with RLQ pain and getting the additional menstrual history. you made the correct diagnosis of an ectopic pregnancy.Example of Good Reinforcement “Your H&P were complete and appropriate for the patient’s complaint.
” “That was not the way to handle that patient. do you need to read.” “Boy. but we should perform a careful physical exam and see if we can get info from other sources such as Invision.” .Microskill #5 CORRECT MISTAKES – – – – Keep this step last Choose appropriate time and place Start by having the learner self-evaluate Then offer specific observations and suggestions for improvement – Avoid: “I can understand the difficulty in obtaining a history from this drunk patient.
Microskill #6 IDENTIFY THE NEXT LEARNING STEPS – Try to foster self-directed learning – Ask the learner what they think that they need to learn from the encounter Offer specific resources where they can get the info Agree with the learner on an action plan – Consider a follow-up session to make certain next step is taken .
The Teachable Moment Occur thousands of times in the ED Every situation offers the chance to teach .
make your point and move on .Teachable Moments in the ED Every case has many teachable moments Requires attention from the teacher Use them immediately Be gentle Don’t tackle too much at one time – Pick the “best one” “Hit and run”.
Making the Most of Teachable Moments Follow sound learning principles: – Be sensitive to learner’s needs and issues – At the bedside. be sensitive to patient care issues – NEVER embarrass the learner .
Identification of Teachable Moments Topics can come from: – – – – – – – – History Physical Exam Documentation Medical Decision Making Charts Presentations Orders and Management Plans Bedside Evaluation Sources can be from: .
Examples from Charts Documentation of tetnus prophylaxis in wound care – Teach importance of documentation – Discuss indications for passive and active immunization .
Example from Presentations Disjointed presentations – Teach how to give an organized presentation – Allow the presenter to try to give it immediately – Formal presentation versus presentation to a consultant .
Example from Management Plan Stabilization of patient in acute respiratory distress – Teach airway evaluation – Discuss evaluation of adequacy of oxygenation and ventilation – Uses and limitations of pulse ox – Indications for non-invasive ventilation techniques .
Example from Bedside Evaluation Observing a pelvic exam – Teach patient comfort measures – Teach techniques to improve exam findings – Discuss utility of pelvic exam. the limitations and value of the exam .
Summary Make it brief – “Educational hit and run” Use facilitated learning techniques – Avoid didactics Keep it focused – Address the learner’s needs Give timely feedback – Encourage self-directed learning with follow-up .