Download Teaching Skills for Residents

Teaching Skills for Residents
Jonathan Finder, MD
Jamie Johnston, MD
Academy of Master Educators, Residents as Teachers Committee
February 4, 2009
Introduction: One of the most important tasks given to residents is teaching.
Teaching occurs at many levels and in many settings. This document is meant to
serve as an outline to help residents consider ways to improve their teaching
skills.
Teaching occurs in 3 primary settings: work rounds, didactic sessions, and oneon-one teaching. Each setting requires different skills and involves teaching at
different levels.
In all settings there are common themes, which include recognizing and using
teachable moments, teaching without intimidation, teaching to level, and making time to
teach.
1. Work Rounds
Ward rounds or work rounds involve trainees at many levels, from medical
student to senior resident. The team is generally led by a physician in his/her
2nd or 3rd post-graduate year. The primary task of work rounds is that of
communication: events of the past 24 hours, including the admission of new
patients to the team are discussed in varying levels of details. Each new patient
presentation is an opportunity to teach with potential teachable moments.
Teaching opportunities in work rounds are broad, and include discussion of
differential diagnosis, physical examination, pathophysiology, pharmacology,
system-based practice, data interpretation, and ethical issues. The challenge for
the team leader is to keep rounds on task and on time without sacrificing
teaching on the altar of efficiency.
Another challenge is for the least experienced members to feel involved and not
overwhelmed. Teaching without use of intimidation is an important skill here.
Rapid-fire questions without follow up is not a useful teaching technique.
When a gross deficiency is identified in a student’s knowledge base, allowing the
student to redeem him/herself to the team by a 3 minute presentation (also called
the educational prescription) the following day is helpful to all (e.g., “OK,
tomorrow come back with a 3 minute talk on how Kawasaki disease presents in
children.”).
Tied in with this technique is the resident’s unique ability to assess deficiencies
in students’ skills, knowledge base, and presentation styles. Identification of
weaknesses in the students is key to their development as physicians. How these
weaknesses are presented to the student is also important, as it is important to
avoid humiliation, intimidation, and devaluing of the individual. Minor
problems are discussed in the setting of work rounds (“did you mention the
family medical history?”) while major problems are best discussed privately.
2.
Didactic sessions
Pure didactic sessions are teaching sessions that are not a part of patient care. In
general, didactic sessions are given by senior/supervisory residents. Teaching
can be topic-based (“antibiotics”), skill-based (student oral presentations,
physical examination techniques). The major issue in didactic sessions is making
time to teach. Having a regularly scheduled time when the students can count
on having a didactic session allows them better regularity in their schedules as
well as gives them a chance to prepare presentations. Didactic sessions can be
led by a resident or attending or can be led by students with precepting by the
resident or attending. Principals of teaching described above (teaching to level,
avoidance of intimidation, etc) apply to small group didactic sessions as they do
to work rounds.
3.
One-on-one teaching sessions
Individualized teaching is generally done during the course of the work day and
not on a scheduled basis. The major task here for the resident is identifying
“teachable moments” when a few minutes of teaching can help cement a learning
point that may have come up during the course of patient care. These sessions
need not be more than a few minutes in length, but can have a considerable
impact on the student experience. Positive teaching experiences tend to draw
students towards the field in which the experience occurs.
One-on-one sessions are the ideal format for constructive feedback (covered
elsewhere in these materials).
The “microskills” approach to precepting
The concept of “microskills” refers to short, yet effective teaching moments
applied during patient care rounds. The 5 microskills of teaching, as described in
Resident’s Teaching Skills (2002, Edward, Friedland, Bing-You) are:
1. Get a commitment (what do you think is causing his fever?)
2. Probe for support evidence (“why mononucleosis?”)
3. Teach general rules (“it’s rare to see mono without
lymphadenopathy”)
4. Reinforce what is right (“Good call on avoiding amox – that would
have resulted in a rash in this setting.”)
5. Correct mistakes (“one of the tests you ordered costs $500 and the
results are not available for 2 weeks. Shall we cancel that?”)
This schema basically takes a successful precepting style and crystallizes it into a
standardized formula that can be reproduced in almost any clinical setting. It is
ideal for one-on-one precepting. The above scenario describes how one may
approach a presentation of possible mononucleosis. This can be applied to any
clinical problem.