Improving Teaching and Learning in Clinical Settings

Professor Hossam Hamdy University of Sharjah

Aim
What is Clinical Teaching Barriers to effective Clinical Teaching Strategies to improve Clinical Teaching

Triad Interactive Learning in the Clinical Context

Context Student

Teacher

Content

Patient

THE PHYSICIAN AS TEACHER

It is still supposed that because a man is an accomplished physician, he is an excellent teacher. Abraham Flexner, 1910

BASIC QUESTIONS
Is training others an integral part of the responsibilities of a Physician/Surgeon? Does the institution recognize it and reward education training?

Barriers to Effective Clinical Teaching A global Concern

Time lack for clinicians. Insufficient space to teach. Crowded outpatients. Increasing number of super-specialist clinics.

Barriers to Effective Clinical Teaching (cont/-)

Lack of patients and inpatient beds. Lack of consistency in what is taught. Lack of organization in what is taught between teachers.

Barriers to Effective Clinical Teaching (cont/-)

Teaching is not considered part of service commitment not recognized by the institutions Lack of knowledge and skills about teaching methods.

The Clinical Context

More shift from Hospital setting to Ambulatory settings. Diminish the significance of bedside teaching short length of stay.

The Clinical Context

(cont/-)

Hospital populated with critically ill and early post-operative patients. Early diagnosis no or little physical signs.

Key Clinical Competencies

What are the key clinical competencies you as a clinical teacher want to ensure that the students have accomplished
Good communication and data gathering (history and physical examination Clinical reasoning Decision Making, investigation and treatment EBM Ethics and professionalism Patient Safety

ADULT LEARNING PRINCIPLE

Adults learn best when the educational experience ensures that:
The content is relevant and has meaning and purpose for everyday issues. The learner is actively involved. Objectives are defined and goals set. Positive feedback is given. Reflection on the learning experience is encouraged.

Effective Clinical Teaching

Planning set
Be available (on time) and approachable. Introduce yourself and know their names. Pre select patients/ Ask permission Ensure respect for patients comfort and dignity

Clinical Teaching
Planning set
(cont/-)

Clarify expectations and goals appropriate to the setting, patient problems and student level prior knowledge

Clinical Teaching
Teaching Dialogue
Teach from clinical cases. Go to the bedside or exam room Use questions to diagnose patient & learners. Train the students how to take a focused history and physical examination

Clinical Teaching
Teaching Dialogue
Role model Focus the teaching on data gathering by or about the patient critical player Promote student clinical reasoning skills..
(cont/-)

Non-Analytical Reasoning
Pattern

recognition

Context specificity. Prior knowledge & net-working. Schemata and script concordance.

Analytical Reasoning

Cues form c/o duration Early hypothesis generation Testing and re-testing hypothesis Ranking and re-ranking hypothesis

Clinical Reasoning
EBM Approach

Pre-test Probability

TEST

Post-test Probability

Each question in the history and each physical examination is a diagnostic test.

Combined Model of Clinical Reasoning

Patient Presents Case Representation Hypotheses Tested

Non-analytic

Interactive

Analytic

Clinical Teaching Tips

Increase the student base of scenarios, scripts and mental images.

Students should be guided to relate novel experience with past experiences Anchor proto-type in their memory.

Clinical Teaching Tips (cont/-)

Model Professional Thinking and Decision Making Preceptor Thinking Out Loud

Implicit / Tacit

Explicit

Key features of disease Relevant information focused history & physical exam.

Clinical Teaching Tips (cont/-)

Model Professional Thinking and Decision Making Preceptor Thinking Out Loud

Priority in investigations and treatment. Review diagnostic probabilities and rationale for diagnosis and treatment.

The Effective Clinical Teacher (D. Newbie)

1.

Encourages active student participation rather than passive observation Emphasis on teaching of applied problem solving Integrates clinical medicine with basic science Close observation of students during interview/examination rather than side-room case presentation

2.

3.

4.

The Effective Clinical Teacher (D. Newbie)

5. 6. 7. 8. Provides adequate opportunity for students to practice skills Provides good role-model for interpersonal relationships with patients Teaching patient-oriented rather than disease-orientated Demonstrates a positive attitude towards teaching

The Effective Clinical Teacher

Most important being willing to teach and be enthusiastic about it

Thank You