STRATEGIES FOR EFFECTIVE
TEACHING IN AMBULATORY
CARE
PROFESSIONAL DEVELOPMENT
October 3, 2013
Dr. V. Antao MD, CCFP, MHSc, Dr. G. Mand MD, CCFP, Dr. J. McCabe, MD, CCFP
Dr. Yves Talbot and Dr. Yee-Ling Chang were involved in the creation of this session.
• This set of slides is adapted for DFCM
Open. You can download these slides at
www.dfcmopen.com/item/basics-effectiveteaching.
TEACHING STRATEGIES
“ The mediocre teacher tells. The good
teacher explains. The superior teacher
demonstrates. The great teacher
inspires.”
~William Arthur Ward
OBJECTIVES
• Acquire an increased awareness of
challenges in ambulatory care
• Review the One Minute Preceptor
Model as a teaching strategy
• Review other common teaching strategies
and teaching methods
OBJECTIVES
• Be familiar with some resources available
to clinician teachers to address common
teaching challenges
CHALLENGES IN TEACHING
• Reflect on your own experience:
• How do you teach?
• What challenges do you face teaching in
your office?
ONE MINUTE CLINICAL
PRECEPTOR
•
•
Focuses teaching on learners reasoning
Based on 5 Microskills
1. Get a Commitment
2. Probe for evidence
3. Teach general rules
4. Provide feedback
5. Correct mistakes
Neher J et al., A Five Step Microskills Model of Clinical Teaching. J. Am
Board of Fam Practice, 5:419-24, 1992
GET A COMMITMENT
• What do you think is going on with this pt?
• What investigations are indicated ?
• What do you think needs to be
accomplished on this visit?
* resist asking data gathering questions at this time
PROBE FOR SUPPORTING
EVIDENCE
• What are the major findings that lead to
your conclusion ?
• What else did you consider ?
• What made you choose this particular
treatment ?
• * “thinking out loud” rather than grilling
TEACH GENERAL RULES
• Keep it brief and focused on identified
issues
• Instruction is more memorable when
offered as a general rule
REINFORCE WHAT WAS DONE
RIGHT
• Be specific
• General praise does not reinforce a
particular behaviour
CORRECT ERRORS
• Consider appropriate time and place
• Start with learner self evaluation
• Consider language
TEACHING STRATEGIES
“ Who dares to teach must never cease to
learn.”
~John Cotton Dana
COMMON AMBULATORY TEACHING
METHODS DISTILLED FROM THE
LITERATURE
1) Orienting learner
2) Prioritizing or assessing learning needs
3) Problem-oriented learning
4) Priming *
5) Pattern recognition
6) Teaching in the patient’s presence*
Heidenreich C et al., Pediatrics 105:231-237,2000
COMMON AMBULATORY TEACHING
METHODS DISTILLED FROM THE
LITERATURE
7) Limiting teaching points *
8) Reflective modelling
9) Questioning
10) Feedback
11) Teacher/learner reflection
Heidenreich C et al., Pediatrics 105:231-237,2000
PRIMING
• Orientation of learner to pt. and tasks
before entering room 1-2 min
1. Tasks
2. Attending role
3. Patient
4. Product
TEACHING IN THE PATIENT’S
PRESENCE
• Learner presents findings to preceptor in
front of patient
– Increases preceptor time with patient
– Enables direct verification of history/findings
– Enables direct observation
– Saves time
LIMITING TEACHING POINTS
• Focus on a few main points, less
teaching, more learning
• General rules more memorable, more
transferable
• At end of clinic, address other issue in
more detail
• At next session review unresolved issues
CONCLUSIONS/SUMMARY
• There are numerous challenges
associated with clinical teaching
• Effective teaching strategies may be used
in ambulatory care
• A learner centred model of teaching is the
One-Minute Preceptor (OMP)
REFLECTIVE EXERCISE
• Implement a Method/Strategy
• -consider using the sample LOG
– Why did you chose this method?
– Why was approach effective/ineffective?
– What would you do differently next time? and
why?
TEACHING LOG
This is a teaching log
created by Dr. Helen
Batty and used in the
Academic Fellowship
Program.
EFFECTIVENESS OF TEACHING
IMPROVEMENT INTERVENTIONS
Effective Teaching Interventions:
• Workshops
• Teaching Evaluations with Consultation
• Faculty development fellowship programs
•
Wilkerson L et al., Strategies for Improving Teaching practices: A
Comprehensive Approach to Faculty Development. Academic
Medicine1998
RESOURCES
• Local undergrad/postgrad/PD representatives
• Rubenstein W, Talbot Y. Medical Teaching in Ambulatory
Care, 2003
• Neher J et al., A five Step Microskills Model of Clinical
Teaching. J. Am. Board. of Fam. Prac. 5:419-421,1992
• Aagard E et al., Effectiveness of the One minute
Preceptor Model for Diagnosing the Patient and Learner:
Proof of Comcept. Academic medicine 79:42-49,2004
TEACHING STRATEGIES
•
•
•
•
•
•
•
•
Case discussion
Case review
Direct observation
Chart review
Chart stimulated recall
Criterion chart review
Role play
Short didactic presentation
Rubenstein W, Talbot Y Medical Teaching in
Ambulatory Care 2003
TEACHING STRATEGIES
“ If you have knowledge, let others light their
candle at it.”
~Margaret Fuller
Thank You