TIPS and TOOLS for Teaching in the Ambulatory Care Setting INTAPT - PDF document

3/17/19 Introductions and Icebreaker TIPS and TOOLS for Teaching in the Ambulatory Care Setting INTAPT Feb 27, 2019 Dr. Diana Hsiang, Dr. Kate Reilly, Dr. Matthew Malokswi and Dr. Nena Watson �� Workshop Objectives Androgogy vs. Pedagogy � Recognize three challenges facing teachers in ambulatory � Androgogy – the method and practice of teaching adult care settings learners � man-leading � Learn and understand one of the teaching tools presented in today’s workshop � Pedagogy – the method and practice of teaching child � Identify one tip for each of the following: structuring a learners clinic, scheduling, reviewing with a learner and generating � Child-leading learning around a case 1

3/17/19 Adult Learning Theory: Adult Learning Theory: Assumptions Principles � Malcolm Knowles � Adults need to be involved in the planning and evaluation of their instruction. � Fundamental assumptions: 1. Self-directed � Experience provides the basis for the learning activities. Come to clinic/projects with important previous life experiences 2. � Adults are most interested in learning subjects that have Readiness to learn related to social developmental tasks 3. immediate relevance and impact to their job or personal life. 4. Prefer learning solutions for immediate relevant problems � Adult learning is problem-centered rather than content- Internally motivated to learn 5. oriented Application of Adult Learning to SPICES Model Ambulatory Teaching � Structure teaching around recent clinical cases � Build on learners previous clinical experiences � Encourage learners to formulate their own daily learning objectives � Highlight relevance of teaching points to future clinic work, upcoming exams etc. � Encouraging learners to develop a self-directed study plans at the end of clinical days 2

3/17/19 SPICES – Student-centred SPICES – Problem-based learning learning � Negotiating a learning contract/expectations at the � Reading around cases or topics encountered in clinic beginning of a session/longitudinal rotation in order to Versus tailor the experience � Prescribing a reading list for information gathering purposes Versus � Offering a standard experience which is teacher-centred without taking into consideration the goals and objectives of the specific learner SPICES – Integrated or SPICES – Community-based Interprofessional Learning � Community-based – a different patient population, greater � Interaction with a variety of healthcare professionals to facilitate learning about interprofessional variety of presentations, different setting and practice pace Versus Versus � Discipline specific learning � Hospital-based 3

3/17/19 SPICES - Elective SPICES – Systemic/Planned � Elective experiences/flexibility within a placement allows � Using a logbook or practice profile to ensure students are students to tailor their experience to learning needs seeing the required range of core clinical problems and focus on appropriate learning objectives. Versus Versus � Standardized program � Opportunistic or apprenticeship-based, which may lack the needed variety Challenges: Preceptor-Related � Preceptor Educational Training � Retention of Teachers � Preceptor compensation � Burnout � Competing Academic Interests �� 4

3/17/19 Challenges: Student Related Challenges: Patient Related � Disagreement on teaching styles with preceptors � Patient characteristics � Medical cases – Variety? Relevant? Practical? � Level of self-direction � Resistant to learners involvement � Competing clinical responsibilities � Poor understanding of the role a learner plays � Additional time spent � Consent Challenges: Structure Related Think-Pair-Share � Private vs Public Clinic and learner autonomy � What strategies have you tried to help with the challenges you have experienced while teaching in the ambulatory care � Academic vs Community setting? Specialized vs Generalized Practice � Continuity vs Block – structured experience � � Physical Space Issues � Time Management Considerations Office Staff Involvement/”buy in” � � Clinic Compensation 5

3/17/19 Organizational TIPS: Organizational TIPS: Reviewing Reviewing One Student/One Clinician Many Students/One Clinician Sitting in Model: Student observes • � Grandstand Model Hot seating • Directed observation • • Note taking Apprenticeship Model: Clinician observes • Team Member Model: Student works independently • Organizational TIPS: Organizational TIPS: Reviewing Reviewing Many Students/One Clinician Many Students/One Clinician � Supervising Model � Report Back Model 6

3/17/19 Organizational TIPS: Organizational TIPS: Reviewing Scheduling Curriculum Many Students/One Preceptor � X+Y block scheduling � Breakout Model Clinic � Wave Scheduling � Multiple learners Organizational TIPS Organizational TIPS Patient orientation Learner Orientation � Clinical space � Patient preparedness � Healthcare staff � Handouts, brochures, posters � Charting method/system � Understanding learner roles � Healthcare policies � Practice “high profile” � Brief learners on Day to day responsibilities & Expectations � Emphasis on affiliation/relationship with academic institution � Practice style/approach (plaque, certificate) � Agreed upon objectives of learning rotation � Comprehensiveness of care � Setting daily limited teaching goals � Volunteer registry for interested patients � “Primer” to patients � Resource/Materials as reference guides 7

3/17/19 Teaching TOOLS Teaching TOOLS Learning contracts One Minute Clinical Preceptor � Tools for structuring adragogical principles of learning � Focuses teaching on learners clinical reasoning � Created by learner with input from educator � Components: � Efficiently structures clinical review sessions � Skills and knowledge to be learned � Based on 5 Microskills Learners interests � Get a commitment – “ What do you think is going on with this patient? ” 1. How learner intends to acquire skills and knowledge � Probe for evidence – “What factors in the history and physical support your 2. Criteria used to evaluate whether the identified learning as taken place � diagnosis?” � Encourages self-directed learning Teach general rules - Keep it brief and focused on identified issues 3. � Facilitate agenda negotiation 4. Provide feedback/Reinforce what was done right – Be specific � Disadvantages: 1. time consuming to construct, 2. may require 5. Correct mistakes - Start with learner self-evaluation; Be specific educator training Teaching TOOLS Teaching TOOLS Eight Step Preceptor (ESP) model � Created by modifying OMP model by incorporating additional adult learning One Minute Clinical Preceptor principles � Model includes principles of adult learning theory that have been associated with improved learning Based on 8 Microskills � 1. Assess level of learner https://www.youtube.com/watch?v=eRBdfXRj5N0 2. Listen without interruption 3. Get commitment Probe for supporting evidence 4. Teach general rules 5. Reinforce what was right 6. Correct mistakes 7. 8. Have learner identify learning objectives 8

3/17/19 Teaching TOOLS Teaching TOOLS Learner-Centered Case Presentations Logbooks E nquiry or history-taking S ummarize briefly the history and physical findings P hysical examination N arrow the differential to two or three relevant possibilities A nalyze the differential by comparing and contrasting the I nterpretation of data possibilities T ask or carrying out a procedure P robe the preceptor by asking questions about uncertainties, O ptions or differential diagnosis difficulties, or alternative approaches M anagement of the patient P lan management for the patient’s medical issues E ducation of the patient S elect a case-related issue for self study Teaching TOOLS Rotating Board Focus Scripts 1. How would you schedule your clinic? Scripts can facilitate learning for focused acute and chronic care office visits � Learning to take a focused history 2. How would you observe/review? � Learning the components of a focused physical exam � Performing a specific task 3. Which teaching tool (s) would you use? � Documenting document focused evaluations 9

3/17/19 Conclusions One-Minute Paper � Commit to one TIP or TOOL that you will use in the next month. References 10