Principles of Teaching and Learning in Clinical Settings

1. Principles of Teaching and Learning in Clinical Settings Professor Hossam HamdyUniversity of Sharjah

2. Aim • What is Clinical Teaching • Barriers to effective Clinical Teaching • Strategies to improve Clinical Teaching • Teaching and learning in different clinical settings

3. Clinical Teaching There should be no teaching without the patient for a text and the best teaching is often that taught by the patient himself (William Osler)

4. Context Student Content Teacher Patient Triad Interactive Learning in the Clinical Context

5. Teaching with Patient • Bedside “Different from ward rounds” • Outpatient clinic • Emergency ward • Day Care Surgery • O.R

6. Barriers to Effective Clinical Teaching – A global Concern • Time lack for clinicians. • Insufficient space to teach. • Crowded outpatients. • Increasing number of ‘super-specialist’ clinics.

7. 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.

8. Barriers to Effective Clinical Teaching (cont/-) • Teaching is not considered part of service commitment. • Lack of knowledge and skills about teaching methods.

9. The Clinical Context • More shift from Hospital setting to Ambulatory settings. • Diminish the significance of bedside teaching “short length of stay”.

10. The Clinical Context(cont/-) • Hospital populated with critically ill and early post-operative patients. • Early diagnosis – no or little physical signs.

11. 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

12. 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

13. Clinical Teaching • Clarify expectations and goals appropriate to the setting, patient problems and student level “prior knowledge” Planning “set”(cont/-)

14. Clinical Teaching Teaching “Dialogue” • Teach from clinical cases. • Go to the bedside or exam room • Use questions to diagnose patient & learners.

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

16. Non-Analytical Reasoning • Context specificity. • Prior knowledge & net-working. • Schemata and script concordance. “Pattern recognition”

17. Analytical Reasoning • Cues form c/o – duration • Early hypothesis generation • Testing and re-testing hypothesis • Ranking and re-ranking hypothesis

18. Pre-test Probability Clinical Reasoning EBM Approach Post-testProbability TEST Each question in the history and each physical examination is a diagnostic test.

19. Combined Model of Clinical Reasoning Case Representation Patient Presents Hypotheses Tested Non-analytic Interactive Analytic

20. 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’.

21. 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.”

22. 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.

23. The One Minute Clinical Preceptor Teaching Model Diagnose Patient & Learner Microskill 1:Get a commitment What do you think the patient problem is? Microskill 2: Probe for supportive evidence Reasoning. Why do you think this is the case?

24. The One Minute Clinical Preceptor Microskill 3: Teach general rules & concepts • When this happens, usually … • Take home message

25. The One Minute Clinical Preceptor • Feedback “closure” • Microskill 4:Provide regular, well timed feedback. • Should be descriptive rather than judgmental. • Reinforces positive behaviors and motivates learner. • Conveys an attitude of concern and interest between instructor and learner.

26. The one Minute Clinical Principle Feedback “closure” Microskill 5:Correct mistakes and promote self assessment and self-directed learning. • Focus on behavior, not individual. • Ask learner for their opinion or perception. • Be straightforward, but respectful.

27. The Effective Clinical Teacher (D. Newbie) • 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

28. The Effective Clinical Teacher (D. Newbie) 5. Provides adequate opportunity for students to practice skills 6. Provides good role-model for interpersonal relationships with patients 7. Teaching patient-oriented rather than disease-orientated 8. Demonstrates a positive attitude towards teaching

29. The Effective Clinical Teacher Most important being willing to teach and be enthusiastic about it

30. Thank You