Click here to download a pdf copy of the 12 winning tips in the 2011 contest. Or scroll down to read them!
Click here to download a pdf copy of the 12 winning tips and 6 honorary mentions in the 2010 contest. Or scroll down to read them!
2011 Contest: Tips for Teaching Procedural Skills
12 Winning Tips
Preparing for medical procedures: mental checklist
Dr. Giulio Dominelli, PGY-2 Resident, Internal Medicine, UBC
The preparation for a medical procedure is often an overlooked component of teaching learners how to perform new skills. Often it is the preparation for the procedure and not the skill of the operator that influences the ultimate success of a given attempt. That is why I always encourage my learners to have their own mental checklist to run through before they get to the bedside. My approach is the rule of 3’s
3C’s, 3 wet 3 dry
Consent, have it in writing
Complications, know what they are
Checklist of supplies, “3 wet and 3 dry” for every bedside procedure
-3 wet: saline, lidocaine and chlorohexadine
-3 dry: procedure kit, personal barriers (gloves, mask etc) and attachment (bandage or suture)
Equipment preparation and patient positioning as an integral part of procedural skills training
Dr. Mark Mackenzie, Department of Family Practice, UBC
Procedural skills training often focuses on the point and time of direct dynamic contact with the patient’s body – the actual insertion of the spinal needle during a lumbar puncture, or insertion of an angiocatheter into a vein. Emphasis on these specific moments of procedural action remove relevant context and artificially compress the procedure. This compression of the procedure makes it difficult for learners to understand what they are seeing or doing and makes it impossible for them to replicate the procedure independently.
Using the lumbar puncture example, students must be exposed to the full logical continuum of the procedure. The lumbar puncture itself is preceded by a sequence of steps that all lead from one to the other including the informed consent of the patient, the examination and land marking of the patient, proper patient positioning on the bed , proper operator positioning relative to the patient, sterile preparation and draping of the site, and review and inspection of the lumbar puncture tray components with an explanation of how the individual components of the tray are used (or not) during the procedure.
By the time the spinal needle traverses the interspinous space and punctures the dura, demonstration of the logical preparatory steps and their connection to each other has demystified the point of contact and allowed the student to process what they are seeing or doing.
Timing of feedback for trainees learning procedural skills
Dr. Orlee Guttman, Clinical Assistant Professor, Department of Pediatrics, UBC
When supervising a trainee who is carrying out a newly-learned procedure, it is common for the senior physician to offer immediate correction and advice as the procedure is being done. This is certainly necessary when safety is a concern, but may not be the most effective at enhancing student learning. Recent literature found that trainees learning endoscopic procedures demonstrated improved long-term retention of skills when given feedback at the end of a procedure, rather than throughout1. Similar results have been shown in students learning surgical knot-tying skills2. Concurrent feedback from a supervisor may distract the learner from intrinsic sensory feedback (e.g., visual, tactile) he/she would otherwise gain from performing the procedure, and the learner may also become dependent on this feedback for decision-making during the task. Terminal feedback (given at the end of a procedure) allows the student time to process self-feedback before incorporating supplementary information from the supervisor.
Supervising physicians should resist the temptation to give feedback at every step of a student’s procedure, and instead offer feedback when it can be most effective: at the end.
Reference
1.Walsh CM, Ling SC, Wang CS, Carnahan H. Concurrent versus terminal feedback: it may be better to wait. Acad Med. 2009 Oct; 84(10 Suppl):S54-7.
2.Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Bubrowski A. Teaching suturing and knot-tying skills to medical students: A randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 2007;141: 442-449.
Utilizing New England Journal of Medicine Procedural Videos
Dr. Heywood Choi, PGY-3 Resident, Internal Medicine, UBC
Many junior trainees in internal medicine have minimal opportunities to observe a procedure before being expected to perform them. To be successful and confident, it is very helpful to have observed procedures in stepwise fashion multiple times at a pace conducive to learning. The New England Journal of Medicine website provides clearly laid out videos for all commonly performed procedures in internal medicine. I find it very help to have Jr residents go through the videos several times prior to attempting procedures themselves. As a teacher, it is helpful for me to review these videos as well, as they often contain details such as potential complications, and detailed diagrams of underlying anatomy, that I might otherwise leave out in my teaching. These videos are readily available on the NEJM iphone app as well, and can be accessed easily on the wards.
Dr. Nancy Humber I teach procedural skills to many of our rural and urban family practice residents. I find that many of the rotations are short and the “see one do one” often does not work out in the resident’s favour with regards to increasing their volume as they work with so many different preceptors. I also find that by teaching your own style of procedure, the residents are unable to develop their own style which is often slightly different but also a safe and acceptable quality of care.
I prefer to let all of the residents do the procedures if they are interested. I ask them to pretend they are teaching me how to do the procedure as they are doing it talking their way through it step by step. I ask them to tell me what their next step is BEFORE they do it so that if there is any potential for error or mistakes, we can discuss that as we do the procedure together. By talking through the step in advance, I am better prepared to supervise the next step. The residents seem to find that by teaching me, they have to develop the skills of thinking ahead for the next step as well as foreseeing possible problems and solutions before they happen. It also presses them to develop their own approach for dealing with potential problems when they do and do not happen with their own approach for solutions.
Let residents teach you how to do the prodedures
Dr. Nancy Humber
I teach procedural skills to many of our rural and urban family practice residents. I find that many of the rotations are short and the “see one do one” ofter doesn’t work out in the resident’s favour with regards to increasing their volume as they work with so many different preceptors. I also find that by teaching your own style of procedure, the residents are unable to develop their own style which is often slightly different but also a safe and acceptable quality of care.
I prefer to let all of the residents do the procedures if they are interested. I ask them to pretend they are teaching me how to do the procedure as they are doing it talking their way through it step by step. I ask them to tell me what their next step is BEFORE they do it so that if there is any potential for error or mistakes, we can discuss that as we do the procedure together. By talking through the step in advance, I am better prepared to supervise the next step. The residents seem to find that by teaching me, they have to develop the skills of thinking ahead for the next step as well as foreseeing possible problems and solutions before they happen. It also presses them to develop their own approach for dealing with potential problems when they do and do not happen with their own approach for solutions.
Consider the development of motor skills and mental tasks
Dr. Karin Joughin, Interim Associate Dean, MD Undergraduate Program, UBC
We have a tendency to concentrate on training motor skills. Judgement and decision-making are critical to the successful outcome of a procedure. This includes determining what the patient needs for the best outcome, identifying the patient’s current state and adjusting technique as required as the procedure unfolds. Medical students and residents appreciate hearing what is going through their mentors’ heads as they work through a procedure. A debrief later about how and why decisions were made is also very valuable. Above all, learners benefit from deliberate practice assessing a situation and making decisions, with and without explicit coaching.
Consider the zone of proximal development
Dr. Stephane Voyer, Fellow, Clinical Educator Program, UBC
The concept of “zones of proximal development” (ZPD) has been applied to all manner of educational settings. In brief, the ZPD is the range of activities or skills that a learner is able to achieve with the support of the teacher. Activities that fall “below” the ZPD are those that the learner could perform on their own; teaching at this level fails to “activate” the learner, is boring, and accomplishes little. Activities “above” the ZPD are difficult or impossible for the learner to complete despite the support of a teacher; frustration and anxiety dominate learning experiences at this level.
When teaching a procedural skill, teachers need to consider what a student’s ZPD might be. Students should be asked about their previous experience with a procedure, any specific difficulties encountered, and what level of support they feel they will require. An opportunity should also be taken to have the student review the steps required to carry out the procedure. This allows to student and teacher to identify the ZPD, and to increase the likelihood that the procedural experience will be sufficiently challenging, yet comfortable at the same time.
To realize that in any procedure one must:
Dr. Ken Harder, Clinical Assistant Professor and Site Director, UBC
1. decide to act
2. obtain informal consent
3. prepare
4. perform the procedure efficiently, safely, and in a comfortable manner
5. re-evaluate if problems arise
6. ensure patient/nurse is informed of after care and follow-up
If you will be spending a block of time with a resident plan to teach parts of the whole process allowing the learner to focus on the part, then add the subsequent steps. For example in an ICU , ER or anesthesia setting, wanting to teach intubation skills, advise the learner that they will be learning in steps. Initially focus on steps 4 and 5. Here the learner’s studying focuses on the mechanisms of intubation. Your pre-procedure coaching would be focused just on the mechanics of the intubation. You would prepare the patient and equipment yourself and have the learner perform the intubation while you coach. After the intubation you would secure the endotracheal, order the CXR, etc. As the learners skill improves add the next steps in a logical progression. This allows you to provide very specific feedback on the mechanics of the procedure and allows the learner to focus their attention. Once there is some level of competence the next steps can be added.
Tips for practicing breast lump aspiration and endometrial biopsy
Dr. Tanya Fairweather, UBC
You can easily obtain practice equipment but what can we use to practice on besides patients? For breast lump aspiration one can fill a balloon with corn starch and place a bath bead or vitamin capsule inside. The small lump is palpated through the balloon and a needle and syringe used to aspirate the bead or capsule. For endometrial biopsy a soft kiwi can be used for sampling.
Old adages don’t always work
Dr. Lawrence Takeuchi, Clinical Associate Professor,Royal inland Hospital, UBC
There is a tongue-in-cheek ‘old adage’ that describes the teaching of procedures, See One, – Do One, – Teach One …
But – ‘How well’ does one ‘See’ the procedure?
A) ‘ How well ‘ one Sees the procedure is based on i ) Size of the field ii ) Angle of View iii) Recognizable Anatomy
Recognizable Anatomy – teach it BEFORE the procedure.
Use a computer generated image (e.g. PowerPoint).
1) Patient anatomy is more easily recognized if it is learned starting with a magnified view. – Anatomy can be displayed using textbook illustrations, or magnified views of an endoscopic image (e.g. bronchoscopy).
2) Angle of View – different angles of view can be displayed (i.e. to simulate the different viewing angles of the learner relative to the instructor). Often a learner is not at the same viewing angle as the instructor e.g.;
i) Across the operating room table
ii) Over the shoulder view from behind the instructor (e.g. laryngoscopy for intubation)
iii) Beside / behind the instructor (e.g. ultrasound)
With these advantages, the learner will be enabled to DO ONE, and TEACH ONE safely.
My Brain is Full: How to Teach Procedural Skills and Avoid Cognitive Overload
Dr. Sandra Jarvis-Selinger, Assistant Professor, Department of Surgery, UBC
While learning a new technical skill, novices need to incorporate a set of complex actions into a meaningful procedure. One of the challenges learners face is the limitation of working memory. Unlike experts who have consolidated a technical skill into an integrated set of steps, novices are still struggling with every aspect of the skill being a separate piece of information. For example, inserting a central line to an expert is four integrated steps but for a novice this seems like forty separate steps. Therefore a novice’s working memory is taxed with keeping all these discreet steps organized and available for recall. Therefore we need to be aware of how learners process information differently in order to learn a new skill. Learners are bombarded by information while they are still trying to build strong foundational connections to their existing knowledge. If not properly managed, cognitive overload may impair learning a procedural skill and will also affect future performance (1). We can help learners by chunking information into smaller and more manageable pieces, allowing learners to practice these sub-steps until they automate them, and only then help them ‘assemble’ these chunks into an entire technical skill from start to finish.
Reference: Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12(1), 257-285.
Problem: many residents do not feel confident with procedural skills due to insufficient experience in their training
Dr. Cameron Ross
Solution: during their time in the family practice, the default position for staff and preceptors is to have the resident do all of the appropriate procedures. The staff are updated on the level of competence of the resident and when a patient calls to book a procedure they are preferentially booked with the resident. If there is uncertainty about the competence, the staff request confirmation about the appropriateness of the booking with the preceptor. If necessary the preceptor will also book the allotted time off to supervise the procedure. If a patient is identified at a visit as requiring a procedure which requires another booked appt (i.e. excision biopsy) this will be with the resident regardless of who sees the patient first. Prior to the visit the preceptor confirms that the resident has the skill set necessary to perform the procedure and arranges for appropriate supervision. In this way the resident’s learning opportunities are maximized during the rotation and with it increased confidence at the completion of the rotation.
2010 Contest: Tips for Teaching in the UBC Distributed Medical Education Program
12 Winning Tips
Using “What if?” questions to maximize clinical teaching opportunities in small to medium sized hospitals and communities
Dr. Mark MacKenzie, Dept of Family Practice, ICC, Chilliwack, UBC
Small and medium sized communities are environments rich in clinical teaching opportunity.
Students often have one-on-one preceptor teaching, enhanced access to patients, and the opportunity to follow patients longitudinally over the course of their illness. One teaching challenge in these environments can relate to smaller patient volumes than those of larger centers. One teaching technique that can maximize teaching opportunity is the use of “what if?” questions when reviewing a patient with a student. The “what if?” variables can apply to symptoms, physical findings, and patient demographics and challenge the student to consider how a differential diagnosis can change.
Example:
20 year old male patient with 10 hour history of right lower quadrant pain.
What if this patient is a sexually active 22 year old woman?
What if the patient is a post-menopausal woman?
What if this has happened before?
What if there has been a history of diarrhea?
What if there is hematuria present?
Using “what if” questions can expand apparently narrow clinical scenarios into broader teaching opportunities.
There Really Are no Stupid Questions
Dr. Pooja Rauniyar, PGY-1, Family Practice, UBC-Victoria Site
It is my experience that medical students can often feel scared or intimidated to ask questions of residents and faculty. Many times I have seen students being asked if they have done/seen something before and upon an affirmative answer, it is assumed that he or she has an adequate grasp of the concept. Hence, more advanced concepts are taught and the student continues to ‘nod’ in understanding despite major knowledge gaps remaining. By this time, the student does not feel comfortable clarifying basic concepts for fear of looking ‘stupid’ for lack of a better word. To prevent this, I find it helpful to initially ask the student to explain their understanding of the topic before jumping into teaching. This way, knowledge level can be identified and the student has the opportunity to ask questions without feeling like it’s too late.
Promoting Faculty/Student Connectivity between Sites in Distributed Lectures and Laboratory Sessions
Dr. William Ovalle, Director, Histology and Professor of Cellular & Physiological Sciences
Faculty of Medicine, UBC
A challenge to lecturers and laboratory leaders in our distributed program is the equitable delivery of instruction in real time to students at several sites, where teachers and learners remain ‘interconnected’ during a large-group session. A common pitfall for instructors at the ‘home site’ is overlooking students at the other sites who are only seen on monitors during a distributed broadcast. To overcome such a hazard, instructors may consider personalizing the learning experience by acknowledging each site at the start. A simple ‘Good morning Prince George, hello IMP, and welcome Vancouver’ is a useful tactic. Instructors may also consider calling for specific questions from each site at selected times, i.e. ‘how about Mr. Jones at IMP or the person wearing green in the back row at UNBC, do you have any questions or comments you’d like to share?’ In our distributed Histology Labs, we initiated another exercise, known as ‘Webber’s Words’, whereby each site is given a pertinent term (i.e. mucous membrane, carcinoma, gingivitis), and at the end of the session, a student volunteer defines the term in simple language to all sites. Another strategy is inviting the ‘Histology Class Rep’ from each site to bring up a prevailing inquiry or challenge of the day (i.e. where can I find a good example of a lymphatic vessel on this slide of the esophagus?). Employing such approaches will engender a sense of interconnectivity and participation between sites, and create an environment where students can be more personally and actively engaged in learning.
Multitask to Allow Direct Observation
Dr. Gurbir Dhadwal, PGY-1 Resident, Dermatology
When I was a medical student I often felt that there was not enough direct observation of my technique in taking a history and doing a physical. I have often heard residents and faculty state that there isn’t enough time to observe medical students. To balance the need for direct observation and time I often review the patient’s chart while sitting at the bedside as the student takes the history. After the student completes the history I am able to ask any clarifying questions and provide feedback to the student.
Use the “Reality TV show” model to maximize retention and captivate learners
Dr. Ryan Lunge, PGY-2 Resident, Family Practice Northern – Rural Price George
Have you ever noticed how Reality TV shows start the show with “In this episode…” And then, just before the commercial break, they do a quick summary of what JUST happened, and then give you a “sneak preview” of what to expect after the commercial. This is a proven technique widely used by broadcasters to captivate viewers and maintain attention. In the classroom, a brief introduction captivates learners and provides relevance to the topic they are about to learn. The summary at the end connects the information to previously learned topics, reinforces the content and provides context to future topics. Maximize this effect by using the “beginning, middle, end” format multiple times throughout a single lecture. Learners tend to remember the beginning and end of a session but have difficulty recalling data from the middle of a session. Take advantage of this phenomenon by breaking up your lecture into multiple discrete bundles, each of which provide an Intro, core content, and a summary.
Less Is More in Distributed Medical Education
Dr. Hanh Huynh, Instructor, Pathology & Lab Medicine, UBC
I have witnessed several lectures with over 100 slides full of information delivered in 50 minute in our Medical Undergraduate Program at UBC. Due to the excitement and enthusiasm about the subject that we teach, we tend to forget that the majority of our learners (1st and 2nd year Medical & Dental Students) has no experience or background knowledge of the presented subjects. From the learners’ feedback, there is not much learning happen by the end of these “rushed” lectures. My suggestion would be to stick with the philosophy “Less is More”. By selecting the basic concepts/principles and eliminating advanced/detailed information, we will motivate the intrinsic learning in our future physicians. For a 50 minute lecture, a maximum of 25 slides (average 5 lines per slide) would be sufficient in our Distributed Medical Education, especially when the lecture is distributed to different sites simultaneously. With this amount of information, the lecturer will have sufficient time to clearly explain the presented concepts/principles to the learners. By the end, it will be a favorable learning experience for the learners and an enjoyable teaching experience for the lecturer.
Making your long distance relationship work
Dr. Luke Chen, Clinical Educator Fellow, Centre for Health Education Scholarship, UBC
Videoconferencing allows delivery of lectures to multiple sites, but teacher-learner interaction is limited by the need to stay in camera range and having a divided audience. These constraints tempt teachers to resort to purely didactic methods. However, learner participation can be improved by directing questions to each and every site. The time-honored art of “pimping” on ward rounds1 can be applied to videoconferenced lectures with minor modifications:
1) Direct the most basic questions to sites with the fewest learners: An open-ended question (e.g. “Prince George, what investigations would you order?”) is fair for sites with even one or two learners, and keeps them involved. Moreover, once learners at larger sites see their isolated colleagues brave an answer, they will feel compelled to attempt the more challenging questions you pose to them.
2) Embrace mistakes: Incorrect answers are often the best conversation starters and your response is crucial for creating a safe learning environment.
3) Be patient: Once you’ve asked a question, wait for an answer. Someone in the audience will be more uncomfortable with silence than you are.
Good communication is essential to all long distance relationships, and medical education is no exception!
Reference: Detsky AS. The Art of Pimping. JAMA 2009; 301:1379-81.
Tell the medical students what you are going to teach them about and then make it relevant
Dr. James McKinney, PGY2 Resident, Internal Medicine, UBC
From my personal experience teaching medical students (through a process of trial and error) I have found that it is best to ask the medical students what they want to learn about and then ask them to go home that night and read about the selected topic. The medical students have the opportunity to take as much time as they need to read around the topic and are generally more prepared the next day. I then try to prepare a short handout that they can read after or that we can go through. If the topic is amenable I print off the pre-printed orders for that topic and go through them to make it relevant and enforce why certain orders are on the pre-printed order sheets. For example, ask the medical students to read about acute coronary syndrome, we then discuss approach, diagnosis, and treatment of ACS. Follow this up with ECGs and go through the pre-printed orders for ACS.
The 5-minute short snappie
Dr. Mark Fok, PGY2 Resident, Internal Medicine, UBC
Clinical rotations are frequently busy with teaching rounds, patient care duties and family meetings. It is often very difficult to schedule teaching sessions within a typical week with my team due to all these competing events. There are moments, however, when it is quiet on-call and I can gather my team together for a quick huddle, pull out my USB key and present a 5-minute short snappie.
Short snappies consist of a Powerpoint of approximately 2-5 slides consisting of a clinical scenario stem, a clinical question and a teachable point or two. They contain interesting chest X-rays or ECGs that I have encountered and saved on my USB key during various rotations. For example, one snappie consists of a stem where a previously healthy 30 year old female presents to hospital with a cough and constitutive symptoms. The next slide shows her abnormal chest X-ray with an anterior mediastinal mass. The next slide goes through a differential diagnosis of this mass and the last two slides go through the investigations and resolution. These short teaching moments increase exposure to interesting cases, while the portability of the USB key allows access whether I’m on rotation in Prince George, Victoria or Vancouver.
Dealing with heterogeneous group of students
Dr. Luke Tse, PGY2 Resident, Family Medicine, BC-IMG program, UBC
Not infrequently, as ‘trainers’, we are dealing with ‘trainees’ at different levels of training among the same group in our ward teaching/ward round. This poses a challenge as we are not sure at what level should we teach to make everybody enjoy and benefit from the education, given the fact that the trainees may range from junior medical students to senior residents. My tip is to convert the session into an interactive one, getting the whole group involved and talking as little as you can possibly do. Assign one of the ‘seniors’ (‘seniority’ is relative to the group) to be the ‘preceptor of the session’. This person will initiate the teaching and/or discussion, answering questions directly from the ‘juniors’. Other ‘seniors’ can jump in to help their colleague. You would step in only when it is absolutely necessary, at your discretion. After the teaching/discussion, you do the wrap up and conduct the ‘take home message’. Both the ‘juniors’ and the ‘seniors’ could possibly benefit from this interactive approach, the former as ‘learners’ whereas the latter as ‘teachers’; teaching is one of the most reliable ways to ensure that one has assimilated his/her knowledge.
Turn On the Technology Tap to Fill the Knowledge Gap!
Dr. Diane Villanyi, PGY2 Resident, Internal Medicine Geriatric Medicine, UBC
The breadth of information available for a medical student can be overwhelming; similarly, given the limited time in medical school, it is not possible to share with the learner all that one would hope to. Internet-based multimedia are effective and efficient tools to bridge the gap. It behooves us to notice and to put to learners’ advantage their resourcefulness with technology, such as when I use a video clip to serve as an example of a model patient-physician interaction, or show an “Image of the Week” from the NEJM to depict a rash that may mean gibberish if described in words, or utilize a NEJM “Videos in Clinical Medicine” to complement my teaching of how a paracentesis is performed. I am giving my learners not only a mental picture of the concept I am describing, but also an introduction to very useful resources that they can then continue to refer to and use to enhance their own learning as well as patient care. It also conveys the message that good teachers are also lifelong learners.
Make Time For Feedback
Dr. Ken Harder, ICC, Family Practice, Chilliwack, UBC
As teachers we all provide feedback throughout the teaching day. I have found it very helpful to establish with residents a weekly feedback time. This occurs outside of clinical time to avoid interruptions. The time is mutually acceptable and flexible but a top priority. I deliberately structure the session allowing the resident first opportunity to ask a question to or request some feedback from me. The second half of the 30 minute session is for me to give feedback to the resident. This format has provided a vehicle to ensure time to review a video, provide feedback that may be more complex or difficult, check in regularly to see that we are moving forward to meet objectives, complete mid and end of rotation evaluations, etc. My staff are informed of these times and they are protected. I have found this to be simple and effective.
6 Honorary Mentions
Using Critical, Learner-Centred and Participatory Approaches to Teaching the CanMEDS Health Advocate Role
Dr. Shafik Dharamsi, Assistant Professor, Dept of Family Practice, UBC
Health advocacy is regarded by educators as one of the more difficult CanMEDS roles to integrate into medical education. It relates specifically to the physician’s responsibility to identify and respond appropriately to the needs of vulnerable or marginalized populations, and to attend to “the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism.” This will require a learning environment that is participatory, collaborative, and learner-centred; one that fosters the development of critical awareness of relevant issues. The educator’s role is to provide opportunities for analyzing the root causes of the related issues that affect health and health outcomes. This can be done, for example, through
• Cases and problems provide examples that can help learners move from simple to more sophisticated ways of reasoning about related issues,
• modelling advocacy and social responsibility in a practice setting,
• community service-learning, and
• empowering learners to establish rigorous and attainable goals.
Learners must participate actively in co-developing learning outcomes, activities, expectations, and assessments if they are to build an increasingly sophisticated and more meaningful understanding of their role as health advocates.
References:
1.Mezirow, J. (1991). Transformative Dimensions of Adult Learning. San Francisco: Jossey-Bass.
2.Dharamsi S, Richards M, Louie D, Murray D, Berland A, Whitfield M, Scott I. Enhancing medical students’ conceptions of the CanMEDS Health Advocate Role through international service-learning and critical reflection: A phenomenological study (In Press, Med Teacher 2010)
The Role of Summary and Review in PBL Facilitation
Dr. Nina Seto, Host Defenses and Infection Week Chair, UBC
And Island Medical Program University of Victoria
In facilitating Problem Based Learning (PBL), one teaching technique that works well is when I summarize, re-order and re-phrase the points the PBL group has just made, rather than my adding any new points to the discussion.
This serves several functions. First, it gives every member of the group the opportunity to think about the previous discussion phrased in a succinct format and organized into a certain framework which facilitates learning. Second, when used at key points during discussions, a short summary by the facilitator can give the group a chance to re-focus and start the discussion with renewed energy, thereby filling in any missing points themselves. Third, it is an useful technique when the discussion gets complex – here the points may be re-ordered such that its obvious the group is discussing separate issues simultaneously. Lastly, this technique serves as a morale booster, as the group has come up with all the relevant points on their own and you are facilitating their learning rather than teaching.
Remember, They’re Not Actually Junior Doctors
Dr. Stephane Voyer, Fellow,General Internal Medicine and Fellow, Clinical Educator Program, UBC
They look like doctors, they dress (for the most part) like doctors, and they speak like doctors. Clerkship students, however, are not actually the “junior doctors” that we sometimes assume they are. Students at distributed sites, perhaps more than their urban counterparts, are invited to take active roles in patient care – this is one of the many strengths of distributed education. Along with this added responsibility however, students sometimes feel as though preceptors assume they know more (or how to do more) than they actually do. This can be frustrating, as many students are reluctant to point out their own knowledge gaps or to ask for additional support. One way to avoid this particular problem is to begin any teaching interaction by asking “feeler” questions to get a sense of any given student’s starting point. Examples might include: “Tell me what you know about heart failure”, or “Have you seen a lumbar puncture? What steps do you remember?” This brief investment in time allows the preceptor to provide teaching that is at a level appropriate to the learner.
Dr. CA Courneya
If you are giving a block of lectures (one-two per week over an entire block) organize to go to the distributed site for at least one of the lectures. Flip the location each year, one year IMP next year NMP. Making this personal connection with the remote sites really makes a big difference to the rapport you can establish with the distant sites.
Send an email to the class reps from the remote sites at the start of the block to let them know you would like their feedback and that students can send you questions by email should they have any questions about lecture material.
As much as possible encourage the VFMP students to use the microphones when they ask a question. In the event that a student in the VFMP (LSC1) doesn’t get up to the microphone, then you have to repeat their questions in order for the IMP and NMP students to hear what was asked.
Using Silence in PBL – The Key to Combating It
Dr. Jane Gair, Faculty Development Coordinator and Senior Instructor,Island Medical Program, UBC
As teachers, most of us are accustomed to talking a lot, filling the silences and making sure that we deliver something valuable to our students – in a nutshell, teaching. This role is different in PBL – our silence is necessary and very effective. The goal in PBL is to become more and more silent as a tutor during the tutorial and to facilitate the learning rather than deliver the content. I have found that the longer periods of silence I leave, the more my students will fill them. The more I fill them, the less they will speak. My tip is to allow for a lot of silence in a tutorial. It forces the students to learn how to initiate discussions, how to lead and facilitate a group on their own, and how to deal with the intricacies of group dynamics.
Maximizing Half Day – Interactive Resident Education. Assign residents a topic needed to solve one aspect of a problem in concert with other resident group members
Dr. Monica Langer, Resident, Pediatric Surgery, UBC
Resident half days are dedicated education time; however these are often passive learning sessions that have variable preparation by residents depending on the topic. In order to encourage participation and preparation we devised a different approach for teaching general surgery residents the basic aspects of evidence-based medicine. To do this we broke into small groups – each of which was assigned to create a randomized controlled trial to answer a hypothetical study question as a group. A week prior to the half day residents were emailed assigned topics, giving each resident a specific topic that they were the group “expert” on. For example one resident reviewed different randomization methods, and then use their “expert knowledge” to inform their group’s trial design, explaining the options for randomization when this was discussed. This allowed residents to “teach” each other the important components of evidence-based medicine assessment by using their knowledge to solve problems in their trial design. Senior residents and staff who had practical experience in clinical research ensured that each group accurately covered all the major parts of study design. Study designs were compared and debated in the larger group – reviewing and reinforcing concepts discussed in the smaller groups.
