JayDoc Lunch & Learn Series

2/4/08

SKILLS REQUIRED FOR TEACHING ON THE JOB IN MEDICAL EDUCATION ENVIRONMENTS:

THE Outpatient CLINIC, O.R., & HOSPITAL

HANDOUT Prepared by: Julie L. Wei, MD

TEACHING CONSIDERATIONS FOR INPATIENT ROUNDS

1.  Factors influencing teaching style

  1. Time
  2. Time scheduled for seeing all patients on service, including consults
  3. Ensuring adequate/appropriate time allotted per patient
  4. Utilizing time spent transporting patient, traveling from patient to patient during rounds, and time spent in discussion with patient and or family members/parents
  5. Different for surgical versus medical services
  1. Number of patients
  2. Influence how detailed discussions are regarding management and plan
  3. Need for prioritizing
  4. Determine “to-do” list for each patient daily
  1. Complexity of patient problems
  2. Extremely interesting/rare/complex patient and pathology may warrant a block of time set aside for full discussion after resident/student preparation for specific topics
  1. Extent of actual patient care
  2. Routine daily physical exam
  3. Dressing removal/changes
  4. Bedside procedures, i.e., irrigation through surgical drains, wound-packing
  1. Review of relevant and updated information for each patient
  2. Vital signs
  3. Laboratory data
  4. Imaging studies
  5. Recommendations from consults

2.  Format

  1. Presentation of patient history
  2. If new admission/consult, need to present CC, HPI, PMHx, Exam findings, Work-up, Differential Dx, and Plan
  3. Faculty should then ask questions, whether agree or disagree, ask reasoning behind plan
  4. After seeing patients, may want to ask residents to explain faculty’s conversation with patient/parents
  5. Always ask when relevant, literature and research evidence that supports clinical care decisions

3. Organization/Preparation

  1. Residents/students may “preround” and gather all pertinent information
  2. Vitals – electronically kept
  3. Discussion with patient’s nurse
  4. Change all dressing prior to rounds with staff
  5. Read the night before on pathology/topic
  6. Faculty may review imaging studies, H&Ps, all medical notes via VPN prior to rounds

Suggestions for effective in-patient teaching

·  Ask residents to discuss risks and goals of the intended procedure to parents/patients in your presence, then you may add/modify/correct the information given, and discuss his/her knowledge afterwards

·  Ask residents to give discharge instructions and follow-up plan to patient/parents in your presence, the modify as necessary and discuss afterwards

·  Do not always give away diagnosis even if you know, try to allow residents/students to arrive at same conclusion by helping them eliminate incorrect diagnosis from differential. Ask questions to direct discussion towards correct answer

OBSTACLES IN TEACHING – Environment

1.  Minimize chaos - Operating Room

§  Faculty is responsible for keeping chatter to the appropriate level, and to a minimal during critical times that demand extraordinary focus on the patient. This includes chatter between OR personnel, resident and OR personnel, and between faculty and residents.

§  Music may be okay, but faculty may choose to eliminate music during induction and wake-up(especially in children), and all other times when it becomes a distraction or interferes with performance or anything that may affect patient well-being

§  Have residents help ensure all necessary surgical instruments are available for the case (Case Planning)

§  Ensure good communication with anesthesiologist and formulate plan

2.  Minimizing chaos – During patient rounds

§  Excessive chatter amongst residents

§  Inappropriate jokes

§  Have consistent rounding plan/routine, i.e., gravity rounds, ICU first, etc

§  Address problems with specific individuals if he/she disrupts rounds by being tardy or by personality/behavior traits

3.  Lack of preparedness by either residents or faculty

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