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: Sarah Taylor, MD

Teaching in the Clinic

As with any clinical teaching, time plays a major role. It is even more so in the outpatient clinic in which you have the patient for a limited period of time and others are waiting. However, this does allow one the opportunity to teach and model time management as well as moving conversations in the needed directions. One teaches what needs to be done

  1. Teaching can be done concurrently: this can go both ways. As you explain things to the students you are explaining to the patient. Be sure to ask the patient permission and to make sure they know that not all that is discussed is pertinent to their case. Caution has to be not to frighten the patient or his family. The literature shows that patients like this type of learning situation. The other teaching which may occur when you are explaining to the patient their illness or plan, the student learns about the disease in lay terms.
  2. Teaching may be done by example. Although most consider this important for the lowest level of learner, it is an ideal time to teach professionalism and methods of doing patient education and interviews to all levels. I have been surprised at how many fellows utilize the interviewing techniques and stories that they observe.
  3. Teaching in the conference room is also helpful.. I identify patients on the board who are good learning patients. The patient who is in extremis should have a concurrent evaluation by student and attending and not be put through a long evaluation twice. Angry, demented or otherwise compromised patients should be assigned with care if at all to a student. I also identify the disease process on the board. After seeing the patient the student presents and questions are asked, in particular what they feel the problems are, the most appropriate diagnosis and plan. After we finish our concurrent visit we again discuss the case in the conference room.
  4. A conference with the learner at the end of clinic can be very helpful. It allows reflection as well as comparative knowledge between cases. I always utilize a short period at the end of clinic to review what we have done, the diseases we have seen, what the follow up will be and to ask if there are any questions. Telling stories about similar cases can also be done at this time. The patient becomes the reason for reading and remembering. I may suggest reading materials at that time as well.
  5. Chart reviews are particularly important for the advanced learner. We go over the previous visits they have had with the patient and look at what is missing in the documentation and how we might do things differently.
  6. The outpatient clinic allows students to witness much of the fun of clinical practice. They see your connection with your patients, your enthusiasm and the respect you share with the patient. They also see patients who are doing relatively well.
  7. Avoid asking impossible or embarrassing questions of the students. Avoid embarrassing the student in front of the patient.
  8. If teaching with a group of students, be careful of one upsmanship.

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