The CORE Educator newsletter is part of our comprehensive program designed to facilitate the continuous improvement of teaching, maximize curriculum effectiveness, and build a collaborative teaching/ learning environment. The newsletter will have several standard features including preceptor highlights, teaching tips, and curriculum updates. Each month a different theme will be featured in the newsletter. The theme for this issue is "role modeling." Dr. Robbin Kirkland, Ph.D., will be the primary writer for the CORE Educator and I wish to acknowledge his valuable contributions in advance.
Our preceptor highlight this month is on James Muntean, D.O. Dr. Muntean won the Southeast CORE family medicine preceptor teaching award in 1998. This award is decided by a vote of the students. Dr. Muntean graduated from OUCOM in 1991 and has been in private practice for approximately 8 years. His office is located in Athens, Ohio, where he sees patients ranging from the newborn to the elderly. He takes students at all levels in his office and enjoys the challenge of teaching in a busy office environment. When asked about role modeling, Dr. Muntean said that one of the most important characteristics he tries to model is his caring relationship with patients. "Showing interest in patients as people and not just a disease or condition is critically important," stated Dr. Muntean. He said he also tries to model the process of involving his patients in decisions about their care. He also models the utilization of a wide range of treatment options including OMT. Dr. Muntean shared his thoughts about lifelong learning and said that he continually learns from his patients and his students. Dr. Muntean is an exemplary role model and OUCOM is appreciative of his participation in a vital component of the teaching program.
Role Modeling
When asked the question, “What is it that you do as a physician that you want students to model?”, most physicians need time to pause and reflect before answering. It isn't something many teaching physicians routinely think about. However, all would agree that the behaviors they model, either knowingly or unknowingly are frequently aspired to by medical trainees, regardless of their level in training. Most clinical teachers would agree with Westberg and Jason in their book entitled Collaborative Clinical Education when they stated, “What we do is likely to have more impact on learners than what we tell them to do.”
There are many studies in the medical education literature that identify the importance of role modeling. A study by DiTomasso, et. al.(1983), asked eleven, 810 first year residents which factors were most important in their ranking of residency training programs, the residents ranked the quality of available faculty role models as number one. A study by Irby (1978), identified the modeling of the following professional characteristics as characteristics of effective clinical teachers:(1) is self-critical, (2) takes responsibility, (3)recognizes own limitations, (4) does not appear to be arrogant, (5) shows respect for others, (6) seems to have self-confidence, and (7) demonstrates sensitivity to others. A study by Ambrozy, et. al.(1998), compared the perceptions of clinical teachers and students to determine if their perceptions of role models were congruent. At two different institutions, students identified 32 role model characteristics and then identified clinical teachers who exemplified these characteristics. Those clinical teachers who were identified then rank ordered the characteristics they felt were most important to model for students. The three characteristics the role models deemed most important were: 1) demonstration of excellent clinical reasoning skills, 2) the establishment of close doctor-patient relationships and 3) to view the patient as a whole. Relative to influencing students toward their particular specialty, they cited enthusiasm and love for their work as the most important characteristics they modeled.
This is just a sampling of the research on role modeling and demonstrates the importance of role modeling in clinical teaching.
References
Ambrozy, DM, Irby, DM, Bowen, JL, Burack JH, Carline, JD, and Stritter, FT, "Role Models' Perceptions of Themselves and Their Influence on Student Specialty Choices," Academic Medicine, Vol. 72, No. 12/December, 1998, pp. 1119-1121.
DiTomasso, RA, et al. "Factors Influencing Program Selection Among Family Practice Residents, Journal of Medical Education, vol. 58, 1983, pp. 527-523.
Irby, DM, "Clinical Teacher Effectiveness in Medicine," Journal of Medical Education, vol. 53, 1978, pp. 808-815.
Westberg, J and Jason, H, Collaborative Clinical Education. New York: Springer Publishing, 1993.
Role Modeling
To have the greatest impact, role modeling needs to be intentional.
Here are 12 suggestions to maximize the impact of modeling.
- Reflect on your characteristics/actions as a clinician and ask, “What characteristics do I have as a clinician that I want to model for students?”
- Write three of these characteristics on paper and elaborate on each with two to three descriptive sentences. For example, if “ showing sensitivity to patients” is one of the characteristics, elaborate by writing two to three very specific things you do that illustrates sensitivity that can be observed by the trainee (e.g. I concentrate on making good eye contact with my patients when they respond to my questions.)
- During the process of teaching, observe the trainee with you to determine if he/she is exhibiting these characteristics. If not (e.g. student doesn't make good eye contact with patients.), ask the student to closely observe you interacting with patients and to describe what he/she saw you do that illustrated sensitivity. This may be an avenue to open up a dialogue with the student that would not otherwise occur. In describing your behaviors that illustrate sensitivity, the student will probably come to his/her own conclusion that he/she should model those behaviors, including the eye contact and if this is missed by the student then the door has been opened to discuss it. An additional feature of such dialogue is that the teacher receives the perspective of the student who may point out behaviors, both positive and negative, of which the teacher is not aware.
- Ask a trainee the following question, “What do you see me doing that you want to model?” The richness of dialogue between the teacher and student has a lot to do with the nature of their relationship. If that relationship is truly collaborative, the teacher may feel comfortable with this type of question. The learner's answer is an automatic check against those characteristics you wrote. As such you may receive reinforcement for the model behaviors you are intending to exhibit as well as become aware of unintended modeling behaviors.
- Try being aware of your style of functioning and your impact on patients and learners. Are you collaborative or authoritarian with patients?
- Reflect on your most influential role models. What specific characteristics did they display?
- Reflect on your level of willingness to let learners develop in directions that are best suited for them.
- Serve as a role model
- Try to model attitudes and skills that learners need to develop.
- Attempt to be consistent between what you tell learners to do and what you demonstrate in your daily behavior with patients and colleagues.
- Explain your thinking to learners.
- When you fear that some behavior you are exhibiting may not be an example of a characteristic to model, explain this to the student.
Teaching Resources on the Web
Click here to read an on-line article entitled, Defining Preceptor, Mentor, and Role Model available in the on-line article section of the Society of Teachers of Family Medicine (STFM) web site. Please note that you will probably have to scroll down the page to see the article on role modeling.
Click on the following Web address if you would like to conduct a Medline search using PubMed (http://www.ncbi.nlm.nih.gov/PubMed/) on Role Modeling.
Clinical Presentation Continuum (CPC)
The Clinical Presentation Continuum (CPC) began in the fall of 1999 and replaced the traditional curriculum. A distinguishing characteristic of the CPC is the integration of the basic, clinical, and social sciences beginning on day one of study. The traditional basic science courses and systems courses no longer exist. The CPC is organized around "Blocks" that focus on systems (e.g. Respiratory Block, Cardiovascular Block, etc.). Each block is subdivided into weekly modules in which a common disease/condition is studied through small group case discussions, interactive presentations, focused labs, simulated patient labs, and early clinical experiences.
A vital component of the new Clinical Presentation Continuum is the twice weekly case-based learning (CBL) sessions. Each group is comprised of 8 to 9 students and they work together for one quarter and then the groups are reconstituted. A primary purpose of the small group format is to provide the opportunity for collaborative learning.
Each Friday the students come together as an entire class for a 2- hour Synthesis and Integration (S & I) session. During the first hour of this session the students discuss content common to all the cases and receive clarification from a faculty panel with regard to information in need of clarification. During the second hour a clinician leads a case discussion of an undifferentiated case that helps bring together some of the elements common to the cases studied in the CBL sessions.
Lectures and labs are still an important part of the CPC. However the number has been reduced and efforts are made to make the lectures more interactive. If one were to look at a weekly schedule for year 1 students.