| Newsletter Overview |
The focus of our September newsletter is "One-On-One Clinical Teaching Strategies." Perspecitive on one-on-one clinical teaching are based on an interview with Dr. William Burke who was interviewed by Robbin Kirkland, Ph.D., Coordinator of Faculty Development. Dr. Burke is one of many didicated preceptors in the CORE system who gives of his time generously to teach and mentor students. All of us who have the pleasure of knowing Dr. Burke know that he is a special person, an excellent physician, and a clinical teacher with exceptional skills.
Dr. Kirkland also provides us with some excellent information and tips based on the research on clinical teaching which is followed by some very useful bulleted teaching tips.
This month we also have some nice pictures from the first meeting of the Academic Leadership Fellowship which was conducted in Athens in addtion to pictures taken at a one-day workshop on clinical teaching conducted for residents at Doctors Hospital of Stark County.
| Preceptor Highlight |
The One-To-One Method in Clinical Teaching
Our preceptor highlight for this month is William Burke, D.O., and interim director of the Family Medicine Residency Program at Doctors Hospital, Columbus, Ohio. Within the clinic setting, Dr. Burke notes that most of his teaching is case-based and primarily involves one-to-one interactions with trainees. With the utilization of cases as the stimulus for discussion, Dr. Burke suggests several features that are vital to the one-to-one teaching and learning experience. Specifically, the trainee must feel comfortable in presenting and discussing patient cases. In addition, it is essential that the trainee be organized in his/her presentation of the case and demonstrates clinical knowledge via strong communication skills. Similarly, the clinical teacher must be skilled at asking open-ended questions that help drive the interaction between the trainee and clinical teacher. As part of the one-to-one teaching approach, Dr. Burke encourages clinical teachers to assess the learning styles of the various trainees and be aware of individual differences among trainees in terms of their ability to absorb and communicate case related information. Dr. Burke also believes that the clinical teacher must exhibit patience and employ listening skills as the trainee is engaged in sharing case information. According to Dr. Burke, try to avoid the temptation of “jumping” in too quickly to provide answers and instruction. Instead, utilize questions and particularly “probing” type questions that cause the trainee to “dig deep” into their “knowledge tool kit”. The one-to-one teaching and learning experience can be greatly enhanced, as Dr. Burke notes, by assigning reading materials and developing mini lectures that pertain to specific cases. Consistent with other training techniques, the one-to-one teaching and learning approach should include sufficient opportunities for providing effective feedback, complimenting the trainee regarding “things done well” and communicating areas for improvement.
| Research on Clinical Teaching |
Beyond the mini-lecture discussions that are a major part of the clinical learning experience, a great deal of clinical skills and knowledge tend to be generated by way of one-to-one interactions between the clinical teacher and trainee. According to Douglas, Hosokawa, and Lawler (1988), “clinical teaching involves an encounter between a single attending and a resident or student,” or could involve “an encounter between a senior resident and a junior resident.” In addition, they also note that the one-to-one “encounter” is characterized by “proper questioning of the learner”, “providing information when needed”, “reinforcement and feedback. Speaking specifically regarding resident training, but certainly applicable to other trainees, Douglas, Hosokawa, and Lawler suggest that questions should be framed according to the “level” of the trainee and questions employed should be “open questions” that tend to generate “analysis, synthesis and evaluation.” In his examination of more than twenty studies regarding instructional skills and effective teaching, Irby (1978) notes that “instructor –individual interaction” was identified as a critical factor when judging the “teacher’s ability to relate well with students and to stimulate their active involvement in learning”. Irby’s examination of studies also found support for the use of clinical cases to stimulate interactions between the trainer and trainee. That is, “the [clinical] supervisor’s ability to relate basic science and theoretical concepts specifically to the case under consideration increases resident ratings of teaching effectiveness”. Fostering an effective one-to-one “encounter” may require the clinical teacher to function within the context of a variety of roles. Kurtz, et.al.(1979) mentions that in the clinical setting, depending upon the knowledge and experience of the trainee, the preceptor may at times serve as “role model”, “educational resource”, and “clinical supervisor”. Each of these functions can be of value in generating a successful one-to-one teaching and learning experience. Clinical teachers and trainees are encouraged to review these and other studies in more detail. Please continue to add to your teaching/learning “tool kit”.
References
Douglas,K., Hosokawa, M., and Lawler,F. A Practical Guide to
Clinical Teaching In Medicine.1988. pp. 13-14.
Irby,D. Clinical Faculty Development.1978. in Clinical Education
For The Allied Health Professions,Charles Ford,1978. pp. 99-101.
Kurtz,M., Farquhar,L., Gerard,R.,Brumm,L. Preceptorship
Training:A Four-Step Model for Student and Preceptor.1979. in
Osteopathic Medicine 1979. p.92.
| Teaching Tips |
Tips to Enhance One-To-One Teaching and Learning
Although questions that generate simple "yes or no" responses cannot be avoided in the clinical teaching setting, try to ask open-ended questions that will allow deep probing into the trainee's knowledge "tool kit".
Employ "good" listening skills.
Exhibit patience as the trainee explains the case or explanations to questions.
Try to create a teacher and trainee relationship that encourages a mutual exchange of questions and sharing of information without fear and misjudgment.
Be aware of the variability in trainee learning styles.
Compliment trainees for outstanding contributions, observations and performance.
Encourage trainees to search for knowledge on their own and engage in self-directing learning.
At the beginning of the rotation, discuss the basic content regarding case presentations.
| Teaching Resources on the Web |
Above, Dr. Bill Burke mentioned the importance of questions as part of his one-on-one teaching strategy. Dr. Dan Benzie, a rural practitioner in Minnesota who precepts students in his office has written an excellent article entitled, Levels of Questioning for Learners that appears on the Society of Teachers of Family Medicine web site (http://stfm.org/precep.html) which has full length, but brief, articles on clinical teaching specifically geared to office-based teaching. To view the article entitled, "Levels of Questioning," go to http://stfm.org/teacher/1998/jan/jan.html.
On our own faculty development web page you may want to visit our Educational Monographs section and read the monograph entitled "The One Minute Preceptor," at http://www.oucom.ohiou.edu/fd/monographs.htm which describes the 5-Step Microskills model of clinical teaching. This model integrates critical one-on-one teaching skills including asking questions and giving feedback.
| Curriculum Update |
The new Clinical Presentation Continuum (CPC) curriculum is underway. Second year students began on September 5th with the neurology block which will be 6-weeks in length. The case based learning (CBL) groups began meeting on September 7th and devoted the majority of their 2 hour meeting time to small group process so as to lay a good foundation for optimal learing. CBL groups are comprised on 8-9 students and one faculty facilitator.
First year CPC students began a week of orientation on August 28th. A portion of that time was spent on learning about learning in small groups so as to enhance the success of the CBL sessions. This year we modified the first four week block which is entitled, The Well Patient. The first two weeks of this block are devoted to the acquisiton of basic science content delivered via lectures. This should provide the students with a good foundation as they go into the third and fourth weeks of the block which will transition into a format where students must take on more responsibility for their learning.
| Residency Program Advisory Committee (RPAC) News |
The Family Practice RPAC conducted a statewide Objective Structured Clinical Exam (OSCE) for all family practice residents in August. This was a huge undertaking as their are approximately 100 FP residents. The residents were divided into four groups by region for administration of the exam. Exam sites included, Athens, Toledo, Columbus, and Sagamore Hills. The exam consisted of 6 ten-minute stations where residents encountered standardized patients exhibiting common disease/problems seen in ambulatory family practice.
Academic Leadership Fellowship News |
The pictures below were taken at our first meeting the Academic Leadership Fellowship class of 2000-2001. The meeting was held at OU-COM in Athens on Saturday, August 26 and Sunday, August 27.
| Upcoming Faculty Development Events |
| Recent Faculty Development Events |
August and September have been extremely busy months for the Office of Faculty Development. Events have included:
| August 23/24 | Workshop/Retreat for Columbus family practice residents |
| August 26/27 | First meeting of Academic Leadership Fellowship |
| August 29/30/31 | Workshops for family medicine clerkship small group facilitators |
| September 5/6/7 | Workshops for CPC II small group facilitators |
| September 6/14/18/20 | Workshops on "Presenting Skills" for new 3rd year students at all clinical sites |
| September 14 | Workshop for CPC I small group facilitators |
| September 26 | PowerPoint workshop for St. Joseph Health Center |