GreysAt the CDEM meeting during the SAEM national meeting this past week, the keynote speaker (Dr. Charles Hatem from Harvard) mentioned a great editorial article called “Inconvenient Truths About Effective Clinical Teaching.”

Here’s a summary of the opinion article from Lancet:

Clinician-educators are increasingly pressured to do more with less time and support (i.e. release from clinical responsibilities). Learners are the victims of this calculated move.

The author talks about 8 habits to emulate as an educator, in the setting of these changing times. This is especially helpful to review as we are about to start a new academic year with fresh interns and medical students in the Emergency Department.

1. Think out loud.

  • This lets learners understand our thought-processes as we apply population-based research to our individual patient. This translational process is often ambiguous with lots of gray areas. Understanding our clinical reasoning process, rather than just the end result of ordering particular tests or treatments, is an invaluable lesson for learners.
  • “If our profession is serious about lifelong learning, we must recognise that learning can’t happen without humility. Teachers who humbly think out loud help to show the way.”

2. Activate the learner.

  • “Experts agree that adult education is a tango: it takes two. The dance will fail, no matter how expert the teacher, if the learner is not actively, even passionately, engaged.”
  • The most effective teachers use the democratic style, where learners are encouraged to think and act autonomously in real-time. The trick is to “activate” learner initiative while “protecting them from themselves” to avoid errors. 
  • With time pressures, it’s easy to fall back to an autocratic approach (do what the teacher says). It’s a constant struggle to employ a democratic style of teaching. In reality in the ED, we teach using a hybrid approach – sometimes autocratic, sometimes democratic.

3. Listen smart.

  • Great patient care is all about taking a good history. Similarly, great clinical teaching is all about listening to the learner. What’s his/her knowledge base, how is his/her clinical reasoning skills, and does s/he see the big picture?
  • Assessing a learner’s presentations and discussions often requires that you (as the educator) independently talk to the patients to ensure that the facts are correct.

4. Keep it simple.

  • Learners are constantly learning and processing various information when working clinically.  Boiling down complex medical issues to a few simple teaching points can be difficult for the educator, but it is most effective for the learner. 
  • Also, I find that you don’t have to unload all of your knowledge on the learner. Pick 1-2 concise teaching points targeted to the level of the learner and focus on them.  

5. Wear gloves.

  • This is critical. Put on gloves and go to the patient’s bedside. Having a learner see your approach to bedside care, empathy, and communication are invaluable. We often take for granted the art of patient care and we can best teach it by demonstrating to others.

6. Adapt enthusiastically.

  • Things rarely go exactly as planned on a shift. Instead of fearing surprises, use these unexpected occurrences (eg. patient clinical deterioriation, medication side effect) as teaching opportunities.

7. Link learning to caring.

  • Teach about empathy and professionalism. 
  • Patient care involves actually caring about the individual patient. Patients are more than just about their disease. 
  • “Understand the patient’s illness as well as their disease.” 

8. Kindle kindness.

  • Patients can sense genuine kindness and caring. Be a role model in how you talk with patients. There is a difference between indifferent politeness and genuine kindness.
  • Learners are more receptive to feedback when spoken with kindness, no matter how critical your comments are. For me, I picture myself as a coach in (rather than an evaluator of) their lifelong learning process, and frame their feedback accordingly. 

 

Reference
Reilly BM. Inconvenient truths about effective clinical teaching. Lancet. 2007;370(9588): 705-11. PMID: 17720022.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD