residents as teachers - grmep doctor 2) learner 3) educator – role model - observer – didactic...

Angie Busch MD, PhDCommunity Assistant Dean

Assistant Professor of Pediatrics

RESIDENTS AS TEACHERSEMBRACING YOUR EDUCATOR ROLE

1) Doctor2) Learner

3) Educator– Role Model - Observer– Didactic Teacher - Evaluator

PGY1 Job Description

See one, do one, teach one…

• History of MSU CHM• Curriculum – past and present• Grand Rapids Campus• Educator responsibilities and

models of teaching

Objectives

You are now a

on faculty atMichigan State University

College of Human Medicine.

Go Green / Go White!

• Access to MSU online library• Faculty development opportunities with

OMERAD• CV Boosters

– Opportunities for paid tutoring– Resident teaching awards– Student help with research projects and health advocacy

activities

Benefits

• 52 years old• Early community-based

medical school• Created in response to

Michigan’s increasing need for medical providers

The College of Human Medicine (CHM)

Recognized nationally for:–Commitment to Primary Care–Patient-Centered Medicine– Innovative Medical Education

MSU CHM

200 students per entering class

MSU CHM- Block 1

Secchia Center in Grand Rapids100 students Fee Hall in East Lansing

100 students

Pre-clinical curriculum – Blocks 1 & 2

Physiology

Pathology

Anatomy

Neuroscience

HistologyMolecular Biology

Clinical Year 3- Community Campuses

Block 3 - Grand Rapids Community Partners

Block 3• Pediatrics• Family Medicine• Junior Surgery• Internal Medicine• Ob/Gyn• Psychiatry

Block 4• Senior Surgery• Advanced Medicine

MSU Clinical Curriculum- Blocks 3 & 4

• 12-16 students on each clerkship• Students rotate on a track• Rotate with the same students for

the entire third year

GR Nuts and Bolts

• Grades:– Honors, Pass, Conditional Pass, Fail

• Grades based on NBME exam, professionalism/clinical practice evaluations, additional requirements

GR Nuts and Bolts

• Pre-round on own patients• Present patients at rounds• Attend any morning report, grand rounds

and multi-disciplinary conferences• Attend patient sign-out in am and pm• Any additional activities required within an

individual clerkship• Complete night float shift when assigned

BLOCK III EXPECTATIONS

• All third year students must be released from clerkships to attend: – Core Competency lectures

• 1-2 Wednesdays/month 3-5 pm– Clerkship Specific Lectures– Clerkship NBME Exams

BLOCK III REQUIREMENTS

• All students may take 1 day off during a clerkship– They should notify you of this in

advance– Any additional time off must be

made up at the discretion of the clerkship director.

Block III requirements

Community Assistant Dean – Angie Busch MD, PhD.

• Community’s Chief Academic Officer• Responsible for curriculum delivery• Responsible for clerkship faculty support

COMMUNITY CAMPUS - CAD

Community Administrators -Corey Madura and Holly Reed

• Responsible for student schedules and student life issues

• Contact for professional or academic performance issues in clerkships

COMMUNITY CAMPUS- CA

• Community Clerkship Directors– First point of contact for residents who have

questions about student responsibilities and expectations, or concerns about anything to do with CHM students

• Community Clerkship Assistants– Schedules students, lectures and didactics

and distributes clerkship information and evaluation forms through New Innovation

CLERKSHIP DIRECTORS & ASSISTANTS

Clerkship Directors and Assistants

Grand Rapids

CLERKSHIP CLERKSHIP DIRECTOR CLERKSHIP ASSISTANT

FAMILY MEDSteve DeLapp Deb Cleland

INTERNAL MED Andrew Jameson Mindy Nienhouse

ADVANCED MED Matthew Karulf Mindy Nienhouse

OB/GYN Lindsay Snyder Donna Maas

PEDIATRICS Abeba Berhane Julie Stoner

SURGERY Mike DeJong Mona Palladino

SENIOR SURGERY

David Scheeres Mindy Nienhouse

PSYCHIATRY Aaron Plattner Elizabeth Marsman

• New curriculum beginning September.• Clinical experiences begin in their first two months.• Students will belong to one of four learning societies• Learning will be based on chief complaints instead of

basic science subjects• Clinical and Basic science will be taught together

** If you see medical students working with an MA in your clinic, these are students of

the new curriculum.**

New Shared Discovery Curriculum

Teaching responsibilities and methods

How do you:• Teach effectively• Teach efficiently• Provide good quality care to patients

You are Teacher!

A new trainee arrives at your busy clinic, and you are asked to instruct the learner

• Clarify goals and objectives• Find a balance between challenging and

safe• Admit your own limitations• Provide frequent feedback• Invite learners to share their opinions

BUILD MUTUAL TRUST

Create a safe learning environment

Students like to be Useful

• Students should have 2-3 patients• Look up evidence-based medicine

topics for you• Investigate lab details of cost• Call to follow up on labs or xrays• Check on your patients for you

You are a Teacher!- Hint #1

Scribing• If they watch you do the entire H&P for an

admission they can scribe for you• When they scribe a note, you can simply state

that you performed the entire evaluation and were involved in the assessment/plan; then co-sign their documentation.

• Students must specifically state that they are scribing for Dr….(your name).

• Give them feedback• Add an addendum to their note when needed

You are a Teacher- Hint #2

• Students may perform and document– Past Medical/Surgical History– Family History– Social History– Review of Systems

• You can refer to student documentation

DOCUMENTATION RULES TO FOLLOW

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• You must perform and document– History of Present Illness– Physical Examination– Medical Decision Making

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DOCUMENTATION RULES TO FOLLOW

Resident teaching responsibilities

• Role Model• Didactic Teacher• Observer• Evaluator

• Model your moral and ethical commitment to medicine (The Hidden Curriculum)

• Model your ability to work as part of a team

• Model your hard work ethic and commitment

• Model your love of medicine!

You are a role model!

• Required course for 3rd year med students

• 8-10 students with a mentor• Topics include: Burn-out, LGBT,

The Hidden Curriculum, Affect of the Pharmaceutical Industry, Prejudice

Virtuous Physician Curriculum

• Shadow- let them watch you• Self-directed learning- ask them

to look something up and teach you the answer

• Pearls• Teach them something new that

you just learned• Recap the day and suggest a

reading assignment that night

You are a Teacher- Too Busy???

• Active Demonstration• Active Observation• Structured Observation• Learning Script• One Minute Preceptor• DiffInE

Teaching Models

• A technique of role modeling• Use when learner is unfamiliar with case

presentation or when teacher has limited time

• Plan– Give learner specific assignment to observe during patient

interaction with teacher– After interaction ask learner to report on his/her observation– Discuss the observation with rationale/goals

Irby DM and Wilkerson L. Teaching when time is limited. BMJ 2008;336:384-7

Teaching ModelsActive Demonstration

• Use at any level of learning or when unsure of learner’s level of knowledge

• Plan– Explain rationale for observation– Provide index card with three columns

labeled:

– Give feedback on observations

Teaching ModelsActive Observation

See Reaction WhyI noticed that you had child sit on mom’s lap for exam.

I was sur-prised that child sat still.

Why didn’t you perform exam on table?

• Learner identifies own learning points• Takes little time from the teacher• Plan

– Learner performs H&P with or without you– After H&P, learner writes down 2-3 things on index

card that want to learn about the case– During presentation, teacher can discuss questions– Learner picks one thing to research further and report

on the next day.

Irby DM and Wilkerson L. Teaching when time is limited. BMJ 2008;336:384-7

Teaching ModelsLearning Script

• Teacher can diagnose patient and learner’s level at the same time

• Can apply to any level of learner• Most studied of all models presented• Plan

– Get a commitment- “what do you think is going on?”– Probe for supporting evidence –”what findings make you

think that?”– Teach general rules– Reinforce what was done well– Correct mistakes

Teaching ModelsOne Minute Preceptor

http://www.youtube.com/watch?v=P0XgABFzcgE

One Minute Preceptor

DiffInE- Tool created at CHM

Feedback: One of your professional responsibilities

• Formative - weekly feedback (Feedback Friday); keep it short and simple.

• Summative - an email-generated Clinical Performance Evaluation (CPE) from New Innovations

You are an evaluator

• Ask for learner’s self-assessment-”How do you think that went?

• Be observant but nonjudgmental• Give constructive feedback- both what they did well

and what they can work on• Feedback should be well-timed, limited, and in a

private place• Give real, specific examples on behaviors that are

changeable- write notes to yourself on a card in your pocket

• Watch for improvement over time

Keys to Effective Feedback

Unhelpful Feedback!

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•Failure to address deficits does not help the student improve. If you are uncomfortable giving constructive criticism, please talk with your senior or chief resident and the clerkship director ASAP.

SCRIPT Competencies

• Service• Care of Patients – communication (oral and written) and

compassion• Rationality – using evidence-based medicine, incorporating

feedback• Integration – working as part of the team, understanding

costs• Professionalism – promptness, reliability, honesty• Transformation- application of knowledge

Clinical Performance Evaluations

New Innovations

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NI

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• CPE Highlights:– Three grades with anchors available

• Below expectations• Met expectations • Exceeded expectations

– Comments are incredibly helpful– Professionalism marks require a comment– Evaluations are due within 2 weeks

CLINICAL PERFORMANCE EVALUATION

CLINICAL PERFORMANCE EVALUATION

• Students may earn the following CPE grades:– Honors:

• 100% in “Met Expectations” or “Exceeded Expectations” with no marks of unprofessionalism

– Pass: • 80% in “Met” or “Exceeded” and fewer than 3

unprofessionalism notations– Conditional Pass:

• Greater than 20% and fewer than 40% “Below Expectations” or 3-4 unprofessionalism notations

– Fail: • More than 40% “Below” or more than 4 unprofessionalism

notations

CLINICAL PERFORMANCE EVALUATION

• Documenting Unprofessionalism– Important to stop the behavior – More than four professionalism notations

results in a “Conditional Pass” and student must complete 4 weeks of the clerkship

– More professionalism notations may result in a “No Pass/Fail” and student must repeat the entire clerkship

CLINICAL PERFORMANCE EVALUATION

• Should reflect first-hand information – Observe and describe

• “When we were on call together, [this student] did not respond to my pages,” NOT “Other residents reported this student was hard to find.”

– Provide specific examples• “The student did not accept feedback well. On

several occasions, I made suggestions for better presentations but she kept telling me she had her own way of doing things.”

• “Student did not show up for morning report on two occasions.”

SPECIFICS ABOUT COMMENTS

WHAT CONSTITUTES PROFESSIONALISM?

- Instances of being unwilling to accept feedback - Repetitively being unprepared or unwilling to participate in discussions - Failure to recognize limitations and/or call upon assistance of others when needed - Lack of civility towards other students, faculty or staff - Failure to respect patient confidentiality - Comments related to sex, gender identity, race, sexual orientation, disability, religion or other identifying characteristics, which are harmful to professional relationships - Repetitively arriving late without notifying appropriate individuals - Repetitively being unavailable for required clinical responsibilities - Failure to meet deadlines or follow through in a timely manner - Failure to work effectively as part of a team - Failure to address the fear and suffering of patients and their families - Failure to consider important social factors that threaten the health of patients - Any instance of dishonesty

• Examples of Unprofessionalism

• What are common concerns that residents have about teaching and evaluating?– It takes TIME during busy duty hours– Teaching doesn’t come naturally– Fear of retribution about comments in evaluations– Fear of being honest and then being challenged to

defend comments.• What are YOUR concerns?

RESIDENT CONCERNS

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There are many barriers to being a great teacher-• your own educational needs• clinical responsibilities• exhaustion

But without you, there will not be a next generation of

physicians.

Thank you sooooo much!

I use your wonderful, specific comments from the CPEs in the Dean’s Letter. I couldn’t write the letters without you!

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