I recently informally polled some of our most experienced teachers in Duke Primary Care and asked them about their teaching tips. Here are some of their recommendations.
One individual thought that a discussion about time expectations was critically important. This provider has a meeting with new learners before they start, and he reviews his schedule with them. He explains how he stays on time. He tells learners that they have about 15 minutes to meet with a patient and obtain a history and carry out a focused exam. He does not want the student to spend a long time reviewing the chart but does encourage a modest review for recent labs and developments. He requests that the students present in the room in front of the patients, and limits this to 2-3 minutes, so the students must learn to summarize, and not just report back all gleaned information. Detailing these expectations helps to create a more efficient learning experience for all involved participants including patients.
A second provider likes to focus on creating a comfortable teaching atmosphere. She gives a tour of the clinic at the beginning of a rotation and makes sure the student badges are activated so that the students are not locked out of a break area. This provider also likes to have a small snack in the middle of a long day, and she tries to share something with the students who are encouraged to take a brief break to enjoy the food or use the restroom. Though this provider might herself work for 5-6 hours nonstop, she tries to encourage her learners to pace themselves and take a break now and again.
Another clinician educator is very deliberate about note writing. This individual won’t have new students write notes. He wants to be sure the students can obtain a thorough history, can carry out a problem-focused physical exam, and can present in a succinct manner. He might not allow students to write notes until weeks into their rotations. Once the students are ready, he only has them write a very few notes, starting with one per half-day session. He gives them lots of feedback on the notes, and over time permits them to write several more, but never more than 3 per half-day session. This educator finds that too much emphasis on note-writing can distract from all the other milestones that must be met along the way.
A fourth provider is diligent about feedback. She tries to give some feedback to her learners at the end of each session. She tries to focus on behaviors, and what she has seen directly. She tries not to overwhelm learners with her feedback and knows that most learners can best handle a few discrete items at one time. She has a place in her phone where she writes down her observations, and at the end of a rotation, it is easy for her to collect her impressions and compose a detailed summary. This provider has found that when she writes down details of an interaction, that the students pay much closer attention to the observations and feedback.
The fifth teacher has a trick that I also liked a lot- she always wants her learners to interview patients first before she comes into the room. She does not like having students just observe her. But she is aware that there are some patient visits that even for her are challenging. When she senses a difficult interaction (such as a visit to share some worrisome test results), she then encourages the students to come watch her. She tries to role model some best practices for communication and patient care, and she finds that students enjoy these visits, and debriefing them afterward can be rewarding.
I hope you might possibly add some of these items to your teaching toolkit. I like the imagery of a toolkit, and I am always adjusting items in my kit-adding new items, trying new tricks, and discarding or adjusting some other items that might not be effective. I think it’s also reasonable to ask a student at the end of a session what worked well- we all need feedback, and I like to hear what might have been favorably received by the students.