Bruce Peyser, MD, FACP
Professor of Medicine, Duke University School of Medicine
At the end of April of this year, my wife and I brought home a wonderful Golden Retriever puppy. We had planned this well before the COVID-19 pandemic, and we were ready with the right type of puppy chow, a sturdy crate, and a baby monitor so I could hear our dog, Leia, if she needed to go out in the middle of the night. My wife had kindly agreed to this addition to our family with the understanding that Leia was mostly going to be my responsibility. We are already super busy from work, we have a lot of outside interests, and we also care for a black lab, two kittens, and a cat.
It turns out that limit-setting and training an eight-pound, two-month-old puppy is very different from working with a 40-pound bundle of energy who is now six months old. After watching Leia race around our house trying to lick every other animal on the face, clean all the dirty plates in the dishwasher, and jump into our pool whenever she wanted, I realized I needed to quickly work on some puppy education for Leia—otherwise, I was soon going to be nesting in my own personal doghouse!
Having raised dogs, including another golden retriever, in the past, I thought, “I’ve got this. No problem. I will set some limits and do some teaching!” After all, I have occasionally educated medical students and providers in the past, and how different could this be?
Well, turns out that training a pup and working with learners have some pretty interesting similarities.
Thank goodness a colleague from Duke Family Medicine and Community Health told me about a local group called the Whole Dog Institute. After begging our way into a puppy (dis)obedience class, we started classes a few weeks ago (all classes are outside and we wear masks, and we are set far apart in a field). And here is what I have learned. Bruce’s new puppy, Leia
First of all, of course, most of the class is spent teaching owners how to work with and reward our puppies for good behavior. I come to class wearing the requisite dorky fanny pack filled with treats, and it turns out Leia will sell her soul for pieces of cooked hot dog! On day one, we worked on sit and down and stay, and we were coached on various ways to inspire desired actions. We were also told that we have to practice a trick at home, and the pup has to perform the new trick in front of everyone each week.
I could write more about our puppy and her improved behaviors and her amazing trick, but that really is not the main goal here. What I have thought about was how I needed to be trained to be a better instructor for our puppy. I needed coaching, guidance, and information so I could do better. Of course, these are the same reasons why we provide faculty development sessions for our providers. No one just naturally knows how to teach. We all need some instruction so we can improve upon our methods.
From class, I learned how to be very specific and mindful about what sort of behaviors and actions I wanted to emphasize and change. I learned to do this one small step at a time, and rewards (like pieces of hot dog) are invaluable. First the dog had to learn to sit, then stay, then adopt a down position; then I could teach her to lie on her side, and now she can roll over (most of the time).
Recently, I began working with a new student. She is going to be amazing. I am so impressed already with her clinical skills. But when she started to see patients individually and present them to me, I realized she needed some specific coaching and feedback. She presented the review of systems first, and she would arrive at the chief complaint last, as a culmination of the visit. The second time this happened, I realized I needed to explicitly ask her to rework her presentation format. I gave her some feedback (with some positives but no hot dogs!), and showed her some changes I wanted her to make. Literally within an hour, she understood what I wanted. I had been clear, the steps were simple, and the reasons behind my approach were explained. That afternoon, she changed the way she presented, and suddenly her presentations were much clearer and more valuable to me.
As you work with your learners, think about how you give instructions, guidance, and feedback. Be specific about what behaviors you want to improve upon, and aim for small steps rather than large changes.
We are hosting another faculty development session Oct. 29 and 30, so think about attending that virtually. (CME credit will be awarded, and the talks will be saved for later viewing.) Look for registration soon. And think about how we inspire behavior change. While your colleagues and students may not appreciate your bringing in hot dog treats, a granola bar and some specific feedback go a long way to inspire improvement in clinical skills.