Teaching when time is limited
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39456.727199.AD (Published 14 February 2008) Cite this as: BMJ 2008;336:384All rapid responses
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I found this article particularly helpful in planning a teaching
session.
With the European Working Time Directive (EWTD), the time for
clinical work for trainees has decreased significantly.
In a typical residency programme in the United States where the trainees
start working before 7am and finish the normal day after 7pm can afford to
have 1hr lunchtime teaching every day. With 48hrs a week working time,
daily formal teaching is not an option; instead frequent bed-side teaching
is becoming the main method of instruction to trainees.
Objective Structured Clinical Examination (OSCE) is gradually
replacing old system of examination making teaching ward rounds more
relevant.
The ‘one minute preceptor’ model is particularly helpful when time is
limited.
As trainees of different levels work together, senior trainees should
take initiative to teach juniors. Junior trainees should encourage this
process and actively participate in these sessions.
Providing feedback to learners is of utmost important, but, this
article does not mention about getting feedback from the students which is
a very important tool to improve teaching.
Competing interests:
None declared
Competing interests: No competing interests
EDITOR - A fantastically simple but effective teaching method I
encountered recently in Australia is as follows: Picture a typical ward
round: senior doctor asks a question of the group of eager and willing
junior doctors and students. All look glibly at the floor, the ceiling or
each other as none are in possession of the answer. Alternatively, over-
confident student blurts out something utterly incorrect and junior
colleagues giggle self-consciously. Either way, rather than grunting in
disgust and instantly conveying this gem of essential knowledge, senior
doctor asks one of the students to find out the answer in the next two
days and present it to the group as a 1 minute summary. This is a daily
event with each of the group taking their turn. By the end of their
rotation with doctor senior, many more facts have been acquired by the
junior team and their presentation skills have been enhanced. Also, senior
doctor finds they no longer have to know everything about everything but
can merely appear to do so as they grunt approvingly and nod knowingly
during said presentations.
Competing interests:
None declared
Competing interests: No competing interests
This is really an interesting article providing knowledge of
different rapid teaching methods. Getting feedback from students is as
important as identifying learner's needs. In my one encounter with medical
students I tried to teach them everything about congenital heart disease
in single one hour lecture,but after taking feedback from them I realised
that they wanted bedside teaching on patients. After this incidence I
always ask students about their learning needs as well as curriculum and
try to teach them accordingly.Before any teaching clear objective setting
is very important.Short teaching during coffee break for 5 minutes is also
appreciated by medical students.
Competing interests:
None declared
Competing interests: No competing interests
After spending quite a lot of time in the hospital environment
especially working for Oxford Radcliffe Hospitals Trust before embarking
into primary care as a GP Registrar, one of the things I quite enjoyed
there was some bedside teaching for medical students who were talented and
keen to learn the maximum. In addition associating myself with the House
officers and Senior House officers especially when doing on-call sessions
as a middle grade doctor – I have enjoyed listening to their patient
summaries and taken them a little further with their management strategies
by adding my experience into action.
Now been in primary care since August last year, I have been enjoying
various consultation models which I rarely came across when I listened to
medical students or other junior doctors in the secondary setup. Also I
was too basically focusing on a doctor centred approach and I always
justified that lack of adequate time in the secondary care was to blame.
But when I learnt for the first time in the GP land that all we had to
concentrate was 10 minutes to think about doctors’ as well as patients’
perspectives and draw up a management plan acceptable for both parties, I
started to concentrate on a focused approach to include both doctors as
well as patients perspectives to get a better outcome.
Currently I am working on this Focused Medical Review, mainly based and
modified from Cambridge–Calgary Consultation model. I feel this could
become a better model in the hospital setup for junior doctors and medical
students with a possibility of giving the doctor his/her perspective to
work on while the patient to reveal his/her story in the given short time
frame. This will definitely be a time efficient model as any other model
which is based on similar principles.
The content of the Focused Medical Review
Patients Complaints/problems
The exploration of patient’s complaints/problems
1.Doctor’s perspective/biomedical perspective
a.Sequence of events
b.Symptoms analysis
c.Relevant systems review
2.Patient’s perspective
a.Ideas
b.Concerns
c.Expectations
d.Effects on life
e.Feelings & Thoughts
3.The background information
a.Past Medical History
b.Drug & Allergic History
c.Personal & Social History
d.Family History
4.Focused examination of the patient
5.Management plan
I welcome your views and you may email me on RShk9@aol.com.
Competing interests:
None declared
Competing interests: No competing interests
This review highlighted a recent experience when I needed to
deliver effective teaching in a short time. During my recent fellowship
examination for the College of Emergency Medicine one OSCE station
presented me with a Clinical Decision Unit ward round. There were two
patients to discuss with the admitting F2 doctor. Both cases provided
atleast one clear learning point as well as associated clinical management
decissions.
I was initially taken back by the station, this scenario had not
having occurred to me in my exam preparation. I fell back on my usual
style of teaching in this type of circumstance and passed the station. In
reading the details of the one-minute preceptor model I realized this
outlines my usual style but lays it out in a format that is easy to follow
and can be reproduced. Were I to advise someone on preparing for a
similar process I would recommend the outline given by Irby and
Wilkerson.
Competing interests:
None declared
Competing interests: No competing interests
All of us remember the apprehension that came with the teaching
round. Having clerked the patient the day before, your heart races and
palms sweat as you try to remember the history and what the team has told
you with regards to his management. Then there are the questions: have I
read up enough? Am I going to be made to look like a fool in front of the
team, my colleagues and more importantly the patient?
For most medical students the main bulk of consultant teaching occurs
on the ward round. However, the ability to teach on a round is multi-
factorial.
The medical students: How keen are they? Have they clerked the
patient and made sure they have understood the case? Have they done their
background reading into the condition? And, most importantly, do they
want to be there?
The team: How willing are they for medical students to clerk patients and
talk to them about the patient’s management and reasons behind it? Are
they approachable and willing to teach?
Finally the consultant: Does he/she enjoy teaching? How busy are they?
Does he/she feel the students want to learn?
Having only recently made the transition from medical student to
doctor, I have realised just how important those teaching rounds are. As
junior doctors, we are expected to ‘just get on with it,’ as teaching on
wards rounds, so far in my experience, has only happened when there is a
student around. I personally think it is important for medical students to
realise this. Effective teaching, I feel, has many aspects to it and has
as much to do with the students attitudes as the consultant lead team’s
approach to teaching. Being a student is the time to be taught and they
need to show interest in order for the consultant to teach and to get the
most out of their placements.
Competing interests:
None declared
Competing interests: No competing interests
It's all in the packaging
Excellent article. Thank you.
As a consultant in one of the busiest EDs in the country we struggle with
the balance of efficient patient throughput vs education. The two are not
mutually exclusive, as the authors demonstrate. The difficulty is in the
perception (from the junior doctors) that these micro-teach episodes are
actually teaching - not just consultant advice.
What I and my colleagues have learned from this article is that
formalising and structuring these brief encounters and making it clear
that this is "teaching" is what we're bad at.
Our junior doctors have more shoulder to shoulder consultant guidance in a
day than doctors of my generation had in a year. To an extent we already
use many of the techniques listed, and have discussed the "mini-teach" at
length as trainers. Despite that we are criticised for delivering no
teaching (meaning standing by the white board in the classroom in
protected time).
As teachers we clearly need to become a bit more organised and focussed.
Maybe if we formally adopt some of the concepts and phrases in this
article and we prime the learners by explaining what we are doing (in
their induction sessions and initial appraisal) the audience will finally
perceive these encounters as "teaching"!
Competing interests:
None declared
Competing interests: No competing interests