Learning Objectives
After completing this lesson, you will be able to:
(1) Identify different strategies to optimize teaching when time is limited.
(2) Apply these strategies while educating learners in busy clinical settings.
Case studies
Hannah wants to teach while managing a busy inpatient service.
Hannah is a pediatric endocrinologist working with medical students and residents on an inpatient service week. She wants to teach her team about relevant endocrine topics while on service but also has five new consults to see in the hospital. She is aware that the residents are busy as well. How can Hannah balance teaching and managing a busy and complex medical service?
Adam wants to help his students learn during clinic.
Adam is a gastroenterologist working with a medical student during a busy clinic day. The student is engaged and asks thoughtful questions between patients while Adam tries to complete other tasks. How can Adam provide learning for the student while also staying on task?
One-Minute Preceptor
Finding the time to teach in busy clinical environments can be challenging. Clinician educators Kathleen Timme and Pete Hannon outline a process for precepting in five minutes or less here.
linician-educators often juggle teaching learners with providing patient care in busy clinical settings. There are numerous challenges, including varying learner levels and engagement, balancing teaching with clinical tasks, and limitations in time. While didactics or chalk talks are valuable, they can be time-consuming.
Even in busy clinical settings, clinician-educators can foster a positive learning environment to create effective educational experiences for students. By incorporating clear communication, an appropriate balance of autonomy and supervision, and enthusiasm for teaching, preceptors can significantly impact student development, leading to valuable clinical experiences for learners and optimal patient care.
The One-Minute-Preceptor (OMP) model offers an efficient way to deliver teaching pearls during clinical encounters. Other time-sensitive teaching frameworks include SNAPPS, a learner-centered model for case presentations, and Illness Scripts, a clinical reasoning tool that leverages predisposing conditions, pathophysiology, and clinical presentations.
What are other tips and strategies to effectively teach when time is limited in busy clinical settings?
1. Include learners in patient and family education.
Conversations with patients and families are great opportunities to teach learners simultaneously. For example, including learners in your anticipatory guidance with a family on febrile seizures is an excellent way to educate both parties, save time, and equip learners to manage similar clinical encounters independently. Another example is family-centered rounds, where patient and family education can occur alongside learner instruction through bedside teaching, direct observation, and attending physician role-modeling.1
2. Complete patient tasks together with learners.
The "see one, do one, teach one" approach transforms everyday tasks into learning opportunities. For example, obtaining informed consent for a procedure reinforces the learner's understanding of anatomy, physiology, and complication management related to the diagnosis and procedure. Another example is when consultants respond to a page from the ED about a patient. Learners can review charts, research guidelines, and gather information from the referring provider, freeing time for focused teaching, while allowing them to contribute meaningfully.
3. Leverage the “Think Aloud” method.
While the traditional Socratic method is effective, it can be time-consuming. The Think Aloud method involves clinicians verbalizing their thoughts while performing patient care. This method enables clinicians to make explicit their otherwise automatic and implicit thought processes, thus teaching trainees clinical reasoning skills.2 This method is particularly effective when treating critically ill or complex patients, where formal teaching opportunities are limited.
4. Prime the learner.
Priming, a technique where learners are coached and prepared before seeing patients, improves both education and patient care. Priming helps students hone in on critical information they should gather in a patient’s history and exam that’s important and relevant to an encounter.3 For example, a patient presenting with prolonged fever can have a broad differential diagnosis that includes both infectious and non-infectious etiologies. Discussing possible causes and relevant questions before a learner takes the history ensures the student collects vital information, leading to better patient care.
5. Promote self-directed learning through illness scripts.
Illness scripts offer a structured framework for learners to organize and retain key features of classic disease presentations. This approach simplifies complex conditions and captures their subtle nuances. By comparing illness scripts, learners can differentiate between diseases and explore potential treatment options. Crafting illness scripts after patient encounters fosters self-directed learning and reinforces clinical reasoning.
6. Set daily learning goals.
Setting targeted learning goals for the day can be particularly useful in the inpatient setting. For example, set "respiratory illnesses" as the daily focus and share relevant pearls throughout the day. Consider gamification to make the topic engaging. For example, in infectious disease, choose an "animal of the day" and discuss diseases related to exposure to that animal throughout the day.
7. Keep it brief.
Teaching pearls can be brief. Concise, targeted points are more likely to be retained and applied in clinical practice.
Let's return to our cases: |
|---|
| Hannah wants to teach while managing a busy inpatient service. Hannah creates a positive learning environment by setting clear learning goals with her medical students and residents at the beginning of each day. She focuses on DKA management on the first day and shares relevant pearls throughout the day. To actively engage residents in the teaching process, she encourages them to guide medical students in creating illness scripts for their patient encounters. To solidify learning at the end of the week, students present their scripts and identify remaining questions, enabling Hannah to fill in those gaps. |
| Adam wants to help his student learn during clinic. Adam utilizes several strategies to provide learning for the student while staying on task. Before seeing a patient, Adam has the student review the patient’s chart, look up relevant labs or imaging, and read about the patient’s chief complaint or existing diagnoses. This helps include the student in patient care and primes the student before seeing the patient. Additionally, Adam uses opportunities in the room to educate the patient, their family, and the student. Adam then spends a few minutes debriefing after each patient to see what additional questions the student still has. |
References:
- Mittal V. Family-centered rounds. Pediatr Clin North Am. 2014;61(4):663-670. doi:10.1016/j.pcl.2014.04.003
- Pinnock R, Young L, Spence F, Henning M, Hazell W. Can Think Aloud Be Used to Teach and Assess Clinical Reasoning in Graduate Medical Education? J Grad Med Educ. 2015;7(3):334-337. doi:10.4300/JGME-D-14-00601.1
- Stuart E, Hanson JL, Dudas, RA. The Right Stuff: Priming Students to Focus on Pertinent Information During Clinical Encounters. Pediatrics July 2019; 144 (1): e20191311. 10.1542/peds.2019-1311
Hannah Jelley
Katie Swenson
Jessika Weber
Kathleen Timme
Cheryl Yang
Frequent and deliberate practice is critical to attaining procedural competency. Cheryl Yang, pediatric emergency medicine fellow, shares a framework for providing trainees with opportunities to learn, practice, and maintain procedural skills, while ensuring high standards for patient safety.
Empathy is our cognitive ability to understand, communicate, and respond to another person’s perspectives, experiences, and concerns. Pediatrician Diane Liu reflects on the very real challenges of nurturing empathy in the face of the relentless demands of practice.
Learners, patients, and teachers are more confident and inspired when we take time to create positive learning environments. Pediatric endocrinologist Kathleen Timme gives practical advice for integrating key aspects of a positive learning environment into your daily interactions.
