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A CHALK TALK TALK
Nichole G. Zehnder, MD
Assistant Professor of Medicine
Director, Hospitalized Adult Care Clerkship
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Special Thanks...
 Joe Sweigart
 Brian Wolfe
 Eva Aagaard
 Learners Okay With Fumbles
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LEARNING OBJECTIVES
1. Describe situations when chalk talks are good
teaching tools.
2. Identify 8 key elements to effectively give a chalk talk.
3. Practice developing and delivering a chalk talk.
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Gameplan
 Adult Learning Theory
Basics
 When Chalk Talks Are
Best
 8-Steps to Forming
Effective Chalk Talks
 Practice With Partners
 Tips and Tricks
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BEDSORES
A Familiar Scenario = A Teachable Moment
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ADULT LEARNING THEORY
Learn best when there is an immediate need to
know.
Retain what they have learned when they can
apply it immediately.
Want to be the origin of their learning.
Thrive in a safe learning environment fostered by
the teacher.
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= PERFECT opportunity for a chalk talk
Neher. A Five Step “Microskills” Model.
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WHEN CHALK TALKS ARE
BEST
 Small learner numbers, one
teacher
 One single clinical question
or topic
 A short time to teach
 Always best when related
to direct patient care
 A great way to engage
learners
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MASTERING THE CHALK
TALK
John & Zimmerman. Chalk Talk.
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Step 1: SUMMARIZE &
REVISE
 Sub-I:
 “83 yo M with DM...
bedsore on his sacrum...
horrible smelling stuff...
doesn’t hurt... doesn’t
tunnel... no erythema or
edema... AND HIS
NURSE WANTS TO
KNOW WHAT I WANT TO
DO?”
Me:
“So in the process of working
up a diabetic patient with a
fall, you note that he has a
stage III pressure ulcer with
exudate and his nurse asks
you what to do.”
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 “And what you really want to know are specifics about
how to treat all types of pressure ulcers.”
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STEP 2: REINFORCE
Reinforce why the answer to the question is
critical to the situation
“So it turns out, this is really way more important
than just getting a wound care consult. 25-50%
of pts with new pressure ulcers will die in the
next year.”
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STEP 3: Set the stage
Foretell the answer to the question.
Chance to introduce ~2 more learning
objectives to review.
“When we are done you’ll know how to deal with
this specific situation but also know how to
stage pressure ulcers and which types of
dressings or treatments there are for each type.”
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STEP 4: Explore understanding
Figure out what the learner already knows and
build on it.
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STEP 5: DELIVERY
General to
specific
Organized
Cover LOs
Engaging
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Engage learners
 Set context, capture learners’ attention
 Use cases, practical examples
 Activate prior knowledge
 Enthusiasm matters
 Manage the process
 Have students look things up, use the board,
answer each others questions
Aagaard. Teaching in the Small Group Setting.
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STEP 6-8: LEARNER
RECRUITMENT
Have the learner summarize the patient’s
case (1-liner)
Learner rephrases original question.
Learner answers their own question.
“Now that we’ve talked about our patient, I’d like to
pass the baton and see what you want to
recommend to Mr. G’s nurse.”
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YOUR TURN
 10 minutes for practice with a partner
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MASTERING THE CHALK
TALK
John & Zimmerman. Chalk Talk.
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TIPS FOR DOING IT WELL
 Best with a case, if none,
make one up
 Avoid the curse of too much
knowledge
 Still a presentation, you are
the actor
 Good chalk talks are
recyclable
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Wrap-UP
 Chalk talks work well
for on-the-fly
teachable moments
 Build on Adult
Learning Theory
 Can be done in 8
easy steps
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REFERENCES
1. Chalk Talk: The 8-Step Process developed by Dr. Jonathan Zimmerman, Dr. Lily Go, Dr. Vijaylakshmi
Nagappan, Dr. David Sengstock. Accessed at
http://www.acgme.org/acwebsite/meetings/2012Conf/presentations/Friday/ses040.pdf on 4/12/2012.
2. Centor R. “Didactic Teaching.” Presented November 2009 at The Academic Hospitalist Academy.
3. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board
Fam Pract. 1992;5:419–24.
4. Aagaard E , Teherani A, Irby, D. Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient
and the Learner: Proof of Concept. Acad Med. 2004;79:42-49.
5. Orlander JD. Twelve tips for use of a white board in clinical teaching: reviving the chalk talk. Med Teach.;
2007. 29(2-3):89-92.