Contact RaDME for more information about the Resident Teaching Development Program www.meded.ucsf.edu/radme

Goals for the Four-Session Workshop Series ............................................................................ 3
MODULE 1: Setting Goals and Expectations ............................................................................ 4
Three Steps for Setting Goals and Expectations .................................................................... 5
Practice Setting Third-Year Clerkship Goals .......................................................................... 6
Personal Goals for Setting Goals and Expectations ............................................................... 7
MODULE 2: Learning Climate ................................................................................................... 8
Principles of Learning ............................................................................................................ 9
Practice Using the Five Principles of Learning ..................................................................... 12
Personal Goals for Learning Climate ................................................................................... 13
MODULE 3: Clinical Teaching Skills Model-The One-Minute Preceptor .................................. 14
Five Microskills for Clinical Teaching ................................................................................... 15
Practice Using Clinical Teaching Skills ................................................................................ 18
Personal Goals for Clinical Teaching Skills .......................................................................... 19
MODULE 4: Giving Feedback ................................................................................................. 20
Definition of Feedback ......................................................................................................... 21
Practice Giving Feedback - Feedback Observation Form .................................................... 22
Personal Goals for Giving Feedback ................................................................................... 23
Evaluation ............................................................................................................................... 24
References .............................................................................................................................. 24
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2

1. Improve your confidence as a clinical teacher and team leader of medical students and interns.
2. Clarify expectations for medical student learning and for you as a teacher.
3. Expand your repertoire of practical teaching techniques appropriate for clinical settings.
4. Assist you in creating a supportive and challenging learning environment for your teams.
At the end of the session you will be asked to complete an on-line evaluation
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 3

The purpose of this session is to learn how to identify and communicate learning goals and expectations to medical students in clinical settings.
Objectives
By the end of the session, residents will be able to:
 Identify prescribed clerkship objectives for your learners.
 Describe three steps for setting goals and expectations for learners.
 Explain how goals are foundational to feedback.
 Consider cultural or other differences that could affect goal-setting for individual learners.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 4

1. DEFINE goals (knowledge, skills, and attitudes) and expectations
(how to function on the team)
 Describe prescribed clerkship goals for your students.
 In addition, what specifically do you want them to learn and be able to do?
 How will they learn it?
2. TELL your learners the goals
 “My goals for you are….”
 Be specific and clear (concrete).
 Tell them the relevance and importance of the goals – why they should learn them.
3. ASK learners for their goals
 Consider cultural or other barriers to defining goals.
Adapted from the Stanford Faculty Development Program, Leland Stanford University, 1998
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 5

Educational Goals Functional Goals
(Expectations for functioning on the team)
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 6

I would like to try….
1. ____________________________________________________
2. _____________________________________________________
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 7

The purpose of this session is to offer guiding principles for creating a supportive, motivating and challenging learning environment in clinical settings.
Objectives
By the end of the session, residents will be able to:
 Define the five key learning principles synthesized from the learning sciences for creating a positive learning environment.
 Describe how each principle can be used to maximize learning for a diverse group of students and interns.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 8

Resident-teachers enhance learning when they…
1. Communicate clear goals and expectations that expose the hidden curriculum.
2. Explain content in a way that is well organized, connected to learner prior knowledge, and avoids stereotypes.
3. Support practice opportunities and guide learning with feedback.
4. Create a motivating and challenging learning environment that is respectful of differences between learners.
5. Encourage self-directed learning through metacognition.
Adapted from Ambrose S, How Learning Works: Seven Research-Based Principles for Smart
Teachin g, 2010.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 9

Resident-teachers enhance clinical learning when they…
1. Communicate clear goals and expectations that expose the hidden curriculum.
Learning is enhanced when learners understand which academic and functional/logistic tasks are expected of them.

Explain functional and logistical expectations
 Share the rationale for goals and tasks
 Address the learner s’ goals and objectives based on your expectations.

Support self-directed learning by guiding learners to choose topics of interest based on their own identities rather than what they think is expected; help them identify their own knowledge gaps, etc.
2. Explain content in a way that is well organized, connected to learner prior knowledge, and avoids stereotypes.
Learning in clinical settings is strengthened when concepts and actions are made visible, related to cases and connected to learner prior knowledge.

Think aloud as you reason through diagnostic or management possibilities
 Use clinical cases that are engaging and avoid stereotypes
 Share basic concepts, conceptual frameworks or protocols for dealing with common problems
 Ask questions that require reasoning
 Ask questions about hypothetical cases
 Give learners time to think and respond to questions
 Draw on learner’s experiences to reinforce key teaching points, For example,
“When was the last time you saw a case like this?”
3. Support practice opportunities and guide learning with feedback.
Learners need to be supported in their practice and to know whether they are learning correctly.
 Provide time for learners to practice skills while you supervise
 Increase responsibility when appropriate

Refer to goals to guide discussion
 Ask learners to self-assess first
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 0


Make feedback targeted, timely, specific and objective, with awareness of your own biases
 Make plans for improvement
4. Create a motivating and challenging learning environment that is respectful of differences between learners.
The learning environment should be respectful, and encourage processing and verbalization of thought.
 Introduce yourself and use learners’ names
 Invite learners’ opinions, and consider cultural or other differences that affect participation in the learning environment

Acknowledge your own limitations, errors, and fears.
 Encourage questions and independent thinking
 Clarify your expectations
5. Encourage self-directed learning through metacognition.
The most permanent type of learning occurs when learners are involved in their own learning process (anticipatory planning, monitoring learning in real time and reflecting on learning afterward).

Encourage preparation prior to seeing a case
 Think aloud and invite learners to do the same
 Use modeling instead of shadowing

Use brainstorming
 Have learners reformulate material and predict outcomes or options (what if…?)
 Assign and discuss readings. Be sure to follow up.
 Encourage learner to learner interaction

Explore and address cultural or other differences that could affect learner involvement (e.g., comfort in speaking up in team)
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 1

Scenario:
Principles of Learning
1. Communicate clear goals and expectations that expose the hidden curriculum.
Selected Strategies
2. Explain content in a way that is well organized, connected to learner prior knowledge, and avoids stereotypes.
3. Support practice opportunities and guide learning with feedback.
4. Create a motivating and challenging learning environment that is respectful of differences between learners.
5. Encourage self-directed learning through metacognition.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 2

I would like to try….
1. ____________________________________________________
2. _____________________________________________________
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 3

The purpose of this session is to offer a practical clinical teaching strategy for use when time is limited.
Objectives
By the end of the session, residents will be able to:
 Describe the five microskills of the One-Minute Preceptor model.
 Apply the model to cases in their own specialty, avoiding biases that could affect clinical judgment.
Materials in this section were adapted from Neher JO, Gordon CC, Meyer B, Stevens N. A Five-Step
"Microskills" Model of Clinical Teaching. Journal of the American Board of Family Practice. 1992 and from handouts by David M. Irby, PhD.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 4

This practical teaching technique is composed of five consecutive “microskills” or steps, which facilitate learning in fast-paced clinical settings where time is limited. It is also called the One Minute Preceptor model.
1. Get a commitment – What do you think is going on?
2. Probe for supporting evidence
– What led you to that conclusion?
3. Teach general rules – When this happens, do this…
4. Reinforce what was right – Specifically, you did an excellent job of…
5. Correct mistakes
– Next time this happens, try this…
Case Presentation
Diagnose Learner
1. Get a commitment
2. Probe for supporting evidence (reasoning)
Teach
1. Teach general rules
2. Reinforce what was right
3. Correct mistakes
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 5

Microskill 1: Get a Commitment
To diagnose your learner and target teaching to what the learner needs to know, first identify learner uncertainty. This step often arises after the learner presents the case to you and pauses for further guidance. Instead of asking more questions or giving an answer, first ask the learner what they are thinking about the case.
Examples of questions likely to get a commitment:
 What do you think is going on with this patient?
 What would explain patient non-compliance?
 What do you want to do next?
 What do you want to accomplish during this hospitalization, procedure or test?
Examples of questions not likely to get a commitment:
 Sounds like pneumonia, don’t you think?
 Anything else?
 Did you find out which symptoms came first?
Microskill 2: Probe for Supporting Evidence
Once the learner has stated an opinion, avoid your instinct to tell them whether you agree or not. Instead, ask questions to find out their underlying reasoning. Their knowledge and uncertainty will not be evident yet. You are taking the opportunity to evaluate them for teaching purposes while allowing them to think through the case.
Helpful Approaches
 What are the major findings that led to your conclusions?
 What else did you consider?
 What did you rule? Why?
Unhelpful Approaches
 I disagree. Do you have any other ideas?
 This seems like a classic case of….
 What were her vital signs?
Microskill 3: Teach General Rules
Steps 1 & 2 are designed to provide clarity about what to teach and at what depth. Use this opportunity to provide the learner with some general concepts or principles related to the case.
The learner can then apply these concepts to other patients in the future.
Helpful Approaches
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 6

 If the patient has cellulitis, incision and drainage are not possible. You have to wait until the area becomes fluctuant to drain it.
 Patients with UTI usually experience pain with urination, increased frequency and urgency, and they may have hematuria. The urinalysis should show bacteria and wbcs.
It may also show some rbcs.
Unhelpful Approaches
 This patient has heart failure and needs diuresis. Don’t start the beta blocker now.
 I’m convinced that to diagnose cellulitis you need an aspiration for a culture.
Microskill 4: Reinforce What They Did Right
Your learner may or may not know what aspect of their reasoning/management plan/diagnostic strategy/presentation style was effective. Let the learner know specifically what was correct and effective.
Helpful Approaches
 You did a very thorough job of evaluating the patient’s abdominal complaints. Identifying the combination of anemia and blood in the stool was critical to making the diagnosis of colon cancer.
 You considered the patient’s finances in your selection of drugs. Your sensitivity to cost will likely contribute to his compliance.
Unhelpful Approaches
 You are right. That was a good decision.
 Nice presentation.
Microskill 5: Correct Mistakes
If the learner has made a mistake or needs improvement, it is crucial to their learning that you address it. Let the learner do a self-critique first then offer your specific observations and ideas for improvement. Focus on the future and how performance can be improved with your suggestion.
Helpful Approaches
 I agree that the patient is probably drug seeking, but we still need to do a careful history and physical exam before we make any recommendations.
Unhelpful Approaches
 You did what? What were you thinking?
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 7

Use for notes.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 8

I would like to try….
1. ____________________________________________________
2. _____________________________________________________
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 1 9

The purpose of this session is to develop skills in giving effective feedback to students in clinical settings.
Objectives :
By the end of the session, residents will be able to:
 Define evaluation and feedback, and recognize the utility of both.
 Recognize common barriers and biases that prevent effective feedback.
 Use effective techniques to provide positive and constructive feedback to their learners.
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2 0

“Specific information about the comparison between a learner’s observed performance and a standard, given with the intent to impr ove the learner’s performance.” van der Ridder, Stokking, McGaghie, ten Cate. What is feedback in clinical education?
Medical Education, 2008:42;189-197
ASK-TELL-ASK Model of Feeback
Feedback Steps
Ask
Ask the learner ’s opinion about what was effective and what they should keep doing
Ask the learner what was ineffective
Listen actively
Respond to the content and emotion of the learner’s reflections
Tell
Tell the learner about any additional observations, focusing on specific observations of behavior
Ask the learner for reactions to these observations, and respond (if applicable)
Keep the amount of feedback in correspondence with the learner’s readiness
Ask
Ask the learner about plans for the next step. Ask for ideas about what to stop doing
Listen actively
Ask the learner
’s opinion of what they should start doing
Listen actively
Respond to the content and emotion of the learner’s reflections
Summarize key points (or ask learner to summarize)
Agree on a plan
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2 1

Teacher: _______________________Date:_____________ Session:___________________________
Feedback Steps Comments/Notes
Ask
Asked the learner what s/he thought was effective or should keep doing
Asked the learner what s/he thought was ineffective
Listened actively
Responded to the content and emotion of the learner’s reflections
Tell
Told the learner additional observations (if any), focusing on specific observations of behavior
Asked the learner for reactions to these observations, and responded (if applicable)
Kept the amount of feedback in correspondence with the learner’s readiness
Ask
Asked the learner what s//he plans to do. Prompt with what does she want to stop doing
Listened actively
Asked the learner what s/he thought s/he should start doing
Listened actively
Responded to the content and emotion of the learner’s reflections
Summarized key points (or asked learner to summarize key points)
Agree on a plan
STRENGTHS RECOMMENDATIONS
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2 2

I would like to try….
1. ____________________________________________________
2. _____________________________________________________
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2 3

Please remember to complete the evaluation for this program on the paper evaluation form provided by the instructor, or at: https://wiki.library.ucsf.edu/x/RwQPFQ
A list of useful references and resources can be found on-line at: https://wiki.library.ucsf.edu/x/RwQPFQ
U C S F T e a c h i n g S k i l l s f o r R e s i d e n t s P a g e 2 4