Motivate
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Workshop on Redefining Role of Teacher in medical education Motivation Dr. Syed Hasan Shoaib 2 Motivation Definition Motivation is derived from the Latin word ‘movere’ which means ‘to move’ or ‘to energize’ or ‘to activate’. What is Motivation? An internal state that arouses, directs, and maintains behavior. Motivation refers to all the internal conditions that stir up activity and sustain activity of an individual 3 How Does Motivation Affect Learning and Behavior? Directs behavior toward goals Increases effort and energy Commencement in activities is sooner Increases persistence in activities Enhances thought processes Leads to improved performance 4 Types of motivation 5 teacher grades job self-fulfillment parents love for the culture pleasure love for the language requirement salary Intrinsic Motivation Associated with seeking out and conquering challenges in pursuit of personal interests and the exercise of capabilities Associated with activities that are their own reward Enjoyment of a task or the sense of accomplishment that it brings 7 Extrinsic Motivation Motivation created by external factors like rewards and punishments Not interested in the activity for its own sake, but instead for possible gains 8 Try It Yourself Put an E next to the examples of extrinsic motivation or I for example of Intrinsic behaviour A teacher assigns points for good behavior that can be exchanged for better grades at the end of each week. A student goes to the library after school to find more information about an especially interesting topic that was introduced in class. A student crams hard for an upcoming exam in order to maintain her perfect GPA. 9 Effects of I vs. E Motivation on Student Learning Intrinsic Eager to learn Enjoy learning Welcome challenges Process information effectively Extrinsic Reluctant to engage in learning tasks Dislike learning Avoid challenges Process information superficially 10 The Effectiveness of Intrinsic and Extrinsic Sources of Motivation The relationship between intrinsic and extrinsic motivation is complex. Sometimes motivation can start out extrinsic and lead to intrinsic. For example, Bilal studies geometry because he believes studying will lead to a good job in the future. The more Bilal learns, the more he becomes intrinsically interested in the subject. 11 The Effectiveness of Intrinsic and Extrinsic Sources of Motivation People can be intrinsically and extrinsically motivated at the same time. Ideally, intrinsic motivation should be used, but sometimes extrinsic motivation, in the form of attendance policies for example, can be effective. 12 Review and Discuss What type of motivation do you have for this class? Why are you taking this class? List 3-5 reasons that you are in this class today. Label the reasons as I (intrinsic) or E (extrinsic) What do the results tell you about yourself and how you are likely to perform or behave in this class? 13 How to improve motivation in Colleges 14 Motivation in Learning and Teaching Most educators agree that motivating students is one of the critical tasks of teaching In order to learn, student must be cognitively, emotionally, and behaviorally engaged in productive class activities Students' motivation has a direct and powerful impact on their social interactions and academic achievements Motivation affects performance 15 Strategies to Improve Motivation Help students understand the value of the task or learning a particular skill • Attainment value—why learning a particular content or skill is important • Interest value—make learning fun • Utility value—explain connections between classroom learning and the “real world” 16 Strategies to Improve Motivation Use variety and familiarity to capitalize on student interests Help students set learning goals Enhance students’ self-efficacy through repeated successful experiences Provide students with choices 17 Strategies to Improve Motivation Help students view themselves as in charge of their behavior and learning Take responsibility for both successes & failures Focus on student effort Increase opportunities and expectations for success View intelligence and ability from an incremental viewpoint 18 Self Efficacy "People with high assurance in their capabilities approach difficult tasks as challenges to be mastered rather than as threats to be avoided." Albert Bandura Introduction Self -efficacy is a person’s belief in his or her ability to succeed in a particular situation. Bandura described these beliefs as determinants of how people think, behave, and feel (1994). Role of Self-Efficacy People with a strong sense of self-efficacy: View challenging problems as tasks to be mastered. Develop deeper interest in the activities in which they participate. Form a stronger sense of commitment to their interests and activities. Recover quickly from setbacks and disappointments. Role of Self-Efficacy People with a weak sense of self-efficacy: Avoid challenging tasks. Believe that difficult tasks and situations are beyond their capabilities. Focus on personal failings and negative outcomes. Quickly lose confidence in personal abilities (Bandura, 1994). Sources of Self-Efficacy • Mastery Experiences – • Social Modeling – • Witnessing other people successfully completing a task is another important source of self-efficacy Social Persuasion – • Performing a task successfully strengthens our sense of self-efficacy. Consider a time when someone said something positive and encouraging that helped you achieve a goal. Psychological Responses – Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about their personal abilities in a particular situation. References http://psychology.about.com/od/theoriesofpersonality/a/self_efficacy.htm http://psychology.about.com/od/profilesofmajorthinkers/p/bio_bandura.htm http://en.wikipedia.org/wiki/Self-efficacy LECTURING SKILLS Dr. Syed Hasan Shoaib ACKNOWLEDGEMENT Jens Dørup, Section for Health Informatics University of Aarhus, Denmark 55 WHY LECTURING? One of the oldest methods of teaching One can transform large amount of information in short time Economical for large group of students WHEN TO USE LECTURES Lectures are conducted for: Presenting new material Emphasize key concepts Explain To difficult concepts relate to PBL case by clinicians Preparation Why are you doing this lecture ? Who are you speaking to ? What is THE most important message ? Finding materials and inspiration Why prepare ? A strategy for preparation Think of the student, not the textbook Time ! Børge Meibom Practise in front of friends Børge Meibom Who are you talking to ? Speak their language Explain your selves Dont talk down – Dont talk up Levers for Learning Assessment Engagement Getting attention Ask a question Look at the audience Tell about a recent problem Use stimulating photograph A joke Jigsaw Learning Each team member is assigned a different reading or topic In-class project depends on each person’s contribution Anonymous Cards Effective for getting opinions or perceptions on sensitive topics Encourages participation by less vocal students Can be made active with variations Can be combined with group work “My Best Professors Ever…” Did not teach me what to think, but taught me how to think Helped me make connections between a serious academic curriculum and my own personal life, values, and experiences Worked with me one-on-one outside of class Asked questions or posed problems that helped me learn to think like a professional in my field Encouraged students to disagree with them, as part of teaching them how to think like professionals Taught students the importance of evidence, how to collect it, and how to use it to make decisions Engaged students in the learning process (Light, 2001) Pictures are worth a thousand words Why is this interesting ? The level(s) of your voice Sell it Set contents in context TRICKS Surprise Ahaaa ! A nice picture Be kind We are in this together The CLEAR MESSAGE Maximum of 3 or 4 points Define special word Use examples – analogies AV media: Be cautious ! Not meant to be your memory list Superfluous slides Too much colors / gimmics Red/green Variation Powerpoint : Tips & Tricks Speak to the auditory – not to the computer Rehearse Powerpoint Test installations in due time Make a printed backup of your slides on overheads Thank you for your attention Børge Meibom Being an effective role model Objectives of the Session Define role modelling Identify characteristics of role model in terms of on job working Identify characteristics of role model as a teacher Definition “Research indicates that being a positive role model is a set of skills, attitudes and behaviours which may be taught and acquired by doctors…” TASK (Plenary Session) Who are / were your role models in terms of on job working? What was their influence on your learning and career choices? Who are you a role model for in terms of on job working? What do you think are your attributes as a role model? “In order to be successful in the workplace, you have to be confident and secure in yourself. Those are the skills that you must enjoy developing in your students.” TASK (Plenary Session) Who are / were your role models in terms of teaching? What was their influence on your learning and career choices? Who are you a role model for in terms of teaching? What do you think are your attributes as a role model? Studies have established the attributes reported in medical role models: Individuals who: Excel in their clinical knowledge and skills Through communication skills they maintain good professional relationships Are effective and enthusiastic teachers A tall order! Students & trainees have multiple role models, learning different things from different individuals; the “composite” role model How learning from role models happens This is a complex process! Aspects have been explained through various learning theories: Individuals learn “to talk, from talk” Students & trainees learn professionalism through the “Hidden Curriculum” : This is a process of assimilation into a community of practice, not only by possession of shared expertise, but also the development of professional values and standards Positive role model attributes Personal characteristics Compassion Caring Empathic Patient-centred approach Excellent communication skills Good inter-professional relationships Respectful Good team player Demonstrates leadership Integrity Honesty Good sense of humour Calm Positive attitude Clinical skill Practically skilful Demonstrates clinical competence Knowledgeable Sound clinical reasoning Ability to reach the correct diagnosis Strives for excellence Presentation skills Aware of own strengths and weaknesses Positive role model attributes Teaching abilities Taking an interest in students and trainees Spending time with students and trainees Enthusiasm Patience Provide clear explanations Versatile, learner centred teaching style Constructive feedback Demonstrating clinical reasoning Facilitation patient interaction and learning opportunities Identifying opportunities for reflection PEARLS OF WISDOM On a Good Teacher “Believing in what you teach and teaching what you believe creates a powerful role model for our students.” “Student success is “the engine that pulls the train.” This is at the core and the reason we do what we do.” “I consider myself to be a "curious character," always analyzing how things function. This is lived out in the classroom. I hope that my enthusiasm is contagious in the sense that my students become passionate and curious about their world, especially since physics is a major part of everyday life!” “I try to treat all students as adults capable of making decisions about their education. An attempt is made to create an environment that fosters participation in class and in the community; an environment where mistakes, made during honest attempts at success, are seen as valuable learning opportunities.” “ALWAYS err in favor of the student. Be a little understanding: Even if 50 students have told you the same story, give the 51st student the same wide-eyed look you gave the first. Be a little forgetful: When a student asks you the same question you just heard 30 seconds ago, forget you already answered it.” “It is necessary to invest in student interests as they relate not only to the classroom, but also to their dreams and future endeavors. You must practice not only to learn the names of your students, but also to inquire about what motivates them.” “The challenge is not for you to pontificate; the challenge should be for your students to interrogate. You must encourage your students to ask you more questions in class than you ask them.” “When I stop having fun, then I’ll stop teaching.” “The best tool to inspire students is to share real life experiences. Learning occurs when knowledge is applied in reallife situations. Your role is to connect that gap in-between.” “Learning is a journey that takes a lifetime. Inevitably, some will stumble and fall along the way. Your job, though, isn’t to stop and pick them up but to provide them with the guidance that is necessary to move them from this part of their journey and help them succeed in the next.” “Toss it in the air, and let all your ideas for teaching fall on your students. Every student will find something they like. It might be working in groups, role playing, interactive lectures where they teach, or it may be a teacher that allows them to reach for their goals. Motivation for me is a smile, a thank you or a card that says, “you’re a first rate teacher.”’ “The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” “Believe in simplicity and plain speech. —"Try to see materials through students' eyes.”’ You teach everyday but the most important lessons you teach are not what comes out of books it is how you live your life and the examples you set in your daily actions, this is what students remember and what they admire most about you. Work very hard at what you do in order to be a positive role model to everyone you teach.” A true teacher is inspired and motivated by students learning and achieving goals they thought impossible. Their excitement becomes contagious as they gain confidence and dream of unlimited possibilities.” “Know your material; know your students,’ Mutual respect in the studentteacher relationship, a contagious enthusiasm in the enjoyment of science, a high expectation for achievement nurtured by generous encouragement, and the development of critical thinking skills for scientific literacy and global service is teaching at its best.” “A teacher is encouraged when he/she sees his/her passion of nursing transform the student into a compassionate, competent caregiver.” “Education is not simply about stuffing information into students’ heads. What really matters is enabling people to do something with that information – to analyze it, evaluate it, apply it meaningfully to their own lives. When students begin to use information, they become confident, engaged human beings. That is my everyday inspiration.” Facilitation Skills What is a facilitator? Literally means: ‘making things easy’ A person who helps a group or team to: achieve results in interactive events by using a range of skills and methods to bring the best out in people as they work together focuses on the process of how Role: Conductor Role: Impartial Helper belonging to no political coalition within an organisation being seen as having no stake in the outcomes Facilitator’s Role: Overview cope with uncertainty use power of credibility to help address issues be calm in times of emotion support and counsel others be understandable mobilise energy surface difficult issues and help others to do so take themselves less seriously empathise Group processes: intervening model appropriate behaviour ensure involvement enable understanding keep a task-related focus push for action outcomes manage time ensure that a record is created Interpersonal Skills/Basic Facilitation Skills language & communication using listening feedback questioning conflict handling Ten Commandments of Effective Listening 1. Stop talking 2. Put your people at ease 3. Show you want to listen 4. Remove distractions 5. Empathise 6. Have patience 7. Hold your temper 8. Don’t argue or criticise 9. Ask questions 10. STOP TALKING Questioning Use O P E N to probe: “Who, why, what, when, how?” Use CLOSED (yes/no answers) to redirect/ summarise: “Are you saying that…?” Questioning Use YOU questions How do you see this? What are your priorities? How important is ...... to you? Tell me more about ......? What if.......Why........How......? Using Feedback Help participants to think through these questions: 1. What did you do well? 2. What could you have done even better? 3. What prevented you from doing even better; what’s the plan to do even better in the future? Conflict Handling identify points of agreement reformulate contributions to highlight common ideas encourage people to build on others’ ideas test for false consensus test consensus for relevance/motivation Good Facilitation Brings Co-operation Results Presentation Skills 4 Key Aspects 1. Voice 2. Language 3. Body Language 4. Visual Speed Effective speakers change their rate of speed to fit their purpose, content, listeners & personal style Pace is the speed at which speaker presents different topics or thoughts within a topic speaker adjusts pace according to listeners’ and speakers’ interest Tone emphasis placed on a word to create meaning variation prevents monotonous presentations Volume / Variety / Vocabulary project your voice - aim for the back go faster to excite to gain maximum attention, say some words louder repeat important words Volume / Variety / Vocabulary slower go to emphasize major points give emphasis with voice & body pause often & look round audience Language avoid… acronyms being too formal long sentences try to… use everyday language use concrete words Body Language – Don’ts don’t point at anyone don’t move while presenting key points don’t stand rooted to the spot don’t leave your hands by your sides don’t avoid eye contact Body Language - Dos move hands & arms move around the room move towards audience move your eyes around the audience Body Language What about your audience? What does their body language tell you? Using Visuals: Don’ts don’t hide behind your visuals don’t let technology or visuals be more interesting than you don’t use visuals as detailed notes Using Visuals: Dos do let your visuals aid you do use visuals to clarify and emphasise do make one point per visual do introduce each visual before showing do practice beforehand Flip Chart / Projector / Posters / Cards… big and bold use drawings use colours face audience, talk, write, talk remove when finished Be Careful with PowerPoint 4 Colours Max Use graphics Check how it looks on projector Use text sparingly Making it Interesting stories/anecdotes explain by analogy involve them - ask questions - pause until reply The teacher as a mentor What is mentoring? Mentoring is about “helping people to become the person they want to be” -Pasloe & Wray, 1999 Mentoring is an intentional process to guide a protégé to proficiency. -Unknown Mentors are: • • • • • • • Guides Virtuous Trusting and trustworthy People lovers Empathetic Non judgmental Authentic What does a mentor do Motivate, Empower and Encourage, Nurture self-confidence, Teach by example, Offer wise counsel, Raise the performance bar. Souba W: Mentoring young academic surgeons, our most precious asset. J Surg Res 1999, 82:113-120. Goals of mentoring • Usually defined by the mentor and mentee in the initial encounters. • Increase professional competence and interest in research and in further specialization • To build up a professional network for the mentees • Developing professional and personal growth Read More: http://informahealthcare.com/doi/abs/10.1080/01421590500313043 Some famous mentor-mentee pairs • Oprah Winfrey mentored by Mrs. Duncan (4th grade teacher) • Dr. Martin Luther King mentored by Dr. Benjamin E. Mays • Marian Wright Edelman mentored by Howard Zinn Can you name some others? What the mentor requires: the skills to build a successful relationship skills in: • active listening • observation • reflective practice • feedback knowledge about and respect for each others’ stage of development expertise in the field of medicine Adapted from the Mentor support Program , 2008 Mentor Support Program What the mentor should do • • • • • Be available Allow for differences in personalities Let trainees make their own decisions Teach by words and example Keep learning about effective mentoring For effective mentoring • Keep a stable presence in the mentee’s life. • Show up for scheduled meetings • Focus on the mentee’s needs––not the mentor’s own wants and needs. • Look to improve the mentee’s prospects while respecting the young person’s life circumstances and perspective. • Keep in mind, the mentee’s need for fun. • Seek out and use the help and support of mentoring program staff. Identify career plans Locate prospective mentors Keep learning about effective mentoring Be clear about needs and expectations Keep the mentor updated with progress Distinguish between supervisors and mentors Performance improvement Help with career decisions and management Long term relationship with an experienced teacher Guidance on settling into the environment Can receive lots of information and advice Benefits to mentees Contact with an experienced person Develop faster as a student Get a personal face in a large institution Can feel a sense of belonging Benefits for Mentor Broadening of skills and knowledge Seeing others develop from your experience(s) Can increase personal and professional networks Provision of a new dimension to current job The ethics The protégé: • Should not spend so much time working on mentor’s projects that there is little time for their own • Should not be pushed to do work towards a patent or mentor’s financial gain • Should not have constraints (e.g. on publication in research projects) • Should not disengage or undermine or compete Adapted from : Jonathan R. Cole The Research University in a Time of Discontent Various kinds of mentoring Traditional one-to-one E-mentoring Peer mentoring Team Mentoring Group mentoring In traditional, e-mentoring and peer mentoring: • Mentors feel satisfaction in doing something worthwhile, having fun, and building a long term relationship. In team or group mentoring: • Time with students, group/team structure, and training are all seen as beneficial and meaningful. School-based Communitybased Types of mentoring Programs Agency-based Faith-based The effect of a good mentor on the academic career • The influence of the mentor begins with collaboration. • Collaboration increases student’s productivity and academic placement . • Collaboration increases student’s later publications and citations. Adapted from Scientometrics Volume 7, Numbers 3-6, 255-80, 2005 Barriers Students from UCSF, in a study conducted in 2005, identified the following as barriers to effective mentoring: • The short duration of courses, • Abrupt change from classroom learning to clerkships • Limited exposure to clinicians Read More: http://informahealthcare.com/doi/abs/10.1080/01421590500271316 References • Guidance for Mentoring Medical Research Council • INFORMATIONAL OVERVIEW OF TYPES OF MENTORING PROGRAMS Compiled from Mentoring School Age Children (1999) by Public/Private Ventures and MENTOR/National Mentoring Partnership, Understanding Mentoring Relationships (1992) by the Search Institute, Elements of Effective Practice, second edition (2003), MENTOR/National Mentoring Partnership, and The Connecticut Mentoring Partnership, Business Guide to Youth Mentoring. • The importance of mentor/mentee relationships [ppt] Johns Hopkins Medical Institution • Formal mentoring programmes for medical students and doctors – a review of the Medline literature 2006, Vol. 28, No. 3 , Pages 248-257 ProfessorBarbara Buddeberg-Fischer and Katja-Daniela Herta Department of Psychosocial Medicine, University Hospital Zurich, Switzerland • Souba W: Mentoring young academic surgeons, our most precious asset. J Surg Res 1999, 82:113-120. Thank you Providing Students with Effective Feedback What is Feedback? “Feedback is an objective description of a student’s performance intended to guide future performance. Unlike evaluation, which judges performance, feedback is the process of helping our students assess their performance, identify areas where they are right on target and provide them tips on what they can do in the future to improve in areas that need correcting.” ~ W. Fred Miser What is Feedback? “Research has shown that effective feedback is not a discrete practice, but an integral part of an instructional dialogue between teacher and student, (or between students, or between the student and him/herself).” What is Feedback? “Feedback is not about praise or blame, approval or disapproval. That’s what evaluation is – placing value. Feedback is value-neutral. It describes what you did and did not do.” ~ Grant Wiggins What is Feedback? “Effective feedback, however, shows where we are in relationship to the objectives and what we need to do to get there. “It helps our students see the assignments and tasks we give them as opportunities to learn and grow rather than as assaults on their self-concept. “And, effective feedback allows us to tap into a powerful means of not only helping students learn, but helping them get better at learning.” ~ Robyn R. Jackson What is Feedback? “Effective feedback not only tells students how they performed, but how to improve the next time they engage the task. Effective feedback is provided in such a timely manner that the next opportunity to perform the task is measured in seconds, not weeks or months.” ~ Douglas Reeves, p. 227 Feedback Focus Academic Behavioral Primary Purposes of Feedback To keep students on course so they arrive successfully at their predetermined destination. ~ W. Fred Miser “It is one thing to collect feedback about students’ progress, but if you simply collect this feedback and never use it to adjust your instruction, then you are collecting it in vain. The data you receive from grading your assignments and assessments will give you feedback about the effectiveness of your own instruction.” ~ Robyn R. Jackson What Does the Research Say? “Academic feedback is more strongly and consistently related to achievement than any other teaching behavior….This relationship is consistent regardless of grade, socioeconomic status, race, or school setting….When feedback and corrective procedures are used, most students can attain the same level of achievement as the top 20% of students.” ~ Bellon, Bellon & Blank What Does the Research Say? “Feedback seems to work well in so many situations that it led researcher John Hattie (1992) to make the following comment after analyzing almost 8,000 studies: ‘The most powerful single modification that enhances achievement is feedback. The simplest prescription for improving education must be dollops of feedback.’” ~ Robert Marzano Power of Accurate Feedback Immediate impact on results Lower failures Better attendance Fewer suspensions Failure here undermines EVERY OTHER EFFORT in curriculum, assessment, and teaching ~ Douglas Reeves, Asilomar Conference 2009 Powerpoint Feedback Timing Good Timing Bad Timing Returning a test or assignment the next day Returning a test or assignment two weeks after it is completed Giving immediate oral responses to questions of fact Giving immediate oral responses to student misconceptions Ignoring errors or misconceptions (thereby implying acceptance) Going over a test or assignment when the unit is over and there is no opportunity to show improvement Providing flash cards (which give immediate right/wrong feedback) for studying facts ~ Susan Brookhart Amount of Feedback For students to get enough feedback so that they understand what to do but not so much that the work has been done for them (differs case by case) For students to get feedback on “teachable moment” points but not an overwhelming number ~ Susan Brookhart Strategies to Help Students Learn to Use Feedback Model giving and using feedback yourself. Teach students self- and peer assessment skills to: Teach students where feedback comes from. Increase students’ interest in feedback because it’s “theirs”. Answer students’ own questions. Develop self-regulation skills, necessary for using any feedback. ~ Susan Brookhart Strategies to Help Students Learn to Use Feedback Be clear about the learning target and the criteria for good work. Use assignments with obvious value and interest. Explain to the student why an assignment is given – what the work is for. Make directions clear. Use clear rubrics. Have students develop their own rubrics or translate yours into “kid-friendly” language. Design lessons that incorporate using the rubrics as students work. ~ Susan Brookhart Strategies to Help Students Learn to Use Feedback Design lessons in which students use feedback on previous work to produce better work. Provide opportunities to redo assignments. (Comparing a rough draft to the rubric/criteria/exemplar.) Give new but similar assignments for the same learning targets. Give opportunities for students to make the connection between the feedback they received and the improvement in their work. ~ Susan Brookhart Attaining Excellence “Students must have routine access to the criteria and standards for the task they need to master; they must have feedback in their attempts to master those tasks; and they must have opportunities to use the feedback to revise work and resubmit it for evaluation against the standard. Excellence is attained by such cycles of model-practice-performfeedback-perform.” ~ Grant Wiggins References Bellon, Jerry, Bellon, Elner, & Blank, Mary Ann. Teaching from a Research Knowledge Base: A Development and Renewal Process, New York: Macmillan Publishing Company, 1992. Black & William, “Inside the Black Box: Raising Standards through Classroom Assessment” Phi Delta Kappan, October 1998. Brookhart, Susan M. How to Give Effective Feedback to Your Students. ASCD, 2008. Davies, Anne. “Involving Students in the Classroom Assessment Process” Ahead of the Curve: The Power of Assessment to Transform Teaching and Learning. Douglas Reeves, Editor. Solution Tree, 2007. Jackson, Robyn R. Never Work Harder Than Your Students & Other Principles of Great Teaching. ASCD, 2009. Marzano(1), Robert. Classroom Instruction that Works. ASCD, 2001. Marzano(2), Robert. “Designing a Comprehensive Approach to Classroom Assessment.” Ahead of the Curve: The Power of Assessment to Transform Teaching and Learning. Douglas Reeves, Editor. Solution Tree, 2007. References, page 2 Marzano(3), Robert. What Works in Schools: Translating Research into Action. ASCD, 2003. Miser, W. Fred. “Giving Effective Feedback” “Providing Students with Effective Feedback” Academic Leadership LIVE: The Online Journal; Volume 4, Issue 4, February 12, 2007. Reeves, Douglas. “Challenges and Choices: The Role of Educational Leaders in Effective Assessment.” Ahead of the Curve: The Power of Assessment to Transform Teaching and Learning. Douglas Reeves, Editor. Solution Tree, 2007. Stiggins, Rick. “Assessment for Learning: An Essential Foundation of Productive Instruction.” Ahead of the Curve: The Power of Assessment to Transform Teaching and Learning. Douglas Reeves, Editor. Solution Tree, 2007. “Synopsis of ‘The Power of Feedback’” by Center on Instruction, 2008. [Hattie & Timperley’s research] Wiggins, Grant. Educative Assessment: Designing Assessments to Inform and Improve Student Performance. San Francisco: Jossey-Bass Inc., 1998. 157 BEDSIDE TEACHING Dr. Syed Hasan Shoaib What is so UNIQUE ABOUT BEDSIDE TEACHING? • IT IS A REAL LIFE SITUATION • IT COVERS ALL THREE DOMAINS OF EDUCATIONAL OBJECTIVES • Cognitive Domain • Psychomotor Domain • Affective Domain OVERVIEW OF PRESENTATION • What is Bedside teaching • Rights of Patient • What is One minute preceptor? • Process of INWARD teaching What is Bedside Teaching? What is bedside teaching? • In modern times our definition of bedside teaching includes any teaching done in the presence of the patient, regardless of the setting (e.g. ambulatory clinic, inpatient ward or conference room). • There should be “no teaching without a patient for a text, and the best teaching is that taught by the patient himself.” HISTORICAL PERSPECTIVE Hippocrates first two principles • Observe all • Study the patient not disease Rights of Patient DROIT – A framework of patient rights for clinical education • Dignity is a human right that recognises the worth of every person. • Respect is an affirmative acknowledgement of individual circumstances. • Obligation to act in the best interests of the patient is fundamental to medical professionalism. • Information is the foundation of healthcare decisions for patients and doctors. • Trust in the competence and ability of the doctor is a pre-requisite for confidence. (Lewkonia, 2011) Teaching in Ambulatory setting One Minute Perceptor The “One Minute Preceptor” teaching model was developed at the Department of Family Medicine at the University of Washington, Seattle. See: Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A five-step "microskills" model of clinical teaching. Journal of the American Board of Family Practice, 5, 419-424. The “One Minute Preceptor” 10 Minutes of “Teaching Time”... Questioning 3 Minutes (Questioning) Discussion 1 Minute for (discussion) Presentation 6 Minutes – (student’s presentation) The 5-Step Microskills Method 1. Get a Commitment 2. Probe for Supporting Evidence 3. Reinforce What Was Done Well 4. Give Guidance About Errors or Omissions 5. Teach a General Principle Get a Commitment Why?… Encourages learner to process the information further and solve problem. Examples... “What do you think is going on here?” “What would you like to do next?” Probe for Supporting Evidence Why?… Helps you to assess the learners knowledge and thinking process. Examples... “What factors support your diagnosis?” “Why did you choose that treatment?” Guide Errors/ Omissions Describe what was wrong (be specific), what the consequence might be, and how to correct it for the future Why?… Corrects mistakes and forms foundation for improvement. Example… “During the ear exam the patient seemed uncomfortable. Let’s go over holding the otoscope.” Reinforce What Was Done Well Describe specific behaviors and likely outcomes Why?... Behaviors that are reinforced will be more firmly established. Example… “I liked that your differential took into account the patient’s age, recent exposures, & symptoms.” Teach a General Principle Symptoms, treatment options, or resources to look information up Why?… Allows learning to be more easily transferred to other situations. Examples… “Remember 10-15% people are carriers of strep, which can lead to false positive strep tests.” Conclusion Why?... Directs remainder of the encounter. Example…“Let’s go back in the room and I’ll show you how to get a good throat swab. Tell me when we have the results, and I’ll watch you go over the treatment plan.” ONE MINUTE PERCEPTOR VIDEO How is teaching done in Wards? Begin outside room Ask patient permission Establish goals and time limit with group Assign each group member a role Ask patient if he/she has Questions Encourage & close by thanking Enter patient room Conduct focused teaching (Role Model, practice) Discussion & feedback End outside room Debrief with group feedback Follow-up with patient Introduce everyone brief overview Diagnose learners and Patient Observation, Question SUMMARY “Trainees do not perform required skills incorrectly on purpose…errors in performance are typically the result of insufficient feedback. They are seldom the result of insufficient interest or caring.” -Westberg and Jason, 1991 4-3 Summary The more the student processes and the less you say ….the more successful the encounter is likely to be. 180 SUMMARY • Definition • DROIT • One Minute Perceptor • PROCESS IN WARD Adapted from Materials…… • Effective Clinical Teaching, Rohan Jeyarajah, MD and Hari Raja, MD • Lehman LS,et.al. The effect of bedside case presentations on patients’ perception of their medical care. NEJM 1997;336:1150. • The “One Minute Preceptor”: Time Efficient Teaching in Clinical Practice. Preceptor Development Program, developed by MAHEC. Funded by HRSA Family Medicine Training Grant # 1D15PD50119-01 • The One-Minute Preceptor & The One-Minute Observation Effective & Efficient • Outpatient Clinical Teaching. JHUSOM Department of Neurology, December 21, 2006 THANK YOU Applying the One-Minute Preceptor MicroskillsAN EXAMPLE • Preceptor: What do you think is going on? • Student: I think he has upper respiratory infection, probably otitis media. • Preceptor: What led you to that conclusion? • Student: He has a history of repeated otitis media and currently has a fever, a painful right ear and a runny nose. Applying the One-Minute Preceptor Microskills- AN EXAMPLE • Preceptor: What would you like to do for him? Student: First, I would like you to confirm my findings on the right ear. If you concur about otitis media, then we should give him some antibiotics. Since he doesn't have any allergies to medication, I think amoxicillin is a reasonable choice. Applying the One-Minute Preceptor Microskills- AN EXAMPLE • Preceptor: You did a good job of putting the history and physical exam findings together into a coherent whole. It does sound as if otitis media is the most likely problem. There is great variability in ear problems. The key features of otitis media that I look for in the physical exam are the appearance and mobility of the ear drum, landmarks, opacity of the drum, and mucus discharge, and in the history prior upper respiratory infections and past problems with the ears. This child would seem to fit these criteria. Amoxicillin is a logical choice for an antibiotic if the patient does not have an allergy. I'll be glad to confirm your ear exam findings. Let's go and see the patient.
