Teaching Tips

This page offers tips to help medical educators in their teaching endeavors. Choose from the following topics, listed below:

Motivating Students: Going Beyond Grades
The One-Minute Paper
Habits are Habit-Forming
The Bedside is the Best Side for Teaching
A Friendly Little Game, Anyone?
Teach by Example
What Are Your Withholdings?
Experience is the Best Teacher...
Trust the Force, Luke
RIME With Reason
Practice Makes Perfect (Sense)
Do You Have a Teaching Mission Statement?
Are You Watchable?
Improve Your Teaching Through Reflection: A "Below-Par" Example
Have the Learner Present in Front of the Patient
Question Your Questioning
Thinking Out Loud
Videotape Yourself
Are You Changing Their Behavior?
Do They Know What They Don't Know?
Switch Gears After 15 Minutes
Priming the Learner
Choosing a Delivery Strategy
Seven Principles of Good Educational Practice

Motivating Students: Going Beyond Grades
While many students are naturally motivated, others are driven by grades and still others expect their teachers to inspire and stimulate them. Of course, there are no magic bullets, but here are some simple guides to help you keep students focused and motivated.

1. Help students feel they are active participants in the learning community, not just recipients of your information. Treat them with respect.

2. Capitalize on students' existing needs. They will want to learn so they can accomplish a task, improve skills, meet challenges. Help them find personal meaning and value.

3. Hold students to a high standard. This tells the students you believe they can accomplish much and also gives them a feeling of success when they meet those standards.

4. Rely on logic whenever possible. Tell students when something is a fact that must be memorized and when the material or process is based on logic. Don't forget to lead them through the "logic pathway."

5. Use visual aids, since many of today's students are visual learners.

6. Emphasize the most critical points continuously through exams, classroom activities, clinical opportunities and other learning contexts.

7. Help students create a link to earlier learned information when teaching new concepts. Remember these links can be to clerkships other than ob-gyn and to specific clinical activities.

8. s a teacher be enthusiastic, organized and involved.

9. Emphasize mastery and learning, rather than grades.

10. Provide feedback as soon as possible.

Reference
Honolulu Community College. Faculty development teaching techniques: Core abilities-Motivating students. Barbara Gross Davis. Motivating students; Lana Becker and Kent N. Schneider, Motivating students: 8 simple rules for teachers.

http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/teachtip.htm

The One-Minute Paper
When we finish a class, a clinic, M&M, or some other teaching opportunity, we often don't really know what students have learned. Typically, we wait until the next exam to find out. The one-minute paper is one way for instructors to receive immediate feedback on their teaching effectiveness, and discover how much students really understood and took away from your session.

To carry this out, give students the last few minutes of the class or clinic to write answers to one or two specific questions you create. Collect their answers, and analyze and synthesize the results to discuss the next time you are with them. For understanding, keep the questions general (What was the most important point in our discussion today?) or make them specific (Summarize the two ways we can demonstrate professionalism in our clinic). You can learn alot about your teaching and, especially, whether the students really grasped the points you thought you had driven home. It's a great, easy and quick assessment method of students and of yourself.

Resource
Adapted from B. Magnan, University of Virginia Teaching Resource Center; http://trc.virginia.edu/Publications/Teaching_Concerns/TC_Topic/DiscussionLeading.htm

Habits are Habit-Forming
Did you know you are a role model to your trainees? Maybe you did not realize that learners are sifting through everything you say and do, inside and outside the patient care setting, "deciding" what parts of your behavior they will incorporate into their physician role. Observation learning, acquired from watching others and through experimentation, is the primary way trainees develop their clinical and interpersonal skills and habits.¹ 

Have you personally observed and benefited from working with physicians who consistently demonstrated the best qualities of patient care, clinical judgment and professionalism? Chances are those physicians had some powerful role models and they have reflected carefully on the example they want others to see and emulate.

In your clinical practice, what behaviors are you modeling for your trainees? Do you encourage self-learning or do you micromanage the case? Do you model and teach work organization or do you reprimand for inadequacies? Do you demonstrate and talk through the steps in the procedure or remain quiet and, then, take over when the trainee flounders? Do you include patients in your discussions or assume that the physician has all the pertinent information and that the patient has nothing to contribute?

The first step in becoming a positive role model entails recognizing your behavioral habits. Is your habit to empty others' buckets or fill them up?² A moment of lost composure that translates into throwing an instrument (underhand or overhand, makes no difference!), snapping at a nurse or belittling a patient, reflects on you and may, ultimately, on the practices and habits of your trainees. Realize that your habits can be habit-forming for others. Set a good example, as "example is not the main thing in influencing others, it's the only thing."<sup>3

1</sup>This teaching tip is developed from J. Friedland's chapter "Social learning theory and development of clinical performances," in Edwards JC, Friedland JA, Bing-You R (eds), Residents teaching skills, New York, Springer 2002, p.32. This revised book is an excellent resource and belongs on the medical teacher's shelf.

²Rath T, Clifton, DO. How full is your bucket? Positive strategies for work and life. New York: Gallup Press. 2004.

³Attributed to Albert Schweitzer, from J. Friedland's chapter.

The Bedside is the Best Side for Teaching
There is a time-honored tradition, dating back to Osler, of teaching at the bedside. Recent studies show that most residents and recently established attending physicians are uncomfortable teaching at the bedside, yet most patients prefer it. Done properly, and following some basic principles, 100% of residents and students thought bedside teaching was valuable and over half said they did not receive enough of it in their training.¹ Those resisting bedside teaching felt that it invades both the patient's and family's privacy, potentially conflicts with floor responsibilities and might have unintended consequences, like embarrassing the learner, or faculty discomfiture with the diagnosis.

There are some simple guidelines that can overcome these obstacles for teaching at the bedside.² Rules of conduct need to be established from the beginning, such as: refrain from whispering in the room; take calls discreetly outside the room; do not laugh at the patient's responses; avoid referring to the patient's age and sex; and exercise proper and respectful behavior - never being flippant. The patients and learners should be introduced, the room "secured" (family and friends directed to the lobby) and the television turned off with the patient's permission. Teach in front of the patient, let the patient clarify the details, carefully avoiding questions the learner is unable to answer, avoid medical jargon, demonstrate physical exam techniques that learners admit give them difficulty, and then properly close the session. Good closure involves giving the patient an overview of the disease process, allowing the patient to ask questions and establishing the management plan, with the patient's input, at the bedside.

Re-establish the rich tradition that is unique to medicine. Begin conducting bedside teaching on a few patients to see how it goes. Shadow a more experienced teacher to learn the skills. Teach more at the bedside - your patients and learners will value it.

¹ Nair BR. Student and patient perspectives on bedside teaching. Medical Education 1997;31:341-346.

² http://wichita.kumc.edu/strategies/bedside/index.html (accessed 12/23/2005). This is a terrific Web site for reading about bedside teaching, complete with a testing module and quality references on studies of bedside teaching.

A Friendly Little Game, Anyone?
Learners working in small groups learn more of what is taught and retain it longer than when the same content is presented in other instructional formats. They find this learning more rewarding and enjoyable too. Problem-based learning is steeped in the tradition of using groups to identify solutions, which are usually better than a single individual could derive. Groups can be assembled on an ad hoc basis, for a specific task or as study teams. To work best, groups should have a task that is relevant, promotes interdependence, fits the learners' skills and abilities, and fosters some competition.¹

Team competition is a game show format - such as Jeopardy! - can be very energizing and educational for the participants. It is particularly effective for learners who know each other well and feel safe exposing their knowledge in front of others. Adult learners like this kind of safety to feel comfortable participating.

Arranging the session such that the learners must confer before giving the answer will create the interdependence. Having the teams choose their names also adds to the team spirit and group identity. Not deducting points for incorrect answers adds to a supportive atmosphere. Be creative with "ring-in" devices, such as a baby rattle, a kazoo, cow bell, etc. Also a prize that the "winning team" can share (e.g., bags of candy) with the other team(s) is a stress reliever from the competition.

Some ready sources for quiz questions can be found in review books, Web sites and the ABOG ABC exam. Commercial game show software is available; however, it is easy to create the same kind of game board with note cards on a bulletin board.

Next time you want to organize a review session for your learners, consider team competition. It is an exciting way to review the material, energize the learners and stimulate some team spirit.

¹ Davis BG. Collaborative learning: Group work and study teams. University of California, Berkeley. http://teaching.berkeley.edu/bgd/collaborative.html

Teach by Example
Want to help learners understand something complex? Then, use something from their daily lives that will work as an analogy to describe the concept, entity or process. For example, the menstrual cycle can be described as a production line¹ with a conveyor belt staffed by managers and workers responsible for inputting, processing, maintaining and monitoring "products." In this example, feedback to the "staff" is critical at each juncture to maintain proper production levels. It is useful for learners to experiment with changing input and feedback to see how these changes affect production levels in the process. How can you convey the amount of DNA in a cell? How about 30 miles of monofilament line stuffed into a blueberry? ² 

Examples work even better when we provide a visual demonstration. Use whatever is handy... expensive models are not neccessary. The simpler forms might use a drawing on a chalkboard; the more elaborate ones may use inanimate objects. Although there are at least three types of learning styles ³, each style responds well to concrete examples. Demonstrations enhance learning and provide powerful memory cue for long term retention, much like an emotionally charged story or event.

¹ Thanks to Gary Frishman, MD, Brown University
² Thanks to Debra DeRosa, PhD, Northwestern University
³ www.ldpride.net/learningstyles.MI.htm (accessed 7/7/2005). This Web site offers a self-assessment of preferred learning styles

What Are Your Withholdings?
Tax season has recently passed and, with it, we all reviewed our net gains and losses. By the same token, have you done an accounting of this year's trainee relationships? Have you told them, specifically, what they have done well and what they need to work on? Or, did you decide instead, that you would just write a final evaluation on them? Have you taken the opportunity to make clear your expectations and give them immediate feedback, or did you figure it would just be easier to complete an evaluation form at some point?

If, over the past year, you were in the habit of giving immediate feedback, then give yourself a net gain (as in gain for your trainees). If you chose to wait or, worse, did not even evaluate your trainees, then you need to record this as a loss (as in lost opportunities).

Typically, the medical education culture puts the trainee in sink-or-swim situations, without much prior direction. Either the trainee, somehow, quickly grasps situations, does what we expect and gets a good evaluation after the rotation, or disappoints us and eventually gets a bad evaluation.

Unfortunately, far too many trainees leave the rotation without any feedback of their performance along the way. Our tendency to withhold feedback and save it for a final evaluation is not helpful to their self-improvement. Those that do well feel good when they get their evaluations, but those who receive negative evaluations are often shocked and disillusioned. They are the ones who claim the process is unfair and often return to grieve the evaluation and, even worse, bad-mouth the experience to other trainees.

This year, claim no withholdings in your feedback of trainees. Communicate your expectations when you first meet, repeat these expectations as needed, and sit down with them regularly to give them feedback on their performance. Start thinking of yourself as a performance counselor. Write an "educational presecription," if necessary, specifying how to improve.1 Make a resolution you can keep - eliminate your withholdings of missed opportunities to recognize and correct your trainees.

Source
¹ Alguire P, DeWitt D, Pinsky L, Ferenchick G. Teaching in your office. A guide to instructing medical students and residents. Philadelphia: American College of Physicians, 2001:36.

Experience is the best teacher...
You are listening to a physician and you hear these words: "Let me tell you about a case that happened to me." Suddenly your ears perk up and you are fully engaged. Chances are you will remember this case better than the content of the talk, particularly if the physician uses an example that is personal and has an emotional element, such as an unexpected outcome ("She nearly bled out and we had to transfuse her repeatedly to keep her alive."). 

The often overlooked, but obvious, truth is that physicians, like everyone else, enjoy hearing real-life stories. Physicians want to hear about other physicians' experiences, particularly the near misses. They use their clinical reasoning skills to see if the patient's patterns fit with what they know (scripts) or if they need to adjust their thinking.

When you ask medical learners to problem-solve on your case, you can learn a lot about their clinical reasoning skills. A study of distinguished clinical teachers found that they use scripts on teaching rounds to quickly diagnose the patient's problems and, simultaneously, to diagnose the learner's level of understanding.¹ 

Use your real-life case experiences to help others develop their clinical reasoning skills and to potentially prevent a mishap. Real experiences are inherently attention-getting and can be used in any number of ways to teach learners how to problem solve.²  

Sources
¹          Irby D. How attending physicians make instructional decisions when conducting teaching rounds. Acad Med 1992; 67(10):630-638.

²          Edwards J, Marier R. Clinical teaching for medical residents. New York: Springer. 1988; 70-71.

Trust the Force, Luke
You've been developing an important hour-long presentation for days. You want to make sure you cover all the details and alay your concerns that someone might draw your attention (embarrass you) to something you forgot to include. To be extra cautious, you decide to script everything you plan to say. In addition, you decide that you will print all your notes from your slide maker so you can use them in your talk.

All this effort is fine when you are planning your talk; however, you need to be far more prepared than this when you actually present your talk. Remember, your audience is likely to retain ony three to four main points in an hour-long presentation, so you should focus on these main points in your planning. First, decide what these main points will be, then add supporting statements and critical supporting research (only if needed) to demonstrate these points. Also, remember to add actual cases from your experience, as people respond to and recall stories better than facts alone. Include a handout that addresses the main points.

Rehearse your talk several times until you feel comfortable without notes, and then rehearse it with a colleague or friend. After these rehearsals, you will be ready to present your important talk. You will know your main points and transitions by heart at this point, and your slides will help you remember. Leave your notes at home - trust the (energy) force that you have used to prepare your talk. Your audience will quickly recognize that the force is with you.

RIME With Reasons
The R-I-M-E model developed by Pangaro is a proven and reliable way to descriptively evaluate medical students.¹ The technique has been successfully adapted to a clerkship in obstetrics and gynecology.² RIME is a classification measure of a student's progression from that of a Reporter to Interpreter, to Manager/Educator. Most medical students should be able to demonstrate they can reliably gather the facts on patients and present this information in an organized manner. It is expected that the students will progressively sythesize this information, learning to connect signs and symptoms with tests, and to develop a differential diagnosis.

The RIME model has particular merit for providing feedback to medical students on their performance. Certainly, all clerkships should customarily give students an opportunity to assess their own performance and to receive feedback from their teachers, notably near the midpoint of the clerkship, such that students know how they are doing, and have the time and specifics for improvement.

The RIME model can also change the teaching culture as we get in the habit of asking questions of medical students that will identify where they are on this learning continuum. Questions that prompt students to think about what they are reporting will encourage them to recognize what is important and to make the learning connections. Students value questioning, especially when we ask their opinion and ask them to formulate a plan. Active questioning will give them the opportunity to demonstrate their knowledge, reasoning and management skills.³ In this manner, the teacher can then help students progress up the RIME ladder.

Sources
¹ Pangaro L. A new vocabulary and other innovations for improving descriptive training evaluations. Acad Med. 74:1203-7.

² Ogburn T, Espey E. The R-I-M-E method for e valuation of medical students on an obstetrics and gynecology clerkship. Am J Obstet Gynecol. 189:666-9, 2003.

³ Alguire P, Dewitt D, Pinsky L, Ferenchick G. Teaching in your office: A guide to instructing medical students and residents, p.48. Phildelphia: American College of Physicians; 2001.

Practice Makes Perfect (Sense)
Can you imagine being a complete novice sitting in the cockpit watching the pilot and, after a few brief instructions, being told to fly and land the plane? How much different is this experience from those that students receive in the operating room (ie, see one, do one)? This apprenticeship model of education can be significantly improved and less anxiety provoking if learners have a chance to learn and practice their psychomotor skills in the classroom or lab.

Barbara Goff, MD's work has demonstrated the validity of this approach for a variety of surgical skills.¹ Virtual reality and computer simulations also make learning these skills easier and less threatening². Importantly, learners can learn this information even on their own; however, those who receive feedback on their performance usually do better.³ Increasingly, we are seeing surgical educators use more models outside the operating room to help learners practice their skills.⁴

Surgical educators in the specialty of obstetrics and gynecology have come to realize the benefits of teaching the basics to novice residents during their orientation phase. The Council on Resident Education in Obstetrics and Gynecology (CREOG) now has a comprehensive curriculum for surgical beginners online at www.acog.org/departments/download/SurgicalCurriculum.pdf.

We can still appreciate that surgery is an art form, much like flying a plane; however, it is important to recognize that each procedure consists of a series of steps that can be further divided into discrete skills to be learned in a progressive fashion. Helping learners build their surgical skills in a less hurried, nonthreatening manner can dramatically improve their confidence and preparation for real-time surgical experiences. You will appreciate seeing them fly solo one day, knowing that you helped them get there, step-by-step (flap-by-flap).

Sources
¹ Lentz G, Mandel L, Lee D, Gardella C, Melville J, Goff B. Testing surgical skills of obstetric and gynecologic residents in a bench laboratory setting: Validity and reliability. AJOG. 184(7):1462-1470,2001.

² Letterie G. How virtual reality may enhance training in obstetrics and gynecology. AJOG. 187(3, Part 2)(Supplement):S37-40, 2002.

³ Rogers D, Regehr G, Howdieshell T, Yeh K, Palm E. The impact of external feedback on computer-assisted learning for surgical technical skill training. Am J Surg. 179(4):341-343, 2000.

⁴ Wanzel K, Matsumoto E, Hamstra S, Anastakis D. Teaching technical skills: Training on a simple, inexpensive, and portable model. Plastic & Reconstructive Surgery. 109(1):258-264, 2002.

Do You Have a Teaching Mission Statement?
Socrates taught us that "the unexamined life is not worth living." The same could be said for our teaching intent for, unless we have a clearly established purpose, we can become off course, adrift and at the whim of the winds, Essentially, a mission statement is a teaching philosophy constructed from fundamental objectives for you, as a teacher, but perhaps more importantly for the learner. The objectives are connected to teaching methods, assessment and learning ideals.

An example of a mission statement might be: "I intend to teach the learner the differential diagnosis (in my content area) from clinical cases, such that they can demonstrate this reasoning strategy when seeing patients in the clinic." A mission statement should be relatively short, easily communicated, memorable and frequently revisited. Post it where you will see it every day. It will force you to examine your intent, your attitude toward the content and learner, your methods, assessment strategies, and your ultimate goals and teaching satisfaction.

Write your teaching mission statement today. It will set your course, keep your bearings and speed, and give you the mental comfort of being anchored in your home port.

Source
Hangen L. Writing a teaching philosophy statement. Center for Teaching Excellence, Iowa State University. www.cte.iastate.edu/tips/philosophy.html

Are You Watchable?
Ask yourself this question. If you turned on the television and saw your presentation, would you watch it or, after a few seconds, zap it with the remote? Experts tell us that the audience decides within the first 90 seconds if they plan to listen to you for the rest of your allotted time. This is what medical students do when they hear us. To be effective, you need to grab their attention immediately.

There are several attention-getters you can use, including tell a story, ask for a show of hands, make a promise or a provocative statement, cite an unusual statistic or make them laugh (This is usually the most difficult). Can you imagine opening a television program with the statement, "Well, I guess we will get started."

A smart way to become watchable is to turn the attention away from you to the audience. You can ask for volunteers to act out a skit (always good for a laugh), ask questions like, "What do you think happened next?", have participants share their ideas in pairs, or make them the experts by asking their advice. In general, the more you involve the audience, the more they like the presentation.

Would you watch a presenter on television who turns his back to the camera to talk about the information on the slides? With today's laptops and data projectors, there is no need to look at the projected image on screen; remember, it is on your computer screen. You now have the long-awaited advantage of being able to look at your slides and the audience at the same time. Actually, some may consider it rude to turn your back to them while you talk to the screen. It is time to get over this 35-millimeter slide habit, if this is your tendency. Continued eye contact with the audience will make you more watchable.

Sources
Pike R. Creative Training Techniques Handook: Tips, Tacics and How-To's for Delivering Effective Training. Minneapolis: Lakewood Publications, 1994.

Greenberg D. Simply Speaking Newsletter, May 2003. www.davidgreenberg.com.

Improve Your Teaching Through Reflection: A "Below-Par" Example
Research on successful teachers shows that they reflect on their successful teaching interactions as much as the unsuccessful ones to incrementally improve the quality of their teaching.¹ We have learned about the one-minute preceptor who uses a five-step micro skills model of clinical teaching.² This preceptor should also take one minute per day to identify a teaching approach that either worked or was ineffective. As a preceptor, ask yourself two questions: 1) "Why was this approach effective or ineffective?" and 2) "What, if anything, would I do differently next time and why?" ³

Golf and teaching have much in common. Like golf, teaching is an acquired skill. To improve your skills, you must have an opportuity to practice, see results, get feedback on your performance and, then, have time to reflect on the experience. Passionate golfers will tell you that they reflect on their performance as much off the course as they do when they are playing. This time for reflection gives your mind an opportunity to relax and to integrate new bits and pieces of information into your skill set as a teacher or golfer. In both cases, do not expect overnight success, and learn to accept setbacks. Seeing yourself on videotape, as mentioned in an earlier teaching tip, is an ideal method for reflection and one increasingly used by golf teachers. Optimally, they should also videotape themselves teaching!

Reflection will teach you about your teaching skills. Focus on bringing your teaching behaviors in alignment with what we know about good teachers. They are enthusiastic and receptive to learners, actively involve students in technical and problem-solving skills, encourage increased responsibility, and answer questions clearly and willingly.⁴ Take the time to reflect.

Sources
¹ Pinsky L, Monson D, Irby D. How excellent teachers are made: reflecting on success to improve teaching. Advances in Health Science Education. 1998; 3:297-315.

² Neher J. Gord K, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. Journal of the American Board of Family Practice. 1992; 5:419-424.

³ Ferenchik G, Simpson D, Blackman J, DaRosa D, Dunnington G. Strategies for efficient and effective teaching in the ambulatory setting. Academic Medicine. 1997; 72:277-280.

⁴ Heidenreich C, Lye P, Simpson D, Lourich M. The search for effective and efficient ambulatory teaching methods through the literature. Pediatrics, 2000; 231-237.

Have the Learner Present in Front of the Patient
If you want to save time and enhance the educational experience in the clinic or at the bedside, have the learner present his or her findings to you in front of the patient, rather than in the hallway. Although this may be a little intimidating to the learner at first, patients prefer this method, as they can hear what is being said about them, they can add to or correct the information and they value the time spent with the physician.

Learners also tend to make more concise presentations in front of the patient. It also gives you an opportunity to role model the skills you want the learner to acquire as you involve patients in the decision-making process. It teaches the learner the usefulness of a skillfully taken history and focused physical exam.

Of course, this approach may not be appropriate for sensitive issues, or in cases where you are assessing the learner's diagnostic skills. In most cases, however, this approach validates the patient's issues and strengthens the learner's data collection and presentation skills.

Sources
Alguire P, DeWitt D, Pinsky L, Ferenchick G. Teaching in your office. A guide to instructing medical students and residents. Philadelphia: American College of Physicians. 2001: 65-67.

Whitman N, Schwenk T. The physician as teacher, 2nd edition. Salt Lake City, Utah: Whitman Associates. 1997: 185-187.

Question Your Questioning
What kinds of questions do you ask of the learner? This is an important question. Research demonstrates that using questions to ask learners to problem solve is one of the best ways to teach clinical reasoning. Questioning forms a basis for interactive learning - the best kind. Questions help the learner organize and clarify concepts, correct misunderstandings, recognize relationships, and synthesize and analyze information.

As a general rule, we need to talk far less and ask more questions. Avoid closed end or pimping (i.e, intimidating minutiae) questions. Rather, ask open-ended and divergent questions. Questions that start with "why," "what more," how," "describe," explain" and "what if" will cause the learner to take the next step in thinking through a case. If you need help in developing this skill, ask one of your learners at the next teaching rounds to keep track of the kinds of questions you ask.

Source
Schwenk TL, Whitman N. The physician as teacher. Williams and Wilkins, 1987.

Thinking Out Loud
What is a proven way of helping learners develop good reasoning habits for making the differential diagnosis or identifying treatment strategies? You can model these reasoning skills by thinking out loud; that is, verbalizing your thoughts when you are seeing patients together.

Start with a cue that tells the learner you are thinking aloud, like "let's see nowﾅshe has right, lower quadrant pain that suddenly started six hours ago and has gotten worse. She's nauseous, but has no vomiting or fever. Her last menstrual period was six weeks ago. At this point, I'm most concerned about ectopic pregnancy or appendicitis, as these are potentially life threatening. I'm going to need more information to make the diagnosis. My next step will be the physical examination."

Thinking out loud teaches reasoning steps, gives rationale to the plan, demystifies the process, fosters open communication and sets the stage for asking questions of the learner; e.g., "What should I be looking for in the physical examination of this patient?".

Source
Edwards JC, Marier RL. Clinical teaching of medical residents: roles, techniques, and programs. Springer, New York, 1988.

Videotape Yourself
What is the best way to view your own presentation style and to see how others see you? Videotape your presentation. It is hard to argue with your own data when it is graphically displayed on a screen.

Do you remember the first (and perhaps brutal) time you heard yourself on audiotape? "Do I really sound like that?" Do you have distracting mannerisms in your delivery that you would like to eliminate? The distraction list is legion and includes jingling change, halting speech habits such as "uh" and "you know" and a favorite of many called the "flamenco dancer ﾖ standing on one foot behind the podium and thumping the other on the floor."

The videotape will help you identify distractions and skills that need improvement. If you are really courageous, review the video with a close colleague to whom you have given permission to "take off the gloves" in the critique.

Make arrangements to get yourself videotaped. It will change your presentation style for the better.

Source
Peoples, David A. Presentations plus, 2nd Edition. Wiley & Sons, 1992.

Are You Changing Their Behavior?
We often rely too much on passive modes of teaching, learning and assessment. The lecture is a prime example of passive learning. Adult education experts tell us that learning has not occurred unless learners change their behavior as a result of what we do. Are you sure learners are getting your message? If people are "forgetting" your message, then you need to work on ways to help them get the message and to put the message into practice.

Case-based teaching is a powerful learning and assessment tool when it forces learners to practice the material from your talk. Audience response keypads can be utilized in larger groups to reinforce the message from cases built from the talk or pairings of people to discuss the cases. You can also use a quiz/game-show format or learning prescriptions, like those used successfully at APGO workshops.

Think of ways to make the talk memorable through demonstration and practice. The bottom line is to get the learners active and to make them responsible for their own learning. Most learners prefer it that way and will respect you for giving them the opportunity.

No source.

Do They Know What They Don't Know?
You have just spent the last fifteen minutes in the clinic watching a medical student interview a patient who is having irregular periods. You notice that the student asked several pertinent questions, yet neglected to ask some important questions that would lead to a definitive diagnosis and plan.

It is tempting to jump in and tell the student what he/she missed, yet you may be getting ahead of the student's thinking, and your feedback may be lost. Before you start with your correction and advice, have the student self-assess his/her line of questioning and rationale for the questions. Always ask, "How do you think you did with this patient?" and "What do you need to work on?" This gives the student a chance to reveal his/her thinking and comfort level while you assess the reasoning and communication skills, purpose and focus. The student will feel validated and you will have the information (and the invitation) you need to shape your feedback and teaching.

No source.

Switch Gears After 15 Minutes
Have you felt your mind wandering during someone's presentation after 15 or 20 minutes, even when it is a good talk? You will be happy to know that this is normal. Experts tell us that our attention fluctuates during a one-hour lecture. We are most attentive during the first 15 minutes of a talk, then we begin to think about other things (e.g., that first OR case or whether we left food out for the cat.)

If you are the presenter, put something in your talk after 15 minutes that will shift participants' attention back to the topic. It can be as simple as moving to another part of the room or changing to a different audiovisual format. Better yet, this is an ideal time to introduce a case example that illustrates the learning points and encourages the participants to apply the material. Most of the participants will be energized by this activity and will be eager to follow you for another 15 minutes, at which point you will need another change in direction. This "interval training" will keep your participants attentive and appreciative. Remember, too, to conclude your talk with your key teaching points, because participants remember most what they heard first (primacy) and last (recency).

Sources
Brown G, Manogue M. AMEE Medical Education Guide No. 22: Refreshing lecturing: A guide for lecturers. Medical Teacher, 2001; 23(3):231-244

Whitman N. Creative medical teaching. University of Utah School of Medicine, 1990.

Priming the Learner
Looking to save time and help your students focus on the relevant information next time you see a patient together in the clinic? Try the technique called "priming," which involves giving the student patient-specific information just before seeing the patient and directing the student to perform specific tasks. For example, you pick up the chart outside the room and tell the student, "Mrs. Johnson is a single, healthy 30-year-old mother of two who is here for her annual exam. What specific screening issues will we want to ask her during this visit?" For patients with chronic conditions (e.g., pelvic pain), you can briefly review with the student the causes of the condition and what to look for during the examination that would help with the differential diagnosis. Priming helps the student avoid repeating the entire history and physical exam, and teaches the student how to focus on the important matters.

Source
Alguire, PC, DeWitt DE, Pinsky LE, Ferenchick GS. Teaching in your office: a guide to instructing medical students and residents. Philadelphia: American College of Physicians - American Society of Internal Medicine, 2001, 39-40.

Choosing a Delivery Strategy
All teachers face the question of "what is the best method to teach this objective?" The usual choices are lecture, discussion or demonstration. The emphasis here isn't so much on how to do it but, rather, "why" choose a particular approach. Demonstrations are especially good for teaching skills, so this teaching tip will concentrate on those.

While demonstrations are generally teacher-centered, there are several techniques available, such as peer tutoring, actual practice, research papers, on-the-job training (in clinics or the surgical suite) and, of course, simulation labs. Keep in mind that if demonstrations are to be successful, much preparation is needed. It isn't simply a matter of inserting the videotape or DVD and sitting back. This holds true for clinic and surgical demonstrations, also. Here are some questions you might ask when considering demonstration as a potential delivery strategy.¹

1. Does the learner need to see the process?
2. How many students need the content now?
3. How much preparation time is available and how much is required?
4. Can you tell and show the content?
5. What "other" senses can be involved in this learning?
6. Do you want the students to imitate you?
7. Is there AV support available?
8. How long will the demonstration last - more than 20 minutes?
9. Can you ask questions during the demonstration?
10. Can you stop and start the demonstration?
11. Can the student take notes?
12. Will there be practice time for the students?
13. Can the student easily identify the steps?
14. Will you permit the students to ask questions?
15. Is there only one right way?
16. Will you support the demonstration with handouts?
17. Have you ever listened to or watched one of your demonstrations?

Your response to these questions should tell you whether you should use the demonstration method and may alert you to some of the issues if you do choose it. Demonstration is a great way to teach and learn, but it needs to be used wisely, not as a default to lecture or discussion.

Source
¹ Honolulu Community College. Faculty development teaching techniques: Selecting a delivery strategy.
http//:honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/teachtip.htm#techniques
 
Seven Principles of Good Educational Practice
Here are seven different principles that teachers and learners can use to make the experience better for everyone. Look at your situation and see if you use these in your practice:

1. Encourage contact between learners and faculty (increases motivation and commitment).
2. Develop cooperation and reciprocity among students and residents (emphasize the health care team, rather than the solo effort).
3. Create active learning (have them apply it in their lives, as well as to their patients).
4. Provide feedback in a prompt manner (keeps them involved, allowing direction change and reflection).
5. Underscore time on task - don't let students take more time than they need (learning to use time appropriately is critical, including in the clinical setting).
6. Set high expectations, based on reality.(push them to their limits; expect more and get more).
7. Respect diverse talents and ways of learning (there are many pathways to learning, just like there are many ways to carry out clinical duties).

Teaching and learning is a two-way street. If both sides practice these principles, it can be engaging and fun for everyone.

Source
Adapted from Arthur W. Chickering and Zelda F. Gamson. Teaching tips, Honolulu Community College.