Taking Advantage of the Teachable Moment: A Review of Learner-Centered Clinical Teaching Models

Two for One: Merging Continuing Professional Development and Faculty Development in the CATE Curriculum for Pharmacy Preceptors

Background

Continuing professional development (CPD) and faculty development (FD) are not traditionally combined, although there is evidence that integrating them enhances knowledge acquisition.

Objective

To explore preceptors' perceptions and the effectiveness of CATE (Clinical And Teaching Education), an education model that blends clinical content with the application of that clinical knowledge through a specified teaching technique.

Methods

Thirty-five hospital and community pharmacy preceptors from the Leslie Dan Faculty of Pharmacy, University of Toronto, participated in CATE, which consisted of a 2-hour synchronous, online workshop integrating clinical content about depression with the "One-Minute Preceptor" (OMP) teaching skill. Qualitative and quantitative data were collected longitudinally using surveys and semistructured interviews. Participant and process outcomes were explored through descriptive and thematic analysis using a modified Kirkpatrick framework.

Results

Participants valued the incorporation of educational theory and opportunities to practise the OMP using scripted role plays based on the depression-related content. The combination of FD and CPD was appealing, although participants wanted more clarity about their integration. The CATE model positively influenced their approaches to serving as preceptors, and using the OMP helped to reveal learners' knowledge gaps. There was a desire to share the teaching technique with colleagues to provide a more cohesive approach to teaching.

Conclusions

Integrating CPD and FD in a synchronous, online environment was feasible and well received, and it helped to solidify preceptors' roles as educators. Combining CPD and FD represents an effective strategy to build the clinical and educational expertise of preceptors, which in turn has the potential to improve the quality of experiential learning for pharmacy students. This novel method of fostering the pedagogical growth of preceptors could be a model for other health professions.

Teaching Before, During, and After a Surgical Resuscitation

Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.

Exploring the barriers to Registered Nurses undertaking clinical teaching in clinical settings: A qualitative descriptive study

AIM

The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching.

DESIGN

A qualitative explorative, descriptive and contextual research design was used.

METHODS

Purposive sampling was used to select 16 participants. Data were collected through in-depth, semi-structured interviews, which were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.

RESULTS

Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching.

CONCLUSION

The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students.

PATIENT OR PUBLIC CONTRIBUTION

This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory-practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings.

Novel Academic Tabletop 2022 (NAT22): A Dynamic Dice-Based Emergency Medicine Education Tool

Gamification is an effective teaching tool that improves engagement and knowledge retention. Tabletop role-playing games are dynamic games that use random chance and foster player/leader partnership. To date, there are no teaching tools that mimic dynamic or unpredictable patient presentations. This style of game may work well as a tool for medical education in a simulation-based modality. In this report, we document the rules, materials, and training required to reproduce a hybrid game created to combine facets of simulation and tabletop role-playing games (TRPGs) to create a dynamic medical education tool. After testing the game for flaws and fluidity of gameplay, we plan to collect data evaluating emergency medicine residents' enjoyability and knowledge retention. In this article, we describe a novel TRPG simulation hybrid game that we hypothesize will improve learner enjoyability/engagement and have similar educational benefits to standard medical education.

Case Cards: A Novel Learner-Centered Initiative to Improve Resident Education in the Pediatric Emergency Room

INTRODUCTION

The pediatric emergency department (PED) provides a wealth of learning opportunities for residents. However, delivering dedicated education can be a significant challenge due to considerable variability in day-to-day schedules, volume, cases, time, and resource availability. Case-based and learner-centered teaching models are well suited for ambulatory settings like the emergency department. Using the Kern model, we designed an educational intervention titled "Case Cards" to facilitate active learning conversations in pediatric emergency medicine (PEM). Our goal was to improve clinical teaching in the PED to demonstrate self-reported satisfaction, knowledge acquisition, confidence, and commitment among residents rotating in this fast-paced, challenging clinical environment.

METHODS

 After general and targeted needs assessments, we developed a compendium of 30 high-yield case cards to facilitate case-based learning conversations between learners and preceptors. Case topics mirror the American Board of Pediatrics Content Outline of Emergent Conditions. The "Learner Card" presents a PEM case for the learner to read and hold, while the "Teacher Card" contains evidence-based teaching prompts following established learner-centered clinical teaching models to guide and facilitate the case. Post-implementation surveys queried Kirkpatrick New World educational outcomes in a retrospective format.

RESULTS

We collected data from 24 pediatric and emergency medicine residents between July 2021 and January 2022. All respondents agreed or strongly agreed that case cards are enjoyable, educational, applicable to clinical practice, enhanced confidence, and would be recommended to others.

CONCLUSION

Case cards for learner-centered teaching in the pediatric emergency setting are well-received and demonstrate resident self-reported satisfaction, knowledge, and confidence in core PEM conditions. Having established and readily available teaching topics, such as case cards, can enhance the clinical experience in the PED and other challenging settings and augment clinical exposure to core content. Educators may wish to expand and explore evolving technologies to facilitate learner-centered clinical teaching.

Teaching Family Medicine and General Practice

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Effective Veterinary Clinical Teaching in a Variety of Teaching Settings

This review explores different modalities for clinical teaching of veterinary learners globally. Effective clinical teaching aims to prepare graduates for a successful career in clinical practice. Unfortunately, there is scant literature concerning clinical teaching in veterinary medicine. Our intent for this review is to stimulate and/or facilitate discussion and/or research in this important area. We discuss the different forms that veterinary clinical teaching can take, depending on their setting, which can be university-based clinical activities, work-based in commercial clinical practices, or in a traditional academic setting with little to no real-time exposure to clients and patients. We suggest that each of these modalities has a place in clinical teaching of veterinary learners at any point in the curriculum but that a mix of these approaches will likely provide an improved experience for the learner. Further, we discuss strategies to improve clinical teaching in these different settings. Potential strategies related to the teaching skills of clinical instructors could include training in delivery of clinical teaching in a variety of learning settings, and instructors’ official recognition, including opportunities for career progression. Potential strategies to improve clinical teaching in different teaching settings would vary with the learning settings. For example, in traditional academic settings, case-based learning with incorporation of simulation models is one proposed strategy. The involvement of learners in ‘teach-others’ is a strategy for both traditional academic and clinical settings. Finally, clearly addressing Day One competencies is required in any clinical teaching setting.

Medical Student Mentorship in Surgery: Lessons Learnt and Future Directions

BACKGROUND

Mentorship is one of the cornerstones of surgical education, providing students with the tools to navigate the challenges of the transition from a trainee to a surgeon.

OBJECTIVES

Our study aims to describe the characteristics of successful mentorship of medical students who successfully matched into surgical fields, and to provide medical students practical information on how to successfully find and maintain successful mentoring relationships.

METHODS

In this multi-center cross-sectional observational study, 2 surveys; 1 for mentees, defined as junior surgical residents (medical students who matched into surgical specialties), and 1 for mentors, defined as staff surgeons, were used to collect data between August 1, 2020 to November 1, 2020. The study was retrospective in nature and did not directly assess survey participants while they were in medical school, but rather while they were residents, retrospectively answering regarding their experiences as medical students. The surveys contained 24 questions pertaining to demographics, the dynamics of mentor-mentee relationships, qualities sought in a mentee, and barriers/benefits to mentorship.

RESULTS

A total of 111 attending surgeons and 138 surgical residents completed the surveys. Seventy-eight percent of surgeons had mentored at least 1 medical student, while 74.6% of residents had at least 1 mentor during medical school. The top three mentee qualities reported by mentors were willingness to learn, being a hard worker, and curiosity. There was a significant disparity between mentors' and mentees' perceptions of the importance of scientific curiosity as a mentee trait (p < 0.05). Mentors and mentees have different perceived barriers to forming successful mentorships.

CONCLUSIONS

While the majority of students have experienced fruitful mentoring relationships, the differences in perception of mentors and mentees still represent barriers to be overcome to allow mentorship in surgery to flourish.

How do nurses promote critical thinking in acute care? A scoping literature review

AIM

Critical thinking is essential to quality health care and patient outcomes in the acute care setting. It is important for educators to understand and apply teaching and learning strategies to promote critical thinking of nursing students and junior nurses in acute care.

DESIGN

We followed Arksey and O'Malley's 2005 framework to undertake a scoping literature review to find out how critical thinking is promoted among nursing learners (i.e., nursing students and junior nurses) in acute care.

METHODS

Between September and October 2018, four databases were searched: MEDLINE, CINAHL, ERIC, and Google Scholar. Search terms included: rapid, teaching, methods, nursing, promote, critical thinking and acute setting. A descriptive thematic analysis was undertaken.

RESULTS

Twenty-three articles were included for review. Three main themes were identified from the analysis: learner-teacher relationship, reflection, and inquiry. Strong relationships promoted positive role modelling and effective feedback - both contributing to the teaching of critical thinking. Reflection strategies such as concept mapping and journaling were frequently used, while active student inquiry further promoted critical thinking in the acute setting.

CONCLUSIONS

The acute setting affords opportunities and challenges to promote critical thinking. Teachers/clinicians should incorporate learner-centred pedagogy and encourage reflective practice to embed critical thinking in teaching and clinical practice.

Great nephrologists begin with great teachers: update on the nephrology curriculum

PURPOSE OF REVIEW

The purpose of this review is to highlight developments and opportunities in the nephrology curriculum from the basic science foundation years through teaching medical students, residents and fellows in the clinical realm.

RECENT FINDINGS

Teaching skills are a vital tool for nephrologists both to promote excellent patient care and attract talented learners to the field. Exposure to dynamic and inspiring nephrologists is one of the main factors given by students and residents for selecting a career in nephrology. Nephrology teaching, including case discussions, problem-based learning, team-based learning and flipped classrooms, provides motivating active learning for medical students and is equally effective for didactics in graduate medical education. Avenues for teaching in the clinical realm include the microskills framework, bedside teaching and grounding in evidence-based medicine. Areas of growth include blended nephrology/subspecialty fields as well as social media applications.

SUMMARY

Medical education is a satisfying and exciting area of growth in the field of nephrology. The recent literature provides a framework for best practices in active learning as well as providing numerous examples of educational interventions and innovations. In addition, this field is ripe for further development and scholarly activity.

Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.

A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61

Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.

Peer assessment platform of clinical skills in undergraduate medical education

Objective

The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills.

Methods

A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data.

Results

Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex.

Conclusions

The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students.

Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial

BACKGROUND

In-patient postgraduate teaching suffers with issues like long and unstructured presentations inclusive of a lot of historical information and time constraints due to increasing workload. A six-step pneumonic SNAPPS a learner-centered model modifies the learning encounter by condensing the reporting of facts while encouraging clinical reasoning. This study was planned with the aim to evaluate the effectiveness of SNAPPS as compared to traditional case presentation for facilitating clinical reasoning in inpatient setting. We also wanted to understand perceptions of postgraduates and teachers about this new method of case presentation.

METHODS

This open labeled randomized controlled trial was carried amongst the 18 residents of department of Medicine, MGIMS. The teachers and residents in the SNAPPS were sensitized to SNAPPS technique by using videos, role plays and handouts over 2 sessions of 30 min each. Twenty-seven case presentations (3/resident) were carried out in each group (total 54 case presentations). Data was recorded into validated data recording sheet after each presentation and feedback was taken from the teacher as well as residents regarding their perception.

RESULTS

The SNAPPS model heralds a change in the preceptor training, pairing faulty development and learner development as companions in education. Guided by the SNAPPS technique, students summarized patient findings concisely (7 vs. 2.7 vs. 5.22vs. 2.33, p = 0.0057) while maintaining the same degree of thoroughness as in traditional case presentations. The students in the SNAPPS group were clearer about their diagnostic hypothesis and compared and contrasted their different diagnosis well (2.56 vs. 1.74, p value =0.002). The students in the SNAPPS group initiated patient management discussion almost 20% more times as compared to the control group.

CONCLUSION

We conclude that SNAPPS a learner centered technique for case presentations facilitated the expression of clinical diagnostic reasoning and case based uncertainties in the inpatient setting without extending the unusual length of the student case presentations. It also paved way for enhanced self-directed learning.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity

PURPOSE AND METHOD

We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity.

RESULTS

Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs.

CONCLUSIONS

Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.