Twelve tips for clinical teaching with telemedicine visits

Telemedicine is now an established mode of clinical care for most medical specialties, and clinical teachers must teach and precept learners in this modality. However, faculty need training on how best to teach students when caring for patients via telemedicine. Effectively incorporating learners into telemedicine visits to optimize their education is a critical skill for clinical teachers. In this article, we review 12 practical tips unique to telemedicine to engage and educate undergraduate medical education learners in building their clinical skills. We outline synchronous and asynchronous elements before, during, and after the patient encounter to facilitate teaching while improving patient care. These principles can also be adapted for teaching in other health professions as well as postgraduate medical education.

Peer teaching of the physical exam: a pilot study

BACKGROUND

Mastery of the physical exam (PE), and the ability to teach it to peers and medical students, are important milestones for residents (junior doctors); however, several reports indicate that PE skills are in decline. To address this need, we explored the use of peer observation of teaching (POT) as a conceptual framework to develop an innovative approach to PE teaching at the postgraduate medical education level.

INNOVATION

We designed a PE POT session to be conducted at the patient bedside, and piloted four sessions in April 2014. Sessions involved a senior medicine resident teaching a focused PE to their team (consisting of two postgraduate first-year residents), while being observed by a peer, followed by feedback anchored in 11 validated measures of clinical teaching. The sessions were completed in 30-35 minutes and were enthusiastically received by residents. Participants valued the interactive approach and the opportunity to exchange feedback with a peer on their PE teaching skills.

IMPLICATIONS

This pilot using POT methodology to teach the PE addressed mandatory core competencies related to patient care and practice-based learning and improvement. Residents gained insights on their PE teaching skills while interacting with their peers in a novel and reciprocal learning opportunity. This experience helped participants to value their role as PE teachers and generate strategies to change their teaching behaviours. Despite this being a small study, POT offers an innovative approach to teach the PE at the postgraduate level, with the potential to address the gap of PE teaching and learning. Several reports indicate that physical exam skills are in decline.

The Case-Based Collaborative Learning Peer Observation Worksheet and Compendium: An Evaluation Tool for Flipped Classroom Facilitators

INTRODUCTION

In a flipped classroom, students learn basic concepts before class, allowing them time during class to apply newly gained knowledge to problem sets and cases. Harvard Medical School (HMS) has introduced a form of flipped classroom, called case-based collaborative learning (CBCL), during preclinical curricula. Finding few published resources, the HMS Academy's Peer Observation of Teaching Interest Group developed a guide for observations and feedback to CBCL facilitators.

METHODS

After conducting an extensive literature search, speaking to flipped classroom methodology experts, and observing 14 facilitators using CBCL methods, the interest group identified specific teaching behaviors that optimize student interaction and knowledge application. The group next engaged in several rounds of the modified Delphi method to develop the CBCL peer observation worksheet and compendium and then tested these materials' effectiveness in capturing CBCL teaching behaviors and providing feedback to CBCL faculty facilitators.

RESULTS

Seventy-three percent of faculty rated the worksheet and compendium as extremely helpful or helpful in identifying new teaching techniques. Moreover, 90% found the CBCL peer observation and debriefing to be extremely helpful or helpful, and 90% were extremely likely or likely to incorporate peer suggestions in future teaching sessions.

DISCUSSION

Medical schools have begun to embrace flipped classroom methods to eliminate passive, lecture-style instruction during the preclinical years of the MD curriculum. This tool identifies specific in-classroom approaches that engage students in active learning, guides peer observers in offering targeted feedback to faculty on teaching strategies, and presents consensus-based resources for use during CBCL faculty development and training.

Blueprint for an Undergraduate Primary Care Curriculum

In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.