By Charles Warlow, The University of Edinburgh
From The Clinical TeacherVolume 2 Page 111 - December 2005
Curtain rises on an outpatient clinic, two 4th year students are sitting rather tensely with the professor who is in shirt sleeves, and a patient
Professor (seeing a patient who has had a stroke some years ago and now complains of brief attacks in which the affected arm stiffens and rises in the air out of his control): What do you think is going on here?
Student (nervous, almost terrified): is it, er…a …stroke?
Professor (astonished): during a stroke do you think the arm goes up in the air or flops to the side? What do you think happens in an epileptic attack?
Student: um………
An hour or so later…………
Professor (after seeing a man with tricky epilepsy, and hoping to strike one of those vertical themes): do you know the difference between compliance, adherence and concordance?
Student (visibly cheering up): oh yes, concordance is when you and the patient agree together with a course of action…
Professor smiling as lights fade, curtain.
I am frustrated; the students seem to know so very little about neurology and how to sort out what is wrong with patients and yet they know so much about how to be nice to them. What on earth has gone wrong?
Read more...
Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor, additional training thereafter, or Physician Assistant education.
Staff development for clinical teachers
From The Clinical TeacherVolume 2 Page 104 - December 2005
It goes without saying that no man can teach successfully who is not at the same time a student. Sir William Osler
The word 'doctor' is derived from the Latin, docere, which means 'to teach'.1 Interestingly, however, although all doctors are prepared for their roles as clinicians, very few are trained for their roles as teachers: 'the one task that is distinctively related to being a faculty member is teaching; all other tasks can be pursued in other settings; and yet, paradoxically, the central responsibility of faculty members is typically the one for which they are least prepared.'2
Professional development can help doctors to prepare for their roles as teachers, and is fundamental to career development and growth. Although the majority of doctors participate in continuing medical education activities, not all of them take part in staff development. My goal is to discuss staff development from the following perspectives:
•What is staff development?
•Why is staff development important?
•What are common goals and content areas?
•What are common formats?
•What is the evidence?
•How can clinical teachers devise a plan for staff development?
Read more...
It goes without saying that no man can teach successfully who is not at the same time a student. Sir William Osler
The word 'doctor' is derived from the Latin, docere, which means 'to teach'.1 Interestingly, however, although all doctors are prepared for their roles as clinicians, very few are trained for their roles as teachers: 'the one task that is distinctively related to being a faculty member is teaching; all other tasks can be pursued in other settings; and yet, paradoxically, the central responsibility of faculty members is typically the one for which they are least prepared.'2
Professional development can help doctors to prepare for their roles as teachers, and is fundamental to career development and growth. Although the majority of doctors participate in continuing medical education activities, not all of them take part in staff development. My goal is to discuss staff development from the following perspectives:
•What is staff development?
•Why is staff development important?
•What are common goals and content areas?
•What are common formats?
•What is the evidence?
•How can clinical teachers devise a plan for staff development?
Read more...
Learning to teach and teaching to learn
BMC Medical Education 2006, 6:20
While an educational intervention for senior internal medicine residents leading morning report improved the educational experience of the audience, the teaching residents reported reduced confidence in their medical knowledge.
Background
Resident-led morning report is an integral part of most residency programs and is ranked among the most valuable of educational experiences. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the educational and teaching experience of morning report.
Methods
All senior internal medicine residents were invited to participate in this study as teaching participants. All internal medicine residents and clerks were invited to participate as audience participants. The educational intervention included reading material, a small group session and feedback after teaching sessions. The educational and teaching experiences were rated prior to and three months after the intervention using questionnaires.
Results
Forty-six audience participants and 18 teaching participants completed the questionnaires. The degree to which morning report met the educational needs of the audience was higher after the educational intervention (effect size, d = 0.26, p = 0.01). The perceptions of the audience were that delivery had improved and that the sessions were less intimidating and more interactive. The perception of the teaching participants was that delivery was less stressful, but this group now reported greater difficulty in engaging the audience and less confidence in their medical knowledge.
Conclusion
Following the educational intervention the audience's perception was that the educational experience had improved although there were mixed results for the teaching experience. When evaluating such interventions it is important to evaluate the impact on both the educational and teaching experiences as results may differ.
While an educational intervention for senior internal medicine residents leading morning report improved the educational experience of the audience, the teaching residents reported reduced confidence in their medical knowledge.
Background
Resident-led morning report is an integral part of most residency programs and is ranked among the most valuable of educational experiences. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the educational and teaching experience of morning report.
Methods
All senior internal medicine residents were invited to participate in this study as teaching participants. All internal medicine residents and clerks were invited to participate as audience participants. The educational intervention included reading material, a small group session and feedback after teaching sessions. The educational and teaching experiences were rated prior to and three months after the intervention using questionnaires.
Results
Forty-six audience participants and 18 teaching participants completed the questionnaires. The degree to which morning report met the educational needs of the audience was higher after the educational intervention (effect size, d = 0.26, p = 0.01). The perceptions of the audience were that delivery had improved and that the sessions were less intimidating and more interactive. The perception of the teaching participants was that delivery was less stressful, but this group now reported greater difficulty in engaging the audience and less confidence in their medical knowledge.
Conclusion
Following the educational intervention the audience's perception was that the educational experience had improved although there were mixed results for the teaching experience. When evaluating such interventions it is important to evaluate the impact on both the educational and teaching experiences as results may differ.
Are Neurology residents in the United States being taught defensive medicine?
From Clinical Neurology and Neurosurgery Volume 108, Issue 4 , June 2006, Pages 374-377
Objective
To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents’ attitudes.
Methods
Neurology residents in the US (n = 25) and, as a control group, Neurology residents training in Germany (n = 42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.
Results
Residents in both countries indicated that litigation is an “important problem”, although US residents stated this significantly more often (p < 0.001). Initiation of tests motivated mainly by fear of litigation (p = 0.004) and explicit teaching of defensive strategies by teaching physicians (p < 0.02) were reported more often by US residents.
Conclusion
Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.
Objective
To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents’ attitudes.
Methods
Neurology residents in the US (n = 25) and, as a control group, Neurology residents training in Germany (n = 42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.
Results
Residents in both countries indicated that litigation is an “important problem”, although US residents stated this significantly more often (p < 0.001). Initiation of tests motivated mainly by fear of litigation (p = 0.004) and explicit teaching of defensive strategies by teaching physicians (p < 0.02) were reported more often by US residents.
Conclusion
Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.
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