The Practical Psychosomaticist is Still Trying to Shut Up, So Listen to Brooks Obr, The Medical Student

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Remember the post about a study that a medical student asked several faculty members to participate in (including yours truly) about a study of what strategies exceptional teachers use to engage learners? You don’t? Shame on you; take the short link to “Who Dares to Teach…” at http://wp.me/p1glcu-1dh. A quote from the introduction:

The Practical Psychosomaticist was a participant in a study conducted by a second year medical student and a faculty researcher this past summer, “What Strategies Do Attending Physicians use to Engage Multiple Levels of Learners on Inpatient Rounds.” Anyway, the Geezer was one of 26 physicians from several inpatient medical specialties selected by junior and senior medical students for being “especially adept at engaging multiple levels of learners.” I think I was chosen mainly because of my sense of humor. The idea was to find out what strategies attending physicians use to actively involve learners, which is thought to enhance the educational value of inpatient rounds.

Anyway, on November 17, 2011, the medical student, Brooks Obr, and the faculty researcher, Dr. Marcy Rosenbaum, PhD presented their poster at the 6th Annual Medical Education Celebration. The way Brooks will speak is via excerpts from his poster. So see the image gallery above for the five Main Approaches and Strategies Attending Physicians Use to engage multiple learners at different levels. Use the arrows (or the arrows on your keyboard) to navigate left or right through the carousel images and click “esc” to come back to the post.

I tend to use role-modeling a little (OK, maybe a lot) too much. That’s why I’ve been trying to shut up lately. I really enjoy a good sense of humor, so I use that, ensuring not to make anyone feel like he’s a target.

Brooks main impressions and insights were the following:

We were able to gain insight into what strategies physicians actually use to engage multiple levels of learners on inpatient rounds.

•The five main themes represent common approaches used by these exemplary physicians to involve learners.

•There were a range of specific strategies employed by physicians to engage multiple levels of learners.

• “Active” learning was consistently described as one of the best ways to keep learners engaged during teaching rounds.

• General approaches used by physicians in different departments were similar though specific strategies differed between individuals. This study provides a basis for educating new/inexperienced physicians who may lack formal training in effective inpatient teaching methods and for enhancing the repertoire of teaching strategies of more experienced clinicians. Limitations of the current study include only self-report and observational data from teachers with no measure of actual learner perceptions, learning or changes in performance. Future studies could examine such things as differences in teacher and learner perceptions of what constitutes “teaching” and the impact of different strategies of learning, performance, professional socialization and overall perceptions of learning environment.

And just to prove Brooks is really doing all the talking and I did shut up, here are direct comments he wrote specifically for this post:

One of the driving forces for this study was the fact that there is almost no information in the literature pertaining to how attending physicians can effectively engage/teach multiple levels of learners in the Teaching Round setting. With that in mind, Dr. Rosenbaum and I performed a study in which we observed (and interviewed) attending physicians who had been identified as students as being especially adept at communicating with/engaging multiple levels of learners.

After observing these physicians on teaching rounds and performing in depth interviews, five main strategies emerged, as this blog has previously written about:

Learner Centered Education: This involves, primarily, teaching the learners in a manner that is appropriate to their level of learning… that is, challenging learners, but within their limits, with a mind towards realistic explanations.

Dedicated Teaching Time: Periods of more lecture based teaching specifically performed outside of the normal teaching rounds time-set. This serves as time that learners can know that the main focus is, in fact, LEARNING. It is an opportunity for attending physicians to follow-up on points made in the teaching rounds setting.

Making it Real to Learners: The title says it all. Making the learners aware that they are going to be independent practicing physicians one day, and that this is the time for them to take on that responsibility and learn in a “safe” setting, where small mistakes are correctable with the help of the attending physician and other members of the team.

Role Modeling: In this scenario, the attending physician will act as a model for the learners, allowing the medical students to learn by observation. This is especially useful when it comes to dealing with difficult patients and/or their families, performing difficult aspects of the physical exam, or treating “rare” patients.

Interaction Among Learners: Probably the most widespread and important among the various themes listed here. Utilized by almost every attending physician, this involves having the residents teach the medical students, and vice versa. While it might seem counterintuitive to have medical students teaching residents a great deal of information, it is easy to forget that the medical student is actually a great deal closer to the basic sciences information than the residents, who may be several years removed from their learning of biochemistry, pharmacology, or some elements of pathology.

As is mentioned (and described) on the poster itself, there are several themes present within of these 5 main strategies.

It is the hope of both Dr. Rosenbaum and myself that we may be able to take this information and further expand on it, so as to provide a type of handbook/guide that might be utilized by new attending physicians who might be unsure how to engage all of their learners on teaching rounds. It is our plan to follow up on this study with additional research into each of the main themes, as well as the perceptions of students themselves as to what aspects of these methods are especially effective.

Thanks, Brooks; nice job.

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