Teaching Rounds: Teaching when time is limited

University of California, San Francisco, CA 94143-0410, USA.
BMJ (online) (Impact Factor: 17.45). 03/2008; 336(7640):384-7. DOI: 10.1136/bmj.39456.727199.AD
Source: PubMed


Clinical teachers face a daunting challenge of simultaneously caring for patients and teaching learners in a time constrained environment. A cohort study of 179 Dutch medical students (79% of the cohort) during an internal medicine clerkship located at 14 different clinical sites found that the quality of supervision has a greater impact on clinical competence and knowledge than does the number of patients seen.1 Even small moments of teaching time can offer important learning opportunities to trainees by providing them with new insights and skills that they would not acquire from simply seeing patients on their own.1To achieve this combined caring and teaching goal in a time efficient manner, clinical teachers use various strategies to (a) identify the needs of each individual learner, (b) teach according to these specific needs, and (c) provide feedback on performance.2 This three step teaching process can be adapted to the environment in which the teaching is taking place. Here we describe several time efficient strategies in relation to each step in this process.

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    • "Boendermaker et al. 2000; Buchel and Edwards 2005) or models to guide supervisors and registrars in making best use of the available teaching and learning opportunities (e.g. Ingham 2012; Irby and Wilkerson 2008; Lake and Ryan 2004). Boendermaker et al. acknowledge that these models are idealised representations of supervisors who are unlikely to be encountered in real-life settings. "
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    ABSTRACT: General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.
    Full-text · Article · Sep 2015 · Advances in Health Sciences Education
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    • "Models for time-efficient teaching, described by expert educators , can be applied successfully in outpatient settings, where so-called ''minute'' teaching is required, but shrinking time and lack of teacher training remain challenges (Neher et al. 1992;Irby 2004;Irby & Wilkerson 2008). During case presentations, teachers can simultaneously work on diagnosis of the patient and diagnosis of the resident's clinical reasoning skills. "

    Full-text · Article · May 2015 · Medical Teacher
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