Enriching Pediatric Learning: A Guidebook for Preceptors PDF
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Pediatric collections Enriching Pediatric Learning: A Guidebook for Preceptors Edited by: Susan Bannister, MD JOURNALS Full pg bleed — Trim size 8.125 x 10.875 PPaattiieenntt ssaaffeettyy aanndd qquuaalliittyy ccaarree aarree aatt tthhee hheeaarrtt ooff oouurr rreesseeaarrcchh.. RReeaadd tthhee ttrruusstteedd cclliinniiccaall rreevviieeww jjoouurrnnaall ffoorr aarrttiicclleess eexxaammiinniinngg ddeelliivveerryy ooff ccaarree aanndd cccuuurrrrrreeennnttt dddiiiaaagggnnnooossstttiiiccc aaannnddd ttthhheeerrraaapppeeeuuutttiiiccc mmmaaannnaaagggeeemmmeeennnttt ooofff dddiiissseeeaaassseeesss... 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Subscribe today Pediatric collections Enriching Pediatric Learning: A Guidebook for Preceptors EDITOR: Susan L Bannister, MD, MEd, FRCPC Editorial Board, Pediatrics Professor, Department of Pediatrics Cumming School of Medicine, University of Calgary COMMENTARIES BY: Robert A Dudas, MD Associate Professor, Department of Pediatrics Johns Hopkins University School of Medicine Karen L Forbes, MD, MEd, FRCPC Associate Professor, Department of Pediatrics Faculty of Medicine & Dentistry, University of Alberta Janice L Hanson, PhD, EdS, MH Professor of Medicine, Department of Pediatrics Washington University in St. Louis Terry Kind, MD, MPH Professor, Department of Pediatrics The George Washington University School of Medicine and Health Sciences Christopher G Maloney, MD, PhD Professor, Department of Pediatrics University of Nebraska College of Medicine Michael S Ryan, MD, MEHP Associate Professor, Department of Pediatrics Virginia Commonwealth University School of Medicine Sandra M Sanguino, MD, MPH Associate Professor of Pediatrics and Medical Education, Department of Pediatrics Northwestern University Feinberg School of Medicine Published by the American Academy of Pediatrics 345 Park Blvd. Itasca, IL 60143 The American Academy of Pediatrics is not responsible for the content of the resources mentioned in this publication. Web site addresses are as current as possible but may change at any time. Products are mentioned for information purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics. © 2021 American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior written permission from the publisher. Printed in the United States of America APC025 Print ISBN: 978-1-61002-582-9 eBook ISBN: 978-1-61002-583-6 Pediatric collections Enriching Pediatric Learning: A Guidebook for Preceptors Table of Contents Enriching Pediatric Learning: A Guidebook for Preceptors Introduction — Medical Education Matters: Pediatric Clinical Teachers Can Inspire the Next Generation of Doctors, by Susan L Bannister, MD, MEd, FRCPC vii What Makes a Great Clinical Teacher in Pediatrics? Lessons Learned From the Literature Pediatrics Perspective | Original Publication | May 1, 2010 Chapter 1 — Fostering Humanism in Pediatrics: The Importance of Developing Non-Cognitive Skills in a Supportive Learning Environment 3 Introduction by Michael S Ryan, MD, MEHP 5 It’s not just what you know: the non-cognitive attributes of great clinical teachers Monthly Feature | Original Publication | November 1, 2014 8 Practical framework for fostering a positive learning environment Monthly Feature | Original Publication | July 1, 2015 12 A Little Hurts a Lot: Exploring the Impact of Microaggressions in Pediatric Medical Education Monthly Feature | Original Publication | July 1, 2020 15 Taking Humanism Back to the Bedside Monthly Feature | Original Publication | November 1, 2015 Chapter 2 — Setting the Stage for Great Clinical Learning 21 Introduction by Sandra M Sanguino, MD, MPH 23 Getting Off to a Good Start: Discussing Goals & Expectations With Medical Students Pediatrics Perspective | Original Publication | August 1, 2010 26 Key Elements of Highly Effective Teams Monthly Feature | Original Publication | February 1, 2014 29 How to “ENGAGE” Multilevel Learner Groups in the Clinical Setting Monthly Feature | Original Publication | November 1, 2017 33 The Clinical COACH: How to Enable Your Learners to Own Their Learning Monthly Feature | Original Publication | November 1, 2018 37 To Trust or Not to Trust? An Introduction to Entrustable Professional Activities Monthly Feature | Original Publication | November 1, 2016 Chapter 3 — Teaching Techniques: Incorporating Learning into a Busy Clinical Practice 43 Introduction by Robert A Dudas, MD 45 The Didactic Makeover: Keep it Short, Active, Relevant Monthly Feature | Original Publication | July 1, 2016 48 Questioning as a Teaching Tool Monthly Feature | Original Publication | March 1, 2015 51 Transform Role Modeling Into SUPERmodeling Monthly Feature | Original Publication | November 1, 2019 54 Failure Is an Option: Using Errors as Teaching Opportunities Monthly Feature | Original Publication | March 1, 2018 57 Just Do It: Incorporating Bedside Teaching Into Every Patient Encounter Monthly Feature | Original Publication | July 1, 2018 60 Getting Physical: The Hypothesis Driven Physical Exam Monthly Feature | Original Publication | March 1, 2016 63 Teaching in a Family-Centered Care Model: The Exam Room as the Classroom Monthly Feature | Original Publication | May 1, 2013 66 The Whole “PROOF”: Incorporating Evidence-Based Medicine Into Clinical Teaching Monthly Feature | Original Publication | July 1, 2017 iii Chapter 4 — The Heart of Clinical Teaching: Observation, Feedback, Assessment, and Evaluation 71 Introduction by Janice L Hanson, PhD, EdS, MH 73 Oh, What You Can See: The Role of Observation in Medical Student Education Pediatrics Perspective | Original Publication | November 1, 2010 76 Getting Beyond “Good Job”: How to Give Effective Feedback Pediatrics Perspective | Original Publication | February 1, 2011 79 Diagnosing the Learner in Difficulty Monthly Feature | Original Publication | August 1, 2013 82 Assessment for Learning: How to Assess Your Learners’ Performance in the Clinical Environment Monthly Feature | Original Publication | March 1, 2020 85 Writing medical student and resident performance evaluations: beyond “performed as expected” Monthly Feature | Original Publication | May 1, 2014 88 The LETTER of Recommendation: Showcasing a Student’s Strengths Feature | Original Publication | March 1, 2021 Chapter 5 — Promoting Clinical Reasoning and Reflection: The Clinical Teacher as Guide 93 Introduction by Karen L Forbes, MD, MEd, FRCPC 95 The Right Stuff: Priming Students to Focus on Pertinent Information During Clinical Encounters Monthly Feature | Original Publication | July 1, 2019 98 What’s the Story? Expectations for Oral Case Presentations Pediatrics Perspective | Original Publication | July 1, 2012 102 Using the Student Case Presentation to Enhance Diagnostic Reasoning Pediatrics Perspective | Original Publication | August 1, 2011 105 You Too Can Teach Clinical Reasoning! Pediatrics Perspective | Original Publication | November 1, 2012 108 Into the Unknown: Helping Learners Become More Comfortable with Diagnostic Uncertainty Monthly Feature | Original Publication | November 1, 2020 111 Stimulating Reflective Practice Among Your Learners Monthly Feature | Original Publication | February 1, 2013 Chapter 6 — Fostering Professionalism Among the Next Generation of Medical Professionals 117 Introduction by Terry Kind, MD, MPH 119 Professionalism in practice: strategies for assessment, remediation, and promotion Pediatrics Perspective | Original Publication | March 1, 2012 122. Supporting the Development of Professional Identity in the Millennial Learner Monthly Feature | Original Publication | March 1, 2019 126 Opting in to Online Professionalism: Social Media and Pediatrics Monthly Feature | Original Publication | November 1, 2013 Chapter 7 — The Value of Trusting Relationships in Shared Decision Making 133 Introduction by Christopher G Maloney, MD, PhD 135 Teaching the essentials of “well-child care”: inspiring proficiency and passion Monthly Feature | Original Publication | August 1, 2014 139 We Can Teach How to Bend the Cost Curve: Lessons in Pediatric High-Value Health Care Monthly Feature | Original Publication | February 1, 2017 About AAP Pediatric Collections Pediatric Collections is a series of selected pediatric articles that highlight different facets of information across various AAP publications, including AAP Journals, AAP News, Blog Articles, and eBooks. Each series of collections focuses on specific topics in the field of pediatrics so that you can keep up with best practices, and make an informed response to public health matters, trending news, and current events. Each collection includes previously published content focusing on specific topics and articles selected by AAP editors. Visit http://collections.aap.org to view a list of upcoming collections. iv AAP PEDIATRIC COLLECTIONS Pediatric collections Enriching Pediatric Learning: A Guidebook for Preceptors Introduction Medical Education Matters: Pediatric Clinical Teachers Can Inspire the Next Generation of Doctors By Susan L Bannister, MD, MEd, FRPC Editorial Board, Pediatrics; Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary COMSEP, the Council of Medical Student Education in Pediatrics, is a community of pediatric educators committed to supporting each other and delivering excellent pediatric education to medical students. The articles and commentaries in this latest entry in the American Academy of Pediatrics’ Pediatric Collections series, entitled Enriching Pediatric Learning: A Guidebook for Preceptors, have been written by COMSEP members, and the principles of our organization have driven much of their work. COMSEP’s guiding principles articulate what its members believe to exemplify excellence in medical student education: Teaching should be excellent, innovative, and scholarly; The learning environment should be safe and enjoyable for all; and Patient/family centeredness, teamwork, professionalism, humanism, and service are essential core values of pediatrics. Another principle is that Pediatric medical student education makes all students better doctors. We recognize that not everyone whom we teach will become a pediatrician, nor will they ulti- mately care for children in their practice. But we also recognize that many of the skills they learn and the behaviors they observe while working with children, families, and pediatric profes- sionals will influence their growth and may ultimately affect the physicians and surgeons they become. They will learn, for instance, a flexible approach to the physical examination, the power of observation, a way to communicate with 2 very different people at the same time, and the value of communication and teamwork and empathy. Students recognize this. Several years ago, I asked my students to write down what they learned on their pediatric clerkship that they might apply to other areas of medicine. Here are a few of the things they had to say: “How to involve families in discussions.” “Sick versus not-sick.” “For adults, similarly evaluating social support networks and home life like we do in kids.” “Empathy for families and parents of kids with chronic diseases.” “Seeing the patient as a whole person in context of family and community.” “Communicating with children and their families.” “Talking with nurses.” “More than anything, compassion for families, patience in medicine.” Enriching Pediatric Leaning: A Guidebook for Preceptors v These students recognize the value of learning in the pediatric clinical environment and can envision how this will influence their future practice. I often imagine the future interaction of a patient and a medical student. The patient might not even be born yet. The medical student might be in first or second year right now. But they will meet when that medical student does their pediatric clerkship. And when they do, I hope their interaction is based on empathy and teamwork and humanism. And I hope that meeting will influence the future physician the medical student will become. And I believe our work in educa- tion, administration, and leadership will play a role in that meeting. And I believe your work as a clinical teacher and the articles in this Pediatric Collection can play a role in that meeting as well. The 35 articles in this Pediatric Collection have been grouped by themes, and together they describe skills and strategies to improve clinical teaching. The authors and editorial board have tried to imagine the clinical practice of a busy preceptor in a variety of settings—rural or regional or urban practice, community hospital, academic centre—and have tried to provide an article that is succinct and captivating, with practical tips that can be put into use that day with a trainee. We hope this collection, too, will be a practical resource that will support preceptors and educators in their quest to teach, assess, and inspire the medical students with whom they work. vi AAP PEDIATRIC COLLECTIONS CONTRIBUTORS:SusanL.Bannister,MD,aWilliamV.RaszkaJr,MD,b andChristopherG.Maloney,MD,PhD,c aDepartmentofPediatrics,UniversityofCalgary,FacultyofMedicine,Calgary, Alberta,Canada;bDepartmentofPediatrics,UniversityofVermontCollegeof Medicine,Burlington,Vermont;andcUniversityofUtah,Departmentof Pediatrics,SaltLakeCity,Utah AddresscorrespondencetoWilliamV.RaszkaJr,MD,Departmentof Pediatrics,UniversityofVermontCollegeofMedicine,GivenCourtyard, Burlington,VT05405.E-mail:[email protected] AcceptedforpublicationMar1,2010 ABBREVIATION COMSEP—CouncilonMedicalStudentEducationinPediatrics doi:10.1542/peds.2010-0628 What Makes a Great Clinical Teacher in Pediatrics? Lessons Learned From the Literature Medicalstudenteducationinpediatricshaschangedsignif- primarygoalofourworkinCOMSEP,istoensurethatstu- icantly over the past 2 decades. There has been an in- dents are prepared to practice effective patient-centered creasedemphasisonambulatoryexperiencesandgreater care. useofcommunity-andambulatory-basedfaculty.1,2Ashift ATTRIBUTES OF A GREAT CLINICAL TEACHER We can all frominpatienttomoreoutpatientprimarycareandsubspe- remember during medical school or residency having cialtyrotationexperiencescombinedwithproductivityand teachersthatmadetheexperiencememorableandinspired academicdemandsmayresultinfacultyspendinglesstime withstudents.3However,thesesamefaculty,oftenwithlittle ustoworkalittleharder,studyalittlelonger,andsleepa formal training, are critical to the pediatric education of little less. Unfortunately, we can also remember teachers medical students. The goal of this article is to review the who made the learning experience either unsatisfying or peer-reviewedliteraturethatdescribestheattributesand at least less enjoyable. Distinguishing between these 2 skills of a great clinical teacher, whether community or typesofteachersisofkeeninteresttoalleducators.4The university based, and outline some strategies used to en- resultsofseveralstudieshavesuggestedthatgreatclinical hancemedicalstudentlearning. teachers possess both unique noncognitive and cognitive attributes.5,6Inareviewoftheliteratureoneffectiveclinical TEACHINGINTHECLINICALSETTING First,whatisaclini- teachingpublishedbetween1909and2006,480uniquede- cal teacher? The Council on Medical Student Education in scriptorsofgoodteachingwereclassifiedinto49themes. Pediatrics(COMSEP)definesaclinicalteacherassomeone Althoughcognitiveattributessuchasknowledgeandproce- whointeractswithastudentinthecontextofongoingpa- duralskillsareimportant(asshowninTable1),noncogni- tientcare.Thefeaturethatsetsclinicalteachersapartfrom tiveattributesplayequallyimportantroles. other types of teachers, then, is the involvement of, and teachingabout,apatient.Teachingintheclinicalsettingis NoncognitiveAttributes complicated,becausethepreceptorneedsnotonlytodiag- Forexample,considerthekeyroleofenthusiasminagreat noseandtreatthepatientbutalsothestudent.Theprecep- clinical teacher.6–8 The importance of enthusiasm is not a torneedstolearnwhatknowledgeorskillsthestudentdoes new concept. In the 19th century, Ralph Waldo Emerson or does not have and ensure that the student has pro- wrote, “Nothing great was ever accomplished without en- gressedtowhereheorsheneedstobebytheendofthe thusiasm,”andSamuelTaylorColeridgewrote,“Nothingis session. The educational goal of clinical teachers, and a socontagiousasenthusiasm.”Enthusiasmisnotnecessar- PEDIATRICSVolume125,Number5,May2010 Enriching Pediatric Leaning: A Guidebook for Preceptors 863vii Downloaded from www.aappublications.org/news at American Academy of Pediatrics on May 11, 2021 TABLE1 KeyCognitiveandNoncognitiveAttributesofClinicalTeachers ticipation in unprofessional behaviors increased and stu- asFoundintheLiterature5–11,13 dents increasingly perceived unprofessional behaviors as Cognitive Noncognitive beingappropriate.12 Isknowledgeable Isenthusiastic Demonstratesclinicalskills Isstimulating CognitiveAttributes Iswellorganized Isencouraging Hasexcellentcommunication Createsapositive,supportivelearning When faculty and residents are individually asked to rank skills environment the critical characteristics of clinical teachers, both rank Providesfeedback Modelsprofessionalcharacteristics clinicalcompetenceasthemostimportantcognitivequali- Explainsconceptsclearly Focusesonlearner’sneeds ty.7,8Greatclinicalteachersareuniversallyexpectedtobe Setsgoalsandexpectations Interactspositivelywithstudents Providesdirectsupervision Listens notonlyclinicallycompetentbutalsoabletodemonstrate and explain clinical skills.5,7,10 They use highly developed communication skills to converse with patients, families, ilycharacterizedbyboisterousnessbutbyanauthenticpas- membersofthehealthcareteam,andstudents.8Moreover, sion.Passioncanbedirectedtopatientcare,theeducation they articulate their thought processes and describe the of the student, or, preferably, to both. In the classroom, clinicalpatternsusedtomakeclinicaldecisionswithclarity enthusiasticteachersmakeeyecontact,areanimated,and andinlanguagethestudentunderstands.9,13 infuse the session with energy. In the context of clinical The great clinical teacher relies on a variety of skills and teaching,enthusiasticteachersareexcitedbythepresence strategies to enhance medical student learning. Briefly, ofthemedicalstudentandinfusethepatientandstudent great clinical teachers set goals with students and hold interactions with a natural, unforced energy. Enthusiastic themaccountable.Studentshighlyvaluesettinggoals,de- teachers capture students’ attention, excite them about briefing after clinical encounters, being involved with pa- learningthepracticeofmedicine,and,bystimulatingreflec- tientmanagementdecisions,andreceivingtimelyfeedback tion,promotestudentlearning.9 in a learning environment that combines both indepen- Although a great number of noncognitive attributes other dence and supervision.10 Direct, competent supervision, than enthusiasm are highly valued, most can be summa- particularly when combined with focused feedback, posi- rized by a single word: respect. As Ralph Waldo Emerson tivelyinfluencesbothpatientcareandstudenteducation.14 alsowrote,“thesecretofeducationisrespectingthestu- In a study of more than 1200 medical students who had dent.”Agreatteacherrecognizesthatthestudent-teacher completed their clinical rotations, supervision correlated relationshipisabidirectionalexchange.Welearnfromthe farbetterwiththeoveralleffectivenessoftheclinicalrota- literaturethatthegreatclinicalteacherisnonjudgmental, tionthanpatientmixandnumbersofpatientsseen.15 develops a positive relationship with students, creates a supportive learning environment, and listens to what the SUMMARY Great clinical teachers occupy a unique and studenthastosay.5,7,8,10Memorableteachersfocusonthe powerful role in the education of medical students. Their learners’ needs rather than their own teaching interests noncognitiveandcognitiveactionsandbehaviorsinfluence and involve the learners in setting relevant educational futurestudentbehaviorsandcareerchoicesand,mostim- goals.11Studentsthrivewhentheiropinionsandviewsare portantly, result in a future generation of physicians who valuedandtheyareallowedtovoicetheirviewsinasafe, areequippedtocareforchildren.16Althoughwecontinueto supportiveenvironment. havedifficultydefiningthecriticalcharacteristicsofagreat Greatclinicalteachersalsoserveasprofessionalrolemod- clinicalteacher,identifyingsuchateacheriseasy:theyare elsandmentorsforstudents,whichisacomplexandpur- theonestowhomstudentsandresidentsflock.Ifwereturn posefulactivitythatinvolvesnotonlymodelingclinicalcom- toateacherweeachrememberashavingmadetheclinical petence but also professionalism. The clinical teacher experience memorable and inspired us to work a little occupiestheroletowhichthestudentaspires.Inthatrole, harder,itistheperson,notnecessarilythecontent,thatwe didtheclinicalteachershowgenuineconcernforpatients, remember.Althoughsomehaveadvocatedthatgreatteach- recognizehisorherownlimitations,showrespectforoth- ingisinnate,13manyoftheskillsandstrategiescan,infact, ers,andtakeresponsibilityforhisorheractions?9Thestu- belearnedanddeveloped.Overthenextseveralissueswe dent quickly learns whether the observed behaviors are either acceptable or worth emulating. The importance of willexploreingreaterdetailtheskillsandstrategiesdevel- appropriaterole-modelingcannotbeunderestimated.Ina opedbyCOMSEPthatcanbequicklyandefficientlyassimi- studythatlookedatmedicalstudentsatthebeginningand lated into daily practice and help make a good clinical midwaythroughtheirclerkshipyear,observationandpar- teachergreat. v8i6ii4 BAANANPIS PTEERDIeAtTaRlIC COLLECTIONS Downloaded from www.aappublications.org/news at American Academy of Pediatrics on May 11, 2021
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