Train the Trainer I

Welcome to the first of our Train the Trainer series: Bedside Education; back to our roots.
 
DISCLOSURE: The episode is inspired, adapted and partially borrowed from Jonathan Sherbino. He runs the great icenet blog about medical education and is one of the hosts of the podcast KEYLIME for medical educators. 
 
 
The great Sir William Osler who is considered the "founder of modern medicine" created the first residency program for physicians and is credited in the US of bringing physicians out of the classroom and into the hospital. He believed so strongly in bedside rounds he wanted it on his tombstone. 
 
I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”
– Sir William Osler, from The Fixed Period, in Aequanimitas.
 
Five Step Microskills model for clinical teaching. Originally published by Neher in 1992. The model includes: 
  1. Get a Commitment
  2. Probe for Supporting Evidence
  3. Reinforce What Was Done Well
  4. Give Guidance About Errors and Omissions
  5. Teach a General Principle
 
Getting a commitment about of learners and making them support their reasoning separates the good educators. The novice educator "teaches" them the answer. The experienced educator makes the learner teach them the answer. 
 
Pick one teaching point about the patient and teach to that for 1 minute. 
 
Jonathan Sherbino's: ED STAT
Expectations
Diagnose the learner
Set-up
Teach
Assess and give feedback
Teacher Always
 
Establish Expectations and Diagnose the learner: most educators spend the first shift diagnosing the learner before making any real improvements on shift 2. This is inefficient in frequently rotating specialty like ICU and ED. Ask your rotator where they are at. Teach for where they are at and try to find out in advance from colleagues what they need to work on so you can gameplan.
 
Set up: give them the right patient to see and tell them what they should be looking for and what potential teaching points are. Give them a timeframe. 
Teach: pick one small portion of the patient's care (example CVP for Sepsis, not the entirety of Sepsis in 2017), this is called targeted teaching. 
     Tag the conversation so they know they are in a teaching moment
Assess and Give Feedback
     We discuss the compliment sandwich, the 5 positives for every negative, and the Jack Welch approach of Candor
     The short version is: make it specific, give examples, give them actionable items to improve
Teacher Always: be the person you want your learners to be
 
Tweet some #postitpearls to us @pulmcast! 
 
More awesome Osler quotes:
“While medicine is to be your vocation, or calling, see to it that you have also an avocation – some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”
– William Osler, from After Twenty-Five Years, in Aequanimitas.
 
“But whatever you do, take neither yourselves nor your fellow-creatures too seriously. There is tragedy enough in our daily routine, but there is room too for a keen sense of the absurdities and incongruities of life, and in the shifting panorama no one sees better than the doctor the perennial sameness of men’s ways.”
– Sir William Osler, from The Reserves of Life. ST. MARY’S HOSP GAZ 1907;13:95-8.
 
“One finger in the throat and one in the rectum makes a good diagnostician.”
 
“By far the most dangerous foe we have to fight is apathy – indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction”
 
“The greater the ignorance the greater the dogmatism”
 
“There are only two sorts of doctors: those who practice with their brains, and those who practice with their tongues.”
 
“The very first step towards success in any occupation is to become interested in it.”
MedEdJeremy AmayoComment