The Sleep Clinic as a Teaching Site

Transcription

1 The Sleep Clinic as a Teaching Site Most physicians believe this site is highly important to the development of sleep medicine skills. Prime opportunity for demonstration of learners patient care and clinical skills Where RIME assessments are made June 2013

2 Learning in the Inpatient Setting History-taking Physical examination skills Clinical ethics Humanism Professionalism, Communication skills Role-modeling Ende, J. (1997) What if Osler were one of us? Inpatient teaching today, Journal of General Internal Medicine, 12(Suppl. 2), pp

3 Breaking down the encounter Helpful to think of the teaching in segments Must like clinical care, there are three components to consider: Pre-Clinic Clinic Post-Clinic

4 Twelve Steps to Improve Bedside Pre-Clinic Teaching Preparation is the key to conducting effective learning and increasing comfort Draw a roadmap for what you plan to achieve Orient the fellow to your plan and negotiate objectives; discuss what is to be taught Ramani, S. Twelve tips to improve bedside teaching. Medical Teacher, Vol. 25, No. 2, 2003, pp

5 Clinic Twelve Steps to Improve Bedside Teaching Introduce yourself and team to the patient Role-model a physician-patient encounter Step back from the patient and observe the learner in an interaction Teach by challenging the learner empathically and gently correcting when needed Summarize, tell them what they have been taught

6 Twelve Steps to Improve Bedside Post-Rounds Teaching Debrief leave time for reflection, clarification Find out what went well, what did not You think about what went well, what did not, what you could do differently Use the reflections of yourself and your team to plan your next encounter

7 Summary Encounters may not lend themselves to do everything in each segment each time However, resident teachers should attend to each segment of the learning encounter Building confidence at each level will make for a smoother, more enjoyable teaching encounter for everyone

8 RIME: Objectives Four categories of classification in professional development Differentiate fellows along a continuum of learning

9 RIME Evaluation Framework Reporter Interpreter Manager Educator Pangaro L: A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999; 74:

10 RIME Evaluation Framework Reporter Can answer the what question about patients Able to accurately gather clinical facts and communicate them in written, verbal form Requires basic skill and knowledge of what to look for in history, basic clinical examination Recognizes normal, abnormal presentations Able to identify, label clinical problems Exhibits consistently high levels of professionalism

11 RIME Evaluation Framework Interpreter Answers the Why question about patients Able to prioritize patients problems Accurately interprets data, use it to identify and prioritize new problems Offers differential diagnosis (at least three) Identifies follow-up of tests and interpretations Selecting clinical findings and applying test results to specific patients Active participant on the team

12 RIME Evaluation Framework Manager Answers the "What's next" questions about patients Excellent fund of knowledge, broad and deep knowledge about own patients Can determine when action needs to be taken Propose, select from diagnostic and therapeutic options for the patient Involve patient in decision-making, considers patient s circumstances and preferences Exhibits high levels of confidence, knowledge, and judgment

13 RIME Evaluation Framework Educator Mastery of basic and advanced skills and knowledge Self-directed learning Can cite evidence that new therapies, tests, and procedures are worthwhile Defining important questions to research Exhibits willingness to, and facility with, teaching Provides superior patient care and consistently possesses superior knowledge of patients

14 Using the RIME Framework Identify the level of the learners on your team Familiarize yourself with their developmental level, and adjust your expectations Communicate your expectations with the learner Keep in mind what you can do to help each learner advance to the next level