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S2: Orientation, Teaching Methods and Tips

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  • 2.1 Tips for Integrating Phase III Medical Students into Medical Practices

    Starting Point

    • It is not as difficult as you may think and you don’t have to do it all at once.

    Plan Ahead

    • Schedule the student into your daily schedule.
      • Creating double-booking slots every hour allows for the provider to see 1 or 2 patients while the student sees a patient.  Works best at the beginning of the hour (i.e.; 8:30, 9:30, 10:30 or 1:00, 2:00, 3:00).
    • On the first day – ORIENT the student to YOUR site.
      • Develop a list of things that need to be covered and plan a formal orientation.
      • Give the student a written description of the practice.
      • Give the student a written list of expectations.
      • Review the clerkship goals and objectives with the student.
    • ORIENT the student to the provider’s lifestyle.
      • What is a day like post-call?  What is a day like on-call?
      • How does the provider balance work and personal life?
      • Invite the student to attend meetings with the provider, if appropriate.
    • ORIENT your patients.
      • Inform your patients that you are a teaching site for the AU/UGA Medical Partnership.
      • Display a notice that you have a student in your practice.
      • Invite the patients to teach and provide feedback to the student.
    • ORIENT the office staff.
      • Introduce the student to the office staff.
      • Set explicit guidelines for staff interaction with the student.
      • Decide how the student should be introduced to the patient.  (Registration Staff? Nursing? Physician? Letter?)

    Roles That Students Can Play in the Office Setting

    • Remember:  Almost everything is new to medical students.  They can spend time:
      • Collecting vital signs.
      • Charting office notes (within compliance regulations).
      • Updating patient’s records. (THINK Past Medical History, Social History, Family History)
      • Talking with patients who are waiting to see physician when they aren’t on schedule.
      • Reviewing patient education materials.
      • Reviewing health maintenance guidelines and ensuring they are up to date.
      • Completing Denver developmental screening (children).
      • Completing mini-mental status exams (older patients).
      • Special project for a patient that has been puzzling or for a disease state that is increasing in your office setting.
    • A student can also learn by working with other members of the health care team.
      • Interesting patients with PA or NP
      • Working with clinical support staff to:
        • Give immunizations
        • Answer triage questions
        • Practice phlebotomy
        • Provide diabetes education
        • Consider working with other clinical personnel:
          • Nutritionist
          • Social Worker
          • Diabetes Educator

    Consider Unique Educational Opportunities

    • Follow patient from first week that may have recurrent visits during clerkship (venous stasis ulcers, new diabetes) or pre-op/surgery/post-op.
    • Obtain student’s cell phone number to contact him/her if important patient experience occurs.
    • Encourage student to follow-up with patients by phone or to read up if an interesting patient is being seen that day.
    • Review library resources with student (good learning opportunity for student and possible CME for health care provider).

    What the Student Needs

    • Some space.  Space is always at a premium, but a cubicle or desk with computer is helpful for students.
    • Access to EMR.  Consider type of access (read-only, limited, full-access) and physician review requirements.

    Allow student to review phone messages, lab work and insurance company communication with physician, nursing or office manager.

    — Terrence Steyer, MD, Former Chair of Clinical Sciences AU/UGA Medical Partnership

  • 2.2 Teaching Tips for the Clinical Setting

    Incorporating Learners into a Busy Clinical Practice

    • Plan ahead
      • Letter welcoming students to your practice
      • Written expectations
      • Schedule time for teaching and feedback
    • Orientation
      • Staff
    • Establish guidelines
      • Patients
      • Student
    • First day
      • Introduce students to staff
      • Review expectations and clerkship objectives
      • Determine how the students will introduce themselves to patients
      • Shadow Model Function Independently
    • Think of ways the student save you time
      • Write prescriptions
      • Phone follow-up
      • See work-in patients
      • Triage patients
    • You are not responsible for the students 24/7
      • Develop 4 day precepting week

    Preceptor’s Responsibilities

    1. Treat the patient
    2. Diagnose the learner
    3. Teach the learner

    Treating the Patient

    The easy way: Do it yourself

    • Have the student watch you…
      • Take a history
      • Perform a physical exam
    • Have the student listen to your…
      • Assessment
      • Plan
    • Advantages/disadvantages?

    The better way: Let the learner try first

    • Allow the student to evaluate and present the patient
    • Advantages/disadvantages?

    The Challenges

    • Teaching time is limited
    • Clinical demands are significant
    • No two learners are alike
      • Different levels of knowledge and skills
      • Different attitudes
      • Different learning styles
      • Different prior experiences

    Teaching and Clinical Demands

    • Make the student more efficient
      • Establish clear expectations
    • Verbally and in writing
      • What do you expect from a good student?
    • Provide guidelines
      • Oral presentations
      • Medical Documentation
    • Give examples

    Diagnosing the Learner

    • It’s like primary care, you don’t have to do everything in one visit
    • Preceptors can easily overwhelm learners with information
    • Students can only retain small amounts of information
    • It’s easy: Ask 3 simple questions!
      • WHAT do you think is going on?
      • WHY do you think so?
      • WHAT do you want to do?

    The Three W’s

    • Provides learner with an incentive to think and apply knowledge
    • Provides the preceptor with information about what the learner knows or does not know.
      • Areas for teaching
      • Areas for feedback

    Diagnosing the Learner: What

    • Ask the learner to make a commitment or decision
      • Diagnosis
      • Course of action
      • Treatment plan
    • Ask open-ended questions
      • What do you think is going on?
      • Do you have an explanation for the patient’s symptoms?

    Diagnosing the Learner: Why

    • Ask the learner for evidence to support her/his commitment
    • Have the learner “think out loud”
      • Insight into problem-solving skills

    Diagnosing the Learner: What

    • Ask the learner what s/he wants to do to take care of the patient
    • Ask the learner to provide other diagnostic or treatment possibilities with supporting evidence

    Teaching the Learner

    • Identify key points for emphasis
      • One or two teaching points per patient
      • Based teaching on the Three W’s
    • Link key points to a relevant teaching point for the student to learn
    • Reflection: Ask the student what 2 things s/he learned that day

    What should you teach?

    • Curriculum Goals & Objectives
      • Knowledge
    • Differential diagnosis
    • Treatment
    • Management
      • Skills
    • History taking
    • Physical exam
    • Presentations
    • Medical Documentation
    • Attitudes
      • Ability to assume responsibility
      • Accountability
      • Punctuality
    • Behaviors
      • Professionalism
      • Communication skills
      • Interpersonal skills

    Take Home Messages

    • Students are most interested in learning when the content is relevant to their
      • Immediate needs: tests, evaluations
      • Long-term needs: career goals
    • By emphasizing the relevance of what you teach, students become more motivated to learn
    • Assessment drives learning

    T. Andrew Albritton, MD, Associate Dean for Curriculum, Medical College of Georgia

  • 2.3 How to Access AHEC Expert Training Modules

    AHEC Expert Training Modules are available 24/7 on a variety of computer platforms, including some mobile devices.  Each is hosted on the HealthtecDL site (along with other content not related to this particular program).  All webinars are presently available at no cost.  Participants who view all modules, complete the related registration forms, Survey Monkey surveys, and post-tests will receive 6 hours of AMA PRA Category 1 Credit™ from the AU Medical College of Georgia.

    AHEC Expert Training Modules

    Modules are hosted by Healthtecdl, a partnership between the Statewide AHEC Network and the Healthcare Georgia Foundation.

    AHEC Expert Preceptor Training Modules Contact

    Darra Ballance, MLIS, AHIP
    dballance@georgiahealth.edu
    Statewide Area Health Education Centers Network
    Augusta University
    Augusta, GA  30912
    (706) 721-9902

  • 2.4 Access TeachingPhysician.org

    About Teaching Physician

    Teaching Physician is a website developed by the Society of Teachers of Family Medicine.  The website was created by leading experts in faculty development and is designed to help connect medical schools to community preceptors. It contains videos, tips, and other content that will help preceptors answer frequently asked questions.  Topics covered include:

    • Preparing a practice team for a student or resident
    • Integrating a student into office routines
    • Setting expectations
    • Teaching strategies
    • Giving feedback
    • Evaluating learners
    • Billing issues

    The site helps preceptors do their jobs more effectively. It also helps medical schools recruit, train, and retain community preceptors.

    How Do I Access Teaching Physician?

    You will receive an email notifying you that AU has purchased a subscription on your behalf.  The e-mail will provide log-in information and will prompt you to create your own log in to receive CME credit. Each month, subscribed clinical faculty will receive an e-mail with a link to resources for the “Precepting Topic of the Month.”
    Subscribed clinical faculty member can complete quizzes/evaluations  to earn up to 14.5 CME credits per year.

    To gain access to www.teachingphysician.org, please contact Becky Mueller, MCG Office of Faculty Development rmueller@augusta.edu.