| As a resident, you
are an important instructor of medical students. What you do or don’t do can have a
major impact on student learning, and it can also influence how they will instruct
students when they become residents. To become an effective instructor,
someone who truly motivates students, it is particularly important to understand
students’ levels of understanding (i.e., stages of development). This means to
understand the students’ background (e.g., how
much exposure they have had to clinical applications and the medical profession in
general), their current level of knowledge (e.g., what courses they have taken and their
present fund of knowledge), and their commitment to becoming a lifelong learner. In understanding your students, it is important to consider
their first two years of medical school. The typical medical school curriculum emphasizes
basic science concepts in years one and two. In years three and four, application of
knowledge, attitudes, and skills to patient care are emphasized. While UASOM is beginning
to integrate basic science concepts and clinical application, which is apparent with the
increased use of small group sessions and with courses such as Introduction to Clinical
Medicine, it still primarily devotes the first two years to transmitting the necessary
factual information to the students. |
Stages of Intellectual Development
Stage 1. Typically, students in the first
two years of medical school memorize a vast amount of information. Students become
conditioned to and expect their instructors to give them information in a clear, organized
manner and tell them what is right and wrong. Because reliance is placed on the instructor
for providing many of the answers, and generally the right answers, students may have
trouble with issues requiring analytical and problem solving skills.
Stage 2. When students enter the third
year of medical school, they discover that there may not always be a right or wrong answer
– that there is actually some ambiguity in knowledge. Students begin to realize that
some things are not known and may never be known, a stage that is often very difficult for
them to adjust to. During your clinical teaching, be prepared to encounter this stage of
development and the resistance that accompanies it, such as pressure by the students to
tell them the answer rather than having them seek it on their own.
Stage 3. During Stage 3 of the
students’ development they discover that they are required to demonstrate a reasoned
process of decision making. Students learn that in the context of a specific patient, some
judgments may be better or worse. Once students enter this stage of their development,
they have reached the point of thinking that will prepare them to deal with personal and
professional decisions – reasoning and analytical skills that practicing physicians
and lifelong learners must possess. |
All of
your students will not progress through each of the three stages at the same pace. Since
some students will advance more quickly than others, it is likely you will have a
combination of students in all three stages in one medical team. Part of being an
effective instructor is the ability to understand and accommodate the learning needs of
each student. Being aware of the three stages of intellectual development that your
students will experience may help you to interact with them in such a way as to maximize
their learning and help them learn to think independently. |
|
Derived from TL Schwenk & N. Whitman (1993). Residents
as Teachers: A guide to educational practice. Salt Lake City, Utah: University of Utah
School of Medicine.
In the next issue of Teaching
Tips, suggestions on things you can do to help your students progress
to Stage 2 and 3 of their intellectual development will be presented.
Editor’s Note: My thanks to Dr.
Roger Berkow, MD and Dr. Nathan Smith, MD for reviewing this issue of Teaching Tips.
Recommendations
for Improving
Residents’ Teaching During Rounds
Derived from D Weinholtz & J Edwards (1992). Teaching
During Rounds: A handbook for attending physicians and residents. Baltimore, MD: The
Johns Hopkins University School of Medicine.
Teaching in the Conference Room
- Limit interruptions of the case presentation by
a student. Reserve the majority of questions and comments until after the
presentation is completed. This will allow the student to maintain focus while developing
his/her presentation skills.
- Actively engage in the discussions after the
case presentation is completed. Use probing questions to help you assess
both the presenter and the other students’ understanding and to provoke thought by
them.
- Use illustrations and diagrams to
accentuate important information and clarify abstract points for the students.
- Give occasional, brief talks or bits of
information on pertinent topics, but avoid using this time for giving
didactic lectures.
- Provide students with relevant readings or
references. Have students read pertinent articles or reference certain texts
or individuals who may serve as consultants on problem solving issues. Requiring students
to do this will teach them how to locate and use relevant information – a necessary
skill in the medical profession.
Teaching at the Bedside
- Elaborate on what the attending is explaining or
demonstrating. Because the physician is an expert, intermediate steps or
major points may fail to get explained. Attempt to identify these oversights and give the
necessary explanations.
- Prompt students to give answers and responses. Diplomatically
give students cues when you feel they should respond. Because the communication can be
somewhat complicated with both the patient and the attending present, students may
initially need this prompting.
- Elicit teaching from the attending.
Whenever a learning opportunity arises but is not identified by the attending, try to
elicit teaching by asking the attending questions. If this is not appropriate, question
the students or offer explanations to create an adequate learning experience.
- Teach clinical procedures thoroughly
by breaking the procedure down into a series of small steps, explaining and demonstrating
each step, and then giving supervised practice with feedback. Be sure to have the student
repeat to you the instructions prior to beginning the procedure him/herself.
- Teach history taking, physical examination,
differential diagnosis, and problem solving by assigning new patients to the
medical students and give them the responsibility to interview and examine the patient
independently. Require the students to present to you their findings, impression, and
differential diagnosis – this is an excellent way that students can learn the skills
that practicing physicians must possess.
Finishing the Rotation
- Prepare to participate in or to solely conduct
evaluating the students. Find out from the attending physician at the
beginning of the rotation what responsibilities you have for evaluating students. Make
brief notes about the critical incidents and quality of performance of the students’
assigned tasks throughout the rotation. This will give focus and detail to document your
impressions of a student’s performance, which will be useful in your evaluation.
- Plan a private conversation with each student at
the end of the rotation. Use this time to give oral feedback specific to the
student’s performance and an opportunity for them to ask you any questions.
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