Improving Teaching

Thank you for inviting Frank
Stritter and me to join you
today at Marshall
Content of our Half-Day with you
Theories of Learning Applied to
Teaching. F. Stritter
Improving Teaching and Learning in
Different Settings. W. Herbert
Instructional Options. F. Stritter
Making the Most of Teaching and
Learning Opportunities. W. Herbert
What We Hope Will Be the Outcome:
You will…..
• focus more on teaching/learning
• appreciate specific methods of
teaching and learning
• feel more confident in both your
teaching and learning abilities
• have a good time this morning
Conduct of the Morning
Interactive and lively
Discussion/Questions welcome
Teaching and Learning
in Different Settings
Marshall University
Wm. N. P. Herbert, MD
University of Virginia
I have no financial conflicts to report.
However, the 7th edition of our textbook
Obstetrics and Gynecology (Beckmann and
Ling) is coming out from LWW next year,
and it’d be nice if you’d buy a copy.
Let’s start with a short puzzle….
When you know the answer,
raise your hand, but make no
sounds, please, or look around
Move one slanted or vertical bar to
correct this equation:
\/ = III + I + III
V = III + I + III
\/ I = II + I +III
What did you think about while
trying to solve that puzzle?
“Please Prepare to Learn”
• Focus on teaching and learning
• Check your emails one more time,
but not any more until we break
• Put cell phones on “airplane” mode
and don’t look at them
• Put pagers on “vibrate” mode
• Sit back and think
Improving Teaching and Learning in
Different Settings
Learning Settings: Clinical/Didactic
Teaching in the Operating Room
Introduction and Background
What is teaching and learning
What are the differences among
parenting, teaching, and
“They call it coaching, but it is teaching.
You do not just tell them… show
them the reasons.”
Vince Lombardi
What are the characteristics of
a good teacher?
a good learner?
The single most important criterion for
effective teaching and learning is
on the part of both the
Experience is a great teacher.
Teaching is a skill, learned like
performing surgery.
Junior learners need very little, but
they need the very little very much.
Regardless of setting, learning is
more likely to occur when….
Instruction is problem-centered
A supportive environment exists
Instruction is experience-oriented
Learners receive feedback
Learning Settings:
Learning Settings
Settings --- Clinical, Didactic
Advantages and Disadvantages of each
Opportunities to improve
Teaching in the Clinical Setting
One on one time
Direct observation
Specific patient involvement
Real life scenarios
Pressures of “productivity”
Variability of clinical situations
Time with patients vs time with learners
Clinical Settings
Resident Clinics
Private Office/Faculty Clinics
Operating Room
Labor and Delivery
Shift Turnover
Bedside Rounds
Teaching Rounds
What’s good? What’s bad? How to improve?
Didactic Teaching and Learning
Efficient in transmitting information
Multiple contributors
Can be boring as hell
Little interaction; usually not “active”
Didactic Settings
Grand Rounds
Faculty Lectures
Resident Lectures
Journal Club
Subspecialty Conferences
Morbidity/Mortality Conferences
In-training Exam Preparations
What’s good? What’s bad? How to improve?
Teaching in the O.R.
Teaching in the Operating Room
Who needs to be there? Who decides?
Does the type of surgery matter?
Prioritization of learners:
Sr level, then Jr level, residents
Medical, then non-medical students
B I D Method
B riefing
I ntraoperative
D ebriefing
Prep and Briefing
Who is learning? Background? Skills?
Scrubsink Conversation:
Overview of procedure/indications
What do you want to learn today?
Have you done this before?
What are the danger points?
Intraoperative Teaching
• Assign a “teacher” to describe what’s
going on
• Use a laser, camera
• Other potential topics to discuss
Common complications
What if….
• As soon as possible after the case
• Reinforce what went right
• Correct mistakes. Next time……
Roberts NK et al. J Am Coll Surg.
Take Away Points
• Teaching doesn’t just happen; it’s
a process, and it takes work
• Enthusiasm for T/L is the most
important factor
• Methods of teaching depend on
the setting
Making the Most
of Teaching and Learning
Marshall University
Wm. N. P. Herbert, MD
University of Virginia
Making the Most of Teaching and
Learning Opportunities
Teaching in the O.R. (First session)
Teaching on Rounds
Teaching in the Ambulatory Setting
Evaluation and Feedback
Value of “Lists”
Teaching Patients
Teaching on Rounds
Role modeling
Meeting family members
Physical exam findings
Asking questions
Looking for support
Effective Ambulatory Teaching
Make learning active; ask questions
Orient and focus
Have objectives
Coach; “blow the whistle,” give feedback
Be positive role model
Provide tips
One Minute Preceptor
Assign a learner a task, usually
to get a patient’s history, and to
report his/her findings to you
The One Minute Preceptor
Get a commitment: What do you think…
Ask for supporting evidence: What makes
you think that….
Teach general rules: When a patient has
abnormal bleeding, the first thing…
Reinforce what was right
Correct mistakes
Neher et al. J Am Board of
Pract 1992;5: 419-424
The Educational Sequence
Teaching/Learning (T/L) is Like a Meal
Say grace --- Prepare/Setting
Appetizer --- Orient/Expecations/Whet appetite
Entrée --- The main of T/L/The “experience”
Dessert --- The wrap up/Debriefing
Coffee --- Reflection/Feedback
Leave the table --- Act
Before: Preparation and Setting
Supportive Environment: Tips
Recognize that expectations vary
Clarify expectations, discuss goals
Solicit their knowledge/experiences
Listen with intensity
Show enthusiasm and energy
Active (Engaged) Learning
Ask lots of questions
Let learners make decisions
Set the stage for participation
Involve everyone
Hush! Give learners time
Link new information to old
Have learners summarize
Role modeling
One-minute preceptor
Feedback and Evaluation
What’s the difference?
Evaluation is the process of making a
value judgment about the adequacy of a
learner’s performance.
Evaluation is a grade.
Feedback is the process of helping your
learners understand the adequacy of their
performance, and then, ….helping them
identify options for improving it!
Feedforward reminds of the direction
we’re taking
If you keep practicing a mistake,
you’ll get really good …..
at making that mistake.
Benjamin Pang Jeng Lo
T’ai Chi Ch’uan Master
The Value of Lists
One list for all; method unimportant
Limit list to concrete tasks
+/- Use of priorities
Be realistic
If you don’t have time to do it right the
first time, when are you going to have the
time to do it over?
John Wooden
UCLA Coach
Teaching Patients:
A “So True” Thought
People will forget what you said,
People will forget what you did,
But people will never forget
How you made them feel.
Maya Angelou
Wake Forest Univ.
Tips on Teaching with Patients
Sit down
Introduce yourself to everyone
Name and nickname. Can I call you….?
Where are you from?
How can I be helpful to you today?
More Tips on Teaching Patients
Be sensitive to knowledge level
Use big words sparingly, for everyone
Summarize first: The Car Repair Story
Ask for questions and give time to ask
Take Away Points
• Teach and learn where you are, while
you’re doing what you do --- but think
about it
• T/L involves a sequence; it’s not “yes” or
• Excellent patient care involves learning
and teaching by you
Thanks very much

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