Clinical teaching techniques

Teachers generally believe they give regular and sufficient feedback, but this is often not how it is perceived by learners!

Set expectations – that most learning happens during daily patient care as part of the team. That teachers expect and welcome feedback themselves, and that feedback is normal everyday component of teacher-student relationship – else can generate defensiveness.

Feedback is a conversation about performance, rather than a 1 way lecture.

Modelling – think aloud, to externalize reasoning (in short spells!)

1-2 minutes direct observation.  Feedback perhaps after a number of episodes – one thing done well, one thing that could be done differently? Beware a list of demoralising fails. Avoid using the word “but” between the two, which seems to diminish the positive praise.

Balance feedback by asking for student’s own perceptions of their performance, and their ideas for improvement.

Send student ahead (“scouting“).

Self- explanation – without any instructions, student finds own explanations for results, obs, management plan etc.

SNAPPS – summarize case, narrow differential, analyse differential, probe [ask questions] where uncertain, plan, select an issue related to case for self directed learning.  1-2 mins only.

Tell me story backwards – Diagnosis, then supporting evidence, then why other diagnoses excluded.  Only then plan.

Contrastive example – ask student to give alternative diagnosis and balance probabilities.

Post it Pearls – record thoughts (not just pearls!) during clinic/ward round, review at end.

Diagnostic challenge – one person/team defends working diagnosis. Other asks about worse case scenario, or alternative diagnosis, investigations done or not done, and checks with patient themselves!

[Operation Colleague, from University of Glasgow; HPE Bytes]