Things To Do:
- As the learner presents the case:
- Listen without interrupting (except when
redirection is necessary).
- Avoid "taking over" the case
by telling the learner what you would do or want done for
the patient.
- Take notes, focusing on both patient
needs and learner needs.
- When case has been presented, elicit the
learner's thoughts and plans. Promote hypothesis generation and
clinical reasoning; get a commitment on differential diagnosis.
For example:
- "Is there anything else
you want to tell me about this patient?"
- "What do you think is
going on?"
- "Why do you think that?"
- "What else might it
be?"
- "What do you want to
do about it?"
- "What evidence did you
obtain to support that approach?"
- Diagnose the learner's knowledge, attitudes,
and skills and decide whether he/she exhibits gaps, confusions,
errors.
- Facilitate integration, differentiation,
and exchange and help learner apply new ideas to patient's problem.
- Take advantage of the "teachable moment":
- Focus on the student rather than the
case. Ask yourself:
- "What one (or two)
teaching points do I want the student to leave this encounter
with?"
- Capture opportune moments that arise
during your supervision of the student to stimulate learning
by:
- Guiding the learner to solve the
problem on his/her own with your guidance.
- Answering a direct question.
- Mini-lecturing on the topic being
discussed (Use this cautiously, as it can have the effect
of promoting the learner's dependence on you for problem-solving
and patient care. Quickly rattling off all you know on
a topic will rarely help your student in the long run.)
- Discussing an observed clinical skill
deficiency, gap in knowledge, confusion, error in thinking.
- Giving positive reinforcement for
appropriate clinical behavior.
- Raising a question at the end of
discussion to guide self-directed learning.
- Encourage independent inquiry and self-study.
For example:
- "Based on what we've
talked about so far, what learning issues would you like
to work on before we get together next?" Clarify
expectations about level of detail and format.
©Teacher & Educational Development,
University of New Mexico School of Medicine, 2002
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