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Things to Do:
- Use the following questions
to guide teaching agenda:
- What are the patient's immediate
needs for care?
- What are the learner's needs?
- Frame situation before learner
sees patient - when learner is seeing patient alone:
- Orient learner to patient.
For example:
- "Mrs.
Jones is a 55-year-old woman who has been under my care
for the past five years. She has a history of hypertension
and is maintained on a daily dose of diltiazem. Today
she is complaining of dyspnea. I'd like you to focus on
her chief complaint and do a focused examination of x."
- Prime learner for new problems
by emphasizing differential diagnosis (determine learner's
abilities and foster his/her ability to promptly recognize
likely diagnoses). For example:
- "What
important causes of dyspnea are you thinking of (get learner
to commit to a differential diagnosis)? What symptoms,
risk factors, and physical signs are associated with each
of these diagnoses?"
- For a follow-up with a patient
without a new problem, prime by emphasizing questions about
health maintenance, different ways to maintain the medical
record, or, for a patient with a chronic disease, complications
of the disease. For example:
- "What
preventive health measures should we address this visit?"
- "What
complications do we need to think of?"
- When time and scheduling
allow, ask student to prepare to see a particular patient
by reading beforehand. For example:
- "A
patient with CHF is scheduled for 3:00. Based on what
you already know, what would you like to know more about
before seeing the patient? Research your learning issue
and then see the patient when he arrives."
- Talk with learner about
how to discuss the problem with the patient.
- "How
will you tell the patient this? What will you say?"
- Frame situation before learner
sees patient - when you and student will see patient together:
- Identify beforehand which
specific behavior(s) you want learner to observe. For example:
- "I'd
like you to observe how I break bad news to this patient."
- "Of
course alcohol is really the problem here. I'd like you
to watch how I try to confront that issue during the interview."
- During the visit, teach
through modeling by thinking out loud, sharing clinical hunches
and insights, pointing out controversial issues, providing
a rationale for what to accomplish during the visit
©Teacher & Educational Development,
University of New Mexico School of Medicine, 2002
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