Teaching in the outpatient clinic

Abstract

For teachers of medicine, the outpatient clinic promises many unique educational opportunities including more complete observation of chronic diseases, closer relationships between teachers and learners, and a more appropriate forum for teaching preventive medicine, medical interviewing, and psychosocial aspects of disease.Despite these educational benefits, teachers face many challenges in the clinics. Not only do most teachers feel there is inadequate time to teach, 1 they also have little control over the distribution and organization of this time. Unlike teachers in hospital wards, who often focus on only two or three patients during teaching rounds, outpatient teachers must address the concerns of each patient while the patient is still in the clinic, leaving little or no time for more elaborate instruction (typically 1 minute or less per case). 2 Furthermore, teaching about a single well-defined complaint often fails in the ambulatory setting because many problems occur simultaneously, organic findings are intertwined with psychosocial issues, and diagnostic questions are settled more often by observation or empiric treatment than by laboratory testing.In a recent, comprehensive review of educational research on ambulatory education, 3 four important points were made. First, the environmental variables of a particular outpatient clinic-case mix of clinic, pace of workload, structured time for teaching, space for teachinghave little if any impact on the overall ratings of teaching effectiveness. 4,5 Second, the behavior of teachers strongly influences the perceived success of the ambulatory experience. [6][7][8] Effective teachers ask questions, show interest, define goals, demonstrate competence, and, most importantly, spend time with the learner. 9,10 Third, the definition of effective teaching in most studies is the learners' perceptions of what is effective, even though this may relate poorly to specific goals of the curriculum. For example, medical students often rank their outpatient experience better than their inpatient one, although formal testing reveals no difference in acquired knowledge between the two areas. [10][11][12][13][14] Finally, role modeling clearly influences learners. In one study, there were striking similarities between what teachers wanted to transmit to their students, what these teachers cherished about their own instructors, and what the students admired during the rotation and wanted to emulate subsequently. 15 However, when residents were assigned to a teacher who demonstrated deficient charting practices and made fewer psychosocial diagnoses, the residents' own practices began to suffer from identical deficiencies. 16 The challenge for the clinician-educator, therefore, is to create opportunity and space for meaningful dialogue with one or more learners in the midst of a busy outpatient clinic full of vague and indolent patient problems. Based upon the literature just cited and years of experience teaching and observing medical students and house officers in a variety of a...

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

“…Studies of the behaviors of clinical supervisors in residency clinics show that they frequently use internet-based resources to answer questions raised during the interaction with learners 38 and role model positive behaviors for asking and seeking answers for clinical questions. 39 These behaviors may contribute to more effective maintenance of current medical knowledge. In addition, faculty likely participate in a number of other educational activities in the program such as morning report, grand rounds, teaching rounds and curriculum development.…”

Improving Participant Feedback to Continuing Medical Education Presenters in Internal Medicine: A Mixed-Methods Study

“…Indeed, research indicates that physician reflection on positive and constructive assessment feedback is important for understanding, accepting and applying that feedback. 2,6 Evaluation and feedback are uniquely different: evaluation is summative and involves judgment, whereas feedback is formative and specifically intended to improve effectiveness. 7,8 It is understood that useful feedback is provided in a timely fashion, behavior-specific, and balanced with both positive and constructive elements.…”

Success of a Faculty Development Program for Teachers at the Mayo Clinic

“…The curriculum was implemented in the internal medicine residency as part of the Education Innovations Project of the Accreditation Council for Graduate Medical Education. The curriculum covers 6 basic topics: asking questions effectively, [17][18][19] diagnosing learners' needs, [20][21][22][23][24] giving feedback, 26,27 using teaching frameworks, 28,29 recognizing learning styles, and providing clinical supervision. A basic summary of the curricular content of FEED was previously published.…”

“…We created a faculty development program that was structured on recognized components of clinical teaching, 13 such as creating a positive learning climate, 16 asking questions effectively, [17][18][19] diagnosing the learner's needs, [20][21][22][23][24][25] and giving feedback. 26,27 The goals of this study were to describe a Mayo Clinic faculty development program on clinical teaching, and to determine whether poor clinical teachers would experience different levels of improvement in teaching effectiveness scores than the best teachers, after exposure to faculty development.…”