How to Assess Your Trainee’s Learning & Vary Your Teaching Role
Linda L. Carr, Ph.D. CEO, Faculty Ed Solutions, LLC
Feel
Learning
Objectives
• How to recognize and treat students as adult learners.
• How to determine the experience level of students to help you teach at the learner’s level.
• How to use productive questions to assess student’s knowledge and clinical reasoning.
• Empowered to apply adult learning principles in your work with trainees.
• Vary teaching approaches depending on trainee’s experience level.
• Ask questions to assess your learner’s knowledge.
Know Do
What is the most important characteristic of the learners that you teach?
Medical students and trainees are adult learners!
Teaching Children vs. Adults
Incorporate principles of adult learning in your teaching.
Pedagogy (teaching children)
Concept of Learner Dependent
Learner’s Experience Little emphasis
Individual Ready to Learn When
Directed by teacher or school
Andragogy (teaching adults)
Self-directed
A resource to build on
Solving a real problem
Focus on Learning Foundation Application
Learning Orientation
Knowledge for later Competency for today
Role of Teacher - Authority - Expert
- Director
- Facilitator
- Clinical Expert
PEP2 Facilitator’s Module 4 (Assessment), p. 4.5. Adapted from the Primary Care Futures Project. Clinical education in community settings.
Worchester, Mass: Statewide AHEC at the University of Massachusetts Medical Center, 1996.
Treat Students/Trainees as Adult Learners
Is there any practice that you’re not doing?
Assign learners clear responsibilities.
Ask about and use previous knowledge.
Put learners to work assigning a real job.
Involve learners in patient care at the start of the clerkship/rotation.
Give learners a chance to practice the knowledge, attitudes, and skills they acquire.
PEP2 Facilitator’s Module 4 (Assessment), p. 4.6. Adapted from Knowles, ME. The modern practice of adult education. Englewood cliffs, NJ: Cambridge/Prentice Hall, 1980:43-4.4 (Assessment), p. 4.5.
①
④
⑤
②
③
3 Ways to Teach Adults
Teacher roles include:
Which role do you use the most? the least?
DIRECTING DIRECT INSTRUCTION: Set clear goals and state time expectations.
FACILITATING FACILITATE INSTRUCTION: Ask questions; listen to your students; share your reasoning process; think aloud.
CONSULTING CONSULT AS PEER TO PEER: Encourage students to set goals; help evaluate learning; encourage new learning goals.
PEP2 Facilitator’s Module 4 (Assessment), p. 4.6. Adapted from Knowles, ME. The modern practice of adult education. Englewood cliffs, NJ: Cambridge/Prentice Hall, 1980:43-4.
A Framework for Assessing Clinical Competence
Daily patient care assessed by direct observation in clinical settings (PERFORMANCE)
Demonstration of clinical skills tested by OSCE, standardized patients, clinical exams, etc. (COMPETENCY)
Application of knowledge: tested by clinical problem solving, etc.
Does
Shows how
Knowledge tested by written exams
Knows how Knows
Miller’s Pyramid of Assessment Adapted
o g n i t i o n
C
from Ramani S, Leinster S, AMEE Guide no 34: Teaching in the clinical environment. Medical Teacher,
e
2008:30(4):347-364. B
h a v i o r
Teach at the Learner’s Level
STUDENT’ S CLINICAL EXPERIENC E
STUDENT’ S LEARNING LEVEL
PRECEPTOR TEACHING ROLE
Little Exposure DIRECTOR
1. Provide structure
2. Set expectations
3. Give direction
4. Plan experiences
5. Select patients
Moderate Acquisition FACILITATOR
1. Ask questions
2. Listen to student’s ideas
3. Share your own reasoning
4. Think aloud
Extensive Integration CONSULTANT
1. Help set goals
2. Help evaluate progress
3. Exchange ideas
4. Serve as resource
PEP2 Facilitator’s Module 4 (Assessment), p. 4.13.
Stritter’s Learning Vector (Model for Professional Development) Exposure Application Integration 3 Stages of Professional Developme nt Novice Mature PROFESSIONAL DEVELOPMENT Independent CLINICAL INSTRUCTION Dependent PEP2 Facilitator’s Module 4 (Assessment), p. 4.8. Adapted from Stritter FT, Baker RM, Shahady EJ. Clinical instruction. In: McGahie WC, Frey JJ, eds. Handbook for the academic physician. New York: Springer-Verlag, 1986:102.
Clinical Vignette 6
After watching the video clip, determine …
Is the STUDENT at the exposure, acquisition, or integration stage?
Is the PRECEPTOR acting as a director, facilitator, or consultant?
PEP2 Clinical Vignette 6
How to Assess the Student’s Level of Experience
ASK in a supportive and collegial manner
DON’T GRILL or intimidate the learner
PEP2 Facilitator’s Module 4 (Assessment), p. 4.11.
Teaching Scenario
A student has presented the facts of a case to you. You’re generally satisfied with the student’s presentation and the quality of the information the student has included, and you think you recognize the patient’s problem.
What do you do?
(1) Tell the learner the answer?
(2) Ask more questions?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.14.
Ask more questions!
Other Helpful Questions or Queries
① Can you tell me why you made that recommendation?
② Was there something else that led you to that choice?
③ Tell me more about your thinking concerning this patient.
④ What else do we need to find out?
⑤ How could we obtain that information?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.18.
Other Helpful Questions or Queries
⑥ Please describe how that encounter went for you.
⑦ So how did you think that went?
⑧ Here’s what I saw; were you aware of it?
⑨ What are you learning from working with these patients?
⑩ Can you tell me what you are learning in my office?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.18.
Clinical Vignette 9
What does the preceptor know about the student’s knowledge?
PEP2 Clinical Vignette 9
CASE 1 SCENARIO
STUDENT: Little Experience
PRECEPTOR: Director
STUDENT:
I have just seen a 21-y/o unemployed male whose chief complaint is that the voices are coming back. He reports that the voices never completely went away but lately they have gotten louder and that he feels he should do what they say.
-Provide structure
-Set expectations
-Give direction
-Plan experiences
-Select patients
How would you respond using the “Director” approach?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.20.
CASE 1 SCENARIO
Student: Moderate Experience
Preceptor: Facilitator
STUDENT:
I have just seen a 21-y/o unemployed male whose chief complaint is that the voices are coming back. He reports that the voices never completely went away but lately they have gotten louder and that he feels he should do what they say.
-Ask questions
-Listen to student’s ideas
-Share your own reasoning
-Think aloud
How would you respond using the “Facilitator” approach?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.20.
CASE 2 SCENARIO
STUDENT: Extensive Experience
PRECEPTOR: Consultant
STUDENT:
I just evaluated a 72-year-old patient with 3 days of increasing dyspnea and cough. She has diabetes that is well controlled with medications but no other medical problems. She’s retired and lives with her husband. She reports pleuritic chest pain on the right side when she coughs. When I listen to her lungs, she has decreased breath sounds on the right side.
-Help set goals
-Help evaluate progress
-Exchange ideas
-Serve as resource
How would you respond using the “Consultant” approach?
PEP2 Facilitator’s Module 4 (Assessment), p. 4.21.
Take-Home Pearls
① Apply adult-learning principles.
② Vary your teaching role based on the student’s experience level.
③ Use other productive questions to learn about your students.
④ Create a challenging but supportive learning environment.
LEARN – REFLECT - TEACH
What will you keep the same?
What will you do more of?
What will you do less of?
What will you stop doing?
What will you do differently & how will you do it?
What will you add?
