Enriching Pediatric Learning: A Guidebook for Preceptors

156 Pages·2021·20.553 MB·English

by  Susan Bannister

Pediatric collections
Enriching Pediatric Learning:
A Guidebook for Preceptors
Edited by: Susan Bannister, MD
JOURNALS
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Pediatric collections
Enriching Pediatric Learning:
A Guidebook for Preceptors
EDITOR:
Susan L Bannister, MD, MEd, FRCPC
Editorial Board, Pediatrics
Professor, Department of Pediatrics
Cumming School of Medicine, University of Calgary
COMMENTARIES BY:
Robert A Dudas, MD
Associate Professor, Department of Pediatrics
Johns Hopkins University School of Medicine
Karen L Forbes, MD, MEd, FRCPC
Associate Professor, Department of Pediatrics
Faculty of Medicine & Dentistry, University of Alberta
Janice L Hanson, PhD, EdS, MH
Professor of Medicine, Department of Pediatrics
Washington University in St. Louis
Terry Kind, MD, MPH
Professor, Department of Pediatrics
The George Washington University School of Medicine and Health Sciences
Christopher G Maloney, MD, PhD
Professor, Department of Pediatrics
University of Nebraska College of Medicine
Michael S Ryan, MD, MEHP
Associate Professor, Department of Pediatrics
Virginia Commonwealth University School of Medicine
Sandra M Sanguino, MD, MPH
Associate Professor of Pediatrics and Medical Education, Department of Pediatrics
Northwestern University Feinberg School of Medicine
Published by the
American Academy of Pediatrics
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© 2021 American Academy of Pediatrics. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic,
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Printed in the United States of America
APC025
Print ISBN: 978-1-61002-582-9
eBook ISBN: 978-1-61002-583-6
Pediatric collections
Enriching Pediatric Learning:
A Guidebook for Preceptors
Table of Contents
Enriching Pediatric Learning: A Guidebook for Preceptors
Introduction — Medical Education Matters: Pediatric Clinical Teachers Can Inspire the Next Generation
of Doctors, by Susan L Bannister, MD, MEd, FRCPC
vii What Makes a Great Clinical Teacher in Pediatrics? Lessons Learned From the Literature
Pediatrics Perspective | Original Publication | May 1, 2010
Chapter 1 — Fostering Humanism in Pediatrics: The Importance of Developing Non-Cognitive Skills in a
Supportive Learning Environment
3 Introduction by Michael S Ryan, MD, MEHP
5 It’s not just what you know: the non-cognitive attributes of great clinical teachers
Monthly Feature | Original Publication | November 1, 2014
8 Practical framework for fostering a positive learning environment
Monthly Feature | Original Publication | July 1, 2015
12 A Little Hurts a Lot: Exploring the Impact of Microaggressions in Pediatric Medical Education
Monthly Feature | Original Publication | July 1, 2020
15 Taking Humanism Back to the Bedside
Monthly Feature | Original Publication | November 1, 2015
Chapter 2 — Setting the Stage for Great Clinical Learning
21 Introduction by Sandra M Sanguino, MD, MPH
23 Getting Off to a Good Start: Discussing Goals & Expectations With Medical Students
Pediatrics Perspective | Original Publication | August 1, 2010
26 Key Elements of Highly Effective Teams
Monthly Feature | Original Publication | February 1, 2014
29 How to “ENGAGE” Multilevel Learner Groups in the Clinical Setting
Monthly Feature | Original Publication | November 1, 2017
33 The Clinical COACH: How to Enable Your Learners to Own Their Learning
Monthly Feature | Original Publication | November 1, 2018
37 To Trust or Not to Trust? An Introduction to Entrustable Professional Activities
Monthly Feature | Original Publication | November 1, 2016
Chapter 3 — Teaching Techniques: Incorporating Learning into a Busy Clinical Practice
43 Introduction by Robert A Dudas, MD
45 The Didactic Makeover: Keep it Short, Active, Relevant
Monthly Feature | Original Publication | July 1, 2016
48 Questioning as a Teaching Tool
Monthly Feature | Original Publication | March 1, 2015
51 Transform Role Modeling Into SUPERmodeling
Monthly Feature | Original Publication | November 1, 2019
54 Failure Is an Option: Using Errors as Teaching Opportunities
Monthly Feature | Original Publication | March 1, 2018
57 Just Do It: Incorporating Bedside Teaching Into Every Patient Encounter
Monthly Feature | Original Publication | July 1, 2018
60 Getting Physical: The Hypothesis Driven Physical Exam
Monthly Feature | Original Publication | March 1, 2016
63 Teaching in a Family-Centered Care Model: The Exam Room as the Classroom
Monthly Feature | Original Publication | May 1, 2013
66 The Whole “PROOF”: Incorporating Evidence-Based Medicine Into Clinical Teaching
Monthly Feature | Original Publication | July 1, 2017
iii
Chapter 4 — The Heart of Clinical Teaching: Observation, Feedback, Assessment, and Evaluation
71 Introduction by Janice L Hanson, PhD, EdS, MH
73 Oh, What You Can See: The Role of Observation in Medical Student Education
Pediatrics Perspective | Original Publication | November 1, 2010
76 Getting Beyond “Good Job”: How to Give Effective Feedback
Pediatrics Perspective | Original Publication | February 1, 2011
79 Diagnosing the Learner in Difficulty
Monthly Feature | Original Publication | August 1, 2013
82 Assessment for Learning: How to Assess Your Learners’ Performance in the Clinical Environment
Monthly Feature | Original Publication | March 1, 2020
85 Writing medical student and resident performance evaluations: beyond “performed as expected”
Monthly Feature | Original Publication | May 1, 2014
88 The LETTER of Recommendation: Showcasing a Student’s Strengths
Feature | Original Publication | March 1, 2021
Chapter 5 — Promoting Clinical Reasoning and Reflection: The Clinical Teacher as Guide
93 Introduction by Karen L Forbes, MD, MEd, FRCPC
95 The Right Stuff: Priming Students to Focus on Pertinent Information During Clinical Encounters
Monthly Feature | Original Publication | July 1, 2019
98 What’s the Story? Expectations for Oral Case Presentations
Pediatrics Perspective | Original Publication | July 1, 2012
102 Using the Student Case Presentation to Enhance Diagnostic Reasoning
Pediatrics Perspective | Original Publication | August 1, 2011
105 You Too Can Teach Clinical Reasoning!
Pediatrics Perspective | Original Publication | November 1, 2012
108 Into the Unknown: Helping Learners Become More Comfortable with Diagnostic Uncertainty
Monthly Feature | Original Publication | November 1, 2020
111 Stimulating Reflective Practice Among Your Learners
Monthly Feature | Original Publication | February 1, 2013
Chapter 6 — Fostering Professionalism Among the Next Generation of Medical Professionals
117 Introduction by Terry Kind, MD, MPH
119 Professionalism in practice: strategies for assessment, remediation, and promotion
Pediatrics Perspective | Original Publication | March 1, 2012
122. Supporting the Development of Professional Identity in the Millennial Learner
Monthly Feature | Original Publication | March 1, 2019
126 Opting in to Online Professionalism: Social Media and Pediatrics
Monthly Feature | Original Publication | November 1, 2013
Chapter 7 — The Value of Trusting Relationships in Shared Decision Making
133 Introduction by Christopher G Maloney, MD, PhD
135 Teaching the essentials of “well-child care”: inspiring proficiency and passion
Monthly Feature | Original Publication | August 1, 2014
139 We Can Teach How to Bend the Cost Curve: Lessons in Pediatric High-Value Health Care
Monthly Feature | Original Publication | February 1, 2017
About AAP Pediatric Collections
Pediatric Collections is a series of selected pediatric articles that highlight different facets of information across
various AAP publications, including AAP Journals, AAP News, Blog Articles, and eBooks. Each series of collections
focuses on specific topics in the field of pediatrics so that you can keep up with best practices, and make an
informed response to public health matters, trending news, and current events. Each collection includes previously
published content focusing on specific topics and articles selected by AAP editors.
Visit http://collections.aap.org to view a list of upcoming collections.
iv AAP PEDIATRIC COLLECTIONS
Pediatric collections
Enriching Pediatric Learning:
A Guidebook for Preceptors
Introduction
Medical Education Matters: Pediatric Clinical Teachers Can Inspire the
Next Generation of Doctors
By Susan L Bannister, MD, MEd, FRPC
Editorial Board, Pediatrics; Professor, Department of Pediatrics, Cumming School of Medicine,
University of Calgary
COMSEP, the Council of Medical Student Education in Pediatrics, is a community of pediatric
educators committed to supporting each other and delivering excellent pediatric education to
medical students. The articles and commentaries in this latest entry in the American Academy
of Pediatrics’ Pediatric Collections series, entitled Enriching Pediatric Learning: A Guidebook for
Preceptors, have been written by COMSEP members, and the principles of our organization have
driven much of their work.
COMSEP’s guiding principles articulate what its members believe to exemplify excellence in
medical student education: Teaching should be excellent, innovative, and scholarly; The learning
environment should be safe and enjoyable for all; and Patient/family centeredness, teamwork,
professionalism, humanism, and service are essential core values of pediatrics.
Another principle is that Pediatric medical student education makes all students better doctors.
We recognize that not everyone whom we teach will become a pediatrician, nor will they ulti-
mately care for children in their practice. But we also recognize that many of the skills they
learn and the behaviors they observe while working with children, families, and pediatric profes-
sionals will influence their growth and may ultimately affect the physicians and surgeons they
become. They will learn, for instance, a flexible approach to the physical examination, the power
of observation, a way to communicate with 2 very different people at the same time, and the
value of communication and teamwork and empathy.
Students recognize this. Several years ago, I asked my students to write down what they learned
on their pediatric clerkship that they might apply to other areas of medicine. Here are a few of
the things they had to say:
“How to involve families in discussions.”
“Sick versus not-sick.”
“For adults, similarly evaluating social support networks and home life like we do in kids.”
“Empathy for families and parents of kids with chronic diseases.”
“Seeing the patient as a whole person in context of family and community.”
“Communicating with children and their families.”
“Talking with nurses.”
“More than anything, compassion for families, patience in medicine.”
Enriching Pediatric Leaning: A Guidebook for Preceptors v
These students recognize the value of learning in the pediatric clinical environment and can
envision how this will influence their future practice.
I often imagine the future interaction of a patient and a medical student. The patient might not
even be born yet. The medical student might be in first or second year right now. But they will
meet when that medical student does their pediatric clerkship. And when they do, I hope their
interaction is based on empathy and teamwork and humanism. And I hope that meeting will
influence the future physician the medical student will become. And I believe our work in educa-
tion, administration, and leadership will play a role in that meeting. And I believe your work as
a clinical teacher and the articles in this Pediatric Collection can play a role in that meeting
as well.
The 35 articles in this Pediatric Collection have been grouped by themes, and together they
describe skills and strategies to improve clinical teaching. The authors and editorial board
have tried to imagine the clinical practice of a busy preceptor in a variety of settings—rural or
regional or urban practice, community hospital, academic centre—and have tried to provide an
article that is succinct and captivating, with practical tips that can be put into use that day with
a trainee. We hope this collection, too, will be a practical resource that will support preceptors
and educators in their quest to teach, assess, and inspire the medical students with whom
they work.
vi AAP PEDIATRIC COLLECTIONS
CONTRIBUTORS:SusanL.Bannister,MD,aWilliamV.RaszkaJr,MD,b
andChristopherG.Maloney,MD,PhD,c
aDepartmentofPediatrics,UniversityofCalgary,FacultyofMedicine,Calgary,
Alberta,Canada;bDepartmentofPediatrics,UniversityofVermontCollegeof
Medicine,Burlington,Vermont;andcUniversityofUtah,Departmentof
Pediatrics,SaltLakeCity,Utah
AddresscorrespondencetoWilliamV.RaszkaJr,MD,Departmentof
Pediatrics,UniversityofVermontCollegeofMedicine,GivenCourtyard,
Burlington,VT05405.E-mail:[email protected]
AcceptedforpublicationMar1,2010
ABBREVIATION
COMSEP—CouncilonMedicalStudentEducationinPediatrics
doi:10.1542/peds.2010-0628
What Makes a Great Clinical Teacher in Pediatrics?
Lessons Learned From the Literature
Medicalstudenteducationinpediatricshaschangedsignif- primarygoalofourworkinCOMSEP,istoensurethatstu-
icantly over the past 2 decades. There has been an in- dents are prepared to practice effective patient-centered
creasedemphasisonambulatoryexperiencesandgreater care.
useofcommunity-andambulatory-basedfaculty.1,2Ashift
ATTRIBUTES OF A GREAT CLINICAL TEACHER We can all
frominpatienttomoreoutpatientprimarycareandsubspe-
remember during medical school or residency having
cialtyrotationexperiencescombinedwithproductivityand
teachersthatmadetheexperiencememorableandinspired
academicdemandsmayresultinfacultyspendinglesstime
withstudents.3However,thesesamefaculty,oftenwithlittle ustoworkalittleharder,studyalittlelonger,andsleepa
formal training, are critical to the pediatric education of little less. Unfortunately, we can also remember teachers
medical students. The goal of this article is to review the who made the learning experience either unsatisfying or
peer-reviewedliteraturethatdescribestheattributesand at least less enjoyable. Distinguishing between these 2
skills of a great clinical teacher, whether community or typesofteachersisofkeeninteresttoalleducators.4The
university based, and outline some strategies used to en- resultsofseveralstudieshavesuggestedthatgreatclinical
hancemedicalstudentlearning.
teachers possess both unique noncognitive and cognitive
attributes.5,6Inareviewoftheliteratureoneffectiveclinical
TEACHINGINTHECLINICALSETTING First,whatisaclini-
teachingpublishedbetween1909and2006,480uniquede-
cal teacher? The Council on Medical Student Education in
scriptorsofgoodteachingwereclassifiedinto49themes.
Pediatrics(COMSEP)definesaclinicalteacherassomeone
Althoughcognitiveattributessuchasknowledgeandproce-
whointeractswithastudentinthecontextofongoingpa-
duralskillsareimportant(asshowninTable1),noncogni-
tientcare.Thefeaturethatsetsclinicalteachersapartfrom
tiveattributesplayequallyimportantroles.
other types of teachers, then, is the involvement of, and
teachingabout,apatient.Teachingintheclinicalsettingis NoncognitiveAttributes
complicated,becausethepreceptorneedsnotonlytodiag-
Forexample,considerthekeyroleofenthusiasminagreat
noseandtreatthepatientbutalsothestudent.Theprecep-
clinical teacher.6–8 The importance of enthusiasm is not a
torneedstolearnwhatknowledgeorskillsthestudentdoes new concept. In the 19th century, Ralph Waldo Emerson
or does not have and ensure that the student has pro- wrote, “Nothing great was ever accomplished without en-
gressedtowhereheorsheneedstobebytheendofthe thusiasm,”andSamuelTaylorColeridgewrote,“Nothingis
session. The educational goal of clinical teachers, and a socontagiousasenthusiasm.”Enthusiasmisnotnecessar-
PEDIATRICSVolume125,Number5,May2010 Enriching Pediatric Leaning: A Guidebook for Preceptors 863vii
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TABLE1 KeyCognitiveandNoncognitiveAttributesofClinicalTeachers ticipation in unprofessional behaviors increased and stu-
asFoundintheLiterature5–11,13 dents increasingly perceived unprofessional behaviors as
Cognitive Noncognitive beingappropriate.12
Isknowledgeable Isenthusiastic
Demonstratesclinicalskills Isstimulating CognitiveAttributes
Iswellorganized Isencouraging
Hasexcellentcommunication Createsapositive,supportivelearning When faculty and residents are individually asked to rank
skills environment the critical characteristics of clinical teachers, both rank
Providesfeedback Modelsprofessionalcharacteristics
clinicalcompetenceasthemostimportantcognitivequali-
Explainsconceptsclearly Focusesonlearner’sneeds
ty.7,8Greatclinicalteachersareuniversallyexpectedtobe
Setsgoalsandexpectations Interactspositivelywithstudents
Providesdirectsupervision Listens notonlyclinicallycompetentbutalsoabletodemonstrate
and explain clinical skills.5,7,10 They use highly developed
communication skills to converse with patients, families,
ilycharacterizedbyboisterousnessbutbyanauthenticpas-
membersofthehealthcareteam,andstudents.8Moreover,
sion.Passioncanbedirectedtopatientcare,theeducation
they articulate their thought processes and describe the
of the student, or, preferably, to both. In the classroom,
clinicalpatternsusedtomakeclinicaldecisionswithclarity
enthusiasticteachersmakeeyecontact,areanimated,and
andinlanguagethestudentunderstands.9,13
infuse the session with energy. In the context of clinical
The great clinical teacher relies on a variety of skills and
teaching,enthusiasticteachersareexcitedbythepresence
strategies to enhance medical student learning. Briefly,
ofthemedicalstudentandinfusethepatientandstudent
great clinical teachers set goals with students and hold
interactions with a natural, unforced energy. Enthusiastic
themaccountable.Studentshighlyvaluesettinggoals,de-
teachers capture students’ attention, excite them about
briefing after clinical encounters, being involved with pa-
learningthepracticeofmedicine,and,bystimulatingreflec-
tientmanagementdecisions,andreceivingtimelyfeedback
tion,promotestudentlearning.9
in a learning environment that combines both indepen-
Although a great number of noncognitive attributes other
dence and supervision.10 Direct, competent supervision,
than enthusiasm are highly valued, most can be summa-
particularly when combined with focused feedback, posi-
rized by a single word: respect. As Ralph Waldo Emerson
tivelyinfluencesbothpatientcareandstudenteducation.14
alsowrote,“thesecretofeducationisrespectingthestu-
In a study of more than 1200 medical students who had
dent.”Agreatteacherrecognizesthatthestudent-teacher
completed their clinical rotations, supervision correlated
relationshipisabidirectionalexchange.Welearnfromthe
farbetterwiththeoveralleffectivenessoftheclinicalrota-
literaturethatthegreatclinicalteacherisnonjudgmental,
tionthanpatientmixandnumbersofpatientsseen.15
develops a positive relationship with students, creates a
supportive learning environment, and listens to what the SUMMARY Great clinical teachers occupy a unique and
studenthastosay.5,7,8,10Memorableteachersfocusonthe powerful role in the education of medical students. Their
learners’ needs rather than their own teaching interests noncognitiveandcognitiveactionsandbehaviorsinfluence
and involve the learners in setting relevant educational futurestudentbehaviorsandcareerchoicesand,mostim-
goals.11Studentsthrivewhentheiropinionsandviewsare portantly, result in a future generation of physicians who
valuedandtheyareallowedtovoicetheirviewsinasafe, areequippedtocareforchildren.16Althoughwecontinueto
supportiveenvironment.
havedifficultydefiningthecriticalcharacteristicsofagreat
Greatclinicalteachersalsoserveasprofessionalrolemod- clinicalteacher,identifyingsuchateacheriseasy:theyare
elsandmentorsforstudents,whichisacomplexandpur- theonestowhomstudentsandresidentsflock.Ifwereturn
posefulactivitythatinvolvesnotonlymodelingclinicalcom-
toateacherweeachrememberashavingmadetheclinical
petence but also professionalism. The clinical teacher
experience memorable and inspired us to work a little
occupiestheroletowhichthestudentaspires.Inthatrole,
harder,itistheperson,notnecessarilythecontent,thatwe
didtheclinicalteachershowgenuineconcernforpatients,
remember.Althoughsomehaveadvocatedthatgreatteach-
recognizehisorherownlimitations,showrespectforoth-
ingisinnate,13manyoftheskillsandstrategiescan,infact,
ers,andtakeresponsibilityforhisorheractions?9Thestu-
belearnedanddeveloped.Overthenextseveralissueswe
dent quickly learns whether the observed behaviors are
either acceptable or worth emulating. The importance of willexploreingreaterdetailtheskillsandstrategiesdevel-
appropriaterole-modelingcannotbeunderestimated.Ina opedbyCOMSEPthatcanbequicklyandefficientlyassimi-
studythatlookedatmedicalstudentsatthebeginningand lated into daily practice and help make a good clinical
midwaythroughtheirclerkshipyear,observationandpar- teachergreat.
v8i6ii4 BAANANPIS PTEERDIeAtTaRlIC COLLECTIONS
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