Susan L. Bannister

What Makes a Great Clinical Teacher in Pediatrics? Lessons Learned From the Literature

Great clinical teachers occupy a unique and powerful role in the education of medical students. Their noncognitive and cognitive actions and behaviors influence future student behaviors and career choices and, most importantly, result in a future generation of physicians who are equipped to care for children. Although we continue to have difficulty defining the critical characteristics of a great clinical teacher, identifying such a teacher is easy: they are the ones to whom students and residents flock. If we return to a teacher we each remember as having made the clinical experience memorable and inspired us to work a little harder, it is the person, not necessarily the content, that we remember. Although some have advocated that great teaching is innate, many of the skills and strategies can, in fact, be learned and developed. Over the next several issues we will explore in greater detail the skills and strategies developed by COMSEP that can be quickly and efficiently assimilated into daily practice and help make a good clinical teacher great.

Using the Student Case Presentation to Enhance Diagnostic Reasoning

This article resumes the series by the Council on Medical Student Education in Pediatrics (COMSEP) examining the skills and strategies of great clinical teachers. So far we have reviewed what makes a clinical teacher great1 and the importance of orientation,2 observation,3 and feedback.4 In this article we discuss how best to use the time during or after a student case presentation to assess and strengthen student diagnostic reasoning skills. The development of good clinical reasoning skills is an essential component of medical school training and remains critical to clinical practice. Each of us has heard lengthy presentations from medical students on patients they have seen. The presentations tend to emphasize the facts of the case (the history and what others have done) but often do not include an assessment or any explanation of why the student has come to a particular conclusion. Using case presentations as a platform, we present 2 models for assessing diagnostic reasoning skills: one in which the student presents the case and drives the learning (SNAPPS)5 and one in which the preceptor directs the learning by asking 5 types of questions after listening to the case presentation (One-Minute Preceptor [OMP]).6 Both models are designed for use in a busy office setting with minimal time commitment by the preceptor. SNAPPS is a learner-driven model in which the student articulates both his or her diagnostic reasoning processes and uncertainties about the clinical case.7 SNAPPS stands for “summarize the history and physical findings,” “narrow down … Address correspondence to Susan L. Bannister, MD, Department of Pediatrics, Faculty of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8. E-mail: susan.bannister{at}albertahealthservices.ca

Oh, What You Can See: The Role of Observation in Medical Student Education

This article is the third in a series by the Council on Medical Student Education in Pediatrics (COMSEP) that focuses on skills and strategies that can help good clinical teachers become great. The purpose of this article is to outline the critical role of observation in medical student education settings. Observation of students can take many forms, including direct observation during a clinical encounter (eg, taking a history, performing a physical examination, or talking with patients and families), with a standardized patient, or indirectly while watching a videotaped encounter. In this article, we focus on direct observation of medical students in clinical settings for the purpose of gathering information for feedback and student assessment. In the past 2 decades, medical education has shifted toward competency-based curricula in which students must demonstrate specific skills and behaviors.1 Some student attributes, such as medical knowledge, are readily and effectively assessed by using multiple-choice examinations. Other attributes such as professionalism and clinical and communication skills are best taught and assessed by observing students with patients. Think of a group of young adults who have never played tennis but who want to learn to play well enough to compete in a local tournament. How would you teach them and assess their progress? A lecture followed by a multiple-choice examination seems unlikely to be effective, but instruction while watching them hitting a tennis ball is much more likely to improve their skills. Recognizing the importance of direct observation, both the Liaison Committee on Medical Education (the body responsible for accrediting medical schools) … Address correspondence to Janice L. Hanson, PhD, EdS, Departments of Medicine and Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. E-mail: jhanson{at}usuhs.edu

Not just trust: factors influencing learners’ attempts to perform technical skills on real patients

As part of their training, physicians are required to learn how to perform technical skills on patients. The previous literature reveals that this learning is complex and that many opportunities to perform these skills are not converted into attempts to do so by learners. This study sought to explore and understand this phenomenon better.

Celebrating Birthdays: An Update on the Status of Undergraduate Medical Education

The Council on Medical Education in Pediatrics (COMSEP) interrupts our “attributes of great clinical teachers” series to celebrate a birthday and 3 births! Although primarily medical educators have celebrated these events, COMSEP feels that all pediatricians should commemorate these milestones. One hundred years ago, in 1910, Abraham Flexner published a Carnegie Foundation–sponsored report about the status of medical education in Canada and the United States.1 His findings and recommendations led, in large part, to the transformation of medical education in North America. In 2010, on the anniversary of Flexners seminal report, 2 new reports on the state of medical education in North America were released.2,3 In addition, a landmark conference was held to discuss ways to reform medical education in the 21st century.4 The purpose of this article is to provide the reports and conference background and highlight the main recommendations. In a subsequent article, we will evaluate pediatric education systems in relation to the 2010 recommendations. When the Carnegie Foundation for the Advancement of Teaching published Flexners Medical Education in the United States and Canada ,1 medical education in the United States and Canada was chaotic, unregulated, and of poor quality. Few standards for admission or promotion existed, basic science instruction was mostly nonexistent, and few students were carefully supervised in hospital-based clinical practice. Within a decade of the Flexner report (Table 1), the number of medical schools had decreased by one-third, entrance requirements to medical school had been standardized and enforced, curricula had been standardized (2 years of basic science followed by 2 years of clinical science), medical schools had forged links to universities, … Address correspondence to William V. Raszka Jr, MD, Department of Pediatrics, University of Vermont College of Medicine, Given Courtyard, Burlington, VT 05405. E-mail: william.raszka{at}uvm.edu

It’s Not Just What You Know: The Non-Cognitive Attributes of Great Clinical Teachers

* Abbreviations: COMSEP — : Council on Medical Student Education in Pediatrics SDT — : self-determination theory Although it is understood that great clinical teachers are knowledgeable about their subject matter, expertise in a given field does not always translate to excellence in teaching. This article resumes the series by the Council on Medical Student Education in Pediatrics (COMSEP) examining the skills and strategies of great clinical teachers.1 Great clinical teachers recognize that “how” they teach is just as important as “what” they teach. This “how” consists of 2 parts: a positive learning environment2 and an enthusiastic, motivating, and respectful teacher.3,4 In an upcoming article, we will outline the benefits and structure of such a learning environment. But first, drawing from the medical education, business, leadership, and sports literature, we will consider “how” great clinical teachers get the best out of their students. They motivate them, they are enthusiastic, they are both leaders and coaches, they remain students themselves, and they have strategies for when things go wrong. Students will have difficulty mastering a subject if they are not internally motivated to do so.5 Self-determination theory (SDT) provides a useful framework with which to consider students’ motivation. According to this framework, the motivation to learn is driven by 3 psychological needs: a sense of relatedness, a sense of autonomy, and a sense of competence.6 In the best-selling book Drive , Daniel Pink examines how this framework operates and finds that a sense of purpose is also important to achieve optimal performance.7 There are multiple ways that clinical teachers can establish an environment in which students are self-motivated to do … Address correspondence to Robert A. Dudas, MD, Department of Pediatrics, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224. E-mail: rdudas{at}jhmi.edu

Just do it: Incorporating bedside teaching into every patient encounter

In this article, we provide practical tips to help busy clinicians incorporate bedside teaching into their clinical care.