Teaching via "Chalk Talks" during Rounds

Everybody uh it's good to see everyone here um my name is abishek ready and I'm an assistant professor at Virginia Tech Caribbean school of medicine I'm the department of Psychiatry and child psychiatry um so I'm just going to talk about uh chalk talks today now um I'm still an early career psychiatrist and U so there's a lot to learn obviously uh I have no Financial disclosures and also I have a disclosure that I'm not an expert uh in the field of either chalk talks or teachings I do have a couple of teachers nominations before but um I'm I'm not higher up in the the med school teaching but I then y all y'all would be probably wondering hey then why is this guy talking about Chalk talks um and um what's the goal of this session right so this started when uh I was doing my promotion feedback with Dr harant and she came to one of the in-person chalk talks on our unit and uh she's a suggested that hey I think your interactive chalk talk was good and it might be beneficial if you could give some inputs to other team members and I thought okay that sounds like a great idea and um I I really appreciate Dr Haren encouraging me um with this and she also gave us gave me some good pointers of suggestions for these slides um so the main objectives of the chalk talk so I'll and again I was talking about this but talking about Chalk talks through PowerPoint is kind of using iOS to talk about uh Androids so I am going to use a few slides of PowerPoint just to kind of create a framework and then I'll open a wideboard session where we can all uh talk about uh we can all talk about a live small presentation that I'm going to do um so the objectives are identifying the framework to develop a chalk talk and recognizing steps of delivering content and then um Dev develop sorry delivering educational content using a chalk talk format so why or what is a chalk talk and I really like this format mainly because it's very to very easy to use wherever you are so if it's in team rounds you can have a white board installed it's not too expensive and it's easy to use there uh you can use it uh if you are teaching on the Fly you can use it uh if you are inviting Med students and residents to your office you can use it very easily also it is a very good environment for Interactive Learning and I'll show you in the demo how how it is more interactive um in the point it's more like a lecture format but in on the Whiteboard or during a chalk talk it is easy to kind of discuss things on the Whiteboard the other thing I felt is very important with chalk talk is when you're doing a chalk talk and when you're pausing and getting feedback the Learners can see the Educators or the teachers Viewpoint or their thought process and I always felt this even as a learner myself that I learned a lot when I could see how my attendance or my teachers were thinking through that process because it really helps me like kind of see how they're using their the the differential Pro the the process for differential diagnosis and what medications and why so it really helped me and I think through the chalk talk um it is very easy to understand and by the way I did not know that they called this the chalk talk uh I had seen this process before by where I trained at University of Alabama in Birmingham but I didn't know it was it was formerly called a chalk talk till one of my Med students talked about when I just started as an attending here that was I I thought that was interesting now what things do you need to do before you work on this chalk do obviously we need a small whiteboard or a big piece of paper that you can kind of write on um a good environment where it's not too much noisy so rounding rooms are always a good opportunity your office if everyone can come in and meet with you there knowing your audience right is it the med students are these the residents fellows um and the benefit of a chalk talk or this kind of teaching me method is you can always have layered teaching and I'm going to talk about it when we do the presentation or the Whiteboard presentation um thinking about learning goals like what would the med students like from this or learn from this what would the residents or fellows learn from this so you can always kind of have it very layered selecting a topic uh I think with Chong talks the best part is you can keep it within 15 to 20 minutes and select topic I'm going to talk about ADHD because I'm a child psychiatrist it's the bread and butter um but for example in the emergency room you can talk about wounds or injuries um uh in neurology you can talk about TBI or uh in the hospitalist team you can talk about kidney uh kidney failure or kidney Aki and things like that so just a few examples and all those can be very like kind of specific and with good learning goals and objectives for each of them so SE selecting a topic is important and layer teaching and Peg system of memory are my two key words you'll probably hear that a lot uh layer teaching is uh in the Articles they talked about different things but for me what might take home was you have to have different levels so you're building on top of things and we'll talk about that in a minute too so this is like your basic present preparation before the chalk talk like knowing the topic knowing the audience having a um a screen set up and then the next subsequent steps of preparing for the chalk talk are what Clinic relevant topics do you want to use so uh what I do is I have um few topics that I select which I think that most residents Learners fellows will like so for example ADHD neurotransmitters brain structures which are important Psychiatry an overview of anti-depressants antis psychotics so those are the topics that I have in my basket and when it when when we see a kid who has ADHD or um problems with brain injury or Tu sclerosis or whatever it is then I use that clinically to kind of teach that and it's not possible to do it every day but whenever we have time U you can do it so topics and outline for the talk like pathopysiology neurotransmitters diagnosis treatment so you can have an outline for yourself and then the headings which are what we talked about which can lay like a foundation for your talk and then obviously the questions that um you can use to engage the audience and um we'll talk about like what a hook is and what kind of questions you can ask to engage the audience without intimidating them uh so there are different ways you can do it U but I'll I'll talk about that in a minute too and then the talk so as I was saying it's like using a hook um to raise curiosity and an example of a hook is before I started this presentation I was like talking about why I was why I I'm giving the chalk talk session though I don't have a great background or experience in teaching and things like that since I'm being an early career psychiatrist and for your presentations you can also use different curiosity hooks that you can engage your audience with open-ended questions uh always Learners always appreciate open-ended questions and then um how do you encourage your audience without guilt and judgment um what I do is I have um we have the med students PA students residents and fellows many times with us and you uh I try to start my questions with the medical student and then go up the ladder and I always have like a a statement which I talk about is hey this is not about being judgmental it's just about making sure we are all thinking through the thought process and I know what your thinking and how how much we need to kind of uh fine tune our presentation uh creating an outline and then building on it and then topic transitions are some of the important things that happen during the talk and we'll have a live example in sometime and then the next thing is during the talk using Peg system of memory have you all heard about the peeg system of memory I'm sure many of us have um but the peg system talks about having the basics and how you build on it and this goes along with the layer teaching that I was talking about so a good analogy would be I have a four-year-old and he learns the alphabet first Like A to Z and then they teach him or he learns about a for apple b for ball so you know you have a foundation and then you kind of build on it and then subsequently he'll be like the Apple a is red in color the ball blue in color so this is like the peg system so understanding what your learners know and how you can add on to them so they kind of build build up on the foundation so that's the peg system of memory um I try to use pneumonics at times to kind of um help them have that point stick using clinical examples is always a good good way so for example as I said if you see ADHD talking about ADHD you see brain injury talking about the the having a chalk talk about brain injury um if you have someone with diabetes then using that to uh using a clinical example and then transitioning to a chalk talk is helpful uh and then they talk about in some articles about Chalk talks they talk about the teacher learner board Triad I thought that was very interesting I put a Google image in there uh also disclaimer I have not used AI in any way or form in any of these presentations um so this is the teacher learner board Trad it talks about the Lear the teacher not facing the board but standing to the side trying to engage the Learners as much as you can asking questions and taking feedback uh and even if you're writing you can always be on the side and not to write too much on the board just just enough Basics that keeps the audience um interactive um and then at the end kind of talking about hey what are the feedback or what are the take-home messages or take-home lessons for each of you so what is it for the learner like med student um what uh do the fellows learn what do the residents learn so for having a session or having a brief few moments where you ask them about their takeaway lessons is usually helpful in kind of cementing what they've learned during the session after the talk talk getting feedback from the Learners taking a picture of the board sadly I I did not do this a lot but uh it is helpful some of the Learners take pictures of the board sharing it and then definitely planning for the next time I think those are um kind of important things so uh with that being said I'm going to do a quick session on using the chalk talk and I'm going to use the Whiteboard feature yes can you all see my whiteboard we can yes all right so um this is if someone is drawing on the white board going that okay so uh and this part is when uh I would appreciate if and because I can't see the messages you can type it in the message too but you can unmute yourself and ask questions this is kind of a free flowing thing where if you all want to mimic the students or residents or fellows everything is fine um but I'm going to start with this question do you all know or and probably most people but do you all know why in the traffic signal the red light is for stop and the yellow is for go slow and green is for go you mean the positioning or the colors the color red stands out more that's a that's a good start and red start I mean stop signs are red it I mean yes I just kind of connect red to stop Yes have to recognize that 10% of your male audience can't distinguish between red and green but so it yeah red has been there for the red like to stop but why red why not yellow or green or blue if they had historically been doing that then I think our brains would have just associated with yellow being stopped or Violet being stopped M Disney World makes a point of guest never seeeing red if you're denied admission the uh admission Turn Style blinks blue that is a good point I didn't know that yep so it was a conscious decision that that the guest would not see red so if you're declined if you try and use your magic command or your uh admission you know uh material and for some reason it's declined the uh the device will show blue but not red that's interesting I don't know if this is going back evolutionary but red seems like a danger color like blood I don't know something that's that's a good point any other guesses it's easily visible from the distance sorry who's that I I can't see all the names it's Deb I'm one of your supports Deb oh nice I think that's a that's a really good one it it is seen from far but do we know why so I I was always a very curious kid growing up I used to ask my dad all kind of questions and he used to get really puzzled and confused um but again going back to curiosity so this is the prism I'm not a good artist but but the Newton's experiment was when the light goes through the prism the red is here and the Violet is here so violet indigo green blue yellow orange and then the red so the red is the one which has the least it's the least refractive it has the longest wavelength um and then the traffic signs were originally for the train drivers they had to see the signal from far to kind of slow down and stop the train takes longer to stop unlike today's cars which can break really quick and so they had they had to have the ability to see the color from far too long so that they can slow their heavy train down and the red is the one that can be seen in fog in Rain the farthest because it has really long wavelength and the refraction is really really low so that's the reason why it's red and again yellow is pretty close there and even green is close there but the red is the one that is seen from the the farthest so I know a couple of youall answer correct so again this is a good example of a hook that you can start with your audience um I there's other one that I use is like why is sea water salty that was the first question I asked my dad when I was nine or 10 and he was like really stomped and remember these were the days where there was no Google so he went to the library brought an encyclopedia for me and things like that but curiosity always helps with a as a good hook so I'm going to just talk about 8 PhD and the the examples that I use in today's presentation um because and I chose ADHD and I'm also sleep I'm trained in sleep medicine I was thinking about sleep versus ADHD but ADHD kind of mimics closely with many other um uh health issues that we can kind of subdivide into categories so I'm going to start with um it's hard to write with this but so pathophysiology right so if think about this as a it's not a good brain just going to use like really rough cude brain structure and then I start with my meds so like when I use the hook question or a curiosity related question then I subsequently will be like see when I asked you the question and I paused for answers you could see the people's brains turning and you could be like hey I I should have known this answer or oh this is my guess and what's next right so that in itself gets your brain running and I have read of many articles and research which shows that when you are actively participating you learn more so if I see an documentary on Netflix about food or colors it's I'm not going to remember most of it because half of the time I might be probably zoning out even if I'm interested but if someone talks to me asks me my perspective and then I'm like going back to the peg system I talked I talked about in the talks I'll be like I thought red is visible from far or red is color of blood and danger that's why red is stopped but then I'm like no it is the wav then you're like huh so probably red has the longest wavelength and red is that color and also the stoplight so when you connect those you remember things far more better than just your attending or your teacher dumping knowledge on you so creating curiosity is always the first step so I asked Med students and probably most of us know about this so and then some of the students will start like okay this is the frontal lob this is the temp sorry parietal lob temporal l oxital l and so on and so forth and then I'll be like okay what part of your brain is ADHD involved in and most students answer this really well so it's the it's definitely the frontal L and then for the residents The Next Step so again layer teaching yes frontal Lo you're awesome you're right what is the next one which is involved in ADHD and so some students will be like yes it's the prefrontal cortex so this is frontal Lo is a little bit bigger but it's the whole free prefrontal cortex which is involved in ADHD good job and then what more in the frontal Loop there are specific areas and that's when some of the fellows will kind of jump in so there is the it's called the dorsal lateral prefrontal cortex and then here is the ventromedial prefrontal cortex so the dorsal lateral does a lot of cognition and again Peg system the D is very close to ABCD C is for cognition D is for dorsal lateral prefrontal cortex that's how I remember it that's what I tell the students um that is very um involved in cognition and ADHD then there is the this is the orito frontal cortex right behind your orbit we all remember the phas gauge experiment that is related to impulsivity part of ADHD so in phas G like the guy phus gagee he was laying railroads and he had an accident where the the steel rod went to his brain it's a neurology case classic uh and he became a really different person very kind of vulgar is the word they use very like he was talking in a very crude way before he was a very refined gentleman is what they say he didn't die but he had all these behavioral issues and he died sometime after so that's our bof frontal cortex right um and then there is this part is the anterior singulate cortex which does a lot of task planning so for example if I drove to work today and drop coffee on myself because my cup was not completely fit the next day me remembering to put the cup properly or use a uh uh something where I cannot spill the coffee that is what ACC does in ADHD when it doesn't work properly U you will repeat the same mistake over and over again and if it goes into hyperdrive then you have OCD symptoms where I'll think about the co the coffee spilling for a month brain is beautiful different parts work different ways but it's not like a piece of puzzle different things to differently and again so the fellows might be able to say some of this but when I do this layer teaching the residents remember some more and the fellows are rein force of the knowledge they have but they'll kind of gather some more and then at the end I'll have something that probably the fellows also don't know this is important but there is something called cstc it's called a cortical stri thalamic cortical Loop which Loops in the forbrain midbrain together because brain definitely is not a puzzle piece of puzzle it is the tract system so this tract is connected in ADHD you'll also hear about that in depression anxiety OCD everything else okay this was pathophysiology and I usually summarize it so in pathophysiology you see some of the brain structur that I have drawn uh it's better on the white like on the main chalkboard but this is kind of crude but these are the brain areas that are kind of important then next step so this is the pathophysiology about neurotransmitters and then I'll ask students what neurotransmitter do you think are ADHD involved in any guesses that you all have so it's definitely dopamine and dopamin has a role in different places of the brain and then norepinephrine which is the fight flight both of them play significant role um in ADHD and so some of the Met students are able to talk about it some residents are and then some of the fellows are but then talking about layer teaching what about dopamin and norrine so the consensus in his in literature is it's neither one or the other increase or decrease It's actually an imbalance between dopamine and norepinephrine which really causes ADHD um and then like students and residents give guesses that okay this might be increase that might be increased and then you add in the final touch that you know from your experience and from your literature riew that okay it's not the increase or decrease per se and also this imbalance mostly in the frontal lobe circuitry is what causes um ADHD so you can use that again the peg system and the layer teaching to talk about this so this is the second subsection and then we talk about and I only have four here so Diagon nosis and then treatment you can do this outline before like on the left side the pathophysiology neurotransmitters diagnosis and treatment or you can do it as you go I try to do it as I go um so for diagnosis the standards are the Vander Vanderbuilt forms so these are the forms that you give parents and teachers uh because ADHD has to be diagnosed in two different settings um at least six of the symptoms for six months below age 12 is what the criteria is so you can talk about the criteria you can ask students and then you can also ask so some of the residents and fellows are definitely able to talk about the Vander bills and then uh there is this continu Conners continuous performance test which you can do it on a laptop you have to have a psychologist or someone with experience doing it and interpreting it so these are the two Vander builds are easy you give the teacher and parent forms and these two are for kids and for adults there is this beautiful onepage form called asrs which is adult symptom rating scale uh I have seen a lot of primary care doctors give that so that they can document that hey I did some test and ADHD is positive and hence I'm using the stimulant which I think is a great idea so um then we that's the diagnosis so this is the diagnostic part and then I ask the res resents or students about the treatment um any guesses about the treatment for ADHD so there definitely amphetamines Rin conserta or methylphenidates then there amphetamines like adol wans and then so I have a pneumonic that I used to use as a resident so it's called Mass so m stands for methylphenidate A is for adol um adal salts s is for stret and then I um I asked them okay now I'll talk about more about these medications but do you know how they work and some of the students are able to guess but methylphenidates are I call them dnis dopamine and norepinephrine reuptake inhibitor similarly amphetamine too and then stret is a pure NRI not a pine and look at that we we were doing a layer or a classified teaching right because you know that the neurotransmitters are mainly the dopamine and norepinephrine all your medications are actually working on the dopamine and norepinephrine so you're now connecting the dots and that kind of emphasizes the Learners to remember both it's like oh yeah like the that's the pathophys ology or the neurotransmitter wise and we are using the medications which actually works on that imbalance um the methylphenidates definitely um so this is only the reuptake Inhibitors the amphetamines are not only reuptake but also release which kind of on paper shows that the amphetamines are stronger than the methylphenidates and then steta is used when you are not tolerating the dopaminergic effect or you are too hyperactive or there are concerns of substance abuse then you only use um and there the methylphenidates arein conser and you and I can go on about that more in detail when I talk to the residents and then for the fellows I'll add that okay why do you use different medications at different times what are the indications and then I have a small handout which talks about like the distribution of the medications or the curves and all that stuff so again with layer teaching I think it helps with teaching the med students like The Basics so they connected and then the residents and the fellows and at the end I'll ask them feedback for the the medical students and for the PA students and most of the times I get feedback that like having this simple outline on the board really helps them have a good take-home message like oh the pathophysiology is this or the neurotransmitter is this and the diagnosis is this and for fellows I hear them talking about okay I heard or Revis my basics in a succinct way but also had some more take-home messages and the end thing um one of my favorite um attendings in med school used to say is if you make your learners go home and open the book about the talk that you had then you were a brilliant teacher it's not about so the term education actually comes from eduse in Latin which means to bring out or to nourish um so if you are able to make the learn ERS go home and read about the topic that uh you were talking about I think I feel like that day I've been a successful teacher so this is about the Whiteboard any questions on this I really appreciate how the Whiteboard or flip chart or whatever you're using you know depending on your situation how it adds a visual element to lock things in and also really encourages you know um the interactivity when you're drawing things out and you're asking for your learners to help help to build the next part of your drawing or the next part of whatever you're going to put on the on the Whiteboard I appreciate that additional element I always support multiple learning styles because I'm a visual learner too absolutely yeah I really love Dr ready that uh when when folks are learning using this method that they can take a snapshot at the end of that chalk talk and have all this really important information that they can take home with them refer back to um share it with others who may not have been able to receive the information you know in that particular um time frame so I think this method is is really helpful really useful for so many different um venues and and uh and different content as well is super valuable and I think also um with if for those of you who are nervous about drawing or writing with the pen um on the Whiteboard you can also use shapes there're shapes that can you know uh really make it a lot easier to draw a circle or something along those lines or um and you can use the text boxes to type things out so you don't have to worry about drawing with the pen in um in the Whiteboard again I'm also not a good artist and it's hard to kind of draw with this so so can I close the Whiteboard I just have one or two more slides to kind of summarize what we talked about absolutely close the Whiteboard and I'm going [Music] share can I can you see my screen again say example okay so yeah uh just to summarize what we talked about and this is I think my understanding of what I feel about Chalk talk it's about an effective the some of the strategies that you can use for effective chalk talk are number one raise curiosity about the topic so you can start with um what do you think about diabetes or what do you think about how kidneys work starting that way and then using very clinically relevant topics or points um and engaging the audience and I think with chalk talks it even if it's not clinical it's just about teaching you can use a chalk talk to help understand how do you teach better or if it is about leadership or it is about improving workflow whatever it is I think having this format really helps but for clinically uh for clinically important topics I think it's very helpful too um it helps us engage the audience um I think it's hard if you have a huge audience I think you can do that if then too but uh with with the groups that we teach during rounds and stuff it's very easy to use chalk talk to engage the audience and again at the end of your chalk talk like having a good summary or good take-home message like I hope you all understood the basics of ADHD with this chalk Talk would be like the a good take- home message I love shro Holmes because he's the the picture of curiosity I guess he was always a very curious person like looking and learning and asking questions and these are some of the references couple of them for chalk talks and couple of them for ADHD and again I'm not a national expert in ADHD but my information is from couple of like stall psychopharmacology which is like the the Bible psychopharm textbook I feel and then um the pharmacology on amphetamines and and methyl Fates stop sharing the screen and I'm open to questions if you all have any questions for me it looks like Dr York has a question hi thank you very much for that um I wanted to ask if you tend to just come up with a talk chalk on the Fly based on patience or conversation or if you have a little library that you will go to and grab Dr urick first of all thank you for coming and joining and be being so attentive I know you have really busy schedule and you handle a lot of things so I appreciate that you're welcome to answer your question I do have a library of things because um when I talk and when you encourage or engage your audience they will come up with really strong questions which is good I want them to be engaged but at the same time I want to be prepared to and many times I do tell them hey I don't know everything about this topic but so I come I have a bucket of topics which I feel are very important during the rotation the fellows are there with me for three months residents only one month Med students one week sometimes P students for one to two weeks so I try to have the the most important topics like ADHD anti-depressants antipsychotics autism um some other learning disabilities sleep um as a topic and so there are bucket of topics that I have and then when a clinical case comes in so for example if somebody has really bad insomnia on the unit that we have then I use my sleep talk uh if somebody has um autism then I use very similar like what brain structures are involved do you think what neurotransmitters or what areas of the brain what is the diagnostic criteria can it be can you be misdiagnosed and what treatment to we have so I have like to answer your question I do have a bucket of topics that I use and I prepare well for them and then I use them in my chop talks sometimes Learners do have other questions which are not in my bucket and then I I try to do it on the fly but it's definitely not as effective if I have it well prepared and I have a uh layout or Foundation but I haven't had Learners uh ask me like a general topic question because most of them are already in my bucket it's very rare that they'll have like a question out of it it might be a small subset question and if they have it so for example like what medications do you use for ADHD that could be a good segue okay good job let's talk about ADHD and then you can do your chalk talk and then uh you you have them like learn the whole thing and then they have a good perspective like oh that's why like that's why nine dopamin medications are used because that's like the neurotransmitter basics of ADHD excellent I always I really love when we don't have all the answers as teachers and then we can guide our Learners to you know here's what I would do if I didn't have the answers which I don't maybe you know there are lots of things um that we just can't have all the answers to so so well I know it's puts us all in a vulnerable spot to um to not have all the answers uh I I think a chalk talk would be fabulous for for even those topics that we're not super um experts in uh Dr White had asked how long do your chalk talks generally last so it's just like no it's Max 10 to 15 minutes um and I don't like to have them long because the longer you talk or the longer the session goes the less people have interest but with chalk talks I have realized that even if it's longer because you're engaging your audience they're always alert and they're like okay what's the next question how best can I answer it and and I use always use disclaimer statements like hey it's it's okay if you don't know the answer we are all learning I don't know answers to everything and and sometimes when the students say what like why is this and I don't know I was like yeah let's let's kind of look it up let's improve like I learn through your curiosity and you learn through my curiosity so I think that's helpful so to answer the question I have seen like 15 minutes max but it has lasted a little long with and the questions are like related to it in addition to the topic and really it seems as if um your chalk talks are complimentary to something else right so maybe you're on rounds or something like that and you do a chalk talk or you have so it's not it may not be like okay we're GNA have chalk talk today it's more complimentary to something else that you're doing is that true yeah so I'm an impatient attending and uh like on the R3 rehab so we have our whole team there and that's a good opportunity too because like if I invite them for a particular time and it's not possible for them people have different things going on and launch lectures and other things going on I have known meetings too so it's kind of hard to kind of coordinate it that way and I have tried two different ways I tell them hey let's talk about ADHD tomorrow and then they do some preparation and I I come in and it helps or I'll say in this week let's cover these two topics like autism and maybe anti-depressants or Autism and maybe sleep and then they do some Basics and then we come up um but like when and and the more the students are prepared the better it is but even if they're not you still get to know okay this this is this kids basic understanding of this topic and in general so I can fine-tune my teaching even in rounds or even in general to his level of understanding because if I teach a student met student at a fellow level I think it would be a really big mismatch they won't understand what I'm trying to say and they'll also feel like oh no I don't have this much of knowledge but if I like fine tune it to different Learners ability I think they feel more involved and receptive that's a feedback I get even in my um it's called the one thing with the med students feedback they they say that the chalk talks really helps because they feel that the the teacher is at their level and the same with this this the residents and fellows because I think they feel very involved and even if the students are not able to answer when they are able to answer they feel like they're teaching everyone so you're having the high upper level Learners involved in teaching the lower level Learners to I love that the glory of working in an academic Health Center um so also are there guidelines it seems like the the topics that you've chosen are very discreet in nature um and sort of contained is that what you suggest for chalk talks or would you also encourage broader topics that could go in various directions um so when you say broader topics so maybe mental health as so I I think that would go that would go opposite to what my or even what the the literature is talking about Chalk talks it has to be specific because if I talk about mental health then it includes a lot of things and my chalk talk will become an hour long talk and also I'll not be able to like create subheadings which is so important to the chalk talk so having like measurable goals and objectives for that session really helps the most and because it's like on the rounds like you'll have five six different P seven different patients with different things going on so you really can't have all of them together at once and it'll be very difficult and I don't think the students will remember everything related to the whole thing so if I do like okay let's do autism today let's learn about the brain structures and let's learn about how it affects or what's going on they'll have a good take-home message to that and then you do uh another aspect the next time the the one thing that I've noticed is sometimes you have to repeat these chalk talks if you have your fellow who's there with you longer and the students but I try to mix it up and and to when the fellow is not there then I'll talk about neurotransmitters which I might have talked a couple of times um with the fellows I'll use that with the residents and students and so that's very helpful thank you um and and and Dr Chris asked a question that I was also thinking do you ever have the student prepare one for the team with pbl it seems like they would be good at that and I bet yours are so well received due to that so I have tried it a couple of times [Music] um uh with one of my fellows I I talked to them about doing a chalk talk uh I think it was with one of the Anar presents and did they did a really good job um but obviously ly I felt like I had more practice doing it so I could do it well and also different Learners might feel it differently when you're the encouragement about questions and being non-judgmental different people do it differently like I was doing it with when Dr Haren was present and she felt that my questions were kind of like non-judgmental and very encouraging not everyone might do it that way but if you train if I had enough time or if I'm training someone to do chalk talks then I can definitely kind of lay guidelines like hey this is how you can involve people and ask them questions without them feeling hey this guy was asking me questions um and I I think it just comes with experience and practice and like at where I trained they used to do a lot of chalk talks without officially calling it that and so I really liked it when some of the attendings did it and I kind of inculcated it and I think it it's come that but I to Dr Chris's question yes if we kind of let the students know or give them a chalk talk about how to do chalk talks and then they can use that to kind of teach other residents and students and some of my fellows have done it and they do it really well but they may not use the exact format that I use they might not do it that efficiently but they do do a good job and even without sh talks I think um some of my fellows teach residents and students just a small topic not using the white card just discussing things but I like to use the Whiteboard that I have in my rounds room to kind of talk about these things I should have taken a picture of that all right next time uh I I I do think it would be a great opportunity to it's so practical and really generalizable to to pass on to our Learners as ways that they can use uh to teach and just share with them the the the core guidelines like it's got to be very non-judgmental it's got to be brief very discreet um those types of things and I I think they would do well with that I love that you're doing this what other questions do we have for Dr readyy Dr urick um I have one kind of General chalk talk that I give in various formats that I thought maybe I would just share and I think I'm calling it a chalk talk but you can tell me if it is or isn't but um oftentimes oftentimes we'll make um a line and when we're talking about a diagnosis let's just say strep throat and I the line is from zero to 100 and I asked the student to tell me where on the line after they saw the patient what do what is percent chance they think this patient has strep and let's just say they say 50 and then we talk about what they need to do to move up or down um you know and that gives me a chance to teach them then about the centur criteria and to teach them um about the um sensitivity and specificity of our rapid strep testing and cultures and things like that appendicitis is another really good one you can say okay you're 20% not good enough can't go home can't go to the o with 20% you got got to move up and down um and obviously that works well in the ER with an undifferentiated patient but I just thought I'd say it out loud because um I find it helps me have a more on the-fly Chalk talk because that's all knowledge we all know how we move on that pre-test probability line um anyway don't know if you have any thoughts on that or that could be considered a chalk talker if it needs more structure Dr URI I'm not an expert in chalk talk anyways that's my disclaimer but I feel like you from my view of things if I was a student of yours I would really like it because two things number one just by drawing the line and asking about probability you have increased my curiosity and I'm now thinking oh like where in this line how correct am I how wrong am I and again you have not created any judgment there by saying or obviously you're saying like tell me what do you think so that that's definitely a non-judgmental statement so I'm going to kind of thinking about it so that raises my curiosity and my participation and then when you put it on a spectrum like that and if I'm thinking it right you're also teaching other things like okay these are the symptoms which are not very important or these are the symptoms which are definitely like red flags so I think that gives some take-home messages and after you talked about it I'll definitely go home and read the the standard textbook about okay what are the symptoms what is causing it so you hit I think you hit all the right button butons there to help like part like students participate more in that and be curious about it other questions comments concerns I have a quick question for you Dr readyy this is H Sarah Harren um in the literature that you've read concerning chalk talks is there anything that um you would uh give us suggestions for somebody who maybe has not used this as a technique are there uh like some guidance that folks could fall back on um beyond the great talk you've given today so that if they wanted to learn more about Chalk talks wanted to get more engaged in this method or maybe they just haven't used this in a while and and want to brush up on um using this as a a teaching method that you could Point folks to so I had the two references I have are the ones that um I have used and I think those are similar ones that you like forwarded to me when we were talking about Chalk talks uh the one in both of them what I felt was helpful was about the backdrop or like an outline but also felt that some of them were too detailed like they were talking they were talking about like drawing or writing the whole thing on the board which I feel is espe especially for like clinical Educators uh it's going to be pretty hard to write the whole thing like I won't be having time to draw the whole brain and all the structures to talk about like uh ADHD yes I'm going to draw an outline and draw the the basics which are important and I'm not going to talk about the whole neurotransmitter dopamine dysfunction and the and talk about the whole thing I think they were talking about writing a little bit more but for me I felt like clinically it's more relevant if I'm like talking about the outline and raising curiosity in my chalk talk so that I I'm giving you the take-home message but I'm also letting you know that for further detailed knowledge you need to go home and read because I'm not going to be the one who's going to dump this knowledge my goal is education which is just increase your um curiosity and bring out your your willingness to learn about this topic so that's where I I agreed with the outlines and stuff in those articles it's in my references slide but also I did not think that I need to write a lot on the board I also agree with standing on the side of the board facing that's what we do facing the Learners engaging the learners but not following everything in those references and I feel like you definitely need to fine-tune it just like Dr Ure is doing is like her format is using um a spectrum scale um other people might fine-tune it to their effort and obviously listening to the feedback of the Learners if if they're like writing feedback consistently that this helps or this does not help um and thankfully like most people have said that this format helps them so that's good but even if in verbal feedback if they say hey I would want to learn more about this or that so you can kind of um include it but uh yeah as Dr har was saying the references were helpful but I have I personally have fine tuned it to and even before reading them I was doing that but after I read through the references I felt hey I follow these things but I don't necessarily agree with these other things that uh and I think what like both those articles are by physicians who do rounds chalk talks or like chalk talk on the Fly kind of thing so because in one of the examples it's actually acute kidney failure is an example that he he like uses on that thing so but I think it was more in detail than than what I would do uh in terms of like putting things on the board thank you so much this was a wonderful talk very helpful very practical um Dr uck also put in the chat if you're a Carilion clinic physician or faculty member in hsis or dbsc 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