Teaching with Intentionality: A Design-Thinking Playbook for the Clinical Learning Environment

Yeah, thanks Mariah.

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Making sure I'm unmuted. You guys can hear me. Okay. All right. So, um thank you guys. Uh thanks Mariah. Thanks for

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everybody from the teach team for um allowing me to come and speak today. Um I wanted to kind of start with sort of a

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a simple idea that would sort of frame what we're going to talk about over the next hour and that's that uh better

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clinical teaching is not usually a time problem. Uh it's it tends to be more of

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a design problem. So most of us um uh clinical faculty are already trying

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really hard. We care very deeply about the learners that are rotating with us and um we do that while we're taking

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care of service demands uh demands on documentation uh any number of uh interruptions to

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care and the unpredictability of the clinical work environments in general. Yet many of us still finish

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rounds the clinic working in the O. Um but sometimes uh at least I know there are days where I feel like you know we

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really worked hard u but I'm not sure that uh the learning that um occurred with me today was really intentional.

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So the the question that I would pose today is not really um how do we become a different kind of teacher but more

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along the lines of how might we design higher value learning moments uh inside

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the reality that we already live in. And that's sort of the challenge for this session for this session. How might we

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design um highv value learning moments for students and residents in busy clinical care without adding additional time?

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So um if you are joining us late,

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there's a QR code on this screen and um you'll need that a little bit later.

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I'll show it again in just another slide or so.

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This is our obligatory objective slide and uh hopefully by the end of today's session you'll be able to describe how

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the principles of design thinking can be applied to the clinical teaching environment and also uh develop a prototype teaching moment tailored to a

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a clinical scenario using the design thinking framework we're going to discuss today.

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So, uh, this is a picture that we're probably all very familiar with or looks very familiar to something we might do,

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uh, frequently in the clinical space or in the hospital learning environment.

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And um what you can readily see right off the bat is uh a physician seated at

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a computer um trying to juggle various uh patient care demands uh provide

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timely documentation uh working on decision making, team communication, just a constant time

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pressure. the whiteboard in the background shows that they're already running uh behind schedule and um and

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somewhere in that same space is a is a medical student. That medical student is present, but it's not clear that they're

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truly being included. And um that's sort of what one of the problems that I wanted to talk about today. So in

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clinical learning environments, the teaching often becomes something that we value but struggle to carry out because of any number of other demands.

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So it's rarely because the faculty don't care. Uh more often it's because the learning environment is crowded uh very

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fast-paced uh unpredictable and cognitively very overloaded for the learners.

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Uh when that happens uh the learners can become observers uh rather than active participants in the care environment and

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they may feel invisible. Uh they're uncertain about what their role is meant to be and they become hesitant to engage

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in the learning process and the patient care progress process and over time that can affect not only

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their learning but also their sense of belonging. uh professional identity formation and willingness to contribute to the team.

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So this isn't uh this topic today isn't meant to place blame on the busy

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clinicians. It's really about naming what's happening and that's um a tension uh that develops because uh there's a

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gap between our intent to teach and the realities of the clinical work that we're doing. And I think once we're able

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to name that gap, uh, we can begin to think more intentionally and creatively about how to design teaching moments that are feasible and meaningful, um,

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even in the middle of a busy learning environment.

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So, I've got the uh Slideo uh QR code posted here again for those who may not

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have um gotten it at the beginning from the beginning slide. And we're going to use this to answer a couple of questions.

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And the first is reflecting on the most recent opportunity that you had to teach in a

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clinical learning environment. Did you feel that your teaching was intentional or just incidental? Incidental um

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indicating that you just kind of taught what happened to pass by based on uh the

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patient flow or what just happened to be happen uh going on in your clinic that given day or was it more intentional and more directed?

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This is great. So, a a large majority of people so far feel like their teaching has been very intentional, but there's

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certainly um a a a pretty good size in the minority that um feel like their

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teaching was sort of incidental, and that that can be a really common feeling.

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So just thinking again about that most recent um opportunity you had to teach in a clinical learning environment and

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what do you feel was the biggest barrier to teaching effectively? So this will this is sort of a word cloud. So just

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respond with one to three words um that really point out the barriers that you had um in accomplishing your teaching goals.

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Yeah, we're seeing a lot of um good responses. I think uh time obviously becoming um one of the more predominant

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themes and new learners uh being present, patient care, competing priorities.

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All of these are really fantastic examples of barriers that come up uh very frequently in the in the teaching

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environment when clinical patient care is occurring as well.

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So at VTC um this uh you know figuring out um what matters is really important

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and I think framing uh these clinical teaching issues as a design problem is

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important because our medical education mission asks us to embrace uh various

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learner characterist istics and to cultivate lifelong learners and health systems thinkers who improve care through um inquiry and humility.

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And that language is important here. If we truly take learner characteristics seriously, then intentional teaching

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cannot mean giving every learner the same tips in the same way at the same time. It means making sort of deliberate

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choices about who this learner is, what this particular teaching moment affords,

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and what outcome matters most right now.

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And we saw from those poll results and the barriers that were showing up in the word cloud um we noticed a lot of things in common. So time pressure,

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unpredictability,

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learn varying levels of learner readiness um are not signs that the faculty

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themselves don't care but it is a signal that the clinical learning environment

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is a complex system and complex systems are exactly the kind of place where a

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design thinking approach can help us. So instead of asking faculty to just teach

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more, we need to be thinking about designing one uh improved learning moment at a time.

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So that's where we're going to be heading today. And we're going to be using uh the design thinking concepts.

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And um again the other part of framing within VTC is the fact that um we

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support what's called the model principle uh within our learning environment. And this was developed at the Pritsker School of Medicine uh but

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has been adopted by VTC and is frequently used for example by the LEAK committee as um what we um idealize

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within the clinical teaching environment. So uh we we intentionally try to model professional behavior,

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offer feedback, delineate expectations for students, evaluate fairly, and prioritize learning.

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So let me make the case again that design uh thinking is an appropriate technique

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to apply to the clinical learning environment. It's not just about motivation and motivating us uh to teach

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more. The first reason is that the clinical learning environment is full of mislearning opportunities.

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The literature about um teaching areas like rounding on the wards is full of

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mislearning opportunities and that literature is fairly consistent. Though teaching is usually squeezed out by the

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size of the workload, various interruptions, the hierarchy of the various uh teams and varying service

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priorities and the fact that different learners need different things at the same moment. So, the senior residents

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need uh different uh educational uh information than the junior residents or

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interns. And those folks need much different information than the medical students who may be on the team.

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And the challenge is that um that teaching moment has to be designed within a system that's currently changing and moving.

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The second problem or the second reason that it's that we should approach this as a design problem is related to

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cognitive load. So our learners especially the more novice learners are carrying far more than what we can see from the outside.

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They're trying to track patient data. Um decode decode what role they're supposed to play on the team. Um anticipate what

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makes up a good answer and manage um how to make a good impression on those who are going to be evaluating them.

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And um and then on top of all of that,

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we're asking them to make sense of new concepts that are um arising with each

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patient that they see uh in clinic or on rounds.

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When we pile on too much or we move too quickly or we uh keep expectations sort

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of implicit, we can really increase the extraneous load that the students are feeling. Um and during those periods,

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the the students can look sort of quiet or disengaged.

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uh when the real problem is that they don't have um any available working memory left and they're trying to just do too many things at once.

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The third reason that uh teaching in the clinical learning environment is a design problem is that um brief

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structured teaching opportunities actually work. So we don't need to

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design a 20inut miniature lecture to improve learning. We have evidenceinformed

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micro structures that fit into the flow of our clinical work. um concepts like the one minute preceptor

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um uh pre-brief or debriefing deal um deals or uh structuring feedback

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um specific reflection prompts um are all opportunities to make their clinical reasoning more visible.

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And these are all examples of design.

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They're not accidental. They're small intentional structures that shape what the learner notices and what the learner does next.

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So, uh this is why I think design thinking fits the clinical learning environment really well. It's useful

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when the challenges we're faced with are human. they are contextual with specific

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constraints and amenable to um iterative change over time. And so that

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description fits the clinical learning environment exactly. So we're not trying to

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uh engineer a perfect treat uh a perfect teaching script for every single scenario that might come up. We're

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trying to become more skillful at noticing the learner, clarifying the goal, and making the next move. Um, and

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um, having a greater deal of intentionality that we would have had otherwise. So,

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if you're not familiar with design thinking, design thinking is a human-

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centered iterative process that is really good for solving a wide variety of problems.

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Instead of starting with specific assumptions, we start by um understanding experiences and needs of

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the people involved and then define the problem more clearly. generate generate ideas, test small solutions and refine

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our techniques based on feedback that we receive.

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So in terms of medical education that means not just asking what should we be teaching but also what do learners need,

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what do teachers need and what do patients all actually need and how do we design learning experiences that work in

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real clinical environments to address all those separate areas of need.

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So design uh thinking is sometimes organized um along a series of five

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separate steps and these are to first uh empathize then define uh ideulate

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prototype and test and I want to uh emphasize um a couple of things about this process. First, it doesn't

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necessarily have to be a linear sequence, meaning that it's not meant to be a step-wise cycle.

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Real teaching, especially in um what can sometimes be a very chaotic learning environment, um needs to be iterative.

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So, you may test something, learn from it, and realize that you defined the problem very poorly. or you may find

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that you need to empathize more deeply with the learner and completely change the prototype that you developed in terms of your how you're going to address that teachable moment.

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So, it's not necessarily meant to be linear. It's but it is a process that that you can um use to organize your

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thinking about how to teach our learners.

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The second uh point is that each step has a very practical translation in

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terms of clinical teaching. While we generally think of design thinking as a

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methodology to um generate you know prototypes of like devices or or um new

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software for example. Um what we're thinking about in terms of the clinical environment is that we have to start

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with the learner and not necessarily start with the favorite topic that you like to teach about each day.

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Um defining uh so empathize means starting with the learner. Define uh means choosing one teachable problem for

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that learner in that given clinical setting.

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ID8 refers to generating a few different possible teaching options that you could

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use before just defaulting to what you would normally do. Uh prototype means making the teaching more executable.

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And then testing means um actually trying it out with the learners and and trying to define what success would look

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like if that uh particular teaching moment goes well.

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So again, def empathize really refers to

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knowing what the learner is um and what that individual context means. Um define

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uh usually means choosing one specific teaching problem. And I would argue a good framework for this is the

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educational program objectives of the medical school. um these are already um

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defined as what we want our learners to achieve um by the end of their uh

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medical school curriculum. And so those um can really be used to backwards

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design uh what type of teaching you might want to to employ for that teaching moment.

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In the ideate phase, again you want to generate options before choosing and then uh prototype them by writing out or

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triing them and then looking for evidence or feedback.

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So empathy um this tends to be the one that um I personally havea

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had struggles with until I um became um more adept with this particular

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technique and that's because as a clinical educator I feel pressed for time and I tend to jump straight into

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the content but um you know sort of counterintuitively to some of us uh

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design thinking should really start with what the learner experiences.

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Um as a clinician we do this naturally when we think about how we're going to interact with a patient. Um we think

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about you know what issues are going on for that patient outside of their disease process that may be impacting

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their care. um what other issues are occurring within the health care system that are affecting their outcomes or

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their ability to obtain um care. And um

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so we have a lot of empathy for the patient in thinking about those and we need to extend that same idea of empathy

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to our learners. And we really need to be thinking about what is uh what is the learner carrying today? Like what is

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going on in their life? What's going on in the rest of their educational journey? Um some of those things may be

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hard to see from the outside. um the individual stressors that they are undergoing.

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And um even if those are topics that the learner is not necessarily comfortable

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in talking about, um we should at least be thinking about, you know, what does that learner need from me right now? And

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that requires a conversation with them to determine sort of where they're at,

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where their level of comfort is with the material in that given uh environment and what their previous experiences have

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been and what um we can do to best help them reach sort of their individual

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learning goals um for that clinical experience.

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And additionally, we really need to think about what would improve the cognitive load for the learner. You know, if I um if I gave this talk with,

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you know,

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tremendously textheavy slides and and and just had you read all the slides as we went through the talk. um there would

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be a lot more uh strain on your cognitive load to try to read and process that information. And so we need

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to similarly make adjustments into how we present a material or set expectations for our students um that

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will help unburden that cognitive load.

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And then in terms of defining again what is the one teachable problem that we can

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address for that learner in that given session whether it's a half day of clinic or a day in the operating environment or um a day on rounds.

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What is the one thing that we can achieve for that student on that given day? And again, I would recommend

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starting with the outcomes you want to see, not necessarily what topic you think that you want to cover in that day. So, for example,

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um this morning you some of you may be able to recognize I'm wearing O scrubs because I was doing a surgical procedure

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immediately prior to this talk. and um rather than uh make assumptions about

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what uh my learners needed um in that particular case about learning from the

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pathology. Um we took some time to define you know where they were at, what

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their experience was with that type of patient, this type of procedure and um get a more concise idea of what their specific goal was.

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And uh and then we made a plan um to define that problem as something that was observable and not necessarily just

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defining that problem as some conceptual broad content area. And so that there

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would be very specific um observable things that would define success uh for

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that teaching session. And again um showing my bias towards uh undergraduate

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medical education. Um I have put a link here to the educational program objectives that uh VTC adopted in 2023.

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And these again form a framework across a broad range of competencies um that sort of define what we're

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expecting our students to achieve and those can directly lead you to um

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determine observable performance goals that you can use in your teaching in the learning environment.

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Um, ideulate is sort of the third step and I think there are two very strict rules when you think about ideiation.

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Um, a lot of us uh have very specific um sort of automatic teaching scripts

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that we fall back on or um very specific preferred modalities or topics that we

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like to talk about in uh particular patient settings, but um that may not

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necessarily um meet the individual learner's needs on that given day. And so when I would

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strongly encourage before jumping into teaching about a topic, uh,

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intentionally taking a moment to step back and sort of ideulate about what types of,

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um, methodology you could use to teach that same topic. So really thinking

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about different ways of teaching the same material. And the first rule uh in

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in design thinking when we ideulate is that the ideas have to be divergent first. And so you want to pick um at

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least three options of how you might teach a given uh material and try to make those as different from one another as possible.

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And then taking into account the things you know about the learner, the context that you're working in in that given

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day, the outcomes that you've sort of defined for that particular interaction.

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You can then converge back down on one particular technique or micro modality

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that might um allow you to achieve that goal.

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And um you know, we've had over the years numerous uh different teach

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sessions that review a number of different um micro moves that you might

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use for um teaching in the clinical learning environment. And all of them are intentionally designed to be very

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short and quick and not interrupt the workflow. But I think it's really important to remember that you don't

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necessarily have to use the exact same one every time. Again, we want to try to individualize that to the learner and

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the context of the day. So things like performing a 30 second pre-brief prior to a learning session in the clinic or

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on rounds. Um there's the one minute preceptor technique um that a lot of folks are familiar with um which does a

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really good job of pushing students to define their clinical reasoning. Um you can provide a quick twominute debrief.

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Um and then there are other methods like the ask tell method for giving feedback that really surfaces how um students

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feel about their performance and uh pro provides a framework to giving sort of more constructive feedback.

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Um, the next step is prototyping. And this isn't prototyping in the way that we might think about prototyping a new uh medical device. Um,

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but is uh is being intentional about how you're going to deploy that teaching

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methodology with that learner. So, and sometimes it's useful to have a set

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template in mind. You know, when uh that starts something related to the learner

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themselves, the clinical setting you're in that day, and any likely barriers that you anticipate may become stressors

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in that clinical setting. and then um sort of jotting down what today's goal

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is and thinking about uh exactly what words you're going to use in that

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encounter and when and where you would use them. Um, I would encourage keeping

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it very low fidelity, meaning it doesn't have to be some elaborate discussion

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with figures and diagrams and um, you know, powerpoints, but um, just

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a very quick 90 seconds, two minutes of teaching time is frequently enough to meet the learner's goal for that

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particular topic, for that particular day. And then um and then other portions

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um of that learning interaction may in fact become uh a little more incidental at that point.

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And then you want to test those ideas out. That's sort of the final step. And so when you have thought about which of

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these different modalities you might want to try, then um you need to define how you'll know if it works. So how are

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you going to know the student actually learned um what you were intending for them to learn? And that really goes back to how you defined the goals at the

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beginning. So, um I strongly recommend um anchoring these to observable metrics, things that you can actually

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see the student perform um and and combining that with one um

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either feedback or reflection type prompt. Um that way you have some objective objective observable data to

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present to the student uh based on their performance and then getting uh either giving them direct feedback or getting

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their reflection on how they felt that process went.

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So um you know potential ideas of observable metrics would be you know um

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doing uh making the next presentation clearer than the most recent one. Doing a better representation of the problem that the patient is presenting with.

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being able to name one specific uncertainty or one specific systems issue and um things like creating the

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next step in the plan of care. All of these are things that um you can intentionally define for the student in

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advance and then give them specific observable feedback about.

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Now this is um this slide is meant to to think just a little bit more broadly um

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in the fact that this um you know this type of design thinking can have

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implications for leadership uh within the clinical environment. specifically surrounding the type of culture that we

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want to develop as an institution that's tied to um this type of thinking and um

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and structuring it with intentionality for the learner. And so there are a

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number of ways um that we can um serve as leaders in our behaviors that will

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34 minutes, 52 seconds

make uh intentionality easier for the students and for our peers within the teaching environment.

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35 minutes, 1 second

And that's to really normalize uh these various micro goals that we're

35:08

35 minutes, 8 seconds

trying to define on a daily basis. And really normalizing the idea that these are intentionally linked to either the

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35 minutes, 17 seconds

learning objectives of a given uh course or clerkship or tied directly to the educational program objectives of the institution as a whole.

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35 minutes, 29 seconds

And I think um we have to be intentional about protecting those pre-brief and

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35 minutes, 36 seconds

debrief moments with students uh because that is a um area where the expectations

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35 minutes, 46 seconds

of the given moment are sort of laid out for the student which decreases their cognitive load. And then those debrief

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35 minutes, 54 seconds

moments sort of allow you to give feedback and uh figure out for yourself

36:01

36 minutes, 1 second

as an educator what sort of went well with that teaching moment or what needs to continue to improve.

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36 minutes, 10 seconds

And we really need to reward um folks who give uh exceptional feedback and reward the concept of feedback culture.

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36 minutes, 21 seconds

Uh I know a lot of students are very fearful of feedback especially negative feedback but those areas where they're

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36 minutes, 29 seconds

struggling or those um events where they may have failed uh with a particular

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36 minutes, 36 seconds

assignment are the best teaching moments. And so we really have to normalize the idea that that feedback is

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36 minutes, 45 seconds

not to be uh avoided or feared and is useful um for their for their ongoing growth.

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36 minutes, 54 seconds

And then I talked briefly at the beginning about the model principle and um I would encourage uh that we should

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37 minutes, 3 seconds

focus on the ideals of that model principle to shape how we develop norms

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37 minutes, 10 seconds

of behavior within our learning environments um here at BTC and curillion clinic.

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37 minutes, 22 seconds

So,

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37 minutes, 24 seconds

I'm going to have JT uh place a um document into the chat that you can

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37 minutes, 31 seconds

all access that is sort of a playbook to design thinking um in the clinical

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37 minutes, 39 seconds

learning environment. And for the next few minutes, I would ask um uh each of

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37 minutes, 46 seconds

you to take a look at that reviewing the different steps of the design thinking

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37 minutes, 52 seconds

process and really think back uh reflecting on your most recent experience in the clinical learning

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38 minutes

environment about what went well and what areas of this process you could incorporate into your own teaching.

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38 minutes, 12 seconds

And so, um, I would like you to take a look at that. Oops.

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38 minutes, 19 seconds

And I want you guys for the next couple of minutes to sort of review that and determine if um determine how you might

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38 minutes, 28 seconds

use that. And then um we'll get a couple volunteers from the audience to kind of

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38 minutes, 36 seconds

make a couple comments about how they might include this in their teaching process.

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39 minutes, 37 seconds

So I'm going to stop sharing for a minute so I can reshare with just just the worksheet. Hopefully everyone can see that here.

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39 minutes, 50 seconds

So again on the left hand side it shows those five steps of the design thinking process and then on the right hand side

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39 minutes, 58 seconds

um talks about alignment of these concepts within uh BTC. Um some examples

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40 minutes, 6 seconds

of micro moves you might choose to employ and um quick tests of how you might judge um the success.

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40 minutes, 16 seconds

And uh so do we have anyone who would like to volunteer to to talk about how

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40 minutes, 23 seconds

they might utilize this process in their own teaching um within the next um upcoming weeks?

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40 minutes, 50 seconds

and feel free to unmute or put some Oh,

40:52

40 minutes, 52 seconds

Dr. Squad put something in the chat. Can you define OM in the chart, please?

40:58

40 minutes, 58 seconds

Oh, sorry. Yeah, so OM is just an abbreviation for one minute preceptor.

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41 minutes, 4 seconds

Um, again, one minute preceptor is one of the um very common u micro teaching strategies that we think about. Um

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41 minutes, 13 seconds

again, one minute preceptor is um really um a really effective tool for helping a

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41 minutes, 22 seconds

learner um express their clinical reasoning. Um, so if you haven't tried it before, there's a lot of literature

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41 minutes, 31 seconds

out there about one minute preceptor and I would highly encourage um considering

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41 minutes, 38 seconds

using that as one technique in your armamentarium. Yeah.

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41 minutes, 45 seconds

So,

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41 minutes, 47 seconds

first just what you've presented already is wonderful and I agree with all of it.

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41 minutes, 55 seconds

Um I it I'm going to make a comment and ask for your observations. If this takes

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42 minutes, 4 seconds

us off track too much, feel free to shut me down. But um the EPOS are huge and

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42 minutes, 12 seconds

broad concepts and what you're describing which which I agree with many already do naturally are micro.

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42 minutes, 22 seconds

So I think it's hard it's for a physician it's almost hard not to be fulfilling one of the EPOs

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42 minutes, 31 seconds

with things that you pick but what what I'm going to say and ask you to comment on is you're caring for patients you're

42:38

42 minutes, 38 seconds

rounding you see a particular problem you have different levels of learners some of who whom are noviceses at

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42 minutes, 46 seconds

presentations and some are just beginning with assessments and management plans.

42:53

42 minutes, 53 seconds

So, you got to design through that. But teaching tied to the case at hand is

43:00

43 minutes

often very powerful. And you can ask questions or ask for people to do things

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43 minutes, 7 seconds

within that framework that can fit within what you're talking about. I'm just wondering how it's easiest to get

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43 minutes, 14 seconds

the physicians to understand this and do this. what you know because this process in in of itself

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43 minutes, 24 seconds

takes a lot of time if you really go step by step for something that physicians may naturally already be

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43 minutes, 30 seconds

doing. So I realize that's not answering your request of what we could do, but I'm just wondering your thoughts about that.

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43 minutes, 39 seconds

Yeah, I mean uh I I agree. It would be very hard um

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43 minutes, 47 seconds

to be teaching in the clinical environment and not have it address one of the EPOs. I I agree with that 100%.

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43 minutes, 56 seconds

What I uh what what I am sort of aiming for in this talk was really to the idea

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44 minutes, 4 seconds

that we have to be intentional not about teaching but sort of tailoring the teaching that we're doing to the

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44 minutes, 13 seconds

individual needs of the learners on that given day. So um what I encourage I in

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44 minutes, 23 seconds

my process is just one process and not necessarily perfect but I'm try to be

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44 minutes, 30 seconds

very intentional in having students and residents prepare uh before clinics and

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44 minutes, 37 seconds

before rounds and before surgical cases um to define um learning goals that they

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44 minutes, 44 seconds

each have. uh that are tailored to their specific level. And whether that means,

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44 minutes, 51 seconds

you know, um you know, history taking skills or specific physical exam skills or if it's clinical reasoning skills and

45:00

45 minutes

sort of having the self-awareness to realize sort of what they need on that

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45 minutes, 6 seconds

given day. And that may change depending on other stressors that are happening in

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45 minutes, 13 seconds

their lives or in their overall scholarly pro progress. And um and so I

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45 minutes, 20 seconds

try to have them define that um upfront and then we would generally have a brief

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45 minutes, 26 seconds

pre-brief session uh before clinic before the O to sort of review those and then um that allows me to then tailor

45:36

45 minutes, 36 seconds

what I'm going to teach about that given day to sort of address those specific needs or to push them or to push them to

45:45

45 minutes, 45 seconds

think more broadly if their goals are a bit limited. Right. That's very helpful. Thank you.

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45 minutes, 51 seconds

So I think there are um and that also helps differentiate between having to

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46 minutes

completely uh spontaneously think of ways to tailor the teaching to various levels of

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46 minutes, 8 seconds

learners because they're each defining upfront kind of what they're hoping to get from that individual experience.

46:22

46 minutes, 22 seconds

Barl, thank you for the resources and the outline. Um, similar to yourself, I have found it helpful to at the

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46 minutes, 29 seconds

beginning of the session, I'm I'm um outpatient and being able to have the students reflect on I asked them for one

46:36

46 minutes, 36 seconds

educational goal, not just for their own cognitive load, but also for my ability to focus um on that learner's need at that particular time. So I think it

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46 minutes, 45 seconds

helps both of us as you previously mentioned um and part of that the other part that I found helpful is you know what feedback have you gotten so far

46:52

46 minutes, 52 seconds

whether it's from my attending colleagues or other residents um what are some of the feedback you've gotten so far and is there something that um we

47:00

47 minutes

can do together today to help um further that skill is there anything particular from that that you would like to

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47 minutes, 7 seconds

continue to to work on so just inviting it um and then once I know their goal it helps helps me direct them towards the

47:16

47 minutes, 16 seconds

patients um that may best meet that goal. Um or if um I can look at even sometimes I sitting by my other colleagues who are are seeing patients,

47:26

47 minutes, 26 seconds

I let them know, hey u this student um really would like to um be able to work on interpreting EKGs. If anyone has an

47:33

47 minutes, 33 seconds

EKG today on a patient in this clinic um please come get me. This is my nurse.

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47 minutes, 37 seconds

This is what we're working on. This is one of our goals. So it also helps me provide sort of a a wider net for that learner. So it's not always just me,

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47 minutes, 47 seconds

it's other faculty that can help them meet those um educational gaps as well.

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47 minutes, 52 seconds

So those are some other things that I have found helpful in a in a clinical setting.

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47 minutes, 58 seconds

Yeah, thanks Tom. That's that's really great. I think I think you're exactly right. Um it once you kind of know that

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48 minutes, 5 seconds

it allows you to spread the net a little bit wider to make sure that um we maximize the opportunities to meet those

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48 minutes, 13 seconds

learning goals. And I'm not very I'm not very smart. So I got to go like very low tech. And so, uh, in in my clinic, I

48:22

48 minutes, 22 seconds

just have the gigantic post-it notes and I just put one in the hallway of the clinic and I everybody writes down their

48:30

48 minutes, 30 seconds

learning goals and um, and then frequently there are new questions that come up in between in between patients

48:38

48 minutes, 38 seconds

and if I'm if I'm bouncing between learners, I just prompt them to to make sure they're writing those questions down. And that way at the end of the

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48 minutes, 47 seconds

clinic session, for example, we just kind of go through the list and make sure we didn't miss any of the points that were confusing, even if those

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48 minutes, 55 seconds

weren't necessarily linked to the specific learning goals they had at the outset.

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49 minutes, 6 seconds

Other questions or concerns?

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49 minutes, 14 seconds

It seems like a very basic process and it's not you know some fancy technical or technological intervention.

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49 minutes, 24 seconds

I think really for me the biggest takeaway for this particular talk is

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49 minutes, 30 seconds

really trying to to place myself in the shoes of the learner. I think a lot of

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49 minutes, 37 seconds

times as a clinician I default to what my experience was whenever I was in

49:45

49 minutes, 45 seconds

their shoes. But that um that context doesn't exist because the stressors and

49:54

49 minutes, 54 seconds

uh requirements and all the uh things that that students are asked to now are

50:02

50 minutes, 2 seconds

much different than when I was a student or a resident. And so I'm really trying

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50 minutes, 9 seconds

to understand how to meet those needs in the greater millu of what they're experiencing on a day-to-day basis.

50:21

50 minutes, 21 seconds

Well, I'll say one other thing, Frell.

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50 minutes, 23 seconds

Um, and again, this is great great advice. I think um

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50 minutes, 29 seconds

for medical students as compared to GME residency

50:37

50 minutes, 37 seconds

residencies in many ways are still and as they should be apprenticeships.

50:44

50 minutes, 44 seconds

A lot of the knowledge about the details of that particular profession are garnered during residency.

50:54

50 minutes, 54 seconds

Uh another important aspect for the medical students, we just had a match day and they're experiencing the various

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51 minutes, 2 seconds

clerkships and at least some of them truly have not decided. So I think it's important for physicians to model

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51 minutes, 10 seconds

joy and passion for the students during these clerkships so they can get a feel. And that's not

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51 minutes, 18 seconds

easy in this day and age as you're trying to do uh all your tasks and take care of patients and finish your EMR

51:24

51 minutes, 24 seconds

notes. But I think as we try to help physicians understand how to do this that that that can't be overlooked.

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51 minutes, 33 seconds

There's nothing as destructive as a grumpy, tired,

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51 minutes, 38 seconds

dispirited physician for for the medical students. So I I' I'd just like to sneak that into your talk here.

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51 minutes, 48 seconds

Much appreciated. Any other questions from the chat?

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51 minutes, 55 seconds

Nope. Just a comment that um I think it was in reference to the the big post-it notes that um Dr. Harren said, "Love

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52 minutes, 2 seconds

that idea." So yeah, mostly because uh by the time I

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52 minutes, 9 seconds

have left one patient, I may have forgot forgotten what this what the student's question was about an individual case.

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52 minutes, 17 seconds

So I have to have some record otherwise otherwise things get dropped and I want to make sure we follow through with those um knowledge gaps.

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52 minutes, 33 seconds

All right, thank you guys. Awesome. Thank you so much, Dr. Adkins. We really appreciate you. And um yeah,

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52 minutes, 40 seconds

if you have any other questions or comments, please feel free to reach out and we can certainly convey them to Dr.

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52 minutes, 44 seconds

Adkins as well. And everyone, have a wonderful rest of the day.