2017 TEACH Education Day

Good morning everybody in thank you for coming at this early hour that malaria fever doctor the red comes to us most recently to Fort Washington University where they have fortunate to retain a senior consultant for medical education and professor emeritus dr. Greenberg completed his undergraduate degree Toledo is medical degree at the Ohio State for medicine internship at Buffalo Children's Hospital the hospital he then serve her a couple of years in the United States Army at Fort B people rolling into his various roles his involvement and medical agency involved John Hopkins Holy Cross Hospital America children commercial match the rock affordable rate and observed in various medical leadership roles directly multiple dr. Greenberg has closed to 150 publications here we have hundred abstracts and Britain numerous both clinical and medical education topics and the present incredibly down rebirth and also made clothes country is covering including probably two-thirds of the medication I believe you'll find dr. Greenberg equally as impressive as it the preceptor so competence thank you so much for a lovely sherry and I go back I don't maybe ten years a drug once she sets the bar I now I'm feeling the pressure so you started clapping you haven't even heard of you so you know this is I hope I live up to your expectations it's good to be the Hokie country I never thought I would say that I just dropped out my grandchild who was on a three-day break in Blacksburg saw the cameras there he's an engineering student I said to him I said Bradley I said you know where the teacher on campus and everything but I'm a Buckeye and it's hard to be the switch allegiances attend to my other grandchild into being you and my third grandchild at University of Virginia so you know I'm wearing all kinds of t-shirts but I got to be a little my allegiance to my a home medical school for my trade so I've got some great news for you this morning oh the bad news is at 7:00 a.m. percent of you to me this was a usual I started work at 7:00 lots of reasons but the good news is I have no slides so you're gonna state blue because you're going to find out how this sessions going to work in a second but let me just do a brief introduction to me this is one of the most important things we do as clinicians that is case based teaching and that's what the session is going to be about and we've done a little bit of study around case based teaching to see how we make it more efficient and effective developing a model and we're going to talk about that model today the way the sessions know and fallible is that we have a medical student who's harmless question of candy the past my own special pediatric emergency motion so she and I are going to do an unrehearsed session as if she just saw a patient in the end go to our department and your job see her go to sleep is you're going to focus on how effective I teach looking at things I do promote learning and looking at things that I do typically so what's going to happen after that five and an accessible third is you're gonna do some evaluation that we'll see in terms of what you saw like what you saw underneath it and that's the way the our old up but the staring out with that I want to talk about this I would assume that most of you in the group to the case based teaching maybe some of you don't but whatever what are some of the barriers that we face in k-space these and you're gonna have to talk loudly because not only can I not hear so I'm quoting my grandmother's but said that everybody so where are some of the barriers yeah we can stop there we can run time to the big capital T cuz that's a major this is a patient driven you know environment we got our we use people are looking to turn over patients and keep the academic health center going but in the meantime they have a major responsibility attorney how future positions not just future decisions but excellent future positions that know how to communicate and do things really well so time is certainly there let's hear some others you may not know where learners at you so de Kirby was a giant in medical education from Seattle we've talked about diagnosing or how do we diagnose the learner how do you know where the learners at we don't know where the Warner's app how do we know what to teach that's an important sometimes we make assumptions about what the learner needs to know but we haven't even gone there to find out you know what issues that's a beautiful what else different levels of learners so then the question becomes and this is a Furby this is a heart and I don't have any answer for this one but in terms of the curriculum for each club I mean how many there's no the curriculum I guess you can pull it up easily on an iPhone or something today and I think that's probably what the students do maybe not in terms of you know for this particular patient for this particular patient one of the competencies were dealing what is the last moment or whatever the old days we would talk about it detectives what are the objectives for this particular interaction so we kind of go in without necessarily thinking about that consciously and when I ask the students are residents you know you say any questions they look at me like a deer attendance they don't want to talk I'm not sure what those exactly are students the same thing I think that's changing especially is when they are in a competency-based environment both at the student level and we need to think about you know levels of learners what's appropriate in each level what should I be teaching because that's important certainly you'll want to fall back on my research that's not approve sometimes that happens in terms of talking about things that are outside the boundaries of what our students and residents need water so really understanding where we should be going with this this is important okay prioritizing teaching points on me in this brief period of time that we have you know we want to make sure that the trainee is getting what we think would be appropriate for them to get and so I don't know how you do that but you know highlighting your teaching points or having that resin or student summarize what they think the teaching points were for that particular session just to make sure because you know what I'm teaching and I'm talking I'm never sure what the learner foot that's a call from Jerry Harvey who wrote a very funny beautiful three-page paper called learning to not teach learning to match issues from the organizational behavior school at GW whether the price guys have ever met this three-page article is a hoot and basically what he said is one of the classroom teacher when he went into a classroom and he was talking you never sure the language occur I challenge anybody to tell me that you know that something's well the students are attending I that's fine and what kind of learning is going but he said what he was quiet and was there faculty from the students he learned because it's your party you could hear didn't learn he was going on so that that's an important addition of learning styles I mean we have you come different learning styles that's part of the don't learn where you know some people are and the verbal some people are need to do hands-on some people need to listen they're talkin doesn't mean that we have to change the way we teach every single time based on the student but sometimes we have to ask our learners you know what's the way you learned us so if somebody brought up an issue one time about he was teaching something I don't know if it was a neuroscience or scientists or whatever he said to the resident talking about circle loss and implications you know how patients would present the problem and the trainee said I can't talk about it body drop away so people do different learning stuff and I will tell you that my worst evaluations which is not surprising me because I'm a facilitative learner my evaluation is a work an affirmative students miss la manera and residents pulmonary who say just tell me what I need to done what you need you know just trying to make you let me go forward my majors you can't tell you what you need to do we have to spend a lot of its faculty to do that so those are the girders any other set you know people times to do so cami and I are going to interact the recession will probably be close to five cuts you will excuse her I just met her 20 minutes ago I told her she is not on this flat I she will read the case excuse her because I wouldn't normally let my student Grossmont do that but she just got the case a few minutes ago again the simulation will be is that she will just have seen someone in the clinical setting and I will be engaging her as the preceptor down there and we'll spend a little bit of time trying to figure out what the teacher and then the evaluation role as superb there and then we'll segue to the mob okay some change of chairs notice the way our agents here not this way it's a little congregation this way you have a patient right let's hear okay it's awfully good in terms of some should she take the bike yeah okay I just thought five were white now that presented with the history of spots all over his body the child's work really well about ten days visit when he developed a pole so with runny nose coughs easing the earth was relatively well till two days prior to the visit when his mom noticed her reddish purplish spots truck spots on his trunk and extremities there non-tender the large swanson thought beside the corner heosu preschool has some sick contacts that now has similar findings mom states she's given her potassium cough syrup during the illness as cool as butter he's been active with a slightly decrease appetite no bleeding points like a miss Valerie Erin Minoo and his family cell and the child's would be of assistance is totally negative mom's concerned she has enough mom's concerned cause she has a nephew at blood cancer who presented with some white spots for history uneventful as full-term circumcised no bleeding development has been normal family history one younger sibling and good health as other parents momma's 32 worked as a bookkeeper for small companies 30 or sprayer past eradication company exam normal parent-child Oh stress by the signs over there normal limits findings are related to this to the skin as gives pinpoint you quarter-sized lesions Muslims abdomen extremities that do not electron pressure what does that mean he has a few shiny cervical lymph nodes that are not tender and his liver and spleen are not palpable but actually didn't perk us these organs there was the rest of the exam is normal and different Titus and HSP ITP sort of this order so that that's a good differential so what level are you there fourth in the pop like to have you at my burger that was a great differential a great presentation by the way a very succinct presentation so you mentioned a different the number of number of different diagnoses how did you come up with us based on a history of physical so far so for example he has been having like the spots that mom described and also on physical exam our most consistent of part for us I was trying to come up with a differential forever okay so you listed a couple things you said vasculitis an interesting suggestion based on furberg petechiae and you also mentioned an ITP prevention also is it valid part of differential what else is I said some sort of plea disorder okay okay so what if I hypothetically told you that thusly I percuss down to the hidden Fila but I purposed down to the iliac crest so this patient had a very large plane and you didn't feel a swing correct that's not unusual if the spleen is large you be not filled unless you start all the way down and come up but that's why percussion might be important here you know your dullness instead of it was mostly what would you every professor than there good okay so what if I told you this thing was large what would that do you that's causing fundamentally survive enlarged that's okay so the question would be and I that might be something you'd look up is what what would give you a boutique out within a large land and I would just tell you that would rule out ITV because the old see would IG be a big player the biggest thing is something else like maybe let this crazy or like PT or something like that so let's let's go and I'm going to talk to the mom a little bit you might want to watch what I do because obviously she's worried about some blood discrete because she hasn't done he was such I'll going to make sure this plane is nine of ours and then we'll come out and talk but it has it right now if if I asked it I'm not saying but if I asked if you wanted to do any lab work what would you do see looking for and that blood smear looking for of the white count also seem abnormal blood cells and you miss the 31 so we have but yeah right okay let's go in and see the patient and then pull over there give me such as you know give me the temper okay so I don't know how long the session lasted probably five minutes let me ask and everybody see back there so we stand the other if we stood it okay okay so cannon just your overall Gestalt feeling how would you regard this as an interaction in terms of teaching on a 1 to 5 of course you can tell me why because it's important I didn't know the answers to your question you owe me figure out what I already you for example that's one roll out a TV any downsides in terms of for an interaction like this okay let's I can take it nowhere or concern me a little bit predicated on [Music] these compression I got weren't entirely sure that she barely you seem to be based on something reexamine the patient okay so we're sort of putting the teaching before something that was fully relevant to this case support all unfold so I think you know again what I did is it's never say never I don't water but indeed you can see the author because of the student so I think you might be referring to my hypothetical where I put and said you know what if I took to the spleen was large because sometimes the OIC where a student resident will miss a large plane right over it but they don't feel all the way down up and they don't percussive I hear you point so that's a that's a valid criticism so okay that's about it also what I think I think you know to differentiate between the two take point is you know sometimes not sometimes all the time we have this going on ahead because you know physicians taking scripts seasoned physicians think in script so when you say well this is a fort Harrod one who has abdominal pain in the right upper quadrant an hour after eating and she's obese I mean everybody's smiling you know what the diagnosis is that's correct and that happens to all of us the men who ever practice I mean their life controller and a hard-on strokes because we don't know exactly what the patient has but we oftentimes think in scripts and error enthusiasm and in the short period time we have to teach we sometimes want to just give it up to the student who the rather in terms of like how I'm thinking versus how is she think she's a novice relatively well I think ants in there her butter pretty it's like experiences which most students residents never get better what you did before he came about I once had a pee-pee a student in the clinic first day we're chatting before he sees a patient I said what did you do before he came to medical school and he said about a PhD for 12 years I said whoa listen are just one up for you and he kind of came out and I said no that's good I said knowing that you've had that kind of experience is important for me because it doesn't mean you've seen the world that it needs you've seen a lot and I need to treat you a little different than some of your peers who have managed for example so yeah okay I think more the job to the general assistant picked that needle out of a haystack and about worker you very even how do you balance the sizing your the thing you do not yes we will make sure this is not right because that's part you're different the helots news she said she felt supported but that's also something that hopefully she has to know for this interaction which okay so there's a really really interesting point and I'm going to refer this back to camera and try and tie this in with your your comic because I think it's important what was my teaching point join over the travel well we did spend a lot of time talking about what we need so that's where we started I just feel like I was in a full teaching session I think we would talk more about that case you encounter another what do you think okay I mean I did get points a very common one and when I asked for that question you see your body language for proper evil see but it's clearly it's clearly based on this unrehearsed interaction that she wasn't totally sure about it I'm addressing what you just said in terms of I got this five minutes what do I want to get across at this five minutes in terms of what I want the resin or scoop to take away and you know have that sink in that this becomes very contextual as part of adult learning you see a patient you've been teaching out and of course it doesn't end here she's going to go read about it right she's going to read about it and that's all gonna come together versus going to read the New England Journal the latest issue and picking out an interesting article but they'll pay connected that lasts about two weeks that now is after about two to hold on to about 20% of their studies on their why no context our neurons just don't I hope there's not a neurology but our neurons is doing you know they don't go that way they put these together that's the way we think so so she needs to read on this and develop some context and then it all fits here yeah there was a medical doctor so how many greens five awesome where's your goodness this is mrs. strong social burger it's a long drive I could come back oh come on so he's got some yeah go ahead three three it's not over yet what do you mean got no Steven page mocha shirt form your own opinion got shot to revisit but she missed you've got your own exam you've got to put it in your context and then that shapes then what you teach because I'm still you know preceding illness the rash [Music] you're not done you're gonna go in the room you may end up teaching in the presence of the patient depending on situation I mean I would be discussing leukemia stuff in front of this moment I mean I might have gone in and talked about about her concern about her nephew and talk to her about you know once I did repeated the exam what I thought was most likely going around patients in the ITP wasn't it was playing a lot of commitment and all you had to do was you know get a CBC it show there are 70 Nia verses HSP which was what are the plate bouncing HSB it wasn't a right distribution anyway what's the plate got HSB do nothing yeah not to outside opinion for the only one it's not them yeah it's because it's a basket left yeah so so going in the room confirming what she told me not a lot of time coming out but you know I could have read for some of the things that are differential and done that outside the room and that would have kind of cool things together but your points well-taken your points well-taken the bottom line is that we do not have a lot of time and whereas this may have been five minutes and then the room put it in another here four minutes and coming out within another couple of minutes a day that's about as much time as you're gonna have the sum is going to be saying that your next patient okay so three anybody else dude that's point I was thinking that that's something cardboard you could just put them in there sure they're gonna go read more about it but the one thing that you need to make sure that this that could be you know the time the differential is leukemia how do you know that this isn't how are you going to rule that out right that's one of the most important things so would you include that in your teaching points with her yeah so you know in this initial you know interaction you know I asked her if she were gonna do that a class and I was retired you laughs what we should do I loved her approach you know I do CDC it's not expensive it's not invasive would give you a lot of information about three cell lines okay kilos okay white counts okay platelets are down mostly the most likely diet it doesn't mean it grows out ALL but it likely does it might because without any he passed by memory at this point or that not the or other think that so yeah I mean that's the patient we deserved watching but she went not only for differential in mind she also had in mind what she might do to kind of separate some of these things out even though she didn't know exactly HSP in purple they'd just be in that red sunset being able to hold that against her before she's new she's not a brother please and when I appreciate hi she offered thank you for that point so you know you're describing a process that came out in the iscope Creek conference I'm teaching the ambulatory setting I think it was like root beer and that's the thing it was like 1998 or something I don't know and one of the processes that they talked about was activated demonstration so when you go into the room to address a patient to examine vision and have somebody tagging along with you you set that up before you order what how I addressed about watch what specific questions I ask watch our interaction her body so when that person goes into the room they are activating they're not standing there like a pop on the wall they don't know what we know we are unconsciously competent they are unconsciously incompetent starting up if not and then they get to the point where they we don't think about every step we go through we do it work it's automatism you go through because we live every day and to not break that down for a trainee is a big mistake despite just sent to a candidate you know coming the room watch me talk to the mom I'm gonna set up it's not a setup for her in terms of what she needs to watch it what I'm going to be doing and so forth so your points won't take it when you take somebody in the room think about it activated activated demonstration so you get that trainee focus on what you're doing and they come out of the room and they it's a great technicai I had a student on his tail not long ago where he was known as into the member so you would never see a new one we're never done a newborn's I said the amateurs to go to these and on chef Iago or you can watch me do it but if you watch me do it I want you to write down everything I do the work is activated it came out everyone said so is this usually the way you do an exam about a patient should not the way honest I said why do I do it in order but there's no harm Paulson's it was nominated for similar area it's just before the baby starts crying I'm doing things I need to get infinite and that's what came up that's a teaching point that came out of obsession with him writing everything and then ever get that return to what they're got to eat if he doesn't want to because he'll return today so you just gave us an example this county of case-based you answered two questions at what point did you decide to what the Kishin point was in this I'm screwing around and number two how in the process did you decide that whoo how do you put me on the spot I have to tell you something what are you doing I don't try to model they ideal I try to model what I think would the reason for you to take me you give me lower scores there is this halo effect who knows what the halo effect it please the start it is kind of assuming because somebody is at a particular position that may be part of it but I think the main part of it is is just being really nice and really supportive and interactive and that Klaus what the heck why not so when you started I said what the teaching point is that I asked him and she fur of her brow and went to you and couldn't come out of it for ten seconds she's a wide thing wendy is a hail of that really takes hold here when you have an attending or senior resident that's teaching that really is carrying nice and so forth but it doesn't say hurry and so that's how this session went so in terms of your question and every thought isn't very good another way to diagnose the learner it's unconscious competence so I dentists didn't help people get out unconscious incompetence to conscious confidence and eventually gone okay we're going to slip right into the model way to go and you've got a handout there so you don't have to take notes or anything it's very well described so we're back in the 90s the family practice group and see how about the one that appreciate a five step process I looked I said completed that process really didn't incorporate very much in the way of adult learning so I decided I was the modified model and that's what we're going to talk about today and the question is is when you teach in an evidence-based way around a case are you incorporating Adult Learning principles work tried-and-true particular affirmative so this is how this is going to unfold so it's not necessarily lockstep but it does start off with some things so one of the first questions and I will ask you is one of the first questions I asked the student or resident when I gave him his have you ever seen a patient like this I don't know he may have dropped out you know gentleman over there but he was addressing this particular issue of diagnosing the learner okay so I'm hearing this presentation and I've got stuff going through my mind because the skirt that you and because of the pgy 47th order is and I'm going time this this path but the point being is I don't know where she is so I will ask you because that's the way the session should have started have you ever seen a patient like this whoa no and she looks fabulous so if the trainee says no what is the only thing you can't to hurt us million five what is the only thing you can teach around this patient the answers entity no way can you possibly discuss everything about this vision no one thought anything in your short period that's why the reading and everything is so important afterwards and they come back to you and confirm how this thing unfolded and and all the pieces to the puzzle would say this is how I you know put this all together that's what learning is all about so I can go anywhere now theoretically I should know her level and I should have some concept of what a fourth year medical students are going certainly $40.00 dude she's going on how to differentiate for purpose again a patient who comes in to sick which is patient what's not right if you just drive a fairly well looking person young boy not not that sick first if something comes in with you know di C or something like that from some portable injection Twitter so I think the anywhere with us but I have five minutes so I'm going to have to choose as we heard over here yeah well with my teaching one I don't have to choose what I really want to teach and assess immediately anything they could be don't forget to perk us the spleen and a patient that presents like this because you think miss and be explained by palpation and that was totally changes diagnosed I mean it could have been my teaching but that's not what I was saying how's it so first of all find out why where she is now if can would have said I've seen lots of patients like this then what do you teach okay so you can explore that a little bit so from the previous patients you've seen like this cleared in in internal medicine TTP which is not soon as you know you could explore that a little bit without taking a lot of time and say well talk to me about their previous diagnosis you've seen the patient's IV one thing so okay so it's hitting here to the next step yeah I'm going to expand on delighteth and say I could say never so how can I help me with this page what would be home now when you asked for us entertaining sitting that would work what responses there's no one's ever asked that question before but you know this this is a collaboration this is a top-down hierarchical you know this is an interaction that's what teaching and learning is all about it's not just my telling somebody something it's engaging them so asking them you know where can I go with this patient you might get some answers right now I might have said hey you've seen five cases of ITP as a senior resident I know that you don't get as much time communication skills that you need I'm gonna go in and I'm gonna demonstrate academic tricky I don't engage his brother around her main concern because if that's not dealt with she will leave as anxious as what you came in you know go into that room and say this child was not having a ll she will be as interested as what you can't put some tackle either duper oh okay so that may be where you're going yeah you just have to figure out you know where you're going should we go through some physical diagnosis skills whatever they might be better particular patient and let me demonstrate that for you or whatever it might be be ready to come backwards again that boxer listen so you know the case is unfolded you think you know what this is it's a classic case cause the stylism you know your enthusiasm as a teacher I think it came out here and questioning comments is you know let let her go down whatever path she's doing it doesn't matter just a lot of that you're here to correct it they want you to do that she's having fun she's gonna be fun so listen to the whole thing I did an eruption once because she said the tea can put but I you ask the students to help me have this often you get interrupted on case presentation just depend on the attending environment so so 80% talk you think your vacation City so some students a president takes pretty high again it's nothing as faculty a rude or whatever just sit there so yeah the one with the case along and they also want to beginning and trying to steer that training down the right path but it's good just to listen Lebanon Pope now I will say especially beginning here for a resident student sometimes you know that and the teaching point maybe but we gotta talk about how to do an effective and efficient presentation and then I would take over I'm sure people like that do I fizzle really make sure is okay but that Heidi you're teaching one because they came okay so teaching beer I mean depending on how this other song closed but the important to us and again I mean I'm assuming the students are giving some and the residents are giving some guidelines and how we like to hear presentations I hope that happens I know it varies from attending do it so they we drive the nuts one attendance it's one thing when I think this is another thing we drive them nuts but in general we should have some consensus on how we like to kiss them okay then you get a minute no I didn't have the a skirt she finishes presenting the HTV and she said oh am i differential diagnosis it goes I don't have to answer a lot of times how many times it doesn't matter but certainly a lot of times you're going to say so what he's thinking okay so they come out with a couple of things that thinking what the estimate prioritize them they do that by the way and so the case unfolds if you go back in the room but the next step in this is appropriate that's very important once you hear the commitment is probably how did I do there yeah I said I said cool is there the differential about that and I didn't over enough that she said you know let's take care of purpura and I know certain things 550 converter and she's listed a couple things and I said yeah that's right at Target so if probate is important it's not just a question of ya know the diagnosis may sound right and maybe what you're thinking but you want to know how the training up there is it's probably big nice I felt at that point you were being too nice oh that's a great differential what was it pretty narrative she couldn't really expanded that yeah I agree enough uh great we're just need to nicely so we can give you number one that was yeah so that could have been expanded by the way I went to ask for what you think my feet after she finished the presentation winter I said wait here you know it was really a good efficient and effective presentation what's the take up like that that's not a feedback come on I was specific and saying you know this is full feedback it's it's a nice government it's fine you can probably win somebody's but that's not either so if I just said to her hey you know for fourth-year student that was really a great presentation what I liked about it is you preserve the critical information that I think I needed to know and it wasn't anything tonight to think of that I would do it you've even said the father's occupation where he worked for a pest control company and that could connect bigger than the differential diagnosis he's bringing pesticides home on his clothes and you know whose family is breathing in that stuff I mean that's far out but I mean yeah that was I would have confident that's what I mean Peter that's not so yeah I couldn't expanded that and again I did this session every time you know go I don't know what I'm going to say I'm not going to do it all I know it and I'm ready for you all the time it's a great job which I hope feel idea because I did I didn't incorporate Adult Learning principles I'm starting out with having never seen a patient like this before is it don't learn in principle where is it today those who don't learn from Noel says that your previous life experiences thumb for something it's not assumptions I don't assume she knows nothing she was unbelievable in this Internet I don't assume she does anything to see a page like they look at the Internet so so don't assumption I mean this is where I'm saying don't learning this way okay so you get a commitment what's out well I mean we did that almost every time hopefully we do it with the trainees in for reading for a reach there by the I've seen exit oh my god this is a classic case of closer before the resident and that's because of there are seconds over but that shouldn't happen tell anybody I think before they talk about they purr they go first I know it I know I think I didn't know a thing so then the company piece and then the teaching or teaching so a five minute interaction or stuff you might say yelling from the rooftop my teaching point today on this particular patient is time stays what a patient presents with a fervor of motika looking fairly well making sure that to me she doesn't have a textbook and if you're not sure how to make sure you put I've seen them Tiffany from Thomas I questioned her on that I want to make sure she knew would it be like if there wasn't clean air we progressed once you want to move it okay so that's that's a teaching point dad procedure then the fever so there's two times feedback where [Music] positive and negative no I've stole this I think I stole it or maybe she stole it from me we will get Marian Hewson was a PhD educator thinks you still feel inclined I don't know if she took it for they are different doesn't matter 2,000 feet back we get our corrective it and construct it's not a negative person you know if you want to tell me about my dress today you don't talk to me no you tell me you know you could've worn a different court blazer if I look better matches your shirt or whatever that best instructor people I've said constructive and reaffirm what kind of we reaffirm indeed I've got blocking on the exact name of some of you reaffirming but it's not it's that you're doing a good job okay is not it's not been framed that's good or bad okay you're dealing objectively in terms of this is what you're doing well reaffirming this is what you go through that's enough you definitely okay that's the next two steps that has to happen in every interaction if you ask the students who read this alchemy a feedback I can tell you I'm flattered and that is a change in what's happened and at that particular - you love kudos to speed that is very good okay those are a tough learning principles no talks about a feedback that's adult learning principles that's the only way we can grow is to hear what we're doing well and what will you improve that sometimes you only hear what we need to improve that include over here we're doing well that's problem does we want people to do things they do well to continue and the last piece is learning objectives so by sending a me based on this interaction what would your learning objectives be for this particular mission what would you say sucking my blood tests where's blood dissipation of eugenia presence hunk over had to come up with a better over her so you know the trainings are pretty good at accessing information but a few cats something good for them to read I mean outside the textbook or the textbook for visto way to go to get an overview if there's something that needs to be value-added a review article whatever and instead of them running to the literature tell them say I got a great review article for you to read on this I think it would really help you think about you know this patient and the context of TDI pervert let's talk about it tomorrow so she's gonna come back and pretty in front of her peers could be just she and I she's gonna tell me what she read and how it integrates with this page that's the motto that's the mom again that's another about learning principle its continuing professional development is activating the student the learner that makes them it says this is not the end of the learning this is around this patient you have to only read about and I'm Amanda I'm not full-time anymore but I demand that students and residents or even every patient because that's how it's that's how it sticks that's the contextual part that's how our nerves and people say I don't have time I said the mone you don't have time for your tummies you don't have a lot of time so read in a way that makes them sense read 15 minutes don't read an hour you may not have already read item in you gonna be a miser you're gonna read about two patients you know any better paper not going to read about it next year if you'll read about it now last impression is happening so we didn't make sure reading patient's the best healthcare that's the bottom again the way that's different from the one that a preceptor is building an adult learning principles with which they did not do so always if you do nothing else always start out have you ever seen a patient like this and maybe no assumptions we wait till the learner to help you and then you decide where you of it since I've never seen a patient you know even go anywhere another day if you've seen lots of patients then you work in collaboration with that learner in terms of what they want to learn about the make sense look at that five away so questions it looks like we will have the fool and I'll post it on our website go to the people who attended here and sign it we will send you this joint directly I apologize that's our policy I could have been me and I was very doing man but now you only have to go through yeah so the way I look at the model is we got one or two points on a lot of that do not do that well right now and just be perfect this and see where it takes me so I again the first point was that thing is that is the very one that we know have you ever seen a thing like this before maybe probating is not something you do enough you know how did you get to this point and if you think this extends this doesn't go there really doesn't once you become proficient at this it's one to you this is not extend your day is that extended time with a trainee but it makes it off using other questions and thanks so much for the invited for being here so early in the morning I think dr. Kirkland tonight some period of his angle thank you all so much [Applause]. 

To once again introduce years education around the speaker dr. Larry greenberg dr. greaver comes to us from George Washington University most recently and currently where they work for enough about him senior consultant for medical education and professor emeritus dr. greaver completed his undergraduate degree at the University of Toledo and a medical degree at The Ohio State University School of Medicine he completed his internship at popular children his pediatric residency and chief residency at Forest Children's Hospital he then served for two years in the United States Army at Fort baby before rolling into various roles in medical education those various roles in medical education spans multiple institutions including Johns Hopkins Holy Cross Hospital in Maryland Children's Hospital national and George Washington within these institutions he climbed the professorial rates and he served in various medical education leadership work with directly starving and directing multiple programs dr. Greenberg which effectively so please join me in welcoming dr. Larry fever [Applause] thank you very much for the invite especially because it's education day and I know it's only one day a year that we focus on education but you know it is part of the mission statement and it's part of what a medical school all about our residency programs and we should highlight this but it is what it is lots of opportunities we focus on education thank you and I want to specifically thank Cheri onihachi Tommy we please go back a few years when she was at Duke but I got I think a TV up of sherry yeah I had somewhere around February asking me if I would come and I asked you know sure I'd be happy to and with the topics you will get back to our faculty and see what our faculty wants and so we'll give you what you want if you don't like this guy definitely but I want to thank sharing or I have Sandra you know that behind scenes people that nobody ever thinks about because you know your lunch is here and the thing is set up and there we got airily people that don't get who doesn't need the need to get the kudos for the work they do so I'm yourself alphago so for this session you know anytime I go places for the visiting professor I always have to do a Grand Rounds or so sort of plenary session which by the way is my least favorite to do because it doesn't allow me to engage quite as much with you in a work though that would be our workshop but I hope this will be a fun session for you because what it's going to focus on this is really two issues one is a whole issue of teaching and learning and what this is not a Greek orgasm you know PowerPoint slides is taken from the literature so butter means up you lose out it's really evidence-based and then the second issue is this how we do the presentation so I'm going to try to point out I probably have to for this route based on what I've already known for the last almost 24 hours is you know how much earnest education Sammy you are about things I'm going to try and show you the importance of making a lecture like this interactive as interactive as you can be and you know a large group setting so the content is going to be what my life's work is know about so I had an epiphany early seventies when it was a very New Year person of managing a group of residents rotating from Children's Hospital to a very nice community hospital and Maryland and I had an epiphany that you know I wasn't sure it was really a greatest teachers everybody thought it was and I ended up going to a workshop in Chicago Illinois South Side Chicago was like a three-day workshop I walked out of there and I said whoohoo another great teacher operated information bureau I gotta change that so serendipitously in those days there weren't a lot of opportunities in terms of how to get yourself educated in medical education but I will say are probably one of the few people that ever sat with the father of medical education you are at the University of Illinois when I went there from two-week they accepted me for a two week kind of intensive training and sat with them and he listened to where I was going when I was all about it I would just tell you one of the things he brought out was so what's happening to people around him and they said it during question but not about and he said we've got up and one to one so pull the book behind change because this is what it's all about it's not just about you your your willingness and commitment education is about how you bring people with you so you as faculty have that responsibility when you do something other than what presidents and students may be used to they give something new for a lecture they understand that there's evidence that you know what you're showing them and another way to present information in terms of activating learners so it's a big it's a big responsibility that we have as faculty in terms of modeling so I need to ask how many of you came to the food nobody oh my god okay before you came Wow okay so the title is how do I call teaching effectively we got a minute you got a minute to turn to somebody next to you go with your costume Oh stories students but that's okay we bring it back together here a little bit what would it recipe you know throwing out questions like this in a lecture format is how activated workers become and then the company that occurs so I challenge anyone have a straightforward lecturer there are places where it for collectors that will be done because of the content it doesn't make it very easy to do interactively but or something else way over money I had if this cacophony is so important because it means that learning is going out a former head of the organization of the engines very well-known unfortunately died a couple years ago has a wonderful article called learning to not compete it's a change magazine which I generally read but this is a new beginning I'm Google it's a three page article but he talked about when he went into a classroom and you saw people five students party Gloria was going on when he was doing the talking this is my challenge is how do you know where any is going I didn't say well before looking at maybe I said yeah but what are they learning what is going on but really learning what you want them to learn so it doesn't mean we should do away with lectures just means we should think about how to make it more interactive and hopefully we do that today so answering the question how do I know I'm teaching effectively what you come up with exactly what you're doing recipe please but second for you so example for form an informant good okay so assessment that's that's important in terms of you know to do that the trend is really going to be information well start just to let you know Deb is gonna be wandering around so if you have a question she's going to stick up show you pick up your time so I know this is being so nice on the outside Mehnaz feedback questions about the topic we are discussing they asked questions about the top so you pique their curiosity and then start having questions because they don't think you have enough or their afternoon focuses to reconfirm what they already know sometimes that happens you say the answer and sometimes it's exactly whether someone yeah what else okay so engaged and actively participated absolutely I mean you know if your cell phones on out and you know you notice good lecture that doesn't there actually is out with a group it's a way to connect with you we look at people's faces you look at their eye contact it's not standing behind something between you and the audience I don't know it's just that big evening sometimes it's a nice day too there so I walked the roadman and that's the way our gratitude so yeah what else I mean if you can tell me work I see a follow through yourself finally made it cooperate some elements in what direction start tuning in to see okay so that's a good point so they read the literature about you know what changes patients behaviors a JUnit lecture you know on high blood pressure medicine and adherence to medical advice so that doesn't do it it's a follow up in terms of what happens during that session that down the road we don't do this very often follow up our lectures with so what happened to you have you changed your behavior and really I would like to know after my visit here if anybody's change their behavior based on stuff that we talked about it's not that your behavior too good it's just going you know the next step may be learning something new whatever I got that point you're learning something you incorporate that I mean kudos to that person is live exercise what else my policy innovation error do so again you know going the next step away and knowledge and application to ADT Chariton that makes an overt Club right so I told you about the objective so we're really going to be looking at how to you know model an interactive session we're going to look at the answers to this question about comma time I'm not teaching effective so here's a couple things I know I'm not saying these are all if you listed a number of them and if you probably anymore I don't think you've seen until the one day's article in The New Yorker 2011 fabulous anything this guy is is such a wonderful paper he's a surgeon that because if Stanford ever recovered another winner every Harvard out and midway through his career if I didn't have someone folks pianist okay so I'm going to see what I'm doing well enough so they call this former cherry and this article is by his former chair was retired came and observed him for a couple weeks doing what he does every day he gave them feedback a while a wonderful kind of opportunity we could do that too in our you have somebody considered our sessions give us feedback as a coach we don't do that something to do reflective practice why don't you use the show the reflective practitioner model under how am i doing respectively how did I do after it's over how would I change things next time to make it even better that's for friend Amita build in I'm hard on myself and I'll after this session I'll go when I'm saying differently to advantage of whatever feedback their outcomes talked about that questions you have to talk about that learners teach what we learn teach will be a tough so they take what we have taught in a trance drive it into a teaching session for either peers or somebody else I like this connectedness and I think faculty need to think about that you know there are there are boundaries but there are certainly as a way to connect was getting to the residence to make them feel that it's safe that that we're here to make them the best they can be and that we're not a barrier but were some money to help them through their experiences portfolios the doctor portfolios but they're so important to document what you do that's it oh I need a lecture to a different area students but I gave a lecture this is how I didn't have to them I'm going based on the paper and that's part of promoting for people will really spend a lot of time teaching and then self-assessment there's another so why interactive lecture as well I don't have to go through this line by line I can just tell you what's the what's the attention span for anybody in the luxury 15 minutes that's based on literature so it means if you're doing traditional lectures you've got to do something 15 minutes and 30 minutes and 45 days you class the group that's the way it goes I don't care - girl you gotta do something to change up the gym you know it could be turned to someone and talk about the seven point is maybe fifty you're gonna see I use because they're aging and that's that neutral and people relate to them but they're like you can use cases you can it is all kind of different things but you gotta get I said you contentious spent twenty minutes but it's really fifteen to twenty minutes at most so we got to use some sort of changeup in order to get them thinking about staying connected and then I gave you Harvey's comment when the teachers doing all the talking I wonder if possible I don't know how you do that the learners are spectators we're not played we're not engaged my whole mantra with learners would make them activate that come activated there's literature not the Gazoo in terms of packaging learners and what that means in terms of retention both breadth and depth versus being passive so we got to figure out a way to activate learners a little bit better Institute of Medicine which really need Congress takes its leap from step back in 2009 I just mentioned earlier traditional electric does not change position it's upset the gear that upsetting to hear that but it's the true do we got to figure out a way to do it better and then again establish keyboard learner centered climate it's not about us it's about our learners and we do that by engaging learners activating learners and getting learners involved in terms of what we're doing I love Ruskin I don't know where I found this I love quotes but Ruskin said John Ruskin was an ardent artist poet author Renaissance person 19th century education doesn't mean teaching people what they do not know it means teaching them to behave as they do not behave it's not teaching the youth the shapes of letters and the tricks of numbers and leaving them to turn their arithmetic to roguery and their literature to the lust it means isn't carefully on the contrary training them into perfect exercise and King the continents of their bodies and souls it's painful pad sometimes we wake up and we said I'm teaching today and it can be people it's continual difficult work to be done by kindness this is a humanism of what we do in our work by watching - enough of that we need to be observing people first and you see how they actually perform my way and not getting out there and signing out what we think with late letting themselves with aging by precept and by French involve all my modeling question he was the doctor would need together so here's the model so the answer the question how it runs its reflectively is based on this model this is not my - what it's a gonna look when I try to answer the question myself it's all about the teacher the learner the learning pilot and the curfew if any one of those is missing you will not be a good teacher I can guarantee that I can lots of them I can tell you where the gaps are did you do the same thing those four issues are absolutely critical in terms of answering the question how to enhance teaching effective so as they go through these things I want you to kind of reflect on as I go through each area one of the factors of make each component regarding your teaching and how would you score yourself and think if you were in someone else's shoes especially the learner how would you feel about some of these okay quotes again pump training trainees learn is as important as what they learn and understanding how they learn and to contribute much to what they would and very important state it's not just about knowledge in fact that it's about the process of learning and taking to account evidence Adult Learning principles and other issues I love this employer I think I've never heard a thing while I was carving he was a good you know I didn't always like him but in that he was a good facilitator terms of engaging people in the conversation and if you notice it's talking time and the person to use it interview talking time it was probably 20% 25% and the first thing was interviewing 75% well you know that it should be down to allocations our patient should be doing what's the time it should be that way with our teachers where the learners doing most of talking so we can make sure we know where they are diagnosed let me help them get through an issue one of the single most important facts about learning is to determine what the learner or knows that's an adult learning principles Schulman said that for putting the Carnegie Foundation we need to start there before we make any assumptions that we know what there is you need to know so I start with a table learning principles because that's really the theoretical construct under all teaching learning so I asked the question don't be embarrassed because I didn't bet a penny sir that's the same question funding you who've had any kind of contact with you read about adult learning produce more than any place I've been it's hard for me to believe it's really hard for me to believe okay I graduated med school like most of you did I went to my residency not a teacher by one good warriors education becomes teachers and I want to know here's a formal training week on the future when I finish my training doesn't make sense so we got to start with adult learning principles because if we know what's out there then we can more adjust to our learners and more didn't tell me - so everybody needs to and I'll tell you two articles if you look up in British Medical Journal an article by Kaufman d-m Kaufman and Pele I figured a TPI healthy six pages burning they'll take a look yes but you know tell you what you need you know what it is posted on our website that very article so again foundation as soon as a learner since alert has a major responsibility for mastery and self-assessment and again I always look at when I teach the learner my ultimate goal is to make them self to ready we don't think something something will define talking to them you make them suffer by captivating them and facilitating learning so when they don't have it quite the way you want it did you interject this you need to interject and stimulate them even more because when they get out and they're not around you this is continual professional tone and it's what our careers are all about no matter what we're in medicine Health Sciences demonstrating whatever it's all about the team and professional development can you train them to do that they need to be reading and taking responsibility for their education not an attendant minute were a small part of their careers [Music] so they bring experience in the play so I did a session couple way so or maybe it was this morning they step three separate and when the pictures you want to cast your learner's in a climate situation have you ever seen a patient like that and then you can determine what you need to see quickly that the person feels like nervous ending syllable before you can see so much better if the person says five it's my patient before tell you have to negotiate where you're chasing two beers no assumptions no something we can't look at learners is you know nothing up here will tell them what will fill arrays we know what they need to know no they bring interesting experiences but we never even asked me one and we need to know that because those like it's a part of where they are today what they bring to the plate I'm motivated beyond its over problem or any well we know that we would be keeping the problem so you think about a problem and maybe the shortness of breath whatever it is that's a way to teach you that's what you dolls talked about in adult learning principles that adult learners in the workforce think through learning around problems that's how learning occurs around specific problems so we don't have students come prepared learning styles I don't change my teaching days go then I try and gauge them based on how they burned up but I'm a facilitative teacher I'm not an information given based on my change in my career that happened 40 years ago so some students and summers of the Lightning does they just say just tell me what I need to do and I can't tell I can't tell it's impossible it's all based on individual issues and what they bring to the place of work so we try to accommodate those learning styles I gave an example whenever was that maybe this work where someone said tell me about the circle wolves and the Trinity responded I can tie it off circle looks like a drug lord okay so there's a different learning style and I can accommodate that if that's the way that were nervous it doesn't mean I'm gonna totally change my teaching but at least I appreciate that learn these a little different than some of the others and then of course wanna be here you know what we say and what we do are important it's not just saying it it's walk in a lot so you know that's gotta go handle it okay so we know that based on Moses work learners are basically self-directed so let me give them a leash and let them run the runners so they can get through stuff with or without us so sometimes they have bad if you teach it not here but other places until where their undergrad or whatever not enough times out here I didn't get any Rose not on service but you know they're gonna get as long as the bars clear don't get it something self erect intrinsically motivated so somebody came up to me earlier and said you know I see some people that are today and I'm saying myself what's going on are their goals and objectives are the roles responsibilities and expectations not good but some trainees when that happens where the hill it's not clear where they're supposed to go and how they're supposed to get there others will look at that and say I'll get there no matter what as long as it's clear wrong so if we go and now go there in Vienna link their learning self-concept so so some people self-concept wise really odd and their training you know are not real confident and not really willing to take chances and go forward and that changes with time that's a developmental issue the important thing is ability to or opportunities to apply what they learned so these Simla apps have been a blessing now you can take a sim lab and make a new procedures they can talk with standardized patients and it is life as real as you can get it's like the real McCoy it's a simulation and everybody knows it's a simulation but it's next to the next best thing is it doesn't replace observing them with real patients but it's next best thing and then the contextual piece of early so you know I'm on the down side of my career I'm a PBY 52 and when I was actively do practice I was a clinician in here I spent about 40% my time practice already have some medical education I was a DI ho I read faculty development I reckon but when I was when I was engaging Trinity's there were responsibilities that they have when they saw patient they run applications don't trust there's no choice why I said earlier I hope exactly know the neurology of that but there's something about neurons and synapses when you see a patient and read about it it's this when it's not even related and you read about 20% steps have contributed to my case it's so pointing to those opportunities when spreads tell me I don't have time to read my report no you have a lot of time and I'm not expecting to read dreams and read just read about your patients and figure out how you're leading fits in with what you're seeing and then I love Cubby's thing with his first book seven Habits this is a pediatric thing as develop now because we see learners going to each other that's the infant the tube independent that's the toddler and a lesson and then independent the way the real world is and the reason I show that is is because getting to the independent but to the energy interdependence date is credible nobody does it's a lump you notice you may be in so a'practice you're not doing this alone together office of people you've got to work with in terms of referrals you've got school systems you got whatever you're not working alone you're Romanian groups learn kind of working group isn't a big shift for students we're used to working in long before they get the message and then they find that that's up in their way medicine it doesn't work that way and some of the other group is involved with those so here's the chronic and I'll show you this first film I want you to think about what we just talked about learning wise and see what happens in this little Club looking at the relationship between the teacher and learner looking at the teacher style teaching what you might have done something different and what made the count a 10 pounder it's active so let's see if I can do this no I shouldn't yeah you fix my plate I really appreciated let's see come inside [Music] I think it's a small tree here hi there by country China here here okay now yeah here's who this father each efficient Oh what you know I mean that being to get that bad so rather than trying to fool around the easy stuff let's turn back on the lights there's another minute or so that I can just tell you what happened this should be oggi the Ralph Ralph is showing interest in this trick if you do this story either kid single my kids are beating up on and smashed by mr. Miyagi fix this bike and they develop this friendship and so he's in there watching mr. Miyagi and he's showing some interest in these trees you just saw them it must have a I can says common good truck and rosin no no no I can do this I've never done this before this is a company you sit here and there's a traitor problem hopefully not expensive but sit down and he says those eyes those eyes Isis think about the tree only the truth make I know this movie though they have perfect a picture like that the tree so Rob does that and he looks up you know but you said Mr P I said you ready and drop of the desires of erotic he says but how will I know it'll be the right one and mr. McCarthy says if it come from inside of you it's the right one and the music but I can't okay so in terms of relationship in terms of the teaching style reflective who's that reflective so meeting asking him to think about what's inside himself not next okay there's no right long way right yeah that's that's fairly safe for a kid and doesn't have much happiness and does not mean if he's happy in front of the Trinity the same person that's coming to the car and then I say okay the cops myself willing to try okay so that's good another one young boys quest interest before so to say about their students their uglies when you pique their interest in something and they start to kind of all my you know when you see them you know follow through with it you know they're obviously doing that because something you've done is turn them on and it's peak their interest and they want more so I know time is valuable and hard to kind of by but at some point another you can pick up on that critical incident and move that forward to make that trendy feel a little different what else this immunity committed to the learner first he fixed the bike so he engaged him initially okay so do it so they see what was said is that he had this previous experience fixing the bike so they established a relationship picture this with your trainees okay one of my differential unfortunately died premature in an airplane crash when he did a newborn nursery in go around the room everybody will introduce themselves and talk about what they would be doing if they were available because they were in medical school sous-chef all kinds of things came out what did this do what does this do when you engage people again it personalizes it humanizes it says I'm not just the positional human being you know he referred you to say this is well I would be doing you know the same thing so I think that's that's important here then you know they segues into the tree and how would you teach differently if at all he just said sit down trim I'm saying you look textbook you read about the layers of the everything you're going through before you hit the appendix do you know what is when you get in there when you get in there I'm going to ask you what layer gentleman turn and then we'll see how this goes so there's preparation Wow what else it's another way of doing that you could read a book on trimming a bonsai shut up to do this all the time to practice it yeah once utilize model a mother watch what I did okay and that's again I said earlier in this session that's about activated demonstration if you do it I'm anxiously confidently but that's not what our learners are over so if you both do it you have to bring it down step by step so the learner knows exactly what you're doing and how you're doing it versatile discriminately learner says okay I'll see if I can duplicate that sure I could never do it does Emily not unless she walked him through that so he wouldn't know exactly what you were doing and how you were doing that's called activator demonstration where the learners not just following you passively but you've got there you know and set it up a little bit so that they're really there as a person not to say something wrong prison I saw mr. Miyagi is not sure in setting the young man up to determine whether he was even in so he he made minimal measures to his questions to see whether he was gonna ask the next question question so it was building round four and whatever his name was into an active learner and they're finding that he wanted to learn ahead of intervention ever third something new every time I see these movies and I don't know if that was cultural whether that was a cultural issue in terms of how he responded or whether that was planned it doesn't matter but you know it continued it wasn't like there was a stopping point but he got them to the point where he said now you're gonna try Rob didn't say I'm going to try it but he showed her pictures he said to himself I'm gonna let him do this there was another question number I think the other thing you should do is say I think the person no it's safe for them to make mistakes when you are there observing there won't be any big mistakes made if there are different evening you can correct it immediately so the patient isn't hurt when you're not there I don't know it's hard it's hard to know okay this is we are we're okay Center so next piece of this a clinic climate to me this is one of the most important pieces I talk to the students and residents yesterday about the inverted inverse relationship between a safe learning climate and disability but I say you have a safe learning climate wherever you are your office your lecture room your small group discussion places if you have a safe learning climate you don't have this ability you don't have the meeting comments you don't have stuff going on that don't belong in any apartment in fact I told those students and residents in some places in the world like Australia is one of them they have zero tolerance for workplace bullying and its ability if you are to do any of that stuff you're out of the job zero tolerance not in this country as you know buy on the internet and other places where kids if it's suicide okay okay John Maxwell author leadership expert people don't care what you know too you know that you care so it's a piece of the learning climate in terms of your connectedness to learn is very important nulls talk to you about him the behavior the teacher probably influences the character the learning climate more than any single factor and you know if some of you who read Blake nozzle glad I love his work you've ever heard speak personally oh my god come close to him but as a speaker but I you know you'd form an opinion immediately you did with me and if it doesn't start out right it doesn't go very well the rest of the world if it starts out okay it usually finishes okay so that's important on learning point because it starts with second one when you engage your group the residency but it starts on a negative note if it's not feeling good and on compensating and say you love it you got one chance to do it that's it so what's a safe learning fun well it includes some of these things so one of the learning experience is going to be in this rotation what what are you likely to sit a learner needs to know that it takes something anxiety out of the situation I remember my first rotation and the NICU at Children's and Buffalo known Orion I was so scared you know scared killing baby I didn't know what I was going to be doing in there but nobody oriented me you know it shouldn't be like that we should know what the learning experience of the week what our support systems are food is available you know if they help us not in this by ourselves this one to me is one where we follow and that is be clear about roles responsibilities and expectations so when I see or someone tells me about a room that doesn't seem interested or student it doesn't seem engaged I will tell you that either those weren't clear or there's something significant going on whatever medically interpersonally substance abuse wise health wise something going on that person so let's be clear about those so we know what they can expect for me what I could expect from them that happens during orientation first day that we're with they're with us whether you're in an office setting no matter where you are it needs to be fitted and to me and I'd like to highlight the major issues and give them a handout and say there are other things I didn't have a chance to discuss look at those and let's talk about if you have equipment it's this if not this so I say this is what I can offer you what do you think you know I'll get some by an unusually when I suppose it's time I do if I don't we'll be talked about see you later though I mean if they don't like the fact that I'm telling them they have to read on every patient we're gonna talk about it I'm gonna tell them why which I usually do to make it seem reasonable you through the wire want it if the balance between challenging and safe I don't have to define that very well but the first day of a rotation for a student or resident might just be a day where they follow Europe just to get a feel for what is this like in this office or this setting or whatever and the next day they're the other and they get a day to do it then they're on their own and you can walk them through that you know what you're doing here today and tuck them again feel this safe learning climb the physical climate I'm not going to get much into that I love this fiscal climate this is not a lecture hall this is our you can turn around you can turn around lecture hall you can talk to people behind you what you will do after the session you find lots of issues around some of the things I'm addressing temperature in the room if it's really hot no one's going to stay so the physical aspects are important the most important l said was my relationship to the learners I love this convinced limitation that's one of my favorites I'd like to talk about that to show now I'm given two I'm out of here it's Mordor we're closer together the difference between Nikki and my learner's cuz I have a senior liner and their jugular we're all learned and by the way we're all teachers right it's obvious to think you can teach me some guarantees again my basic size was in 1961 I think what Mendel was Spiro yeah so everybody's a teacher everybody's learner and that needs to be clear you know and admitting limitations is perfectly fun so sometimes I will use I questions and I will say I can remember when I was a student you know how and I've started to learn the Krebs cycle I had no idea what the club publications were and all I knew was I had a memorized succinylcholine and all the rest of that crap after the test I said that's done until I had my first diabetic patient that things change a little bit yeah safe learning climate you know a tone or atmosphere you can walk in a room and feel you can feel you can see what students are doing the residents are doing the teachers doing you can feel what our pieces feel safer doesn't feel so you know we we absolutely suppress our dreams no I say that I see the mountain from the Medical School joke you know interacting with one another and then look what were there like in the classroom I'm thinking learners names are important that's not always easy we have a big lecture hall I know you only have 42 students for class but trying to learn as many names as you can is really helpful you know the clinical setting when you're one-on-one or you have just have a couple people with you that's important that's part of learning fun the educational contracts neat that's and also stuff so some people and I've done this many times is I'll hand them a piece of paper beginning the rotation I'll say what do you really want to get out of this rotation write down three or four objectives that you feel would be important for you to learn there'll be other things but these things you absolutely want to get to and then midway through the rotation I'll say here's your objectives back how you doing and have a conversation about them and I've seen this but I really haven't had this okay and then two more weeks or see if we get to this so that's kind of a learner initiated thing where they write down their major issues so if a student knows she's going in an orthopedic surgery it's not crazy about the newborn nursery you know babies have strange things with their extremities their feet turn in your position in utero and then you know we need to make sure they don't have to click connect in general developmental love dislocated hip and somewhere so you know future the exertion can concentrate other things too but we can guide the network kindness collegiality again contouring and stability teamwork is important issue in terms of learning climate and I love this thing about connectedness and you know when you're connected to a student you know and you know when you're not and the students and residents definitely know okay Indecent Proposal the movie want you to look at what this guy is doing first day of class architecture class how he's handling it and if you didn't learn in that class how would you have felt hopefully this movie will go better don't know sander I am [Music] you can't you can't make this up to a dorky character mission of trying [Music] left hand it sorry [Music] great architecture move you're passionate sweet moving on [Music] dad in a minute through Penn Station no one claimed the body everything is that beautiful the money men did not mean because the great ones are impossible with you if they do their jobs properly they justice once it is right actually No [Music] is having it's about movies [Music] so so again I'm gonna have to deter prett this movie helped me to go so [Music] beautiful honey man looks like Jesus comes he does because the great ones are impossible okay so we're done you know I know this movie by Arthur Brittany says what is this and somebody else I grew up he says yeah someone else has a weapon that everybody like he says he then throws up some slides the pyramid the loo these beautiful places that have been created through brexit stone and so forth and what what he ends up doing in this class is inspiring the students to go to the next level now they're not going to build necessarily anything like that but this is a very inspirational the rest of the play this is a very inspirational have first contact students that they can feel like this course is really doing something they're going to like enjoy and be part of mostly because of isn't Divya which is now so mean you know they're doing some of the same things with students and residents yet the very might accept that this may be the 40th time for ATF ever other time for you but it's first time for that student first time for that run so to build that learning climate is just extremely important again I apologize about the slides that don't know what happened but it's probably on my shoulders so ok I hope the rest of them I don't want to go back to school nobody likes me they tease me and pull my hair and beat me up I hate it no one said it's easy would be a teacher somewhere close everyone sees the world in a different way and I'm trying to capture what I see and encourage others to look to learn to grow and understand and build an affinity with the sky Steven where we teach to change the world see Steven Brookfield as a adult learning guru justanna she waits actually about michael carbon is talking about another drummer he's almost clever white in the sense that it really gets inside the student and those each particular person's needs Billy Hart jazz musician is really it's not really about how many things you can do it's about how many ways you can do one thing but this is these are nice quotes I think about teaching in terms of you know the latitude we have in terms of being creative thinking out of the box maybe have fun somebody wrote up my session this morning yeah this morning that it was a fun session I'm thinking wow that to me is what learning I mean learning isn't always fun because it's around difficult patient problems that are sad but when it can be learning should be fun and not some sort of thing that we just have to do so so so the excellent teacher were finally on the teacher I think the excellent teacher promotes enjoyment of learner it facilitates useful work I think that's an important job of ours if somebody said that I really was instrumental in challenging stimulating inspiring promoting enjoyment of learning they wouldn't have seen anything else that's enough I think I said it all because I think our cap is not information primer it is to facilitate further investigation by the learner together whether they were there as a way to help promote them trust again I think it's important in terms of how people learn it gets back to learning climate but I think small groups this is easier to do in larger groups in the lecture hall it's a lot harder to do but you know again getting out from behind the podium walk in the room you know talking directly to students residential they really help that situation models humanism so I mean part of what we're all about and that's walking the walk it's one thing to say in the classroom complete on the model it train these are not going to pick up the leadership issues we don't teach some of these things very well facilitated group discussion is like around many places have workshops that help residents with that or even faculty being mentors coaches and so forth searches for meaning in our work through scholarship it's important for a teaching and providing timing feedback which is corrective and reinforcing the former head of the American College of Surgeons came to visit us one time and I heard him say something about taking people to new heights and I went up to him afterwards and I said I'd love that can I use that he says well absolutely I think you know taking people to new heights is something that really is an important part of what I do most of the people that came through Pediatrics didn't become pediatrician the very few of them you know plenty of some three months but the fact is is if you can stimulate the inspire people and take you to that next level where they never expected to go to youth in your job you've done your job even if they're going to be a surgeon or an internist or a family but if you were promoting self-directed learning already talked about that in terms of learner that's critical and that doesn't happen by talking down it happens by stimulating them and making them to be accessing knowledge and so forth of course we have to be accessible we got to you now as well and then there's that families please showing ship and content expertise okay I'll these this film plays so again toys we're going to figure out what was the message to the learner and the implications of the message and how would you describe the teachers that new tech at age 21 that's a little scary seaweedy opening paragraph the premise behind understanding poetry understanding poetry by dr. J and his Pritchard PhD to fully understand poetry we must first be fluent its meter Brian and figures of speech then ask two questions one how artfully have the objective of the poem been rendered and two how important is that objective question one rates the poems perfection question two rates its importance and once these questions have been answered determining the poems greatness becomes a relatively simple matter if the phone score or perfection is plotted on the horizontal photograph and its importance is plotted on the vertical happily the total area of the poem yields the measure of its great a son by Byron might score high on the vertical but on the average are some experience islands on the other with score high both horizontally and vertically a massive circle area thereby revealing the plume to be truly great as you proceed through the poetry in this book practice this rating method as your ability to evaluate poems in this manner growth so so will your enjoyment and understanding compulsion that's what I think mr. J Evans Pritchard he playing pipe we're talking about poetry my life fire 142 but I had danced don't you agree about that page about the entire page with that we rip it out tell you with the doll that they tear up the entire introduction I wanted history nothing of it I will check that it was a lot these guys aren't always easy get all of that you know like to tell some of how we use movies that they did it because they probably never even knew their movie should be used like that every time you see movie the person teaching point B point what's the message so he was able to engage the students by shocking them and making them realize that everything that Sinha in the gospel not just because it's written doesn't mean it's perfect okay so the comment there was is there any engage the students he had them you know he had their attention by shocking them and basically what he was saying is everything in the book is not the way it always it so what is that message was about of mine in this class please you got you got them to step outside of what they normally do and actively engage and something they would not normally expect to do like tearing them apart so how do how do you hope that message wasn't that good how do we get them to think about actively engaging in this course ripping out the pages of the you know they're used to reading books and like a textbook you don't even markup and you got them pages out in the textbook so how are they interpreted poetry you couldn't do it on their own you're stepping out of that's where I was looking air environment so the message there was you're gonna read the poem you're gonna come to class prepared and your your opinion of that poem is going to be important and then we're going to discuss them so this is going to be a group right now I'm not lecturing to you about these bones and jinyang evans-pritchard whatever news it's not going to take it's a good moment what's not a good one this is going to be discussing class meaning you come prepared so I don't you to do TDL the be prepared for flip classroom the students or residents need to be prepared that even if you've given them something to read on the outside it needs to be read that's it there's a purpose today so that they hub has engaged learners and you can take them to greater heights because they've already mastered a little bit of mallet to give them not even take them to further things up on the cognitive scale that's I understand oops that huh that's how many like synthesis analysis not knowledge and not comprehensive but way beyond make sense so challenge is how do we make our teaching more learner center and how do we facilitate learning giving up control what kind of questions we ask that seminars to think at higher levels I don't we deal with reflection in order teaching those are the things that I just listed you probably think of a lot more okay just real quickly so the curriculum today is a lot different than what I has around the realize we're tied about objectives now we're talking about competencies here that student level and milestones and interests about professional activities so you know what they are we know that there are six basic companies competencies that the residency ACGME is outlined those have also again trickled down to the student level other moments are being used here but they are being used around the country as our lyric so those happen in residents we need people to have time to apply with their learning so it's not enough just to present them with information they have to have time so if they're learning communication skills and I know that happens here they have to be talking to a standardized patient around a breast biopsy that was positive and the student has to walk in the room is given the information and it has to tell that woman I'm sorry to tell you but your biopsy keep it positive and using that standardized patient will start a cry and if the student is doing this in her job we'll take the box of Kleenex and offer it to the woman and maybe even put a hand on and as a comforting thing and that's our videotape and then the students given feedback and then in terms of what he or she did with the improved that's opportunity to apply objectives in the corrective isn't it it's just not enough to know stuff we have to judge people by performance I don't care what they know if they perform well I know they know stuff if they don't perform oh then I'm not sure what they know the evaluation has to believe obviously balanced between learner versus teacher centered activities considering the level the level of the learner so if we're talking about giving bad news which is a second-year medical student da bonobo give it again this versus a first-year resident very different in terms of their development and what they know and so forth and then providing opportunities of the contextual content in the field to other questions so we'll do this one more film but what this is okay so I'll show you a clip for my tea notes and I just want you to watch in terms of what was the curricular objective here how the teacher teach it how do you know the Lord got it and how does it apply to how we teach residents so timeout I'm talking to my teacher as they're on that property get your way dance shoot the puck to your teammates [Music] no praying for that one - work - oh I'm so tired of explaining movies this work Oh College I die your acting skills are being called to question okay so in this movie he really wants to teach the kids how to pray don't pop a hockey puck so he uses and tank so of course when the kids first start out Vickers splattering all over so the curricular objective is is how you cradle a huddle and instead of using a puppy very hard would be hard to know whether they get it or don't get it he innovatively thinking out of the box uses a name and it's messy ministers but what happens is the kids start together but when they start again if you see his encouragement no great job you know you didn't break the egg and you can send it to whether your team into it and that's what the bully really focuses on so in this particular objective you see something you know I don't really teach this well how do I know they get it and of course the next step would be going to look to a Papa ever with an egg you can see that they carefully crate of the egg so it doesn't break okay so I'm going to back up now and look at the question you posed at the beginning how do I know I'm teaching effectively but we really look at this credibly we're talking about four areas that we need to pay attention to anyone we have met there's gonna be the gap how effectively RIT so it's going to about you know when I first started I thought about the teacher when I went to that first workshop I said they can only improve the way I teach well that's not the way it worked out the way it worked out is I learned all about learners and who they are how I fit in with them and learning climate so that's what we need to think about in terms of answering the question we need to think about the teacher in terms of our oh we need to think about where learners are we didn't think about what learning time they are we operating in and how do these curricular objectives or competencies or milestones get implemented so that we know that that our trainees get it and haven't had the best so what we had planned initially and there's only 20 minutes left because I black someone we were going to break you out into groups in teacher learner learning environment and friggin but instead of doing that I'm going to just feel questions and ask or or cannot you can come up with some concrete suggestions on how we may improve any one of those four areas that's really something you would be doing at a table kind of thinking about it but if you have any thoughts or suggestions about them just they'll about but I'll take questions in general about the actual presentation - two movies that didn't play through about three weeks to recap 33 [Music] I'll never get it by the back okay yeah please and stand and I think I gotta come to this already this means advice so Miyagi you got independent those people are learn more [Music] but a tall order some clear recommendations on how to get somebody to bite boy [Music] committed and being everybody hear the question all right repeat the question again to some people of Europe in there how do you hook somebody why do you look somebody okay so as a teacher I'm going to role model something for you that you need to do a lot more in terms of what I've seen at my own institution and then just don't answer the questions you can handle to it and if it's a to learn first year medical student ethic dad really is an interesting question how did you see you've been thinking about that how would you best answer that that's one way if you're in a group because I already have been obviously if you're in group you can say so what does a group thing about that how does a guy with things when you're allowed to be service you shutting off all you know conversation by you saying well the way I would do that would be apparently you have responsibilities now I'm making this go forward there's one important for them to commit themselves so in a group you can have great questions who's to have an answer to that you're not copping out you're going from a sage on the stage to subscribe on the side whatever that is so anybody want to answer that what's up how do you get people up very drug bust so what were you thinking specifically with double-up history [Music] well if somebody's into it and they're already didn't provide you know they're gonna be significant so they're already going to be giving you their initiative [Music] flame but if you have somebody that's in a team that has been disengaged and you'd said maybe they something person is an issue how do you if you're in you have a week with this person and if you still want that student for our role or in some ways to glean some information can do this efficiently so it's happening getting one I was just something for a tipper yes up at the student level how to see the shooter hurt but they really are being mentor program okay so this enemy content right they're going to be interested in content to start out with keep going [Music] needs to be in context the needs of okay they seem highly the value of material how I could best fit in with is that's another issue inspirational Mentors there you go now we're getting someplace so who are the people in this profession are these people I want to spend time are these people I relate to that changes people's career choices immediately something I had a woman who was going into surgery because of one surgery at our school who really walked on water he was the most unbelievable guy and became the head of surgery at Georgetown left GW went to Georgetown and Steve Evans was an unbelievable guy she came to me in August of her senior year and she said I changed my mind and said what would he be she said well I found out that no one's like Steve Evans and I guess I was just gone by my one contact with him and so she ended up switching of pediatrics I get very sure that's where she belong with a lot of questions and so forth but it's the people that work with and the environment in which you work so it's content people environment so to answer your question as they look at those things one of the most important things which is pretty sup it's how you role model and how much enthusiasm you show and how much humanism you have and you know someone says themselves 12 I don't know if I could be like yeah but I like what he stands for further 40 stairs so I don't know if that answers the question but that certainly is one book and of course the other hooks are you know just raising people's creativity levels and doing fun things and you know so when they leave the rotation they can say Pendleton could taste that was fun even though I'm not going in in that field that I'll remember that and those are the things that people like anything else um I'm very the kids are so beginning a little teaching one thing that I found that works is if I can learn enough about your resident to know where they're going or what they're interested in and then make weight or whatever we're doing practical to that and try to put them in a practical scenario but you're going to see the society this kid's gonna walk into your office or this that would make it realize it almost shocks them in a reality I'm going to see you Sunday hours whatever it is another good example well thanks to their question to the moment when he said it's clear roles and responsibilities with what so it's clear roles and responsibilities this student has to know what you're expecting them to do and you have to be clear that what you are and what you aren't going to do and I think if those boundaries are set up they're more likely being gauged also making the cultivation see in whatever they are interested of is what is relevant for example I'm a psychiatrist and podium is rotated in consultation so what's the link between the foot and the brain or the mind so they I make them see how this mental illness is when they're feeding there's still the primary and how it is relevant for them to know about it so I'm approach it from the side of perspective as a podiatrist why this is so the day it must becomes more annoying about the aspect that's how you can put them up there yes because we question any other questions about in general what we talked about any people everything you say about how during some of the things or reaffirming some of those things or a city ruins mountains in practice and so forth so well the practice in this room through your experiences with trainees what do you think the value of collegiality with students in other words they're aspiring to be part of the professional so it's a broad term and I'm thinking about this because you know I think there are a lot of aspects this it's a question of you know the collegiality of students so give me give me just an example of what you might be thinking you know it's it's very difficult for a first or second year medical student to see themselves as part of the profession but I think sometimes calling them a call in the profession talking about their life when there young physicians and what that might be like you know how how you as an oak I might even be seeing them this is over five welcoming them and the propulsion so I don't know that I can answer your question but I'll just give you one example in terms of boundaries so I have a non-american will be a free parking at the 40 so I have a group of volunteer we have a course called professional development it's really a professional identity we really full of course it is what happens to a student on the way to the clinic position it used to be that one gets my stage in life you'll find out what it's like well we're trying to teaching them and the session that's going to be held on Thursday thought Elysium invited the students I'm gonna give you request this boundaries father is routine doctors the patient's baggage between teachers and students teachers of Germany and I'm not sure what the answer to that is but I'll tell you how it started out so our first day whenever in the room you're in juice well a little bit about ourselves so we have a chance of really know each other a student that too for some of their my co-facilitator is a social worker in private practice and she's monitor yeah so I came to the point where okay what you want to be called no wonder we talk about my first day new students listen what do you want to call me so what we're going to call you dr. Graper oh because of my age and you know this is not very clear but what was the side of knowing not because I considered a well how about dr. g4 that's what you want dr. G the question of you know where the boundaries are and how close they're yet I'm still conflicted on that when I've been awarded attending in the past I've taken the residents and students out to lunch every time I can award lieutenant is that breaking boundaries I'd see it that way I see it as a collective whatever humanism whatever you want to call it the police he'll thanking them for the time on service and what they did some people may look at that is you know you're giving them giving students a great you're evaluated around this I mean wherever the boundaries is it really hard question I can everybody comment I don't know sometimes it's easier to go back to the things that we're going to share as an attendings and students the kinds of emotions we might feel when we approach a patient and so when you're making rounds or doing things with patients and it's okay to say that makes me sad how does that make you feel or this was really hard for me to talk to that family I'm not sure that I did it right what do you think you would do I mean you because those that's a commonality that we all share we're all adults we're all human means we all share these things and focusing on that I don't know maybe it's different coming in the question from a different a different direction but using the commonalities that we have to establish a common ground and yeah I think there do there are boundaries that things you probably can't do they're usually more institutional type restrictions as opposed to what we should I like I like your answer like Tyrion terms of breeding groups closer together it's that paternity you know an underside he's I mean they are presses doesn't some students are oppressed that's when they'd like your training just like we did but yeah we don't have to treat them in a way that's not respectful a little you know the candy for me I like to think the students is almost junior officers show okay okay there are a lot of boundaries but it's already answered I said I'd like to I like to think of the students as junior officers chef I'm sure there are many many boundaries and then see how those preferential of the students but the CEO does have events where the officers don't get to know my students like Jos have an awful lot to learn but they're part of that office or submitted via yeah they're gonna need an excuse if you use yeah I think a great place to dr. Gilbert's point to initiate this is during orientation like you spoke up a little bit earlier dr. Jim Sherman pediatrics recently retired key he could have observed his orientations at any time he would have these upstanding orientations really simple laid-back you sit together as a group so where'd you go to med school what you do when you're a kid just familiarizing yourself with one another hey I went to Ohio State I did this you know just making those connections early on and those continued out throughout the rest of you or the rest of the rotation and he really saw a lot of Alvin and just observing his Orient to get excited yeah I said yeah what crack that so it's something has to be planned and you know it's you got to gather engaged people the first time around and by when I was picked up American Pediatrics I told the students but they didn't think this is the best educational experience in medical school at the end of the very weeks I want to know what about my family you've got people that disagree but that's how you hook them in and how you that first impression is you know is this going to be this going to be a good experience for Peters is nice yeah we're about out of time a series one more question we take one more otherwise I don't I want to thank all of you because you give your valuable time and thank you Vienna or a really hire anybody by T to your educational day and I know there are few more activities left hopefully some of you will come this evening and again appreciate your attendance today how was it exciting to lock the room is it really enough [Applause].