Top 10 Clinical Teaching Pearls
By Mel L. Anderson, MD, FACP
- Set the stage – Meet with your trainees to discuss goals, objectives, expectations, learning climate, and how teaching and patient care will work. Take advantage of this time to introduce yourself, team members, and to begin the process of team building.
- Plan your feedback – Set times at the start of a rotation for feedback sessions. Establishing the feedback expectations lets learners know you value it. Have learners fill out one side of a note card with their name and a list of things they want to learn. Use the back to write specific observations about their performance as the days go by—strive for timely, specific, respectful and actionable feedback.
- Teach to the gap – Let your learners know you will engage in questioning in order to best deliver relevant and useful teaching—but never to shame or humiliate. Watch the nonverbal communication of your learners to know when to add hints, when to normalize (e.g., “this is tough stuff”), and when to provide your own positive nonverbal communication as encouragement. Top tier teaching relates to the extent by which you create a safe and effective learning climate where your learners feel they have the latitude to ask questions, reveal what they don’t know, think out loud and even struggle without fear of retribution.
- Mind your nonverbals – As you ask questions, take care to not “telegraph” the expected answer through nonverbal communication, like gently shaking your head “no” or nodding your head “yes.” You can prepare your learners, who often have gained experience in being able to read nonverbal communication in previous teachers, that you intentionally plan to not provide nonverbal clues, but for an educational purpose: so that they can complete their thoughts independently.
- Not what you’re thinking, what they’re thinking – Effectively phrasing questions is an art. Try to avoid “guess what I’m thinking” questions. Instead of asking “what are the most important things we need to do for this patient,” try “what do you think the most important things are that we need to do for this patient.” You want them to share their clinical reasoning in a way that allows you to assess, correct, add or embellish and praise.
- Go to the bedside – Independent of teaching setting, the educational literature consistently shows that patients prefer being present for the presentation and discussion and that the overall time spent is no different. Teachers and learners can efficiently layer simultaneous activities by going bedside: confirming correct clinical information to guide patient care, observing learner skills, and teaching the patient and other team members.
- Be a model – Demonstrate your compassion, professionalism, and communication skills with patients in the presence of learners. How you interact and speak with patients may provide some of the most memorable experiences for your learners, in both positive and potentially negative ways. Remain vigilant about your own emotional responses in the clinical setting in order to best care for patients and best provide an example for doing so.
- Lifelong learners, one and all – If you don’t know the answer, just say so. Learners will appreciate the candor.
- Coaching is good – Seek out great teachers and ask to tag along on a teaching excursion. Ask them to do the same for you. Apply lifelong learning principles to your teaching practice.
- Dare to observe – Make plans to watch your learners in action: interviewing and examining patients, communicating with families or specialists, and interacting with peers. These observations can be a rich source of feedback on clinical skills, communication and professionalism.