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
- 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.
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
- 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.