While it took me much longer than expected to complete my practicum, compiling teaching logs over almost 3 years afforded me a birds-eye view perspective that has been immensely valuable to forming a foundation for my developing teaching career. Upon reflection, 3 general observations warrant particular focus.
First, a wide canvas of teaching opportunities permits experimentation with a wide array of teaching modalities at different moments in one’s career. When I started logging activities, I was a Fellow just learning how to mentor junior trainees. Many of these earlier experiences involved learning how to assume the “Junior Attending” role and the basic tasks (e.g., co-ordinating care, leading discussions, providing feedback) of running a team. As my career transitioned to a staff physician role, I was able to dedicate increasing time to honing a teaching style and refining previously given talks. I also had increasing opportunities to not only teach, but to “teach about teaching.” For example, in log 8 I talk about how the experience of reviewing consults was aided by using Kolb’s experiential learning style to “abstract” key concepts for teaching that learners could apply in future clinical scenarios (McLeod, 2017). Later in Logs 36 -40, after creating a family medicine teaching unit as a staff physician, I had the opportunity to teach this style of “attending” to new fellows and create an educational unit that focused both on learning for junior learners and leading for our fellow. In this way, teaching becomes a transactional exercise across generations of learners.
A second observation I’ve made is that a prolonged “education” practicum can be challenging inasmuch as it leads to a certain degree of ‘inherent disorganization.’ Despite attempting to form a cohesive and consistent experience based on a unifying teaching philosophy, I instead discovered that many teaching opportunities were haphazard, impromptu, and not necessarily closely related to my areas of interest such as integration or curriculum design. In log 28, for example, I document my somewhat unplanned and awkward experience teaching a resident how to perform a sebaceous cyst removal. While these ‘extraneous experiences’ might result in a somewhat disjointed collection of logs, they can also prove reinvigorating. I began to learn about new possibilities, unknown weakness, and the value of experimentation.
A third and final observation is that, a multitude of different experiences notwithstanding, I can still see the signal amidst the noise. As I scan over my logs, I see increasing focus over the years on my personal teaching philosophy, specifically on the value of integration. In later sessions, I was able to experiment increasingly with pre-fabricated talks that teach an approach to a common clinical problem using a physiology-based classification scheme. I increasingly came to appreciate what worked well and what didn’t. For example, in Log 43 and in accordance with previous studies in the literature, I found that integration of basic science was most effective when embedded throughout the talk with explicit links to clinical application (Baghdady MT, 2009) (Woods NN, 2005). In this teaching experience, I talked about how reticulocytosis in the bone marrow is a physiologic response to anemia that permits a classifications schema of what’s wrong (e.g., bleeding, hemolysis etc.) that clinicians can use to create a robust approach to patients with a low hemoglobin.
I can conclude by noting that, cumulatively, these experiences form a blueprint for what comes next in my teaching career. As can be seen from later logs, I have begun several program-level initiatives to build on past activities. In Log 48, I comment on the experience of designing a “rehabilitation hospitalist curriculum” for incoming residents and fellows at Bridgepoint Hospital. Here I am hoping to draw from principles of integration to design an elective experience that focuses on Systematic rather than Opportunist educational opportunities. One such activity might be a “neurology day” wherein learners have a chance to practice integrated care of neurological patients, including a supervised physical exam, an introduction to therapy, and active discharge planning. Consistent with Harden’s SPICES model of curriculum design, the objective will be to focus on structured planning of educational experiences rather than simply “hoping for the best” that residents see what they need to see on their rotation (Harden RM, 1984). Through this and other opportunities, the collection of teaching exercises that comprise my practicum continue to imbue me with a confidence that my teaching will continue to evolve in dynamic, yet systematic ways.
References
Baghdady MT, P. M. (2009). The role of basic sciences in diagnostic oral radiology. J Dent Educ, 73(10), 1187-1193.
Harden RM, S. S. (1984). Educational strategies in curriculum development: The SPICES model. . Med Educ., 18(4), 284-297.
McLeod, S. (2017). Kolb’s Learning Styles and Experiential Learning Cycle. Retrieved from Simplypsychology.org: https://www.simplypsychology.org/learning-kolb.html
Woods NN, B. L. (2005). The value of basic science in clinical diagnosis: Creating coherence among signs and symptoms. Med Educ, 39(1), 107-112.
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