Author: richardosbornemedportalca

Concluding Thoughts

On By richardosbornemedportalcaIn Conclusion, ReflectionsLeave a comment

Completing my teaching practicum over more than 2-years has been a unique and challenging experience, not least of all because it can be difficult to maintain a coherent strategy and sense of direction for extended periods of time. Notwithstanding any initial uncertainty about where all this was heading, I’d like to think I’ve staked out a teaching vision that is at once personal and scholarly.

When I first began logging teaching experiences as a Fellow, they consisted primarily of 1-hour morning report-style exercises. The objective was simply to pass knowledge forward. While working through INTAPT, I started to notice my teaching becoming more scholarly, informed not only by learned pedagogical concepts, but by new educational strategies. Be it hosting an INTAPT workshop or leading a panel-discussion on Medical Assistance in Dying (MAID), I had the opportunity to experiment with different modalities. Aided by numerous sources of feedback, I began to appreciate what worked and what didn’t.

At the heart of this journey has been a commitment to emphasizing the role of basic science in clinical education. Throughout my practicum, I’ve been increasingly focused on integration theory, infusing pre-fabricated learning modules (see appendices) with a physiology-based approach to common clinical problems. As a new staff physician, I have been teaching these to my learners over the last 2 years.

As I look to the future, my hope is to operationalize some of these initiatives on a larger level. At Bridgepoint, I am the education lead for the rehabilitation medicine elective, where I am currently developing a mini-curriculum on our teaching units. It is my hope that I will be able to implement much of what I have learned from INTAPT and my practicum when devising the core components of this curriculum, including formalizing a needs assessment, implementing various educational strategies, and creating a feedback structure. Integration of clinical science with medical education will remain fundamental to this program, for I believe now more than ever that doctors are scientists at heart. We function best when we are able to deconstruct our problems into their constituent biological, chemical, and physiological substrates. Before we can treat, we must first understand.

 

Sample Integration Exercise: Respiratory Failure

On By richardosbornemedportalcaIn AppendicesLeave a comment

This was my first attempt at developing an integration-focused teaching session. I was particularly interested in breaking down a complex physiological process (i.e., the alveolar gas equation), an otherwise forgettable medical school quiz question, into a useful schema for approaching undifferentiated respiratory failure during clinical emergencies. The objective is to teach learners to systematically approach a frightening clinical scenario in a way that considers all possible causes, while avoiding diagnostic premature closure. The physiology-based explanations extract key deductions from clinical tests (e.g., ABG) and patient history so that clinicians can arrive at the correct diagnosis, which is indispensable to initiating life-saving management.

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Sample Integration Exercise: Acid-Base Disorders

On By richardosbornemedportalcaIn AppendicesLeave a comment

I am perhaps most proud of this integration exercise, which I developed for learners to use when approaching acid-base disorders. The focus here is on breaking down this very challenging area of medicine into concrete physiology-based steps that allow one to easily approach acid-base problems that might at first glance appear otherwise unsolvable. I belief that a rigorous, systematic, and physiologically intuitive approach makes for a more reliable clinical problem-solving schema.

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Feedback: A Reflection

On By richardosbornemedportalcaIn Feedback, ReflectionsLeave a comment

An advantage of a prolonged practicum is that I have had the opportunity to obtain feedback from a variety of sources across a wide array of teaching experiences at different stages in my career. This, in turn, has allowed me to learn from my mistakes and build on my strengths.

Early in my training, I often gave “lecture-style” talks on common clinical cases. Feedback on these sessions was instrumental in identifying strengths and weaknesses in my presenting style. For example, during an early presentation on atrial fibrillation, while I received positive feedback on the breadth of my talk, observes also commented on the “overwhelming” nature of the talk. At times, I used too many slides with too much data covering an excessive amount of literature. I recognized that this was a frequent flaw. Fearing exclusion of key information, my talks had a tendency to come across as exhaustive literature reviews equipped with unnecessary statistics and extraneous tangents. Receiving honest feedback on this aspect of my teaching was invaluable to enhancing the cohesion and accessibility of my future talks.

As I transitioned to a mentorship role as a PGY3 Fellow in Hospital Medicine, my talks necessarily became more focused and clinically-oriented. Case-based discussions supplanted lectures, with my audience typically numbering only a handful of learners rather than a full auditorium. Much of the feedback I received during this ‘era’ helped confirm that I had corrected my previous errors. Over a year later, I once again gave a talk on atrial fibrillation, which was received more favourably. Participants noted my emphasis on practical applications and clinical cases. My slides were also noted to be “informative” rather than “busy.” Overall, it was helpful to see how tangible feedback led to meaningful changes in teaching effectiveness.

Moving through my practicum and my fellowship, I found myself trying to increasingly integrate basic science concepts into my clinical teaching. Feedback allowed me to see that I was having some success in this endeavor, with several learners commenting on the valuable process of “connecting physiology to medicine.” Throughout this stage, I also tried to obtain informal feedback after sessions and rotations, which I think highlights a key caveat when considering the yield of feedback. The format matters, as does the anonymity of the responder. Most, albeit not all, learners are hesitant to provide honest, constructive feedback face-to-face. This realization has been particularly helpful as I’ve transitioned to my role as a staff physician. It is important that learners are allowed an opportunity to provide anonymous feedback. Seeing my faculty evaluations on Power allowed me access more candid assessments of my teaching, as well as provide me with numerical scores that I can compare with my faculty and department peers. As with student evaluations, it is helpful to know “how I compare” with the average instructor, while also seeing first hand what works and what doesn’t for my learners.

Particularly helpful in making this determination are hand-written comments, which are typically more insightful than lickert scale-based questionnaires. As I’ve received more evaluations, I’ve started to pick up on themes. For instance, multiple learners across different types of educational experiences have commented on their appreciation for my tendency to concentrate teaching around case presentations, where students have the opportunity to see their learning come alive at the bedside. On weeks when I have failed to prioritize this, it has been cited as an item under the “room for improvement” section.

To conclude, it is clear that feedback has played an important role throughout my career, from honing my presentation skills early in training to providing reinforcement to effective teaching strategies as a staff physician.