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Family Medicine Chief Resident Advocates Residents as Teachers

Benjamin Huff, MD, Chief Resident in Family Medicine at the University of Tennessee Graduate School of Medicine, recently presented at Family Medicine Grand Rounds video clips of time-saving teaching techniques that teachers with learners can use in the ambulatory setting when seeing patients. These videos were produced by William P. Metheny, PhD, Assistant Dean, Graduate Medical and Dental Education, and Rick Green, Audio Visual Coordinator, Health Information Management and Services with funding from Physicians' Medical Education and Research Foundation. Patrick C. Alguire, MD, from the American College of Physicians wrote the scripts for the videos as examples of case-based learning, which he developed from his textbook "Teaching in Your Office." Models discussed include active and passive approaches.

Dr. Huff said Microskills is the "quintessential model." This model, also known as the One-Minute Preceptor, uses five steps to involve the learner in critical thinking about the case. The first step, Getting a Commitment, allows the learner to provide an opinion on what may be going on with the patient. The next step, Probe for Supporting Evidence, asks the learner, "What led you to that conclusion?" The third step is for the resident to Teach General Rules, such as, "When you see this, think this." The next step is to Reinforce what was done right and why it was right. The final step is to Correct Mistakes, letting the learner know where he/she went wrong and how to avoid it in the future.

Model Problem Solving, a passive teaching approach, occurs when the teaching physician "thinks out loud" while examining a patient, going through the Microskills in essence. Dr. Huff cautioned that while in some cases this style may make the patient more comfortable with the physician, in other cases, this style can cause patients to question the physicians' credibility, knowledge and skills.

Dr. Huff also discussed the One-Minute Observation. In this model, the teaching resident observes one piece of a patient examination or history taking, allowing the teacher to focus on one skill as a teaching opportunity. Over time these small snapshots will lead to a larger picture and assessment of learner knowledge and skills.

In his presentation, Dr. Huff also warned about the pitfalls of case-based learning, which include taking over the case, asking too many questions, not allowing enough time for the student to form an answer and not giving feedback.

"It's not until you actually teach that you solidify the material," Dr. Huff said. "Medicine is constantly changing, so we must continue to teach and be taught."

March 12, 2013