Teaching Resident Physicians to Be Educators
BEST Module 5: Work Rounds/Group Teaching
Bringing Education & Service Together (BEST) is an interdisciplinary service learning project for resident physicians
- Faculty Guide - Module 5 - Work Rounds/Group Teaching
- Handouts - Module 5 - Work Rounds/Group Teaching
- Lesson Plan - Module 5 - Work Rounds/Group Teaching
- Slides - Module 5 - Work Rounds/Group Teaching
By the end of the module, residents will be able to:
- Define the elements of the “LMNOPQRST” approach to small-group teaching.
- Practice work rounds and personalize the “LMNOPQRST” approach by participating in a simulation exercise.
- Employ effective small-group teaching techniques.
- Small-group teaching may include inpatient rounds (work rounds, morning report) or other small-group settings (problem-based learning sessions, ambulatory rounds, multidisciplinary rounds and other groups).
- A distinguishing challenge of small-group teaching is that the teacher must facilitate learning for multiple learners at once. These learners may be from different training levels or from different disciplines.
- Even when an attending physician is present, the senior resident can still take a leadership role during rounds.
The "LMNOPQRST" Approach
- Who are all your learners for this small- group discussion?
- Why are the learners here?
- All team members (teacher and learners) should meet to:
- Get to know each other.
- Discuss mutual expectations for time together (how patient care, teaching and learning will occur).
- Set an agenda for rounds.
- Emphasize team cooperation and creating a safe educational environment.
- Inform learner that they will be asked questions during rounds to identify areas of high-yield learning.
- Help create a positive learning climate by ensuring that everyone in the group knows each member’s name, discipline and training level.
- As always, teach through questioning. The "five microskills" model by Neher et al. works well. (See "Questions" below.)
- Briefly establish learning goals for rounds, starting with the learners.
- Is there anything they especially want to learn today?
- What are your goals for them?
- How can you best organize rounds?
- During the time you have?
- Take into account the number of patients to discuss and any other scheduling factors (clinics, other time constraints) as well as your learning goals for the team.
- When learners present their patients, have team listen without interruption.
- Be a focused listener.
- You can set guidelines for the length and format of case presentations and conditions that might prompt the teacher to step in.
- Encourage independent thought to teach and asses clinical reasoning.
- Tell learners what you expect to hear when they present new patients.
- For ongoing patients, presenters can give a one-sentence case summary, followed by a summary of overnight progress and a review of the problem list with updates on management and disposition, including plans for the day.
Use the five "microskills" to maximize "teachable moments" for each case:
- Get a commitment (a plan)
- Probe for supporting evidence
- Teach general rules
- Reinforce what was done right
- Correct mistakes
Make sure each team member participates in the discussion, gently prompting nonparticipants as needed.
Lower-order questions test learners' recall of factual information (e.g., "What is Murphy’s sign?").
- Higher-order questions go a step further and test learners' ability to synthesize and analyze information (e.g., "Given these physical findings, how would we now alter our differential diagnosis?").
- Try to incorporate some of these “thinking questions” into rounds too.
Teaching opportunities can focus on one or more of the following:
- Patient care: Role-modeling, clarification of the history, PE findings, correction of clinical reasoning, communication.
- Learners' questions: Questions asked explicitly by learners or implied by other comments.
- Attending's agenda: Medical topic teaching, relevant medical literature, other areas of learning.
- Next steps: feedback, debrief, identify areas for deliberate practice, identify learning points to revisit as a team.
Discuss resources for the team's further learning (texts, online resources, other teachers).
Bringing in resources (e.g., articles) can be very helpful in encouraging ongoing learning.