Teaching Resources for Faculty and Residents

INTRODUCTION FOR FACULTY AND RESIDENTS

The Department of Medicine has a major responsibility for guidance of student development throughout the four years of medical school, and the Medicine Externships (Medicine 7-500 and 7-501) are integral to the overall educational process designed to foster clinical competence.  There are significant differences in emphasis between the two clerkships.  It is essential that all tutors, attending physicians and residents understand the Course Objectives and schedule as they relate to their particular student(s).  This will enable both student and teacher to share the same goals and to establish reasonable expectations and will allow the process of evaluation to be fair and objective.

Setting expectations should be an initial activity.  We encourage you to sit down with all learners and teachers (students and residents and attending) to set expectations on Day 1 of the rotation.  This should include:

1.  Go over the student and resident schedule to understand what will take them off the ward (conferences, clinic, days off)

2.  Understand learners’ goals,

3.  Set a schedule of times you will round,

4.  Tell students what you value/expect in student performance (3^rdyr students should be at Reporter moving toward Interpreter, 4^thyears should be at Interpreter moving toward Manager)

5.  Consider having students and/or residents prepare a mini-talk (5-10”) on subject related to their patients

Feedback is one of our most important responsibilities as educators.  Feedback should be provided at midpoint of your rotation and at the end of your time with learners.  Try first asking the learner about their assessment of their performance.  Follow this with your observations about skills, attitudes and behaviors (be specific).  Include any suggestions you may have for improvement.  For the students include your assessment of where they are performing in the O-R-I-M-E scale and what they need to do to move to the next level.  At the end ask the learner if he/she understands or has any question about the feedback. Any potentially serious deficiencies or problems perceived in student performance should be brought to the attention of the hospital coordinator as early in the rotation as possible. 

Ende, J. (1983). Feedback in Clinical Medical Education. JAMA 250(6):777-81.

Irby,D. (1986) Clinical Teaching and the Clinical Teacher. J Med Educ. 61:35-45.

Observer

• A student who is “shadowing”/passive
• This does not meet criteria for passing a 3^rdyear student

Reporter

• The “What” questions
• Accurately gathers and clearly communicates clinical facts
• Performs a good history and physical examination, reliably distinguishing normal from abnormal.
• Demonstrates day-to-day reliability (on time for rounds, follows-up on a patient’s test results).
• Demonstrates responsibility and consistency in “bedside” skills and dealing with patients.

Interpreter

• The “Why” questions
• Able to prioritize patient problems
• Appropriate differential dx (3 reasonable possibilities)
• Interprets data as test results come back.
• Demonstrates skill in selecting the clinical findings which support possible diagnoses
• Should be an active participant in patient care.

Manager

• The “How” questions
• Proposes and selects appropriately among multiple diagnostic and therapeutic options
• Tailors treatment plan to fit patient circumstances, taking into account concurrent diagnosis and treatments, psychosocial factors, and patient preferences.

Educator

• Reads deeply and shares new learning with others. 
• Defines important questions to be answered and has the drive to look for and evaluate evidence needed to guide therapy.
• Is an effective and accurate source of information for patients and families.

The clerkship committee expectations of students are detailed in the evaluation forms found on E*Value. Upon completion of the first medical externship (Medicine 7-500), the student should be able to conduct a complete general physical examination and appropriate special examinations.  In addition to identification of relevant symptoms and physical findings, the student should know the pathophysiologic basis and clinical correlates of these findings for problem identification and problem solving, and based upon a reasoned differential diagnosis be able to plan an adequate diagnostic evaluation using principles of evidence-based medicine.  Students in the second medical externship (Medicine 7-501) will continue to practice and develop these skills and begin to participate responsibly in the management and treatment of patients.

An effective way to encourage independent learning is to use rounds as a stimulus.  Faculty and residents are encouraged to provide students with positive direction through both questions and assignments.  Identify “knowledge gaps” which are directly important to care of current specific patients and assign students to do a (5 minute) minitalk on the topic during attending rounds in two days.  Students really value the opportunity to develop some focused expertise, contribute to teaching and to patient care.  Every encounter, clinical or conference should provoke discussion, questions, and the mutual search for answers.  Preparation by students prior to ward rounds, seminars and tutorials is necessary because they will actively participate with student colleagues and faculty in solving problems.  Faculty can frequently help by suggesting additional source materials or direct literature searching to aid in the student’s search for information.