TABLE OF CONTENTS

Acknowledgements
Contact Information

Prelude
Rationale for Another Teaching Skills Manual
Structure of the Toolbox
A Brief Review of Relevant Educational Theory
Teaching Ethics in a Clinical Setting: Finding
  Teachable Moments

Preview of Toolbox Features Yet to Come

Core Teaching Skills
 Overview of Skill-Based Teaching
Goal Setting
Giving Feedback
Using the Group
Addressing Emotion
Common Teaching Challenges
  (& Tips for Recovering from Them)


Unique Teaching Issues with Special Topics
DNR Orders
Medical Errors

Resources for Teaching
Annotated Bibliography
Domains for Small Group Teaching

        


     

We teach skills in many settings, including at the bedside, on teaching rounds, in noon conferences, and in small group settings. We have developed a model for small group teaching of communication skills that has been employed in multi-day retreats and also in one-hour workshops. Many principles and practices from this teaching approach are applicable to other teaching settings. The brief overview here provides a roadmap for specific teaching skills, some of which will be developed further in the modules that follow.

Before you get started, you will have an idea of what you want to teach: your teaching objectives, core content to cover, perhaps even the teaching strategy you want to use. The content of your teaching will need to fit within the process of a teaching session, regardless of the teaching strategy you decide to employ. This module provides an overview of the process considerations you should make. Examples of core content for teaching sessions follow in the Specific Topic modules.

Any teaching session will have an Opening, a Middle, and a Closing. For an overview of the skills relevant for a skill practice teaching encounter, see the Resources for Teaching. These teaching skills should be considered as tools that you can use when you need them. Not all teaching encounters will require every tool from your toolbox. The tools described below are considered the most useful for a successful teaching session. In this module, we highlight key activities that should be accomplished in each segment with examples to illustrate the concept described.

THE OPENING

Opening a teaching session requires a few key activities that will set the stage for the rest of the entire session. Opening a session will be necessary whether you have worked together as a group many times or whether it is a new group. How much time you spend during the Opening, and what you do, will depend on how long you have for the teaching session (3 minutes? an hour? a half day? a week?) and how well the participants know each other.

A teaching session often comes in the middle of a busy day, or is set among competing demands. Your job as facilitator is to prepare the participants for the work that is to come. This requires engaging them, identifying goals for the session, setting clear expectations for how the group will work together, and also setting a tone. Each of these tasks is described further below.

Engaging the Group: Focusing the attention of the learners is an important first task regardless of teaching setting. This can often be accomplished very quickly, or with a simple comment (e.g. "I want to spend some time this week working on responding to patient emotion"). With more time, it can help to first elicit pre-existing beliefs the learners may have about the skill of interest. If learners can voice their concerns or skepticism up front, this can go a long way toward diffusing any resistance or anxiety. You can foster discussion about the concerns (e.g. "do others share this concern?") or, if time is short, you can simply ask them to humor you and try something different today and see how it goes. Asking permission to go forward aligns you with the learner and creates a more collaborative atmosphere.

Setting Expectations: Being explicit about what you want from your learners can go a long way toward making that behavior happen. Learners have participated in many learning experiences up until this point and will bring a number of assumptions to the teaching session. You need to help them understand what kind of session this will be (e.g. "This session is about skill practice, so I am not going to stand up here and lecture at you.") If there are certain behaviors you would like from the group, be explicit about those (e.g. "We all are going to be giving feedback to the person in the hot seat, so it can help if you take out your notebook and jot down some phrases or behaviors that you notice that worked especially well for the learner.") By being clear, you are giving learners an opportunity to meet you for the encounter.

Setting the Tone: Setting expectations will only go so far if you do not also follow up by modeling some of what you expect. For example, if you have emphasized group participation, go out of your way to invite group members into the discussion very early on. Respond to contributions positively or invite other group members to respond to a comment, so the tone of collaboration and group work is fostered. If collaboration is a goal for you in teaching, you can invite your participants to help create ground rules that will work for them, or decide on the way the practice sessions will work.

THE MIDDLE

The Middle of the teaching session is where the bulk of the work occurs. This is the skill practice in a small group setting, or the bedside interaction in bedside teaching. If you have done your work setting expectations and focusing attention in the Opening, the learners should be primed to work. Here, more specific goal setting is needed as each learner will need to set goals for the particular learning encounter. The learner will need feedback and guidance forming take-home lessons from their patient encounters. Each of these tasks is described below and also in greater depth in the Core Skills Modules that follow.

Set Up: The task of setting up a skill practice exchange can help all participants to be clear about what the expectations are. This step can focus primarily on setting up the patient encounter. Set up can also create safety by reinforcing the ground rules set earlier and by being clear about the parameters of the encounter (e.g. "You have about 25 minutes in the hot seat. We can start and stop as many times as you like. If you haven't called a timeout within about 5-7 minutes or so, I may do so just to check in with you and see how it is going.") During this stage, other tasks are assigned, including asking group members to observe and give feedback on specific aspects of the encounter.

Focus: Helping the learner identify a focus for the skill practice session can help them attend to a specific set of skills during the encounter. Without focus, there is the potential for too much to be happening during an encounter and the learner will have a hard time making any meaningful observations about it. Identifying a focus, primarily through goal setting with the learner, can also give you and the group a place to focus your observations for targeting feedback. In some cases, like open role-play sessions, where the learner wants to work will define the whole encounter.

Manage Group: Some of your teaching will occur in 1-1 sessions, but more often, you will have a team or other workshop participants to attend to in addition to the learner. Much of what you do in the Opening will help set the expectations and tone for how you want the group to be involved. During the skill practice session, you must continue to monitor them to assure your expectations are being met. Are they paying attention during the skill practice session, perhaps taking notes? Are they giving useful, specific feedback? Are all members of the group contributing, or just a few? Are the quieter members paying attention and do they have an opportunity to contribute if they wish?

Summarize: After working through a skill practice session with a learner, it is important to check back with her and ask what she is taking away from the session (e.g. "Having gone through this, is there a take home point for you?"). Asking this simple question prompts the learner to self-assess her own learning. By naming a specific point, it reinforces it in the learner's mind and she will be more likely to carry it forward from the session. Depending on the learner's reply, you can either simply reinforce their assessment (e.g. "That is a great point to walk away with") or you can offer an additional point you think came from the session (e.g. "You know, I also thought you made great progress with using silence during this encounter. I can see that being a useful skill for you in the future.").

THE CLOSING

The closing of a teaching encounter can get short-shrift because we often run short on time. The work of closing is important because it reinforces the learning that has taken place. Closing can be the place for the faculty to give a summary of teaching points, to praise the group, and give appreciation for hard work done. It can also be a good place to ask learners to identify lessons they are taking away. Key tasks of closing can be conducted in the space of just a minute or two if necessary.

This Overview of the process of a teaching session should provide you with the basic tools you need to get started. The Core Skills modules that follow build on each of these basic tools and the Specific Topics will get you started thinking about your teaching content as well as process.