Friday, August 12, 2011

How to Teach

In our orientation to becoming senior residents, we were talking about how to teach. It's common for a lot of residents to feel like teaching is a burden -- teaching less experienced residents and medical students is essentially an additional job and our primary job is pretty much all-consuming. Therefore, I wanted to share a couple of tricks, especially for new interns, about what I've learned about teaching in the last year (especially teaching medical students)

1. Probably the biggest point about teaching is that you DON'T need to be an expert to teach. Lots of interns still feel very inexperienced and diffident. It's normal to feel threatened by teaching. It's normal to feel scared about what will happen if a medical student asks you a question and you don't know how to answer. There's two prongs to addressing these fears:
A) As an intern, you have really learned a lot in the last year/year and a half of training that you have compared to a medical student. Think back to when you were a third year, just starting rotations. Everything was new. Even if you don't know a lot about a topic, what you have to say is valuable to a medical student
B) It's totally okay to be honest about your limitations. If a medical student asks me a question I don't know the answer to, I usually encourage them to look it up and let me know. Everyone learns by looking things up and that's a really healthy habit to get into. I don't think of it as me being an inferior teacher by resorting to having the med student look it up (or looking it up with them), I think of it as me teaching them how to learn.

2. Time. Time is the perennial enemy of the resident. The secret is that teaching doesn't need to take a lot of time -- if you're clever about it, you can even net time from teaching.
A) Make your limitations clear. If I don't have a lot of time to teach, I make it really clear how much time I do have by saying things like: "let's talk about asthma for five minutes" or "here's the five things that are really important to know about Kawasaki disease." This makes the discussion feel complete, rather than rushed. If there are questions I can't answer due to time, I treat that limitation the same way I treat my knowledge limitations -- encouraging the student to seek some answers on their own and regroup with me later.
B) Remember how much you learn by doing. People feel guilty making medical students do work. That's a really, really silly attitude. Most medical students realize that the currency in which they get paid is teaching and the currency with which they pay is by doing work. Even with that transaction aside, medical students are not just there to learn the academic side of medicine; they are there to learn the practical side of medicine. Have a ton of orders to write that's keeping you from teaching? Awesome! Medical students need to learn how to write orders. They also need to learn how to examine patients, talk to nurses, write prescriptions, call outside labs to check on results, call consults and the million other day to day things that make intern's lives hectic. I'll be honest -- it usually does take me more time to teach the medical student how to do these things than to do everything myself, but it doesn't take THAT much more time and I don't feel guilty for ignoring my student.

3. "But I don't know WHAT to teach!" or "I don't know HOW to teach!" It's unfortunate, but we're never really taught how to teach well. Not as medical students and not as residents. But it's not that different from anything else you teach yourself how to do: you learn it by doing it over and over, watching what mistakes you make and trying new things until you get it right. For me, a lot of how I learned to ad lib teach was by creating a couple short teaching talks that I could give and giving those over and over until I felt confident. I learned how the would go, solicited feedback on them from the med students and perfected them. If I'm stressed out or intimidated, I still go back to them. It works best if they're things that are common, so that they're likely to be relevant to one of your patients, likely to be something you know well and likely to be something the student will use again.
For peds, I think the newborn exam is perfect. It's fast, easy to teach, easy to teach while you're getting work done (like admitting a newborn), something all pediatric residents know well and something that's usually totally new to students.

4. Teaching repays you. Besides being fun, making you feel like you've contributed to the next generation of doctors and helping you recruit med student minions to help get your work done, I think the biggest benefit of teaching is how much you learn by doing it. Medical students ask questions I never would have thought of and by having them look it up for me (or looking it up with them), I've learned things I never would have on my own. But even more importantly, by spending my time thinking about how to boil down topics to a few essential points to make them quick and easy to teach, it really helps me remember things.

1 comment:

Neil said...

Loved it!
One way to feel less intimidated by being a teacher is to remember that one is really just a facilitator of learning.
If you can ignite a passion for learning and point the student in the right direction you have done a big part of your "job".
I love how you state that learning on the job is important, that learning how to learn is important. That is what a resident can very easily show a student. The clinical years are the transition from formal to more informal learning and just helping the student realize that is important.
Thanks for sharing this!