- Email: [email protected]
The Two-Minute Teacher
Educational Perspective
The Two-Minute Teacher Richard B. Gunderman, MD, Harprit S. Bedi, MD Key Words: Teaching strategies; point of care; learner; educator. ªAUR, 2013
R
adiology educators frequently find themselves working next to medical students at a view station or in a procedure room. Often the clinical workload is substantial, and relatively little time is available for direct student teaching. In such a context, much of the student’s learning is largely observational, listening as radiologists dictate cases and interact with residents, fellows, and referring physicians. Yet it is important that students benefit from the attention of radiology educators. If not, they may leave the radiology department having learned little and even feeling that they have been largely ignored. How can radiology educators ensure meaningful educational interactions during the clinical workday without setting aside large chunks of time specifically for teaching? One way is to arrive every day with a set of strategies and techniques that make meaningful educational interactions possible in even very short periods. We have developed such a set of approaches, each of which generally requires only a few minutes. At the beginning of the day, between cases, as interruptions in workflow occur, and at the end of the day, the 2-minute educator can draw as appropriate from this set of options to promote learner-educator interaction and foster enhanced learning. This may happen only once or multiple times per day, but each time it does so, it helps to make the most of what otherwise might be a missed educational opportunity. Having such a standard set of approaches can lower the ‘‘energy of activation’’ of teaching. If an educator has no standing set of strategies and techniques to draw on, other demands on time and attention can make it difficult to devise new teaching opportunities on the spot. With this approach, however, the educator has a preexisting menu from which to choose, based on the particular circumstances at hand. Moreover, each approach can be adapted and customized as appropriate to meet the needs of individual learners. These are starting points for an educational encounter, not rigid formu-
las. Finally, this approach can be employed not just by faculty members but by residents, fellows, technologists, and other radiology educators. Here are seven such strategies.
Acad Radiol 2013; 20:1610–1612
3: ESTABLISH A LEARNING CONTRACT
From the Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202 (R.B.G.) and Tufts University School of Medicine, Boston, Massachusetts (H.S.B.). Received April 30, 2013; accepted April 30, 2013. Address correspondence to: R.B.G. e-mail: [email protected] ªAUR, 2013 http://dx.doi.org/10.1016/j.acra.2013.04.021
1610
1: MAKE A CONNECTION Get to know learners. A variety of questions can be posed. Where did they grow up, what college did they attend, what did they major in, what was one of the best classes or learning experiences they have ever had? Did they bring any notable life experiences to medicine? What do they find most exciting about medical school? Have they identified a field or fields in medicine that they intend to pursue? In a one-on-one or small group setting, it is always important to connect personally with learners, and getting to know each learner as a person enables educators to adapt their approach to the interests and needs of each. Moreover, this goes a long way toward establishing a friendly learning environment. 2: EXPLORE WHAT THE LEARNER KNOWS To teach a new topic most effectively, the educator should build on the learner’s prior knowledge (1). Hence it is important to assess the learner’s level of knowledge and experience with the subject matter. Students may range widely in this regard, from a surprising degree of familiarity to essentially no knowledge of a given topic. If we are teaching concepts that are too basic or too complex for the learner, we are likely to squander the teaching opportunity. To avoid this, we need to ask learners questions. For example, ‘‘Tell me what you know about the appropriate imaging workup of suspected ‘‘stroke,’’ or ‘‘what’’ are the typical imaging features of stroke on noncontrast head computed tomography scan?’’ Once you know the learner’s level of background knowledge, you can optimize your time by focusing on the most appropriate next knowledge step.
Another valuable approach is to establish something like a learning contract (2). Having gotten to know learners a bit, the next educator-learner interaction can focus on the learner’s objectives. Why are they in the radiology department? Are they considering a career in radiology? Are they attempting to
Academic Radiology, Vol 20, No 12, December 2013
learn about particular aspects of radiology that they think will be useful in another field? What would they most like to learn? Helping learners identify their objectives is beneficial as a stand-alone motivational tool, and it also helps the educator to tailor teaching more appropriately. In general, education is most effective when it is focused on what learners most want or need to know.
THE TWO-MINUTE TEACHER
patient care units, referring physicians, and pathology departments. Most medical students choose careers in medicine because they want to make a difference in the lives of patients, and inviting them to enhance the efficiency and effectiveness of the radiologist’s work is a great way to help them feel more engaged and useful. 6: PROMOTE PATIENT MANAGEMENT
4: CONNECT TO EMOTIONS OR EXPERIENCES When a learning experience is linked to a past emotion or experience, the learner is more apt to remember the event (3). As particular clinical cases arise, it can be helpful to ask learners if they have any clinical or personal experience with similar cases. Suppose, for example, the case is a head computed tomography (CT) scan obtained to rule out stroke, or an abdominal CT to assess for appendicitis. Has the learner known anyone who had a stroke or appendicitis? What signs and symptoms did that patient present with, how was the condition treated, and what was the experience like for the patient and family? Asking such questions not only helps to situate the imaging evaluation in its larger clinical context but also reminds learners that images are always part of a larger human story. 5: ENCOURAGE COLLABORATION AND RESPONSIBILITY A great way to boost learners’ energy levels is to invite them to become educators. Over the course of a day, educators may encounter aspects of cases about which they would like to know more. This might include the typical presenting signs and symptoms of a disorder, epidemiology or pathophysiology, or clinical management. When this occurs, the educator should often invite the learner to assume responsibility for educating the team about this matter. For example, the student might step away for an hour or so to do some research and then return to the group with a brief presentation. Or the student might work on the task overnight, presenting the next day. A related approach is to invite learners to enter into a collaborative learning relationship. For example, suppose the educator expects to interact with a learner daily over five consecutive days. At some point each day, a topic might arise about which both educator and learner would like to know more. They can simply agree that each will do some reading on the matter at night and then report back to each other the next day. Both of these approaches help the learner to understand that radiologists are eager to learn and always seeking to understand new things, exemplifying the important lesson that a career in medicine represents a lifelong learning commitment. Another great way to move learners from a passive to an active role is to engage them as collaborators in patient care. Medical students at all levels are capable of contributing in different ways to the work of radiologists. They can look up information in hospital information systems. They can phone
When the focus is the case of a particular patient, educators should look for opportunities to get students to commit to a particular course of action. Instead of just asking the student, ‘‘Where is the aortic knob’’ or ‘‘What is the differential diagnosis of a lobar airspace opacity?’’ the student should be challenged to make a decision. Examples include: What are you worried about in this patient? What further diagnostic imaging is needed? What laboratory tests should be obtained? Would you hospitalize this patient? By getting students thinking in the role they seek to assume—namely, the physician managing the patient’s care—educators can increase their level of active engagement. A corollary approach is to ask students to defend their management decisions. What aspects of the available information—history, physical examination findings, laboratory results, and so on—most support your diagnostic hypothesis? On what basis do you conclude that no further diagnostic imaging is indicated, or why do you want to order a CT or ultrasound examination? Why do you think the particular laboratory test(s) you recommended would be helpful in this case? What is your basis for recommending hospitalization? On each point, educators can also ask students where they would turn for evidence (such as the American College of Radiology Appropriateness Criteria) as well as the associated costs. 7: PROVIDE PERFORMANCE APPRAISALS It is important to help learners understand how well they are doing and what they are doing well and poorly. Doing so helps them to do better. Such appraisals generally prove more helpful if they are both relatively immediate and specific (4). Although it is great to say ‘‘You did a great job today,’’ it is more effective to say ‘‘You did a great job in looking up the clinical histories on the patients today. It really helped us to interpret the studies.’’ Appraising the student’s performance on these and other points provides another great teaching opportunity (5). What mistakes did the student make by failing to consider a possibility, rating another one too highly, or connecting elements in the case inappropriately? For example, the student may have omitted a key item in the differential diagnosis, failed to consider the most appropriate diagnostic test, or recommended an inefficient, ‘‘scattergun’’ approach to the workup. The goal is not simply to inform students of their mistakes but to help them understand such errors in a way that will help them do better next time. 1611
GUNDERMAN AND BEDI
On the flip side, it is equally important to commend the student for what was done well. Where possible, such praise should be formulated around specific actions, rather than just a blanket statement. Sometimes the student knows the right answer. Other times the student knows where to turn to find out. In some cases, the student makes the right decision. But getting the answer right is only part of the story. Equally appropriate are the habits of mind and commitments to patient welfare and professionalism students exhibit, and the general approach is often as revealing and praiseworthy as anything specific the student said or did.
CONCLUSION The purpose of 2-minute teaching is not to supplant more lengthy and in-depth teaching opportunities. Instead it is meant to function as an aid to making the most of educational opportunities as they arise on the fly at the point of care.
1612
Academic Radiology, Vol 20, No 12, December 2013
With this repertoire of seven brief educational interactions in mind, educators can do a better job of recognizing such opportunities when they arise, seizing them briefly but effectively, and ensuring that both student and educator time on busy clinical radiology services is put to best use. Furthermore, learning how to teach effectively in a few minutes also provides insights into how to get more out of longer educational interactions, including those that last an hour or more. REFERENCES 1. Mann KV. Thinking about learning: implications for principle-based professional education. J Contin Educ Health Prof 2002; 22:69–76. 2. Pratt D, Magill M. Educational contracts: a basis for effective clinical teaching. J Med Educ 1983; 58:462–467. 3. Zull J. The art of changing the brain. Edu Leadership 2004; 62-1:68–72. 4. Bowen J. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006; 355:2217–2225. 5. Neher JO, Gordon KC, Meyer B, et al. A five-step ‘‘microskills’’ model of clinical teaching. J Am Board Fam Pract 1992; 5:419–424.
The Two-Minute Teacher Richard B. Gunderman, MD, Harprit S. Bedi, MD Key Words: Teaching strategies; point of care; learner; educator. ªAUR, 2013
R
adiology educators frequently find themselves working next to medical students at a view station or in a procedure room. Often the clinical workload is substantial, and relatively little time is available for direct student teaching. In such a context, much of the student’s learning is largely observational, listening as radiologists dictate cases and interact with residents, fellows, and referring physicians. Yet it is important that students benefit from the attention of radiology educators. If not, they may leave the radiology department having learned little and even feeling that they have been largely ignored. How can radiology educators ensure meaningful educational interactions during the clinical workday without setting aside large chunks of time specifically for teaching? One way is to arrive every day with a set of strategies and techniques that make meaningful educational interactions possible in even very short periods. We have developed such a set of approaches, each of which generally requires only a few minutes. At the beginning of the day, between cases, as interruptions in workflow occur, and at the end of the day, the 2-minute educator can draw as appropriate from this set of options to promote learner-educator interaction and foster enhanced learning. This may happen only once or multiple times per day, but each time it does so, it helps to make the most of what otherwise might be a missed educational opportunity. Having such a standard set of approaches can lower the ‘‘energy of activation’’ of teaching. If an educator has no standing set of strategies and techniques to draw on, other demands on time and attention can make it difficult to devise new teaching opportunities on the spot. With this approach, however, the educator has a preexisting menu from which to choose, based on the particular circumstances at hand. Moreover, each approach can be adapted and customized as appropriate to meet the needs of individual learners. These are starting points for an educational encounter, not rigid formu-
las. Finally, this approach can be employed not just by faculty members but by residents, fellows, technologists, and other radiology educators. Here are seven such strategies.
Acad Radiol 2013; 20:1610–1612
3: ESTABLISH A LEARNING CONTRACT
From the Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202 (R.B.G.) and Tufts University School of Medicine, Boston, Massachusetts (H.S.B.). Received April 30, 2013; accepted April 30, 2013. Address correspondence to: R.B.G. e-mail: [email protected] ªAUR, 2013 http://dx.doi.org/10.1016/j.acra.2013.04.021
1610
1: MAKE A CONNECTION Get to know learners. A variety of questions can be posed. Where did they grow up, what college did they attend, what did they major in, what was one of the best classes or learning experiences they have ever had? Did they bring any notable life experiences to medicine? What do they find most exciting about medical school? Have they identified a field or fields in medicine that they intend to pursue? In a one-on-one or small group setting, it is always important to connect personally with learners, and getting to know each learner as a person enables educators to adapt their approach to the interests and needs of each. Moreover, this goes a long way toward establishing a friendly learning environment. 2: EXPLORE WHAT THE LEARNER KNOWS To teach a new topic most effectively, the educator should build on the learner’s prior knowledge (1). Hence it is important to assess the learner’s level of knowledge and experience with the subject matter. Students may range widely in this regard, from a surprising degree of familiarity to essentially no knowledge of a given topic. If we are teaching concepts that are too basic or too complex for the learner, we are likely to squander the teaching opportunity. To avoid this, we need to ask learners questions. For example, ‘‘Tell me what you know about the appropriate imaging workup of suspected ‘‘stroke,’’ or ‘‘what’’ are the typical imaging features of stroke on noncontrast head computed tomography scan?’’ Once you know the learner’s level of background knowledge, you can optimize your time by focusing on the most appropriate next knowledge step.
Another valuable approach is to establish something like a learning contract (2). Having gotten to know learners a bit, the next educator-learner interaction can focus on the learner’s objectives. Why are they in the radiology department? Are they considering a career in radiology? Are they attempting to
Academic Radiology, Vol 20, No 12, December 2013
learn about particular aspects of radiology that they think will be useful in another field? What would they most like to learn? Helping learners identify their objectives is beneficial as a stand-alone motivational tool, and it also helps the educator to tailor teaching more appropriately. In general, education is most effective when it is focused on what learners most want or need to know.
THE TWO-MINUTE TEACHER
patient care units, referring physicians, and pathology departments. Most medical students choose careers in medicine because they want to make a difference in the lives of patients, and inviting them to enhance the efficiency and effectiveness of the radiologist’s work is a great way to help them feel more engaged and useful. 6: PROMOTE PATIENT MANAGEMENT
4: CONNECT TO EMOTIONS OR EXPERIENCES When a learning experience is linked to a past emotion or experience, the learner is more apt to remember the event (3). As particular clinical cases arise, it can be helpful to ask learners if they have any clinical or personal experience with similar cases. Suppose, for example, the case is a head computed tomography (CT) scan obtained to rule out stroke, or an abdominal CT to assess for appendicitis. Has the learner known anyone who had a stroke or appendicitis? What signs and symptoms did that patient present with, how was the condition treated, and what was the experience like for the patient and family? Asking such questions not only helps to situate the imaging evaluation in its larger clinical context but also reminds learners that images are always part of a larger human story. 5: ENCOURAGE COLLABORATION AND RESPONSIBILITY A great way to boost learners’ energy levels is to invite them to become educators. Over the course of a day, educators may encounter aspects of cases about which they would like to know more. This might include the typical presenting signs and symptoms of a disorder, epidemiology or pathophysiology, or clinical management. When this occurs, the educator should often invite the learner to assume responsibility for educating the team about this matter. For example, the student might step away for an hour or so to do some research and then return to the group with a brief presentation. Or the student might work on the task overnight, presenting the next day. A related approach is to invite learners to enter into a collaborative learning relationship. For example, suppose the educator expects to interact with a learner daily over five consecutive days. At some point each day, a topic might arise about which both educator and learner would like to know more. They can simply agree that each will do some reading on the matter at night and then report back to each other the next day. Both of these approaches help the learner to understand that radiologists are eager to learn and always seeking to understand new things, exemplifying the important lesson that a career in medicine represents a lifelong learning commitment. Another great way to move learners from a passive to an active role is to engage them as collaborators in patient care. Medical students at all levels are capable of contributing in different ways to the work of radiologists. They can look up information in hospital information systems. They can phone
When the focus is the case of a particular patient, educators should look for opportunities to get students to commit to a particular course of action. Instead of just asking the student, ‘‘Where is the aortic knob’’ or ‘‘What is the differential diagnosis of a lobar airspace opacity?’’ the student should be challenged to make a decision. Examples include: What are you worried about in this patient? What further diagnostic imaging is needed? What laboratory tests should be obtained? Would you hospitalize this patient? By getting students thinking in the role they seek to assume—namely, the physician managing the patient’s care—educators can increase their level of active engagement. A corollary approach is to ask students to defend their management decisions. What aspects of the available information—history, physical examination findings, laboratory results, and so on—most support your diagnostic hypothesis? On what basis do you conclude that no further diagnostic imaging is indicated, or why do you want to order a CT or ultrasound examination? Why do you think the particular laboratory test(s) you recommended would be helpful in this case? What is your basis for recommending hospitalization? On each point, educators can also ask students where they would turn for evidence (such as the American College of Radiology Appropriateness Criteria) as well as the associated costs. 7: PROVIDE PERFORMANCE APPRAISALS It is important to help learners understand how well they are doing and what they are doing well and poorly. Doing so helps them to do better. Such appraisals generally prove more helpful if they are both relatively immediate and specific (4). Although it is great to say ‘‘You did a great job today,’’ it is more effective to say ‘‘You did a great job in looking up the clinical histories on the patients today. It really helped us to interpret the studies.’’ Appraising the student’s performance on these and other points provides another great teaching opportunity (5). What mistakes did the student make by failing to consider a possibility, rating another one too highly, or connecting elements in the case inappropriately? For example, the student may have omitted a key item in the differential diagnosis, failed to consider the most appropriate diagnostic test, or recommended an inefficient, ‘‘scattergun’’ approach to the workup. The goal is not simply to inform students of their mistakes but to help them understand such errors in a way that will help them do better next time. 1611
GUNDERMAN AND BEDI
On the flip side, it is equally important to commend the student for what was done well. Where possible, such praise should be formulated around specific actions, rather than just a blanket statement. Sometimes the student knows the right answer. Other times the student knows where to turn to find out. In some cases, the student makes the right decision. But getting the answer right is only part of the story. Equally appropriate are the habits of mind and commitments to patient welfare and professionalism students exhibit, and the general approach is often as revealing and praiseworthy as anything specific the student said or did.
CONCLUSION The purpose of 2-minute teaching is not to supplant more lengthy and in-depth teaching opportunities. Instead it is meant to function as an aid to making the most of educational opportunities as they arise on the fly at the point of care.
1612
Academic Radiology, Vol 20, No 12, December 2013
With this repertoire of seven brief educational interactions in mind, educators can do a better job of recognizing such opportunities when they arise, seizing them briefly but effectively, and ensuring that both student and educator time on busy clinical radiology services is put to best use. Furthermore, learning how to teach effectively in a few minutes also provides insights into how to get more out of longer educational interactions, including those that last an hour or more. REFERENCES 1. Mann KV. Thinking about learning: implications for principle-based professional education. J Contin Educ Health Prof 2002; 22:69–76. 2. Pratt D, Magill M. Educational contracts: a basis for effective clinical teaching. J Med Educ 1983; 58:462–467. 3. Zull J. The art of changing the brain. Edu Leadership 2004; 62-1:68–72. 4. Bowen J. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006; 355:2217–2225. 5. Neher JO, Gordon KC, Meyer B, et al. A five-step ‘‘microskills’’ model of clinical teaching. J Am Board Fam Pract 1992; 5:419–424.