Teaching Efficiently

In medical school, most of our didactic learning came during the first two preclerkship years. During clerkship, while we occasionally still have classroom sessions spread out through the year, the expectation is that we will learn primarily through a self-directed manner at home or during our clinical rotations. This learning may come in a variety of forms, including structured morning or lunch rounds, formal bedside teaching, and case-based discussions. Certain clinical rotations such as internal medicine, tend to have more formal teaching sessions, while in other rotations, it is really up to the student to be proactive in asking the preceptor for teaching moments.

Unfortunately, integrating numerous teaching moments into a clinical day may lead to decreased efficiency in delivering care, especially noticeable in community outpatient clinics, where a physician may see up to 60 patients a day. Having a medical student in this setting can result in significant delays, even more so when the preceptor tries to inject important teaching points after each case.
As such, many academic physicians may find it challenging to balance their teaching responsibilities with their primary role as a physician in deliverying efficient, quality patient care. Some, who are extremely motivated to teach, compromise by scheduling fewer patients on the days that students are present, while others who are less enthusiastic about teaching may act more distant toward students. This dilemma speaks to the need for teaching strategies designed for quick case-based learning in fast-paced and time-constrained environments.

Of the many existing teaching strategies, the One-Minute Preceptor (OMP) model has been studied the most and demonstrated to be effective in improving student clinical reasoning skills, knowledge base and case presentation. The model, which recommends five steps for an effective teaching encounter, has been shown to not affect overall clinic efficiency, although studies specifically looking at physician productivity while utilizing this teaching strategy have yet been done. The role of teaching and the art of teaching aren't part of the standard curriculum that all medical students and residents go through, thus resulting in physicians with varying levels of teaching experience. This has certainly been evident as I rotated through the large number of preceptors during clerkship. I can therefore see how incorporating teaching strategies such as the OMP into the post-graduate medical education curriculum (and faculty development) can be beneficial in establishing standards for teaching as well as standardizing learning expectations for students.

One of the reasons why I was interested in this particular selective was that I wanted to learn how to teach and how to teach effectively. However, learning how to teach isn't as easy as it sounds when you consider the different levels of competency of each student, the content-appropriateness based on level of training, the deliverance of the content, and incorporating the teaching moments into a busy day without compromising efficiency and work flow. By being introduced to effective teaching strategies, such as the OMP, early on in our medical career, we can begin to apply them earlier and use them as a springboard in synthesizing our own personal approach to teaching students.

- JJ