Learning to be a Teacher

On Friday afternoon, I gave a 30-minute teaching session for the third-year clinical clerks (CC3’s) on blood films using four cases as a framework: Hodgkin’s lymphoma, multiple myeloma, thrombotic thrombocytopenic purpura (TTP), and acute myeloid leukemia.  My aim was to target the teaching session towards their upcoming Internal Medicine Objective Structured Clinical Examination (OSCE).  The purpose of an OSCE is to have objective criteria by which to evaluate the clinical competence of trainees and their overall interaction with patients.  It has been shown in literature that the OSCE also evaluates areas such as communication skills and being able to handle unpredictable patient interactions.  (Zayyan, 2011). In Internal Medicine clerkship, both Faculty and students have indicated that incorporation of an OSCE motivates them and provides opportunities to reflect on learning. (Cruzeiro & Bollela, 2014)

During my teaching session, to address their upcoming exam, I tried to go through Q&A in a structured format.  I asked the CC3’s a variety of sequential questions for each case such as what questions they would ask on history of presenting illness, which physical examination maneuvers would be important, investigations and interpretation of the blood film or biopsy, and what their differential diagnoses were.  One of the challenges of physical examinations is that a focused physical examination for a complaint may actually involve multiple organ systems and having an approach is important.  One of the mock cases in my teaching session was the first case on Hodgkin’s lymphoma.  In the scenario, the patient presented with a neck lump and constitutional symptoms.  We reviewed the lymph node examination and the names of the nodal regions that should be palpated as well as the concerning features.  In addition, organomegaly would be part of a focused physical examination here and this allowed us to discuss the JAMA Rational Clinical Examination for splenic enlargement.  These cases also provided us with an opportunity to revisit the pathophysiology of these disease states and how the conditions are managed.

Thinking back to some of the experiences that I have had, there are several techniques for teaching that are engaging.  I particularly enjoyed the EBM rounds that we had earlier in this selective, in which we critically analyzed a paper on edoxaban for the treatment of cancer-associated venous thromboembolism.  We split up into smaller groups within a large audience to answer a subset of questions before reconvening and sharing our analyses.  Other techniques that work well include the team-based Jeopardy at morning report, hands-on learning such as with a simulator like Harvey, and the use of online surveys (or Student Response Systems/iClickers) such as the one used in the Harm Reductions lunch-time rounds to gauge medical professionals’ opinions and practices.  There are several creative ways to engage audiences when teaching and I hope to incorporate some of these strategies next time I get to teach!

SH

Resources:

Zayyan, M. (2011). Objective Structured Clinical Examination: The Assessment of Choice. Oman Med J, 26(4): 219 – 222.

Cruzeiro, M. & V. Bollela. (2014). Faculty development of an OSCE in an internal medicine clerkship. Medical Education, 48(5): 545 – 546. DOI: 10.1111/medu.12472