What are types of clinical skills? How Clinical teaching is different from Classroom? What are the tools? Challenges / Problems in clinical teaching How to improve?

1. Clinical Skills Facilitation
Devender
MAMC

2. Objectives
• What are types of clinical skills?
• How Clinical teaching is different from
Classroom?
• What are the tools?
• Challenges / Problems in clinical teaching
• How to improve?

3. What do we do in Clinics?
• Structured and specific ?
• Clinical decisions in the context of patients’
lives

4. Types of clinical skills
• Communication
• Physical examination
– Inspection
– Palpation
– Percussion
– Auscultation
• Procedure
• Reasoning

5. How Clinical teaching is different
from Classroom?
• Cannot “cover” all content in your area
• Focus on application of knowledge
– Dx work-up, interpretation
– Formulating treatment plans
– Communications with clients, staff

6. • Facilitate the transition to being the doctor
– Active involvement
– Accept responsibility
– Create opportunities for students to
be the doctor
• Promote critical thinking, decision-making

7. Clinical tools
• Peyton’s 4-stage approach
• George & Doto’s 5-steps
• Experiential learning
• ‘One-minute preceptor’ model
• SNAPPS

8. • Demonstration
– The teacher performs the skill in real time without comment.
This step is taken to provide a benchmark
• Deconstruction
– The teacher performs every step slowly with an added
explanation. The skill should be divided into smaller subsections
• Comprehension
– The student describes every step of the skill whereupon the
teacher performs on instruction. The description and execution
do not occur simultaneously
• Execution
– The student simultaneously narrates and executes step by step.
Peyton’s 4-stage approach

9. Peyton’s 4-stage approach
- Demonstrate, normal speed, no explanation
- With explanation of each step, allow
questions
- You do, Learners explains, you question
- Learner does and explains

10. George & Doto’s 5-steps
• Step 1 Overview
– To be motivated to learn a skill, the learner must
understand why the skill is needed and how it is used
in the delivery of care
• Step 2 Demonstrate silently & exact
– The preceptor should demonstrate the skill exactly as
it should be done without talking through the
procedure
– This silent demonstration gives students a mental
picture of what the skill looks like when it is being
done correctly

11. • Step 3 Demonstrate
– The preceptor then repeats the procedure but
takes time to describe in detail each step in the
process
• Step 4
– Students talk through the skill
– By asking students to describe step by step how to
do the skill, the preceptor will ensure that the
students understand and remember each step in
the sequence of performing the skill
• Step 5
– The students perform the skill.

12. Experiential learning cycle
Planning

13. Questioning
Discussion
Presentation
10 Minutes of “Teaching Time”...
3 Minutes
6 Minutes
1 Minute
The One-minute Preceptor

14. 1. Get a Commitment
2. Probe for Supporting Evidence
3. Reinforce What Was Done Well
4. Give Guidance About Errors or Omissions
5. Teach a General Principle
5-Microskills

15. SNAPPS
• S - summarize the case
• N - narrow the differential (3)
• A - analyze the differential
• P - probe the preceptor
• P - plan management
• S - select an issue for self directed learning

16. Challenges
• Time pressures
• Competing demands - clinical, admin, research
• Increasing numbers of students
• Lack of clear objectives and expectations
• Lack of congruence/continuity with the
curriculum
• Emergencies

17. Problems
• Inadequate demonstration
• Imprinting of past obsolete/incorrect
• Improper correction/reinforcement
• Affective factors (Behavior) ???

19. How to Improve?
• Go with an objective
• Make discussions relevant
• Teach a general principle/ competency
• Follow through with time commitments
– Rounds start at 8:15 a.m.
• Be cognizant of students’ other
responsibilities
– Fatigue
– Time of day

20. Conclusions…..
• Students as competent clinician
– Encourage students to become independent
learners
• Students - who are critical thinkers
• Students as explorer
– Give students the opportunity to figure out the
answers themselves