Medical education 5th year teaching 2

Dr Bishan Rajapakse – Miscellaneous clinical education tutorial (8/2/12)

5th Year medical student teachingPort Hedland – Rural Clinical School Wed 8th Feb 2012

Dr Bishan Rajapakse – Emergency Medicine Advanced TraineePhD Candidate – Toxicology/ Medical Education


ObjectivesObjective based learning

◦CAN Meds PrinciplesApproach to self-poisoning

◦Organophosphate Poisoning case (separate presentation)

Clinical CasesTips for getting the most from

your clinical education


Objective based learning

http://www.slideshare.net/DeirdreB


Objectives vs competency



Practice makes perfect! (or at least unconsciously competent)



Roles



Discussion: what do these role mean to you – give real examples?

Slide from Western Australia ASM May 2011 given by Allan Killen (CEO ACEM)


Do you know your learning objectives?For each clinical context;

◦Overall?◦By term?◦Each day?◦Every patient?

For each learning encounterClarify (& communicate)

objectives◦Before, During and After


Organophosphate Poisoning(see separate presentation)


Self-Poisoning PrinciplesHistory

◦Names of Drug(s) taken◦Quantity/Dose◦When◦Veracity (how believable – operate

on worst case scenario) ◦Co-ingestants (eg Alcohol)

Doctor -Thought processes◦Pharmacokinetics

Onset – peak action - Off-set


Examination & InvestigationExamination

◦Looking for poisoning Toxidromes Eg Opiate toxicity – pinpoint pupils,

decreased LOC

Investigations ◦Fbc, U&Es, LFTs, Blood sugar◦ECG ◦Blood Gases

Acidosis?

◦CXR Aspiration


General Management Principles

DRsABCDE◦Send for help

First resuscitateThen decontaminate if

appropriateAppropriate anti-dote

◦Seek consultation & Expert advice EARLY

CLINICAL CASES(see “clinical ED cases 8-2-12”)


Getting the most from your clinical education AttendanceCommunicate

◦Clarify & develop teacher-learner relationship

◦Update frequently for different contexts

Record & Reflect◦Record patients seen

Ask good questionsAvoid conflict


Barriers to Asking for Helpwhen you don’t know something

Feeling Inadequate◦Knowledge◦Skills

Feeling Guilt & Shame◦Should know this already

Fear of “loss of face”Ignorance to not knowingNot knowing and Not Caring


Strategies to support asking for help

TRAINEE TEACHER / TRAINER

INADEQUATE

GUILT FOR NOT KNOWING

FEAR OF LOSS OF FACE

IGNORANCE

NOT CARING

Recognising that they are still training

Trying to find out information from a quick reference book, or larger text

Learning how to ask a question from a senior

Presenting pt history well Telling what they already

know about the patient

ASKING THE QUESTION

• By recognising that they are still training

• By being compassionate– Remembering what it was

like not to know

– Thinking of subject that they are themselve vague about Obscure rashes dermatology?

• Acknowledging what that trainee knows, and did correctly

• Education – Telling what the trainee

could have done better

– and what they needed to know


Strategies to support asking for help TRAINEE TEACHER /

TRAINER

INADEQUATE

GUILT FOR NOT KNOWING

FEAR OF LOSS OF FACE

IGNORANCE

NOT CARING

Recognising that they are still training

Trying to find out information from a quick reference book, or larger text

Learning how to ask a question from a senior

Presenting pt history well Telling what they already

know about the patient

ASKING THE QUESTION

• By recognising that they are still training

• By being compassionate– Remembering what it was

like not to know

– Thinking of subject that they are themselve vague about Obscure rashes dermatology?

• Acknowledging what that trainee knows, and did correctly

• Education – Telling what the trainee

could have done better

– and what they needed to know

“The only stupid question is the one not asked!”


Communication is KeyBut still - how do we practice it?Insights from Simulation…

◦Practice in front with audience◦Ask for feedback◦Hopefully receive “compassionate

feedback”◦Practice some more & improve


Positive feedback first! Human mind has tendency to negativity“we are like velcro to the negative

feedback and teflon to the positive stuff”

Is the ‘shit sandwich’ is rubbish?◦Or perhaps “insincerity” is the problem?

Give sincere positive feedback on regular basis (builds confidence)

Thereafter give constructive criticism (builds expertise)


Positive Feedback & Constructive criticism

“Whatever your message deliver it with love, otherwise both the message and the messenger will be rejected”

Mahatma Ghandi


Avoid ConflictBe considerate of Staff pressuresBut look after yourself

◦Don’t take abuse – avoid it◦Avoid negative situations where

possible◦If incident occurs – discuss with your

seniorDon’t take it personally


4 Agreements

Be impeccable in your speech

Don’t take it personallyDon’t make assumptionsDo you best

Don Miguel Ruiz


Making MistakesFear NOT making a Mistake!

◦Mistakes are part of learning◦In medicine we must make them

safely Simulation is a safe place! Supervision Debriefing Compassionate feedback Learning


Final Tips!Be social - doctors and non

doctors alike◦Stay in touch with society◦Remember the patient is part of

society & society is part of the patient

Read widely (within & outside medicine)


Tips: Use technology and social media to your advantage..

Presentation on Social media and Emergency Medicine (Mike Cadogan)◦ “Survey of 212 students in 2010 – 90% used social

networking sites, 20% read blogs frequently, 8% had their own blog..” (slide 17/53)

◦ http://www.slideshare.net/sandnsurf/into-the-jungle-of-social-medicine-4719295


Tips: Watch TED talks & Education talks

TEDx - Lawrence Sherman on “Turning medical education upside down”◦Patient centred education

Clinical contact from day one

◦Collaborative◦“WE are all patients”

http://youtu.be/YpSd5u_di9w


TED talks & Education talks

Sir Ken Robinson on Changing education paradigms

http://youtu.be/zDZFcDGpL4U


TED talks & Education talks

Mel Herbert (EM Rap) on today’s Med Ed

http://youtu.be/aOYzUZ1_4Vk

“unless I can get it on my ipod, my ipad, or I can get it in an archived format that I can go over again and again the education is a waste of time… the average person needs to go over it 5 times before it goes into long term memory”


Tips: Show respect, empathy & compassion towards patients!

“You treat a disease you win, you lose, you treat a person.. you win no matter what the outcome” - Patch Adams (Doctor & Clown)

http://www.youtube.com/watch?v=1gTwkAL3kLY


Tips: See if Mind Maps work for you?

mind map this talk!


But most importantly!Never stop doing what you

love doing!Try to lead a balanced life;

Always follow your heart and your "own" dreams as life is too short to follow someone else's dreams

Life is not a race, but unfortunately we live on a race course


SummaryLearn with an objectiveHave an ‘approach’ for PoisoningClinical cases teach us much

medicine◦Ask questions & ask good questions!

Practice & communicate compassionately, Avoid conflict

But most of all “have fun” whilst you learn!

Medical education 5th year teaching 2

Education

larger text thinking

themselve vague aboutlearning

presenting pt history

ted talks

avoid conflict

patientcorrectly educationasking

separate presentation

caring telling