3/16/17 1 The POWER of Teaching, the Ripple Effects in Clinical Practice. John DeWitt, PT, DPT, SCS, ATC Mel Kidder, PT, DPT, OCS Objectives: By the end of this presentation, the audience will: • Discuss evidence to promote the clinical physical therapist as an educator. • Describe strategies to train clinicians to become more effective educators within clinical practice. • Analyze how residency and fellowship teaching experiences enhance the clinical culture that positively impacts clinical practice and inter-collaborative partnerships. • Discuss how the integration of post- professional programs facilitates talent recruitment, development, and retention. • 2 Ripple effect - a spreading, pervasive, and usually unintentional effect or influence - Merriam Webster 3
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3/16/17
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The POWER of Teaching, the Ripple Effects in Clinical Practice.
By the end of this presentation, the audience will: • Discuss evidence to promote the clinical physical
therapist as an educator. • Describe strategies to train clinicians to become more
effective educators within clinical practice. • Analyze how residency and fellowship teaching
experiences enhance the clinical culture that positively impacts clinical practice and inter-collaborative partnerships.
• Discuss how the integration of post- professional programs facilitates talent recruitment, development, and retention.
•
2
Ripple effect - a spreading, pervasive, and usually unintentional effect or influence - Merriam Webster
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Mel
Patients = 16 yrs
Residents = 20
Students = 192
CI = 7
Jacque
Patients =10 yr, community ed 50
Residents = 3
Students = 354
4
Unlimited potential!
Patients
Roody
Patients = 4 yr, community 400
Students (PT and DO) = 216
What is YOUR professional dream?
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PTs as Educators
Why do we all need to be educators?
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PTs as Educators
• APTA Educational Strategic Plan ‒ Goal 15:
Provide opportunities for academic and clinical faculties to develop approaches to teaching using evidenced-based strategies that are effective in promoting learning
• APTA Vision Statement for 2020 - ….”Guided by integrity, lifelong learning, and commitment to comprehensive and accessible health programs for all people…”
• Embedded in all components of clinical care and all core documents. (CPI, Guide, etc.)
• Elements of education in Descriptions of Specialty Practice (DSP)
PTs as Educators: Descriptions of Specialty Practice
BEHAVIORAL SCIENCES: Teaching and Learning
EDUCATION CONSULTATION and ADVOCACY
Teaching and Learning Theory1234
Implementing and evaluating and educational plan13
Education and Health Promotion2345
Principles of Adult Education1234
Peer-assessment2
Teaching Methodology123
Interacting with Community-based organizations, residency programs234
Expert practitioners are thought to “do something better,” because they know how to do the “right thing at the right time,” and thereby “provide better care.” (Rothstein JM, 1999)
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Vital components in expert practice • Knowledge • Adaptability • Individualized patient-
centered care • Psychosocial sensitivity • Accountable • Excellent observational
skills • Excellent listening skills
(Jenson, et al 2007)
Attributes of an expert practitioner • Recognizes patterns or features • Work toward understanding problem • Collaborates with patient, colleagues • Good at self assessment and
metacognition • Uses various means of clinical
reasoning • Highly reflective
Developing expertise- • Attained in a stepwise fashion • Moves from deliberate, explicit thinking ->
intuitive thinking based on knowledge and experience
• component is reflection
PTs as Educators: Expert practice
PTs as Educators: Expert practice
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“A means by which practitioners can develop a greater self-awareness about the nature and impact of their performance, an awareness that creates opportunities for professional growth and development” (Osterman and Kottkamp, 1993)
REFLECTION
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Clinical Reasoning
Cognition The process of
acquiring knowledge by the use of reasoning, intuition or perception
Knowledge Possession of
information, facts, ideas, truths or
principles Metacognition “the use of different
strategies for thinking more
deeply about [your] thinking or clinical
reasoning”
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Metacogni5on? • “Assis5ng a resident to learn how to assess or cri5que his/her own clinical performance is essen5al and a founda5onal component of the reflec5ve process. Residents must then be able to use different strategies for thinking more deeply about their thinking or clinical reasoning, a process called metacogni*on. The use of worksheets and clinical supervision prepara5on forms that focus on clinical reasoning and judgment are good metacogni5ve tools. Mentors have a good grasp of clinical knowledge aNained through reflec5on on their experience. They challenge residents with ques5ons to facilitate that same growth and development of the resident’s clinical knowledge. Residents must con5nue to self-‐assess performance as a tool for advancing clinical reasoning”
• (APTA, AAOMPT Guidelines ’01) 26
PTs as Educators: Mentors
Often, resident focuses on practice techniques and insufficient time is devoted to clinical reasoning and patient management skills.
PTs as Educators: Mentors Metacogni5on (goals of mentoring)
o Monitor clinician’s thinking processes and conclusions
o Detect rela5onships and inconsistencies between clinical data and clinical paNerns
o Reflect on soundness of observa5ons and conclusions
o Cri5que the reasoning process itself – what have I missed?
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PTs as Educators: Mentors
Six Roles of a Mentor 1. Teacher – enhances person’s skill, intellect 2. Sponsor – uses his/her influence to for the benefit of the
protégé 3. Host and guide – professional socialization for values,
resources, contacts, customs 4. Exemplar – role model 5. Counselor - moral support • All need to occur in a mentoring relationship
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(Levinson 1978)
PTs as Educators: CI vs Mentor?
• (Jenson GM, et al. 2000)
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Student Resident • Goal is to move toward “entry-
level” • Need close supervision to abide
by state and regulatory laws/rules
• Guidance needed for learning, initiative
• Assist them in learning basic skills
• Goal is to move them toward expert practice
• Licensure not an issue so supervision corresponds to need only
• Residents take initiative or guided to delve deeper, research, justify, explain
• Assist them in learning more advanced skills
CI for Student
Mentor for Resident
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Acedemic Faculty Role Models/Mentors
CI Professional Collegues/Mentors
Involved in prof org, PT ed, & clinical practice
Involved in prof org & activities
Involved in prof org & activities, encourage prof engagement
Dedicated to their field and students
Dedicated to their patients, being a patient advocate
Dedicated to their work and patients.
Knowledgeable and up to date
Open, clear and honest in communication, clear expectations, feedback
Knowledgeable and current in their area of practice.
Encourage students to think critically and ask “why”
Patient, made student feel comfortable and welcome.
Creative “Think outside the box”
Modeled Evidence Based Practice
Treated student as member of the team.
Collaborator, “team player”
(+) & respectful with students Respectful of students and prof colleagues
Modeled prof behaviors: Respectful of students and prof colleagues
Well-rounded
Committed to assisting student to learn
Supportive of CI as a clinician and cliniacal teacher, took under their wing
(Jenson et al, 2013)
Why does it benefit you to step into the role as an educator?
• Gratifying to help others • Pure enjoyment of teaching • YOU will LEARN
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To teach is to learn… a generally accepted concept
“Tell me and I’ll forget; show me and I may remember; involve me and I’ll understand.”
– Chinese Proverb “To teach is to learn”
-Japanese proverb
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To teach is to learn: Laying the foundation
• Evidence that teaching
encourages learning and deeper learning
(Reyes-Hernandez et al, 2015)
To teach is to learn: Cogni5ve effects of teaching
Preparing to teach
Presenting to the students
Responding to questions
3 stages of teaching
(Bargh et al 1980)
Tutors learn by explaining
Comprehension-‐monitoring
Answering ques5ons
Genera5ng and
ar5cula5ng explana5ons
Use of examples
Selec5ng and summarizing main ideas
Meta memory
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Peer teachers learn more when using
higher metacognitive
abilities
Integration
Comprehension-monitoring Reflection
(Amorosa et al, 2011)
To teach is to learn
To teach is to learn
(Bargh and Schul,1980) (Fiorella and Mayer, 2014)
Study for the test
Prepare to teach Teach
To teach is to learn– Medical education
• Residency teaching model (Jibson et al, 2010) • Faculty intentional with teaching to residents • Outcomes of each program included an increased career
focus on future teaching activities • Didactic teaching, professional teaching (ie CEUs),
presentations, and clinical education of future residents.
• Near peer teaching, a medical school equivalent, provide med students valuable input for clinical and communication skills and enhance their professional development . (Alkhail, 2015)
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To teach is to learn: Near-Peer teaching
Teacher-Student • Traditional model
Near-Peer • 2-5 years more
experience than the student
• Social and cognitive congruence with student
• Similar learning experiences
Peer –Peer • Peer tutoring = 1:1 teaching
• Resident to resident • Resident to clinician/colleague
To teach is to learn: PT-related evidence
• Near-peer teaching in gross anatomy by 2nd year DPT students to 1st year DPT students ‒ Students
• Found it useful in their learning • Increased performance on practical exam
‒ Peer tutors • Increased their understanding of anatomy • Enhanced their teaching skills • Improved organizational and time management skills • Increased confidence
(Youdas et al 2008)
Why does it benefit you to step into the role as an educator?
Critiquing residents during or after actual teaching encounters
Practice teaching with standardized students
Facilitated interactive discussions in large groups
Facilitated interactive discussions in small groups
20%: no training at all
56%: would prefer more
Educational responsibility at your current place of employment.
No education role
Clinical instructor
Residency or fellowship mentor/faculty member
Intra-facility presentation
Continuing education instructor
Adjunct faculty member (Entry level
program) Academic faculty member (Entry level
program)
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Teaching Competency
Clinical Instructor
for PT Student
Small Group Teaching (i.e.
clinic in-service)
Large Group Teaching (i.e.
residency conference,
grand rounds, etc.)
Professional
Conference (i.e. CSM,
OPTA, etc.)
Academic Course
Patient instruction
*COMPARED TO PHYSICAL THERAPISTS WITH EQUAL AMOUNT OF CLINICAL EXPERIENCE
Residency Graduate Comments:
“I believe it was a very important part of my residency. It helped me expand my knowledge
along with become responsible for it. I recommend that anyone looking into a residency
have a teaching component. “
“I specifically chose my residency because there was an opportunity to teach. I found a passion for
teaching I didn't know I had and it was an important part of my drive to gain a deeper
understanding of the content for the sake of the patients.”
DPT Student Survey: comments
“The residents are early in their careers, are close to their last major learning experiences, and have established technique. They also are getting
constant feedback from their own mentors and experience with patients, and so are able to integrate that feedback into what they teach us. It's a fabulous
part of our curriculum.”
“It helps to have a peer who understands what we are going through…., but having a resident present really helped ease the nerves (especially during the
earlier practicals).”
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Conclusion
• Ripple effect • Flight pattern • Teaching is important to who we are as a profession.
‒ Great value to our patients • Education is key to expert practice.
‒ Teaching and learning found in DSP • Teaching strategies can be incorporated in many aspects
of residency training.
Resources
• Webpage: (www.abptrfe.org) ‒ List of credentialed and developing programs ‒ RF-PTCAS information and application link ‒ FAQ’s re: postprofessional education ‒ Much, MUCH more ‒ Link to Store
• Description of Specialty Practice documents
• Section Websites • Individual Program Websites
‒ Mission, Goals, Objectives ‒ Policies and Procedures ‒ Admission requirements ‒ Financial Information
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