are you in a hurry? - philippine college of physicianspcp.org.ph/documents/46th ac lectures/one min...
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Are you in a hurry?A SHORT LECTURE ON
A QUICK TEACHING METHOD & A RAPID EVALUATION METHOD
Heizel Manapat-Reyes, MD, MHPEd, FPCP, FPRA
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Teaching should be
intentional. http://realestatetalk.com.au/wp-content/uploads/2014/02/wall-clock.jpg
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Evaluation should be
deliberate.
5 Basic Teaching Skills
1. Set induction & Closure
2. Variability
3. Questioning
4. Reinforcement
5. Facilitatinghttp://thumbs.dreamstime.com/x/green-checklist-8400822.jpg
STEPS
Get a commitment
Probe for supporting evidence
Teach general rules
Reinforce what was done right
Correct errors
ONE-MINUTE PRECEPTOR
Get a Commitment
Goal: learner processes the information
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ONE-MINUTE PRECEPTORhttps://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcRjbctK1BEGzdfEBCLpwdRZ8gN8SyEcMSC9QqEmFiofxbzfOn3p
What do you think is going on?What do you want to do?
What tests will you ask for?How will you write your admitting orders?
Get a Commitment
Goal: learner processes the information
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ONE-MINUTE PRECEPTOR
May clarify information
but do NOT take over the case.
Try NOT to be inditimidating.
Probe for Supporting Evidence
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ONE-MINUTE PRECEPTOR
Goal: explore the learner’s mindmap
What is your basis for the diagnosis?
Why did you prioritize those tests?What factors did you consider in choosing those medications?
Probe for Supporting Evidence
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ONE-MINUTE PRECEPTOR
Goal: explore the learner’s mindmap
Do listen carefully.
May elaborate, if needed.
Teach General Rules
Focus on an important area
for the learner and the patient.
Choose generalizable rules than specific facts.
BREVITY is key.
Sometimes, assignments are necessary.
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ONE-MINUTE PRECEPTOR
Goal: target the lesson appropriately
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Reinforce what was done right
Verbal reinforcement of effective behaviors
Be specific.
May be done early to reduce learner performance anxiety. https://s-media-cache-
ak0.pinimg.com/736x/b2/dd/35/b2dd353c007f2a49e316e8b899998a50.jpg
ONE-MINUTE PRECEPTORhttp://www.athleteassessments.com/articles/images/feedback2.jpg
Correct Errors
Choose the setting
Start with self-evaluation of learner
Be specific
Be mindful of the language
ONE-MINUTE PRECEPTOR
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STEPS
Get a commitment
Probe for supporting evidence
Teach general rules
Reinforce what was done right
Correct errors
ONE-MINUTE PRECEPTOR
Let’s try it!
• Form triads.
• Choose who will be the teacher, learner and observer.
• Teacher & learner will discuss the case.
• Observer to give feedback on the interaction.
CASE:
55 yo/M, at the ER for acute onset of right knee arthritis with fever.
The knee is warm, erythematous & with effusion.
Patient on meds for diabetes, had gout in the past.
Miller’s Pyramid for Clinical Competence
MINI-CEX
Context-free MCQ exams
Case-based MCQ, essays, oral exams
Practical exams, OSCE, simulations
Workplace based
Mini-CEX
Focused observation of specific skills
Evaluates the learner in the workplace
Applied to various settings
Multiple observations over time (longitudinal assessment
Takes 5-30 minutes
MINI-CEXhttp://www.bma.org.uk/~/asset/4/13322.ashx?format=2%7C10000
Skills Evaluated tied to Oucomes
MINI-CEX
Medical Interviewing
Physical Examination
Counselling, informced decision making
Clinical judgment, reasoning
Over-all competence
MEDICAL INTERVIEWING
• Facilitates accurate collection of a patient's history
• Effectively uses questions/directions to obtain accurate information needed
• Responds appropriately to non-verbal cues
• Shows respect, compassion, empathy and establishes trust
• Attends to a patient's needs of comfort, modesty, confidentiality and information
PHYSICAL EXAMINATION
• Follows efficient, logical sequence
• Balances screening/diagnostic steps for problem
• Sensitive to a patient’s modesty and comfort
Demonstrates judgment, synthesis, caring, effectiveness and efficiency in patient care
MINI-CEX
COUNSELLING SKILLS
• Explains rationale for test/treatment, obtains a patient's consent
• Educates/counsels regarding disease management
• Discussion is prioritized, timely and concise
CLINICAL JUDGMENT
• Selectively orders/performs appropriate diagnostic studies
• Considers risks and benefits of prescribed treatment
Demonstrates judgment, synthesis, caring, effectiveness and efficiency in patient care
MINI-CEX
Rule Description
Correct positioning Avoid being in the line of sight of the learner & patientMake sure you can view techniques of the learner
Minimize external interruptions
Avoid taking routine calls
Avoid intrusions Don’t interject or interrup, if possibleExemption: trainee is giving wrong information
Be prepared Be focused on the goals of the encounter
SIMPLE RULES FOR OBSERVATIONS
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