Council on Medical Student Education in Pediatrics


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Teaching Tips for Busy Outpatient Clinicians
Memorable outpatient teaching: The sum of many teachable moments.
Ramani S. Medical Teacher 2015;37:971-973.

Reviewed by Michele Haight

What was the study question?
How can teaching in the outpatient setting be transformed into a higher yield learning environment?

How was the study done?
The author uses a case in which a learner made an erroneous diagnosis to demonstrate additional opportunities for “teachable moments” that enhance teaching in the outpatient setting. The author notes the time constraints of outpatient clinical teaching and outlines three strategies designed to create “bursts” of teaching across the clinical encounter.

What were the results?
The first strategy is “planning” which includes establishing teaching goals for the session, promoting a positive learning environment and encouraging learners to generate clinical questions through chart review. The second strategy is “efficient teaching.” This creates opportunities to diagnose the learner’s clinical reasoning through probes and prompts, plan for bedside maneuvers to confirm or dismiss diagnostic hypotheses and observe learner/patient interactions. It is recommended that this type of teaching take place in the patient’s room. The third strategy is “active reflection, ” which ideally occurs at the end of the session. This allows for summarizing key teaching points. It also generates a format for both the teacher and learner to reflect upon their own performances and to identity areas for improvement.

What are the implications of these findings?
These are simple steps that can serve to improve teaching and learning in the outpatient arena through focused teacher/learner interactions. Maximizing the educational potential of ambulatory clinical teaching “routines” through added strategies is an efficient and effective way to teach and learn.

Editor’s Note: The author does a nice job reviewing many evidence-based strategies for direct observation, efficient teaching and self-reflection and showing how they might apply to a single patient encounter. (JG)

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