Drs Geoff Stetson (@GStetsonMD) and Jennifer Spicer (@JenniferSpicer4) from the @MedEdTwagTeam take us on a deep dive on how to run effective teaching rounds. We’ll help you improve your skills in creating rapport and inclusion, share concrete tips to be a better ally and upstander for your team, help you find a balance between autonomy and availability, and figure out how to fit teaching into a busy schedule. Your team will thank you!
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Consider reaching out to the senior resident a week or two in advance to connect and discuss roles on the team, structure of rounds, preparing them to lead from day one. Depending on your service, it may be best to start off the first morning sharing the plan for the day, then set the expectation that the senior resident/fellow is going to be leading things from then on.
Consider reaching out to the prior attending about what specific learners are working on, while keeping in mind that this can perpetuate bias, so keep an open mind.
Make sure to introduce all members of the team and take some time to get to know each other as individuals.
Start with an open ended ‘getting to know you’-type question. Instead of asking people where they’re from (which can have loaded connotations), try: “what does home mean to you?” or “what’s a food that reminds you of home?”
Set goals with learners and ask what they want to accomplish. Dr Spicer tries to share her values for the team without a long intro spiel. (Lane 2013)
Allyship as an attitude and a commitment to helping everyone feel comfortable in the clinical setting, and then upstanding is the act of demonstrating allyship.
Justin Bullock, MD’s recent paper is a great resource on how to address microaggressions in the clinical setting. He breaks it down into three steps: pre-brief, the actual addressing of the microaggression in the moment, and then a debrief.
A pre-brief could be saying ‘Bias and discrimination are present in our clinical space and microaggressions are going to happen. Whether they’re based on race, gender, sexual orientation, or body habitus, biases are going to happen. And I want to be the best ally I can for all of you. Not every learner wants the same thing, and it’s really important to ask them deliberately ”‘if something were to happen, what would you like me to do?” Dr Stetson discusses this as a whole group, because some people might not know how to answer, but others may, and it can be enlightening.
In the moment: When handling a microaggression, remain conscientious of your position and privileges and honor the lived experiences and biases trainees have likely encountered.
Debrief: Allow team members to have agency in responding to the incident. What happens in the instance is important, but making sure everyone knows you’re on their team upfront and then talking about it and getting feedback on how you did is really important afterwards.
Share your cell phone number and create a secure team group chat (e.g. WhatsApp). Appropriately lighthearted conversation and humor helps build rapport.
Promote trainees’ autonomy while reassuring learners you are supportive. Consider checking in in person or via text at the end of the day/shift or before bed. The extent and frequency of contact will vary by trainee (e.g. a 2nd year resident may have different support needs than a fellow). Dr Spicer’s strategy is to spend the first two days closely monitoring learners’ practice to get a sense of their skillset and comfort level, and to gauge what areas the trainee may need more support in. Dr Stetson monitors how closely a resident checks in with questions/insecurities.
Be open with the team about the preparation you are doing ahead of rounds to complete necessary work, allow rounds to focus on sharing discussion instead of reiterating data if you’ve already reviewed it.
Reduce mental load by sharing important basics– when does the team meet, when to eat, etc
Consider emailing a brief summary (one-pager) to share in advance that addresses goals and expectations for the team, but be aware that this does not convey tone.
Reassure learners that it’s okay to make mistakes: foster a ‘growth mindset’ among the team that emphasizes learning and applying feedback to improve performance, not perfection. Model learning from one’s mistakes; acknowledge your own knowledge gaps and opportunities to improve.
Cultivate humility and challenge impostor syndrome by being transparent about what you know and don’t know and the strategies you use to refresh your own clinical knowledge. Cultivate curiosity and let trainees teach you or look for answers together.
When teaching on rounds, choose a single pearl to teach for each patient. Think about this ahead of time and prepare one thing for established patients. A tip from Dr Chiu: write down the teaching pearls you go over while rounding, and send a summary email to the team every day. The length of the summary helps assess whether you spent enough time–or too much time–rounding.
Commit to a time to teach! Set aside 10 minutes before rounds or cap rounds at 90 minutes to create space for 15 minutes of focused, didactic teaching to learners. Limit rounds to seeing 4-5 patients that have learning opportunities and see other patients by yourself (Gonzalo JGIM 2013).
Learn to write learning objectives to focus your teaching. Bloom’s taxonomy is a great starting point for optimizing learning objectives to take your teaching from ‘average’ to ‘great’ (Adams 2015).
Being a good teacher requires preparation and intention.
The learning climate and the environment you set on the team is the most important thing to the success of learners: so before all else, make the team environment fun, comfortable, and one where learners are encouraged to grow.
Listeners will review best practices for attending on a hospital team to aid learner development.
After listening to this episode listeners will…
Dr Jennifer Spicer and Dr Geoff Stetson report no relevant financial disclosures. The Curbsiders Teach report no relevant financial disclosures.
Spicer J, Stetson G, Chiu C, Kryzhanovskaya E, Heublein M. “#2 Level Up your Rounding Skills”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/teach. Dec 21, 2021.
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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Comments
Excellent pearls. Thank you !
Thank you for listening!