#35 Learner As Educator with Dr Travis Crook

June 20, 2023 | By Molly Heublein

Audio

Dr Travis Crook (Vanderbilt) shares his passion for teaching on this special Cribsiders-Teach Collab on the learner as educator.   We cover the continuum of health professions learners from undergraduate to graduate, including both direct teaching skills along with educational theory important for a career as a clinician educator.   Whether you are looking for practical tips to get started with one on one teaching opportunities with your learners or want to create a formal “learner as educator” program at your institution, you’ll get valuable pearls.

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Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Best Piece of Advice
• Picks of the Week
• Case from Kashlak Children’s
• Academy of Resident Educators 
• Continuum of Professional Pathway from Medical Student to Attending
• Medical Students
• Building Excitement/Enthusiasm
• Barriers to Teaching as a Learner
• Resources to Build a Learner as Teacher Program
• Interprofessionalism
• Identifying Goals
• More resources to build a Program
• Case Continued
• Supporting a Learner directly to Teach
• Teaching with Intention
• Peer Mentorship
• What is the Evidence?
• Adult Learners
• Teaching Skills (vs Knowledge)- Simpson’s Taxonomy
• Supporting Learner-Teacher via Feedback
• Take home points
• Outro

Dr. Crook is an Associate Professor of Pediatrics in the Division of Hospital Medicine at Vanderbilt. He is the director of the Pediatrics Clerkship and the Director of the Clerkship Year as well as the Director of the Master Clinical Teacher Program at Vandy. He has a passion for evidenced based medicine and, more importantly, understanding why we do the things we do to care for our patients.

Learner as Teacher Pearls

1. “Don’t just get stuck on the teaching, and think about what it means to be an educator.”  Formal learning pathways for health professions educators should include direct teaching skills (ie chalk talks, bedside education, etc) and also cover some of the less tangible skills (administrative responsibilities, educational theory, feedback, etc)
2. If you’re helping a learner improve teaching, know your goal outcome.  Are you trying to build a formal program for learner-educators or mentor a specific learner?
3. Help learners gain confidence!  If learners want to teach, do it!  It’s okay not to know everything; it’s okay not to have all of the answers.  Providing teaching is better than nothing – just start there, you are adding value! 
4. Be intentional with your modeling.  Tell your learners why you are doing what you are doing.

Learner as Educator Show Notes

Learning Pathways such as the Academy of Resident Educators

Formal learning pathways, such as the Academy of Resident Educators, cofounded by Dr. Crook and Dr. Prathit Kulkarni, when they were second year residents, can help learners who are passionate about teaching understand the framework and receive the training to succeed as an educator.  Dr. Crook felt building this learning pathway as an Academy valuably demonstrated the seriousness of it- learners need to apply, successfully meet requirements, and meet goals that provide accountability.   The Academy goes beyond just direct teaching skills like chalk talks and bedside education, but also covers some of the less visible skills needed as an academic clinician educator (administrative responsibilities, educational theory, feedback, showing worth with educational value units or an educator portfolio, etc).  Programs like these can help early educators build their professional identity (Moza 2015). 

Dr Crook, “Don’t just get stuck on the teaching, and think about what it means to be an educator.” 

Continuum of Learning

The professional pathway toward becoming a medical educator is a continuum.  This should start with medical students and build along levels of learning, in the same way that we have clinical competencies for different stages of learners. 

In creating a curriculum for learner-educators, be intentional about the goals.  Use backward design: decide your outcomes then design assessments and learning activities to make sure your learners meet these goals (White 2021).  (Check out our episode with Dr. Kendra Van Kirk on Backward Design if you are interested to learn more).  It is important to consider the whole professional continuum, and sequence the curriculum. 

In medical school, take senior students who may be showing interest in a future as an educator and allow teaching opportunities with junior medical students.  Start the journey of curiosity around educational theory – the goal is not to teach it all to early learners, but to help nurture their interest (Dandavino 2007).

In residency, how do we make sure graduates are ready to step into the role as educators?  If we can get learners excited and build curiosity to learn more, they can succeed.  Dr Crook says, “Education is not providing knowledge, education is kindling that fire.”  Dr. Crook highlights that teaching is not about your personality or natural level of enthusiasm, the important part is reaching your learners.  If education fills your bucket and brings you joy and energy, it may be the path for you.

Barriers to teaching

Time, energy, money, confidence.  Dr Crook highlights that confidence is probably the biggest barrier, especially for learners who are in the stage of forming their professional identity as educators.  We need to model that it’s ok to not give the perfect lecture.  “You are enough and some teaching is better than none.”

Building a program at your institution.

If building a learner as educator program, having mentors and sponsors who can support you while giving guardrails are key to success.  Find others who have done this and talk with them- educators want to teach and want to talk about their passions.  Dr. Crook recommends it’s okay to just google and cold email people who have gone through this.  AAIM Residents as Teachers Curriculum  and MedEd Portal have valuable resources.  In Dr Crook’s opinion, toolboxes and published reports can be helpful, but asking people what worked and didn’t can be even more valuable.  Go to conferences, such as  AAMC and GEA program educators conferences/residency leadership education conferences. 

Interprofessionalism

Incorporate social work, nursing, NPs into your program- this can help build buy-in from leadership, benefit a greater swath of the institution,  and allows more mentors with a variety of expertise to get involved.  Learners from different backgrounds come with different lenses; having interprofessional educational programs can push educators to vary strategies, adapt levels of teaching.

 “Learners don’t fail to learn; teachers fail to teach.” – Dr. Crook

Identify specific Goals 

Without highlighting a clear outcome, it is impossible to identify success or when you have gone off course.  If a learner is exploring ideas about ways to integrate more teaching curriculum, are they trying to get more personal mentorship? Build something for selected residents?  Build something for all residents?

For a program directed at self-selected participants who desire to focus on education, Dr Crook stresses the importance of well-rounded focus.  While being great teachers is important and often the invigorating aspect of a career as a clinician educator, it is important to also be intentional about including theory, administrative duties, and more about what a profession as a medical educator looks like.  Be ready to adapt and change: curriculum should evolve over time, there will be things that don’t work right the first time, and these need to improve.  Understand that residents are busy- find ways to balance the time/energy trade off.

Specific tips for working with Learners who want to Teach

Directly put the senior learner in the role of teacher:

1. Pick a specific topic or skill. For example, assign the learner to teach one part of the physical exam to the medical student. Explore interests, strengths, and weaknesses with the senior to help pick an area of focus.  
2. Provide support. 
   1. Help narrow down specific teaching objectives – what are they hoping to have the junior learner go home with?  
   2. Teaching skills (for example cardiac physical exam) is different from teaching knowledge (cardiac anatomy).  Bloom’s Taxonomy is more helpful for considering learning objectives around knowledge, Simpson’s Taxonomy is more valuable in skills based objectives (Simpson 1966).  
3. Provide guidance in creating a teaching plan. 
   1. Have the intern talk you through the agenda, “if you were going to teach this, walk me through it?”  Walk backward from the learning objectives to make a plan. 
   2. Help the learner consider better ways to teach. How can we get creative about this?  
   3. Lead the learner instead of showing them. Give them an outline or framework, and let them fill in the blanks to build the teaching themselves.  
4. Make sure to debrief.
   1. Ask the educator: what went well, what didn’t go as well as you hoped?  What can we change for next time? 
   2. Point out the intentionality of planning teaching sessions with modeling- “remember when we started planning for this teaching, how I probed you to narrow down your goals, this is why we did that.”  
5. Name when you are teaching, since this creates a safer space to explore and push than if you are asking questions directly related to patient care.

Check out more tips on teaching physical exam skills from our episode with Dr André Mansoor on Teaching the Physical Exam.

“The difference between teachers and educators is intentionality.  Teachers get up there and teach and they have natural talent.  Educators are intentional with the messages they are trying to get across.” – Dr. Crook 

Peer Mentoring

There are benefits to (near) peer teaching relationships.  Relevance and applicability are heightened.   It is easier to be vulnerable and share with someone in a similar role (Mohd Shafiaai 2020)

What’s the Evidence

In other fields, for example research, learners who start these processes early (in undergraduate education) are more likely to gain more grants.  It is much harder to measure outcomes and study the success of medical educators.  Dr Crook suggests that even though we don’t have the evidence directly, hopefully we can transfer knowledge from other approaches, and anecdotally you see that early attendings are more confident and prepared if they have had early training.  This is an area for research.  What are measurable outcomes- chief residencies, teaching awards, etc?  These are hard to track and follow. 

Adult learners

Adult learners are unique in that they are generally more self-motivated.  Draw from their experiences when providing educational opportunities to adult learners. 

How can the attending help support a Learner-Educator?

Feedback is so important.  Use positive reinforcement to help boost the learner-educator’s confidence, “I saw your teaching was good, and here’s why… keep doing this…” or “I saw you doing this, what would take it to the next step is to do it this way”.

Check in with the learner-educator.  Model so they can build the skill set-  the same way that the attending will give feedback to the senior resident around their teaching, they should encourage their senior learner to give feedback to their junior learner (Burgess 2020).

Take Home Points

End rounds with “tell me one thing you learned today, yes patient care is important but you are here to learn.”  Use recall to allow learning moments to sink in.

If you’re helping a learner improve teaching, know your goal outcome.  Are you trying to build a program for learner-educators or mentor a learner?

If you want to teach, do it!  It’s okay not to know everything; it’s okay not to have all of the answers. Your providing teaching is better than nothing – just start there, you are adding value! 

Be intentional with your modeling.  Tell your learners why you are doing what you are doing.

Links

1. K-pop Band Mamamoo
2. These Vital Signs: A Doctor’s Notes on Life and Loss in Tweets by Sayed Tabatabai 
3. Parade on Broadway
4. Daisy Jones and the Six by Taylor Jenkins Reid (book) or (show)
5. @PrathitKulkarni twitter by Prathit Kulkarni, MD 
6. AAIM Residents as Teachers Curriculum 
7. MedEd Portal
8. Turtles all the way Down 
9. ACGME Clinician Educator Milestones

Goal and Learning Objectives

Goal

Listeners will understand the variety of approaches to helping learners of all stages gain important teaching skills. 

Learning objectives

After listening to this episode listeners will…

1. Recognize the unique role of learners as teachers from different backgrounds
2. List the barriers and opportunities for learners who want to be teachers
3. Describe methods that a learner can use to teach a desired skill
4. Distinguish ways to help create environments that best support learners who wish to engage in teaching opportunities 

Disclosures

Dr Crook reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Crook T, Heublein M, Rochat C, Spata M, Kryzhanovskaya E, Chiu C. “#35 Learner as Educator. The Curbsiders Teach Podcast. https://thecurbsiders.com/teach June 20, 2023