This course provides those involved in educating members of the health professions an asynchronous, interdisciplinary, and interactive way to obtain, expand, and improve their teaching skills. These skills can then be applied within their own professional context, with a variety of learners, extending across many stages. After completing this course, learners will: 1. Understand educational theory as it relates to health professions education 2. Match instructional methods with desired educational outcomes 3. Learn a variety of applied teaching techniques 4. Share successful teaching strategies Suggested resources will include educational videos, individual readings, recommended reference books, and crowd-sourced recommendations. All students should have dependable access to the internet with video streaming capabilities. Some students may want the ability to utilize on-line video conferencing as well.
04.03 - "Big Ticket" Technique
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From the course by University of Michigan
Instructional Methods in Health Professions Education
137 ratings
From the lesson
Unit 4
In this unit you will learn about knowledge transfer, including active learning in large lecture formats, supportive questioning, and "Big Ticket" technique.
Meet the Instructors
Caren Stalburg, MD, MAAssistant Professor, Obstetrics & Gynecology
Medical School
Hello again.
We're still talking about ways to help people with their knowledge, and
[INAUDIBLE]
and using techniques to teach both clinically and in large lecture formats.
So this is a very, very brief lecture about what I called
the "Big Ticket" Technique, but let's talk a little bit about it.
So the intention here is to describe the challenges that
we all know are inherent in clinical teaching for everybody involved.
Right? The student,
[LAUGH]
the learner, the patients, who have to wait for us, and
identify a few strategies to focus learning during a clinical encounter.
So you can think of clinical learning as learning in action.
Right?
Where you have the learner with you in a clinical scenario, whether that's
in clinic or in the operating room, or in a home setting, etcetera.
So there's lots of strengths there.
There's lots of things that people learn
while being in the setting, and obviously its real world.
It has great application of their knowledge base.
In some ways, they're acting as an
apprentice, so they're learning our professionals or
ways and ways of communicating what we
had talked about before in Professional Identity Formation.
But, activities are going to be relevant to their future activities and so,
from an adult learning standpoint, it just makes more sense and it's more fun.
And one other thing that's very neat, is that we use
our patient as the pedagogy.
So, whatever the patient's issues are, are what we teach from.
And the patient can actually participate and help in teaching.
Now the weakness, obviously, we all know, is that there are time constraints.
So if you are in a very busy clinic, then it
can be very difficult to take, sort of time out, to teach.
Patient privacy is an issue.
Also, when we have a learner with us in clinics, sometimes we just don't
have any clear goals or objectives, we sort of, don't know what
we're doing, we didn't realize we had a learner with us that day.
And so, many of us as educators actually
feel under supported either with time or with space
[LAUGH]
or with sort of, understanding of, what are we
supposed to do when we have someone with us?
Unfortunately for the student, depending on the situation.
They just may be observing.
And so that's not necessarily learning in action or very effective.
And the situations can just be overwhelming for everyone involved.
For the patient who has to wait, for us, as instructors,
who are feeling sort of, you know, torn between seeing patients
and, and processing information, and creating
electronic medical records or paperwork or,
you know, there's 40 people in line to come to the clinic.
it can just be a lot.
So how do we help manage that?
Well, many, folks have heard about the one minute preceptor.
And let me just share that with you a for a second.
Basically, what happens is your student goes and sees a patient.
And then comes back and presents.
Correlate to you about what that patients situation is
so they can give you the history they can give
you the physical exam results, they may give you laboratory
results but the one thing that you want to do is
actually push them up booms taxonomy into sort of an
interpreter or an, an analysis phase, its basically getting a
commitment from them saying what is the diagnosis that this
patient has or what's your plan of what comes next.
So one of the question that I'll often ask is, so what do you want to do?,
or what do you think's going on?
And once you get that commitment from the
learner, then you need to probe for supporting evidence.
So, basically you're trying to figure out is this person, who
has said, well I think we should order this, this and this.
Know why they want to order those things, and what evidence are they using?
Once you know what they have you can also identify gaps in their knowledge.
And once you have the patient and the pieces together, the
diagnosis plan then you basically just want to teach general rules.
So sort of the take home points.
Like when I see a patient with this, I think this,
and I will often follow up with this or these exams.
You want to reinforce for the learner what
was done correctly by giving them positive feedback.
And you also want to
correct the mistakes with constructive criticism.
So again, thinking about well, in this case
we sort of didn't think about this piece and
so next time when you see a patient with this, make sure you remember x, y or z.
There's a reference at the bottom of the slide
that talks about teaching with the one minute preceptorship.
So, I have personally morphed this idea of
a take home point and general rules, into what
I call the big ticket item.
Because generally, students feel like there's so much to learn
and they just have no idea what to do or
where to start or how to sort of put it
into context and so I call it the big ticket.
And what that means is that each patient or a case has a theme
or an issue, sort of the big ticket item that's important to that scenario.
So after we engage in the clinical care of that
individual, I will ask the learner to say okay, what's the big issue?
What's the big ticket here?
What do we need to think about for this person?
And then I want to define the perimeters for learning.
So let's say we are on labor and delivery
and we have a patient with pre-term labor, so the
[INAUDIBLE]
the big ticket item could be pre-term labor or
if the individual has a uterine anomaly, the big ticket
item could be uterine anomalies and where do they come
from, how, you know, how are they, developed embryologically, etcetera.
So I want to find the parameter for learning; are we talking an
anatomy issue, are we talking a physiology issue, are we talking sort of ideology,
that kind of thing.
So there's lots that you can do with that big ticket.
And once you've defined the parameters then you can focus people's
readings, you can help them review materials and their efforts will actually
not be sort of surrounded by this oh my gosh, you know
I have to read 50 pages tonight of what I don't know.
But again, it helps ground their learning,
put in in context, and helps them assimilate
it into their memory, so they then can become experts.
But the other key piece is that I actually asked them to
track the ticket, and we're going to follow up at our next session.
So if we see patients all day, and we've got five tickets, some of which may be
preventative care or, screening for cervical cancer or
other gynecologic cancers, if we have, a ticket about,
sexually transmitted infections, or a
ticket about, sort of reproduction management.
Then the next time we're in a session
together, I'm going to say okay, let's review our tickets.
Is there anybody on this list today that we've
seen that actually fits in with the other tickets?
and by this technique I found that
individuals actually engage more with the information.
You help
them sort of scaffold their way through it and help them think
about what do they need to read, where do they need to be.
And then you also follow up to ensure that
that learning has been reinforced, and that it sticks.
So I know this has been a very short
lecture, because this is really sort of my idea and
my technique, but what I'm going to do is actually
have you work a little bit of a longer quiz
to help identify, gosh what are the big tickets in a bunch of these scenarios.
Because in this case, I think that a lecture is sort of a hard
way, to help impart this information and
so I'm actually going to take the advantage,
[INAUDIBLE]
that the system gives us and use some short answer, quizzes for this section.
Thanks so much for your time.
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