Context

Academic hospital physicians strive to balance patient care with clinical teaching and team management. Individual styles differ, but the following are some common strategies.

• The One Minute Preceptor 
  • Requires the teacher to involve the learner and provide immediate feedback.
  • Does not require any special training for the learner. 
• SNAPPS 
  • Requires both the teacher and the learner to be familiar with the framework as it is more learner driven.
  • Allows the learner more input in the teaching process.

Plan Ahead

Most effective teaching and management does not happen spontaneously.

• Day 1: establish expectations and priorities for medical students and housestaff, especially:
  • Patient care priorities.
  • Work rounds and attending rounds logistics.
  • Specifics of oral presentations (level of detail, length, references to current literature).
  • Scheduling issues (call nights, clinics, and days off).
  • Process for feedback and evaluation.
  • Specific learning and teaching goals for individuals and the team.
• Every day
  • Identify learning opportunities by taking time before rounds (or the night before) to review patients and possible teaching topics.
  • Identify patients who will require more time for discussion either due to complexity (e.g. ICU patients) and identify patients that may need to be discussed sooner to expedite hospital discharge.
  • Schedule formal teaching (e.g., attending rounds, work rounds, student presentations).

Ward Teaching

Highly rated teachers are enthusiastic, flexible, and teach within clinical context.

• Teaching files: it is never too early to develop or collect teaching files (e.g., pneumonia).
• Clearly identify the goals for instruction and summarize a few key teaching points at the end of every learning session.
• Bedside teaching can be time consuming, but almost uniformly preferred by students and models physical examination and patient interactions.
• Frequent, short, pertinent sessions are highly preferred to episodic long ones.
• Teach clinical reasoning, which can be as valuable as teaching clinical content. Use clinical cases, involvement of learners in decision-making, and explicit discussion of clinical reasoning.
• Turn “to-do’s” and mundane tasks into teachable moments.
• Take time with learners to reflect on family meetings, condolence cards, and adverse outcomes.

Feedback and Evaluation

• Learners respond best if feedback is immediate (e.g., after presentations), frequent (e.g., everyday or call cycle), and specific (i.e., more than “great job”).
• Schedule formal feedback and evaluation.
• An approach to giving effective feedback:
  • Step 1: ask for self-reflection (e.g., “How do you think you’re doing?”).
  • Step 2: focus on types of behaviors, not the person.
  • Step 3: reinforce positive behaviors.
  • Step 4: give specific feedback, use examples.
  • Step 5: develop new goals and a plan for improvement.

Furney SL, Orsini AN, Orsetti KE, et al. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med 2001;16:620-624.

Irby DM. Three exemplary models of case-based teaching. Acad Med 1994;69:947-953.

Neher JO, Stevens NG. The one-minute preceptor: Shaping the teaching conversation. Fam Med 2003;35:391-393.

Pascoe JM, et. al. Maximizing teaching on the wards: Review and application of the One-Minute Preceptor and SNAPPS models. J Hosp Med. 2015 Feb;10(2):125-30.

Wachter RM, Goldman L, Hollander H.  Hospital Medicine, Second Edition. 2005: Chapter 11: Effective clinical teaching in the inpatient setting.