Balancing your workload as a junior doctor whilst teaching medical students effectively is difficult so here are some tips!
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As a junior doctor, it is a requirement to have provided teaching each year. You need evidence to support this (example feedback form). It is also vital for your future career plans: all training programmes will ask you about your teaching experience, evidence of it & a reflection on the feedback you’ve received. I’m happy to support anyone interested in medical education (or if you want to get involved with my online websites etc.) – do leave a comment!
In terms of the best way to collect evidence, I recommend making a Google Form and giving all students a customised shortlink using bitly.com. This allows you to create lovely summaries with graphs – the interview panel won’t have the time nor interest to read every feedback form.
Example feedback form to customise & print
When you have too many students or too much work
- Get them involved with the ward round
- Ask them to clerk the last few patients on your ward round in order to present them to the consultant or registrar
- Ask them to review and present the ECG or chest x-ray (thereby getting it up for you for the ward round)
- Prepare notes for the next patient you’re about to see
- Stay with an interesting patient to clerk them & write this up. Bonus points if they use their clerking & review of investigations to prepare a discharge summary
- Help you with jobs
- They can prepare referrals, obtain observations or a urine sample (supervised by a nurse), obtain collateral histories or complete forms like an MMSE
- Shadow a nurse administering a medication (thereby also reminding the nurse to give it)
- Shadow others e.g. pharmacists, therapy team, dieticians or specialist nurses
- Practice a history or examination (print out a mark sheet from my other website) until they don’t miss any steps and demonstrate this to you later
- Perform skills such as cannulation, venepuncture or ECGs & subcutaneous injections with the nursing staff
- Accompany patients to their endoscopy or imaging
- Go to clinics
Pitching it at the right level
Everyone remembers that one lecturer in medical school who delivered their lectures at PhD level to first years…. It just doesn’t work. Consider asking their allocated clinical tutor, reviewing their logbooks or asking their medical school for advice on curriculum and objectives. Here’s a rough guide:
|Pre-Clinical Year||Remembering all the headings|
(HPC, PMH, FH etc.)
|Knowing the steps of the examination|
(but not necessarily interpreting findings)
|First Clinical Year||Focus on exploring differentials|
Asking relevant associated questions
|Performing all parts of the examination well|
Identifying clinical signs
Presenting their findings
|Second Clinical Year||Addressing Ideas/Concerns/Expectations effectively|
e.g. abdominal pain: urology, gynae, surgery, gastro
|Performing specialist examinations|
Identifying most clinical signs
Presenting their findings
|Third Clinical Year|
(or pre-FY1 year)
|More relevance to investigations|
Explaining & considering management
|Tying together clinical signs effectively|
Presenting findings succinctly
Considering further management in an MDT fashion
Getting everyone to engage
Aim for activities or case-based discussions that require students to actively problem solve and answer questions. If one keen bean is answering all the questions, consider directing your questions to particular students. If students are particularly quiet, you can get them to work in pairs and then present their joint answer. Bedside teaching is brilliant as students usually take turns.
To avoid students getting anxious if you pick them, explain at the beginning that you’re going to increase the difficulty of questions until you find a place where they are challenged & get things wrong otherwise you’re teaching them stuff they already know.
Providing constructive feedback
Focus on things students did well and then discuss things to improve on next time. For example, if they missed a vein whilst trying to cannulate a patient, remind them that they followed the correct ANTT procedure fully and then suggest perhaps tethering the vein next time. Reassure them that if they do this next time, they are more likely to succeed.
Aim for goal focussed feedback: “Examine 2 patients each week, present their findings asking specifically for doctors to critique your presentation of findings”
How to prepare & plan for sessions effectively
Make sure you’re knowledgeable in the subject area or that you do some pre-reading. Mind the Bleep or our OSCE website are great websites to use for this purpose & handouts!
For classroom or formal teaching
- Review the lesson plan provided by the medical school
- Plan your learning objectives & content so you can neatly fit it whilst leaving time for questions
- Consider what you want them to achieve and how (read the “Pitching it at the right level”)
- For example, if you want them to consider differentials, ask them to come up with a list and one by one go through what the relevant questions would be
- If you want them to understand a difficult topic – provide pre-reading materials and present a case for them to work through in the session (known as flipped teaching)
- Ensure you have a range of group tasks to keep them engaged. Avoid lecturing them by talking incessantly – they will quickly lose interest in the same way you probably did in medical school
- If you’ve not prepared anything, consider asking them to bring a case. You can always focus on history, investigations or management of the case or differentials leading to that presenting complaint
- If you’re not particularly knowledgable about an area use the principles of problem-based learning where the students identify areas they feel unfamiliar with (terms & themes) and identify learning objectives that they can read about and present at a future session that you organise. You can use this time to do the same reading then consolidate the learning with them.
For bedside teaching
- Remember this is what students often crave. They can learn theory from a textbook but doing the skills and seeing patients – this is exciting and intimidating
- There are many formats you could use – find what works for you & your students
- For histories
- You print out actor briefs & mark sheets & get them to take histories from each other or you and then provide feedback
- With a real patient, you ask them to focus on different aspects (history of presenting complaint, family history, past medical history etc.)
- You allocate several patients for them to take a history from and present back to you
- For examinations
- You perform an examination on a student or patient, slowly demonstrating how to perform each part correctly
- One student performs the full examination & the others examine for a specific sign. The first student presents and you discuss the case
- Students examine the patient and present the case to you afterwards. You then go with them to re-examine the patient to confirm their findings and address issues
- You ask students to rotate around several patients in pairs and then at the end you take them around demonstrating the findings of each one in turn
- You ask students to demonstrate the examination on each other & you can critique them
- For histories
- Patient selection is vital – focus on several patients that are well enough and willing enough to endure endless questions or several examinations. Consenting them in advance is crucial & finding sufficient numbers in case they are with relatives, eating or unwell
- Common clinical presentations or signs are incredibly important and make for a great case-based discussion, review of management or reviewing investigations
- Remember to perform a debrief after bedside teaching, preferably away from the patient to avoid embarrassment. Use this to focus on key take-home messages & goals for them to achieve before the next session
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