Angkor Hospital for Children Faculty Development Course

Micro-Skills

5 Micro-Skills for Clinical Teaching

Get a commitment - to a diagnosis, work-up, treatment plan - dont jump in make the resident commit first - can use to assess the residents thought-process - if resident doesnt process information correctly, use the opportunity to guide/teach - provide individual teaching based on their level of knowledge and skill Probe for supporting evidence - explore the mental process behind their decision - again use to assess the residents level of knowledge - dont pass judgment, but ask for the residents ideas - dont quiz the resident on general concepts (pimp) this should be a safe, low-risk learning experience Teach general concepts - teaching points will arise from the previous two steps (If not, the preceptor can skip this step) - it is not essential that the preceptor teach something in every encounter - you dont want to insult (talk down to) or overwhelm (talk over the head of) the resident Reinforce what was done right - some appropriate actions are pure luck and other deliberate - to become established, good behavior/decisions must be rewarded in some fashion positive feedback builds the residents self-esteem - dont say they did a good job, but tell them specifically what they did correctly Correct mistakes - an important part of the encounter but only one part - feedback must be done tactfully to be effective - choose an appropriate time and place as soon as possible after the event - ask for their own self-evaluation first - vague, judgmental statements like, you could have handled that case better provide no instruction on how to manage the case better

- What do you think is going on with this patient? - What laboratory tests do you feel are indicated? - What would you like to accomplish on this visit? - Why do you think this patient has been non- compliant?

- What were the major findings that led to your diagnosis? - Why did you choose that particular medication given the availability of many others? - What factors did you take into account when developing your treatment plan? - What else did you consider? - If the patient has a cellulitis, incision and drainage is not possible. An abscess which has fluctuance can be drained. - I havent encountered this condition before either. The best dermatology reference is ___ or in this clinic, the person to check with is ___.

- Obviously, you considered the patients finances in your selection of therapy. Your sensitivity to this will certainly contribute to improving his compliance - When prescribing that medication, you appropriately considered the patients condition and the prolonged half-life of its active metabolites given their renal insufficiency. - You could be right that this childs symptoms are due to a respiratory tract infection, but without checking the ears, you could easily overlook an otitis media. At a minimum, a missed ear infection will result in a cranky baby and perhaps more phone calls and unnecessary visits. At worst, the infection could lead to mastoiditis. So try to include an ear examination on every patient with URI symptoms

Remember we dont always have to present new knowledge for a teaching interaction to be effective. Simple reinforcement of good practices is often enough.
Adapted from: Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. A Five-step "Microskills" Model of Clinical Teaching. Journal of the American Board of Family Practice, 1992, 5, 419-424.