Jennifer Spicer, MD, MPH Profile picture
Sep 21, 2021 17 tweets 6 min read Read on X
1/ Have you ever...

...promised yourself that THIS time you'll prioritize teaching while on the inpatient service but then get TOO BUSY?

...or WANT to teach something on rounds but realize that you have FORGOTTEN the details of that clinical pearl.

Then this week is for you! Image
2/ This week, I will share tips to help you prepare to teach effectively on rounds as one of our “foundational skills” for inpatient teaching.

It's another #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends. Image
3/ Before we get started, I want you to reflect on something:

When you travel, do you tend to plan an itinerary for your trip or "wing it"?

Now, what if you only had a single day in that city but wanted to see all the famous sites?

Would your answer change? Image
4/ I think teaching is very similar to traveling - you can either "wing it" or "plan it".

Both can be fun & effective.

BUT, you can teach MORE in LESS time if you plan your teaching. Image
5/ So how do I prepare for teaching when I already have 10 million other things to do?

I select ONE thing to teach for each patient when I'm reviewing charts in the AM.

Doing this:
1. Ensures teaching HAPPENS.
2. Keeps my teaching FOCUSED.
3. ALIGNS teaching with patient care. Image
6/ This planning for teaching is WHY I believe in reviewing patients’ charts before rounds.

1⃣ It makes rounds more efficient since the team doesn't have to recite ALL data to me
2⃣ It allows me to quickly look up or review information prior to teaching if I need a refresher Image
7/ So let's use this patient list to illustrate my process.

First, I consider WHAT content I want to teach.

Ideally, I try to teach something that I ALREADY KNOW or MUST look up to advance that patient's care. This avoids giving myself more prep work! Image
8/ Here are examples of teaching points that I was able to come up with from memory for the patient w/ MSSA bacteremia.

Although I may need to reference a few details (e.g., exact numbers for sensitivity of TTE), I can easily teach this content b/c this is a COMMON diagnosis. Image
9/ New senior residents often tell me they fear they don't know enough to teach & feel they need to put in hours of preparation for teaching.

However, I bet all of us can easily come up w/ 1+ teaching point for every patient!

The challenge is LIMITING the teaching to ONE point.
10/ Once you've come up with a list of potential teaching points, how do you decide which one to teach?

Well, I try to remember that I need a teaching point for EACH DAY of a patient's admission. Thus, I try to align my teaching with relevant patient care activities/decisions. Image
11/ Here's an example of how I may align my MSSA bacteremia teaching points with a patient's clinical course. Image
12/ Once you have decided WHAT you want to teach, consider HOW & WHERE you want to teach it.

Some teaching points are better for the conference room where you have a white board to draw on (eg. developing a Ddx) whereas others are best at the bedside (eg. patient counseling). Image
13/ New admissions or possible discharges often lend themselves best to teaching points at the bedside (yellow highlighter), although sometimes my teaching points fit better in the conference room where we have time & space to discuss our clinical reasoning (blue highlighter). Image
14/ Finally, I try to ensure that I'm diversifying my teaching by "mixing it up."

I try to ensure that I go beyond medical knowledge & patient care topics to actually teach the other ACGME competencies too!

For example, discussing ethical dilemmas can teach professionalism. Image
15/ In summary, remember teaching doesn't require much prep.

Look at the list in the morning and decide WHAT to teach & WHERE/HOW to teach it.

Choose teaching points that:
1⃣ you already know
2⃣ align with CURRENT patient care needs

And mix it up using the ACGME competencies! Image
16/ To teach effectively, it’s important to establish GOALS, even for quick clinical pearls.

Next week @GStetsonMD will describe how to develop clear, focused learning objectives.

Follow @GStetsonMD & @YihanYangMD so you don't miss anything from @MedEdTwagTeam! Image
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More from @JenniferSpicer4

Mar 17, 2023
Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

@gradydoctorImage
Do you want a 4-step process for questions to ask when you get a page next year when you’re alone on nightfloat or ICU call?

Check out this framework! Image
And now, do you wanna remember who the heck to order DEXA scans for in clinic?

Thankfully Miko De Bruyn comes to the rescue. Image
Read 16 tweets
Mar 7, 2023
1/ You're seeing a new consult with your team, and you want to teach the primary team too.

But WHEN is the best time to teach them?

On the phone?
At the bedside?
In their team room?

And in the morning?
Or maybe the afternoon?

This week: Image
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.



But when should we teach them?

Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.

With one caveat.

Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.

But let's explore some general principles to consider.
Read 15 tweets
Feb 21, 2023
1/ You're finishing your last consult of the day.

It's late.
And it's been a long day.

You intended to find the primary team to teach them, but you have a million other things on your "to do" list.

Here are 8 reasons why you should still find time to teach the primary team. Image
2/ Reason #1: They want to learn

The primary team called with a question.
They are invested in the answer.

It's all about finding out what they want to know and targeting your teaching accordingly.
3/ Reason #2: It empowers them

Often the primary team has an idea of what to do but wants reinforcement that their plan is correct.

Teach them general rules that they can re-use. Image
Read 12 tweets
Jan 31, 2023
1/ Your team just saw a patient with syphilis, and you're ready to teach, but:

Resident #1: on week 2 of their rotation
👉 Has already seen 2 patients w/ syphilis

Resident #2: started today
👉 Hasn't seen a single patient with syphilis

What should you do now? Image
2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons. Image
3/ As @VarunPhadke2 previously pointed out, all learners on the team are usually not present all day, every day for the entire time we are on clinical services.

Image
Read 16 tweets
Jan 24, 2023
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.

Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow

How can you possibly provide valuable teaching to all of them?

This week: Multi-level teaching Image
2/ Teaching multi-level learners is hard.

Their range in baseline knowledge means a single teaching point is often not effective for everyone.

So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.

This is one 🗝️ for effective multi-level teaching.

Know what materials is RELEVANT and INTERESTING for each learner level.

Read 14 tweets
Jan 10, 2023
1/ *Re-consult 📞*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🤦 I feel you... We'll see the patient again. Image
2/ You wonder...

💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?
3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

Read 15 tweets

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