Final Reflection

Ability to accurately assess learners

A majority of the teaching experiences that I have had throughout my residency year have included the opportunity to assess learners, which has helped me improve in this area and further meet one my teaching goals. One selective learning experience that I was able to participate in towards the second half of my residency year was co-leading a BEERS Criteria workshop for a group of P4 and M4 students. I learned through this workshop that each student learns and interacts in a team differently and that it is more difficult to assess learners in a large group setting than it is in an individual or small group setting.

Ability to differentiate between poor, average, and good learner performance:

Good learners are prepared ahead of time and often ask questions to expand their knowledge. They participate in required activities, but also look for projects or ideas of their own. Average students will do what is asked of them, but will not go above and beyond. Lastly, poor students are rarely prepared and seem disinterested in the projects or duties in front of them. I’ve learned this year that challenging and making learners interested is difficult. I have seen that all types of learners, poor, average, and good, need re-iteration and reassurance. In the future, I hope that I am better at giving very frequent reassurance and feedback based on the learner’s performance.

Tools used to measure learner performance:

    • Evaluation forms provided to students and co-residents at the end of topic discussions/presentations
    • Providing the audience the opportunity to ask questions to clarify concepts
    • Case presentation and SOAP note rubrics during recitation
    • Teach-back method during patient counseling

To further improve in this area, I planned to give students a baseline knowledge quiz or evaluation at the beginning of topic discussion and again at the end to compare before and after the session how much they learned. However, I did not incorporate that this year during any topic discussions, but will look for opportunities to do so in the future while precepting students and residents.

Ability to give meaningful feedback

Throughout my residency year, I have had an endless amount of opportunities to provide meaningful feedback and become more confident in my ability to do so. A few areas that I have provided feedback include topic discussions, journal clubs, grand rounds presentations, feedback to preceptors regarding each learning experience, and so much more.

Individualizing feedback to meet specific learners needs:

I gave individualized feedback to each student that I taught in recitation regarding his or her SOAP notes and also case presentations. The feedback given to them was very specific to their performance and how they could improve. I believe this individualized feedback was well accepted by the students. Also, as mentioned in my teaching goals below, I began providing at least one individualized, constructive comment on each evaluation I filled out for a co-resident. Regarding student case presentations, I provided two constructive comments that they could apply to their next case presentation.

Examples of successful and unsuccessful attempts to provide feedback:

The most successful attempt of giving feedback that I experienced was through P3 Therapeutics recitation. Being a recitation leader really challenged me to individualize feedback and look for ways that students could improve their presentation and writing skills. Although mostly a positive experience, being a recitation leader had some tough moments. As expected, students did not always agree with the feedback I had given to them. Another example of unsuccessful feedback I had was in performing a midpoint evaluation of a student on rotation. The feedback I gave at midpoint was not clear enough the first time given, so through this I learned to be more direct in giving feedback.

Learners reaction to feedback:

Throughout my residency year, the most memorable reaction that I had from a learner regarding feedback was from a P4 student on rotation. The student did not take feedback well, and from this experience I learned how to give honest and constructive feedback gently. I have learned that most learners are very receptive to feedback and actually seek it from their teachers and preceptors.

Throughout this program, I have learned many things about giving feedback and how to improve in this area. The most important thing I have learned is that feedback is much more helpful to learners if it includes both positive AND constructive feedback. In the future while precepting students or listening to resident presentations I plan to continue giving at least one constructive comment and really work towards giving one constructive comment with each positive comment. I also plan to frequently ask students that I am precepting if and how I am meeting their expectations in terms of giving feedback.

Teaching-related strengths and weaknesses

I believe my teaching-related strengths have continued to strengthen throughout my residency year and that I have found more strengths the more teaching experiences I encounter. I have become even more confident in student and patient interactions throughout the year. I have also turned my weakness of “incorporating new techniques into learning opportunities” into more of a teaching-related strength. For example, I provided an interactive worksheet during a Diabetes topic discussion with P4 students, asked students to explain what atrial fibrillation means in “patient friendly” terms.

Strengths

1. Building strong relationship, students, learners, co-residents, and preceptors

2. Allowing patients to feel comfortable during counseling/medication review sessions

3. Creating a comfortable, non-judgmental learning environment for learners

4. Highlighting important concepts in discussion and presentations

5. Creating new ideas/worksheets into teaching activities

6. Confidence in counseling and in patient interactions

Throughout the year, I have also worked on improving the below teaching-related weaknesses.

Weaknesses

1. Allowing students to formulate their own thoughts and answers to questions before interjecting

    • Resolved by allowing at least 10 seconds before giving an answer to allow student to formulate a response and asking stepwise questions to allow students to come to an answer.

2. Reliance on notes during presentations/giving self more time to practice presentations

    • Resolved by finishing and practicing my journal club given in March well in advance so I was able to look at the audience more as opposed to reading off of my handout, as well as giving the anticoagulation student topic discussion twice so that I had less reliance on the handout the second time.

3. Delegating tasks to students and learners

    • Progress made through assigning students to write notes, work up patients, and present in-services, but plan to continue to address this in the future by giving students a more wide variety of opportunities (ex: more patient counseling, more medication reconciliations) within a learning experience.

Progress toward teaching goals

Teaching Goal #1

Provide specific and consistent feedback in a timely manner based on strengths and areas of improvement.

Through the teaching program I have become more comfortable with providing negative feedback. I have found that providing positive feedback is very easy and that is normally what I focus on when others are giving presentations, etc. At the beginning of my residency, I shied away from giving any negative feedback at all. However, I grown to look for both positive and negative aspects of presentations and in the students I have taught. As suggested from a mentor of mine, I have really strived to give each presenter that I evaluate at least one constructive comment on his or her evaluations.

Activities completed related to this goal:

    • Therapeutics II Recitation Leader to P3 students (including SOAP note feedback and case presentation feedback)
    • Evaluated students during topic discussions and student presentations
    • Evaluated co-residents during in service presentations, fall and spring grand rounds, and journal clubs
    • Provided midpoint and final feedback to three P4 students on rotation
    • Began to write at least one constructive comment on each evaluation I filled out for a co-resident

Future plans to strengthen this area:

    • Continue working on providing constructive feedback in any way that I can – practice giving more constructive comments with each presentation (ex: giving each presenter or learner one constructive comment for each positive comment)
    • Work on giving more timely feedback to students as I hope to be a preceptor in my future career


Teaching Goal #2

Effectively incorporate different teaching modalities into presentations and discussions based on individualized student learning styles.

Throughout the residency year, my plan for this goal was to incorporate a different learning style into each topic discussion that I led with students. And still, I have found that this is difficult to do based on creativity and time restraints. However, I have improved in this area and tried out different ideas as mentioned below, but I hope to continue to grow this skill even more in the future.

An example related to this teaching goal that I experienced was when I was counseling a patient over insulin and discussing diabetes management. The patient had a hemoglobin A1c of 14.5% and their goal was <7%. In normal conversation with the patient, the importance of lowering their hemoglobin A1c was not something they could grasp. I then used a model of two tubes that mimicked sugar within blood flow for hemoglobin A1c’s of 7% and 15%. After using a model, the patient more clearly understood the importance of lowering their hemoglobin A1c to goal.

Activities completed related to this goal:

    • Topic discussions with P4 students (HTN/HPLD, Anticoagulation, Bugs and Drugs)
    • Pain/palliative topic discussions with P4 student (Pain Management, Nausea & Vomiting, Agitation/Delirium, Palliative Sedation)
    • P4 students on Internal medicine teaching and hospitalist rotations
    • P4 student on Pain/Palliative rotation
    • Patient counseling over diabetes management in PACT clinic
    • Patient counseling over stroke signs/symptoms in PACT clinic
    • Patient counseling in medication management clinic

Future plans to strengthen this area:

    • Incorporate more visual and kinesthetic learning into topic discussions I hope to lead with students and residents on rotation
    • Incorporate visual learning into patient counseling (ex: use of an inhaler, patient handouts, pictures)


Teaching Goal #3

Assess and adapt to knowledge base of the audience by asking open-ended and engaging questions.

This has been the hardest teaching goal to measure throughout my residency year. I have found that through outpatient staffing and multiple patient counseling experiences both over the phone and in person, that patients respond best to open-ended questions that are asked at their knowledge base. I have also seen that patients respond well to repeated questions and re-iteration. For example, I recently had a discussion with a patient regarding high and low blood glucose levels. I assumed that the patient knew signs/symptoms of each and that low blood glucose levels were more dangerous than high as the patient has had diabetes for a long time. I came to this realization that the patient did not know these things by asking him open-ended questions. I was then able to better explain blood glucose levels and consequences of both low and high readings.

Regarding small group teachings, I made an evaluation sheet asking students to specifically evaluate me on this goal and received positive feedback that I did well to meet the students where their knowledge base was. However, I still want to work on being able to assess the large variety of learners during a large group presentation.

Throughout leading topic discussions and having multiple students on rotation, I have become more confident and skilled in this teaching goal.

Activities completed related to this goal:

    • Topic discussions
    • P4 students on various rotations
    • Grand rounds presentation
    • Patient counseling (especially during medication management rotation)
    • Staffing in the outpatient pharmacy

Future plans to strengthen this area:

    • Have students and resident take a pre-quiz before any learning experience or activity I teach
    • Formulate more challenging questions to incorporate during large group presentations to better assess audience knowledge