Throughout the past 6 months of this residency year I have been presented with a multitude of opportunities to assess learners’ understanding. Most of this experience has come from being a recitation leader for the Therapeutics II course at the University of Arkansas for Medical Sciences. However, I have also led monthly topic discussions with APPE students, co-precepted an APPE student on my internal medicine rotation, presented a pharmacy continuing education to the pharmacy staff at CAVHS, and provided patient education in both clinic and hospital settings. With all of this experience I have found that it can be difficult to differentiate between poor, average, and good learner performance depending on the teaching setting but I have been able to learn from past experiences and adapt.
Recitation
During this course, the recitation leaders were provided with the patient cases that the students were to present as well as a checklist and a rubric to be used for the evaluation. I found that it was sometimes difficult to assess the learners in a consistent manner when the checklist of items they were to discuss changed with each case and changed based on which professor wrote the case. However, as time went on I felt as if I was able to work to make sure that the main objectives were being covered by the learner. This sometimes meant that I needed to ask more questions at the end of the presentation in order to assess their knowledge of the case and the disease state as a whole. Another way I assessed the learners was by starting off each session asking them what questions they had over the topics in general. Based on their initial responses I was able to gauge how comfortable they felt with the material and how much time I would need to spend reviewing the cases in their breakout groups. I feel like the different methods used to assess their ability to learn helped me to differentiate the poor, average, and good learner performance. For example, when a student did not participate in discussion, did not cover a majority of information on the rubric, or was not able to answer questions it was an indication that they did not put a lot of effort into the case. I would then discuss this with them during the individual evaluation to determine whether it was a lack of effort or lack of understanding on the material so that I could help them to better grasp the topics. I feel like this experience was a great opportunity for me to practice assessing learners.
Topic Discussions
To assess a learners ability during topic discussion I used both the questions provided to them on the patient cases as well as additional questions that they had not had time to review. I tried my best to incorporate a large number of open-ended questions, although this is something that I am continuing to improve upon. Based on how the group answered the questions I was able to evaluate their baseline knowledge of the topic to determine if we needed to stay at a more surface level and cover the basics or if they would be prepared to answer more in depth questions. I was able to use their responses to assess whether the learners in the group were poor, average, or good. Those on the lower end of the spectrum or poor learners were the ones who did not participate in discussion or did not provide answers. The average learners were able to discuss the questions provided and the good learners were the ones who were able to answer additional questions and have a more in-depth discussion. I used this to try and improve with each topic discussion. For example, if a student was not participating, I would try to allocate a question specifically to them by calling their name. Sometimes students are just shy and do not feel comfortable speaking up, especially virtually, so this tactic has helped me to assess the learners.
Co-precepting an APPE student
The experience of co-precepting allowed for me to work on my ability to assess a learner’s knowledge extensively since I was working with them every day. I was lucky enough to have a student who had already completed similar rotations at our facility, so they were familiar with the computer system and where to find information. My first assessment with the student was in the morning after we worked up the patients on our team. I would have them discuss what they found and asked what changes they would recommend. This gave me a good baseline knowledge of how comfortable they would be with identifying problems and making recommendations. I would also ask them open ended questions about the patients to further assess their knowledge of the disease states. I was able to use this throughout the month to see how well they were incorporating what we discussed previously and if they were progressing.
Presentations
Assessing learners during presentations was something that I found to be a little more difficult as there is not always time allocated for discussions. I would incorporate audience response questions that were both based on the objectives and ones that were more detailed. Since all of my presentations this year have been virtual, I use the speed and amount of answers to determine their understanding. If only a few people responded during a large group presentation, then I knew that there was a gap in knowledge and I would make sure to cover the information again when discussing the answer to the questions. This is an area that I hope to gain more experience with throughout my time in residency so that I am able to give effective presentations.
Patient Counseling
When providing education to patients or caregivers, it is important that they understand the information. One way I liked to do this was by asking a couple questions in the beginning to see what their baseline knowledge was. When I was on rotation at the clinic in Conway, I provided diabetes education to multiple patients so I would start off by asking them to tell me what their understanding of diabetes was. By doing this I was able to assess their knowledge and see how much detail I should provide during that appointment. I would also use the teach back method and ask them to repeat back to me what they learned so that I could make sure the information being received was clear and accurate.
Tools used to assess learners:
Audience response questions
Patient cases with discussion questions
Asking open ended questions
Teach back method
During my time as a recitation leader I was able to provide feedback to the group and individuals. Learners were to complete four SOAP notes that would be graded but they were also given the opportunity each week to provide a practice SOAP note for review. When I was looking at the practice SOAP notes I was able to provide written feedback directly on the document that was specific to their work. I would make some changes to the document directly as well as leave comments about ways the note could be improved. I think this type of written feedback was valuable to the learners because they were able to go back and review it for future reference. When the groups completed their graded SOAP notes, I had to provide feedback in a different way. I used a rubric provided by the class instructor to review if appropriate information was included and then I discussed the cases with the entire class the next time we met. When providing feedback to the group I had to compile a list of the common themes seen throughout the notes and give more generalized feedback so that all learners would benefit.
I was also able to provide informative and meaningful feedback on multiple occasions during my time as a co-preceptor. Each morning after we worked up our patients, I would have the student present the information to me. I was then able to provide immediate feedback on what they did well and areas that needed further review. Another way I was able to provide feedback was through note review. After the student finished their notes I would have them send it to me so that I could review the content and format and then I would make edits and send them back. Sometimes when the notes needed more than just a couple of edits, I would provide them with verbal suggestions so that I was able to explain my thought process behind the edits needed. Lastly, I provided a midpoint evaluation with the student to address what was going well and areas where they could use improvement.
When providing feedback, I try to look for the reactions of the learners to gauge how it is being received. I have found that it can be difficult for me to present the more constructive feedback as some learners may become dismissive or disengaged in the conversation. I used those experiences to really focus on the way I was presenting the information. I like to use the tool of asking learners what they thought they could improve on in order to start an open discussion that they would be more willing to receive. It also helps me to evaluate their self-assessment skills and provides me with a starting point for the discussion.
Strengths:
Willingness to adapt based on feedback
Care for learner’s education and and learning experience
Approachable and easy to talk to
Strong work ethic
Time management
Weaknesses:
Giving feedback on areas for growth
Self-confidence in clinical knowledge
Engaging with the audience during large group presentations (eye contact)
Comfort level with using different teaching styles
Engaging learners in discussions that require critical thinking was something that I was nervous about when starting residency. However, as time goes on and I become more confident being the leader of a discussion I have found that people would rather have an engaging discussion than sit through a lecture. I have asked my mentor to sit in on a topic discussion to specifically evaluate me on this goal and some of the feedback I received was to let the students read the patients cases and try to ask more open ended questions. After receiving this feedback, I started to go through the cases and write down additional open ended questions I could ask the group that would promote critical thinking and I feel it has helped improve the value of the experience. I have also been able to work towards this goal during my time as a recitation leader. A large portion of this class was aimed at helping students discuss the cases and use their critical thinking skills to come up with a plan. I would go around to each group and ask questions that would stimulate a discussion between the learners such as asking about a secondary treatment option for the patient and the students seemed to appreciate this as it may not have been something they thought about previously. Throughout the rest of the residency year I hope to continue to improve upon this goal.
Activities completed to achieve goal:
Monthly topic discussions x4
Journal club presentations x3
UAMS recitation leader
Co-preceptor of an APPE student
Pharmacy Grand Rounds
Plans to strengthen skills:
Continue to receive feedback from learners about my ability to engage learners and different activities I could incorporate and adapt my teaching style based on the responses.
Participate in another Grand Rounds in the Spring.
Provide a lecture to third year pharmacy students at UAMS that includes time for discussion.
Some of the small group activities I have participated in include the monthly topic discussions, journal clubs, and recitation. To assess my communication skills, I focused on the learners evaluations and ability to answer questions. If the students were able to answer the open-ended questions during the discussions I knew that the information I was providing them with was effective. If the learners were unable to engage in discussion or provide answers, I would spend more time reviewing the topic and teaching them. When the students used the information provided in future situations, it was a sign to me that I effectively communicated a concept to them.
I tend to become very anxious when speaking before large groups of people and struggle to not use filler words. Because of this I set aside time before my Grand Rounds presentation so that I could practice presenting with one of my co-residents. This allowed for me to work out the kinks in the presentation and see what questions the audience may have. I felt like this was a very helpful tool as I was much more comfortable with the material on the day of the presentation and more prepared for potential questions. Some of the feedback I received from my Grand Rounds presentation included “Seemed very well practiced”, “good eye contact at times but continue to work on”, “Good voice projection”, “Appeared to be reading some portions of the presentation”, “very professional and calm but mispronounced a couple of words”, and “used mouse well to point out areas you wanted the audience to focus on”. I plan to continue to seek out opportunities where I can practice my presentation skills and deliver information effectively.
Activities completed to achieve goal:
Monthly topic discussions x4
Journal club presentations x3
UAMS recitation leader
Co-preceptor of an APPE student
Pharmacy Grand Rounds
Plans to strengthen skills:
Provide a lecture to third year pharmacy students at UAMS.
Practice presentations with my mentor or a peer before giving the final presentation.
Review feedback from previous evaluations and continue to incorporate it into the next presentation.
When it comes to giving positive feedback, I feel like I excel because I am always able to pick out the things a student, resident, professor, or other healthcare professional is doing well. I enjoy the response received when someone is recognized for their time and effort. However, when I need to give feedback on areas for growth, I tend to shy away from it because I fear being seen as rude, harsh, or judgmental. This is especially hard when I have formed a relationship with the person such as a co-resident. One thing that I have tried to do to make this easier is I try to focus on a specific example of something that they could improve on. When a learner knows exactly what I am referring to they will be able to address it directly and it will leave out the chance of misinterpretation. I also try to avoid focusing on things that are a matter of opinion such as the way a presentation is formatted. I feel like my abilities to give both positive and constructive feedback will continue to grow with more practice.
Activities completed to achieve goal:
Topic Discussions x4
UAMS recitation leader
Co-preceptor of an APPE student
Peer evaluations
Plans to strengthen skills:
Continue to provide feedback that is positive and includes specific examples of what the learner can work on.
Review feedback I have received and adapt my methods of giving feedback based on what I thought I received well and areas that left me with questions.