teaching to teach with a focus on millennial learners. My name is Matt Haas. I'm a first-year attending in Peds Rehab Medicine at Northwestern University based out of Shirley, Ryan & Biddley Lab. I'm thrilled to be joined today by two of my former attendings and Med-Ed mentors. First, Dr. Ashley Bolger, who's Assistant Professor and Program Director for the Combined Pediatrics and PM&R Residency, as well as PM&R Clerkships at the University of Cincinnati, as well as Dr. Leslie Rydberg, my colleague here at Northwestern University and Shirley, Ryan & Biddley Lab, where Dr. Rydberg serves as Assistant Professor, Associate PM&R Residency Program Director, as well as the Monica and Henry Betts Medical Student Education Chair. This session was born out of suggestions from the Physiatrist and Training Council, so I'd be remiss not to thank them, my fellow FIT Council members, as well as Myra Stanley, as well as the rest of the Academy staff for the support for getting this included in this AA. Before we move on, none of the session faculty have any financial disclosures to, financial interests to disclose. Touching briefly on today's learning objectives, we will cover some key concepts in adult learning theory, which really just to kind of account for any differences in experience for those with the topic for our attendees. Next, we'll look a little bit closer at comparisons between different characteristics and learning styles or learning style preferences between generations. And then lastly, we'll dive a little bit more deeply into some case-based scenarios to implement certain teaching strategies across multiple venues with the hope that all attendees will find some strategies to incorporate into their practice. That session, especially at the end, will include a lot of interactivity, so we encourage you at that time to turn on your cameras and use the chat feature throughout. And that's kind of what's coming up. Before, we'll use that kind of as a segue, we have a couple of polls just to kind of get to know the audience and kind of who all's with us today. A little bit more time just for some people to answer. Hi, Dr. Houtrow, glad you could make it. All right, if we could close the poll. All right, so we have a couple of med students, some residents and fellows, some junior as well as senior faculty. So I'm glad to see we have a decent mix overall. Hopefully you'll be able to find something to incorporate into your practice. And then in terms of prior experience with regard to adult learning and medical education in general, it seems like there's some that have attended lectures and read and then less who kind of pursued additional kind of certificates or masters. And thankfully no one that could write a book on medical education. Although I suspect that there may be some in the audience that could do that. So touching just kind of briefly on adult learning theory, we, the field of adult learning theory was really pioneered by Malcolm Knowles and who borrowed and defined the term androgogy to really develop a specific theory for adult learning. And Knowles discovered this through work with adults that instruction or instructors needed to really care about the actual interest of learners. And it was based on his own observations that Knowles really developed five key assumptions that enveloped as well as developed his concept of androgogy, which we'll go through kind of one by one. I'll say that there have been some critiques or criticism of his concepts, but these are kind of the foundations of androgogy. So I think it's important to cover. So the first, adult learners have self-concept or self-direction. There's a progressive development in one's desire and capacity for deciding what, when, how they wanna learn and then other decisions that really affect them. So that's kind of the foundation. Secondly, Knowles realized the value that experience, value of experience that learners bring to the educational environment. And he viewed this experience really as an important resource for both learners, as well as facilitators that contributes to the richness of discussions, which is kind of what we're hoping for today as well. This experience is not only just kind of prior personal or work experiences, but also their analytical thinking skills. And Knowles really encouraged teachers or facilitators to probe at the kind of thinking of learners to understand how and why they came to a certain conclusion and kind of allow the learners to discover that themselves. Thirdly, we assume that adult learners enter the learning environment ready to learn, which is usually triggered by the need to learn something new, such as a new or evolving responsibilities or assigned roles, which is different than kind of child-based learning, which we'll cover in a second. The fourth assumption is really kind of the focus of adult learners. Knowles believes that adults don't pursue additional knowledge for the sake of learning, but rather when they encounter a problem and they want an immediate application of new information to kind of solve that with a greater focus more on the process rather than the content. And this is kind of where adults start to question or ask like what's in it for me with regards to new learning. Lastly, Knowles believed that really the strongest and most sustained motivators for adults are entirely internal. And really kind of based on kind of self-esteem and self-actualization, he did recognize that there may be external factors or kind of motivators, but those are primarily in regards to kind of being recognized and appreciated for individual contributions to the learning environment, which kind of factor into kind of more internal motivators. These really five key assumptions of adult learning are in contrast to those of pedagogy, which is the art and science of educating children. That's often used as a synonym for teaching, but anyone who's kind of more involved in medical education realizes that pedagogy and androgyny are kind of really different aspects. We don't need to go through this entire chart, but I kind of leave it up here for a second just to kind of note the differences. And I'd say overall in practice, pedagogy really represents greater teacher-focused and teacher-driven education and practically speaking for adults, instruction should really focus a little bit more on kind of process rather than content with the use of case studies, role plays, simulations and self-evaluations at times much more useful than kind of didactics for acquiring new skills as well as knowledge. On adult learning theory, I'll kind of conclude with some best practices, which is based on suggestions from Knowles and others. First, we really need to create a psychologically and physically safe learning climate that's based on the tenets of mutual respect, supportiveness, openness, and fun. Next, learning to really have to kind of learn to identify particular interests of our learners and kind of help them identify any gaps of knowledge that they may want to address themselves. Then gather input from the learners to identify specific learning needs, developing learning objectives and then plan and design instruction. It's important to allow learners to take kind of the majority, take kind of the lead in the majority of an activity oftentimes and some scholars recommend the 70-30 rule where the trainees or the learners are kind of more active for about 70% of the time. But really kind of key is making sure that you're collaborating with the trainees and the learners to kind of develop the different strategies with the key in mind that, you know, as you're helping them facilitate, you know, towards their end goals, really need to be sure that the learning objectives and the activities meant to achieve them are practical. So with this kind of overview foundation on adult learning, next, we'll hear a little bit about key differences in generations of learners, which Dr. Bolger will present for us. Okay, thanks Matt. So I know some of you already expressed interest in kind of delving beyond the millennial learners and this is kind of our opportunity to review all of the different generations that have come before us as well as that are up and coming. And we're going to go through that now and just kind of some of the focuses specifically on how that impacts specifically medical education and not only you know how they live their lives and how they interact in society but these are the five generations that are currently with us. So kind of going and then the order we're going to go in is kind of going from the oldest to the youngest. So we have the first generation is the silent generation. Those are going to be people that are roughly 76 and above. The baby boomers are going to come next. Those between 56 and 75. Generation X, 41 to 55 years of age. The millennials are 26 to 40 year olds currently and then generation Z is the newest generation and those are the five-year-olds to 25-year-olds. And so we're going to go through each of these and kind of delve a little bit more in but I often like to start when I talk about generations of learners and just let people know that this isn't as clear-cut as I made it on this slide. So yes, I have a very clear distinction of like a 25-year-old as a generation Z and a 26-year-old as a millennial. What you'll find in the literature is that the lines are very blurred and a lot of people that are right around where generations are sort of changing can probably find themselves having some characteristics of the generation before and some characteristics of the generation behind. And so many of you on this call may fit kind of on one of those lines and so I think that that's just something to keep in mind as we go through the talk. So before I get started on telling everybody about the different generations, if we could launch the poll. I just want to get a sense of what generations we have in the audience. I recognize a lot of names and I think we're going to have some pretty wide spread on what generation we belong to. Are we able to see those results? Awesome. So as I kind of expected, you know, the three, the three largest chunks of people in the audience are kind of those three middle ones. So Generation Y are the Millennials, Generation X and the Baby Boomers. We do have, it looks like, at least a few Generation Zs, so that's amazing and welcome. But we'll kind of get started and learn a little bit more about the different ones. So I feel like you can't, you can't talk about generations without really understanding what drives generational change. Like why do, depending on, you know, when we came and when we grew up and, you know, when we did things, why does that mean we're going to think differently and learn differently? And so these are just some of the things that the literature supports as driving generational change. So societal changes, what were you going through at various ages and how does that impact how you think on life? Same kind of similar thing, you know, sharing of major life experiences. They often talk about times of war and different, you know, main breakthroughs. You know, what was science doing specifically related to medical education? Were there specific breakthroughs that really changed how we as medical educators fought through things or, you know, treated our patients or things like that? Socioeconomic conditions certainly play a role. And then technology shifts I think is the one that probably, I think for me at least, is most intuitive because that I feel like has changed so drastically across generations. But all of these things are just pieces of the puzzle for each of the generations. So starting with the kind of oldest generation that we still have with us. So these, they go by a couple different names, but traditionalists are one name, silent generation, veterans are another one. These are the folks I alluded to earlier, 76 years and above. I thought it'd be fun to pull some celebrities that fall into each generation. So if you were curious, Chevy Chase, Tina Turner, and Dr. Fossey all fall into the traditionalist generation. And their experiences are really characterized by a lot of wartime. So they, you know, some of them may be present during World War II, the Great Depression, the Cold War. So they're going to have a lot more of their stuff based in this. Because of that, they have a lot of patriotic duty. They're very respecting of order and have a strong sense of community and like duty and honor to people that came before them and are above them in hierarchy. But at the same time, they're also very mindful resources and waste because they did grow up in times where, you know, for periods of time, you may not have had quite as many resources and had to really ration what you had. So how does that impact traditionalists when they're in the medical education realm? So, you know, certainly, I think for those that are 76 and above, these are going to be some of our more emeritus professors, maybe not practicing full time at this point. But at least where I work, we do have a couple of volunteer faculty that I think would fall into this just because they love to give back and love to keep abreast with all of the different medical education things. But they do have a different focus, so to speak, than some of us that have came after. And so they really are teaching out of a sense of duty. And that's probably why they're still volunteering and coming back, you know, not even being paid for many of them. But they're really set on formality. They value hierarchy. They're very loyal. But they also, at the same time, value conformity without really challenging the systems in which they work. So when they're thinking about how do they bedside teach, a lot of them, you know, kind of use their personal experiences and their anecdotes. And they don't necessarily understand why we shouldn't respect information from websites or technology based experiences. They really value that, like, you know, I saw this, and this is what I'm telling you kind of theory. They can teach across, you know, the different size spectrums. You know, they kind of grew up in a time where probably large group lectures were more common. But certainly recognize that sometimes that is not the only way to learn. They do not expect gratification right when they finish something. And then they rather would focus on the process of education compared to the outcomes. So moving into the next generation, these would be the baby boomers. So those of you out there that are 57 to 75, it looked like we had a few of you in the audience. They also are known as the boomers, the quote unquote me generation, things that kind of led them together. So sex, drugs, and rock and roll. The Vietnam War was a big thing that impacted their generation. And they're often described as workaholics. But they're also very optimistic. So they really grew up and kind of came to maturity, so to speak, in a time where there was a lot of economic and educational prosperity. And so they're kind of accustomed to having that. This is the time where the typical family had a stay at home mom, a hardworking father. And that's just what they grew up with and what they kind of saw on a day to day basis. And so because of all these things, and kind of that workaholic mentality, they really, their self worth is driven by personal fulfillment, what they've contributed to their jobs, and kind of how that all plays out. So the way that impacts medical education is that these are the folks that are quite competitive within educational realms. So they're the ones that they really want to reach those top tier, you know, the CEO of the company, full professor level kind of titles. And they really equate that with monetary compensation, as well as those titles. And so they're, they're willing to give up a lot of their personal lives for professional success. You know, they're not necessarily, you know, if there's a meeting out there that they feel like they need to attend, and their, you know, grandkid has a softball game, well, maybe they're not going to go to the softball game or something like that. But they also value a strong chain of command. And thus, maybe judgmental of differing views, they value educators to teach them. Again, that's more of that hierarchy thing, you know, the person above me teaches me, they mentorship is just part of what they grew up in and what they expect. And just as a friendly reminder, I know, you know, this term still exists. But these were the folks that really grew up in the system of pimping, and that kind of asking questions on rounds and doing, you know, education in that method. So that may be something that follows them along, and maybe something that they typically kind of give back or the way that they teach. So the next generation is Generation X. These are the folks that are currently around 41 to 55 years of age, we had a good chunk of people in the audience that belong to Generation X. And I think I saw in the chat, while I'm trying to do multiple things that there's a lot of people, you know, really owning their generations, which is awesome. So these folks are described as independent, self directed, pragmatic, and flexible, the things that they kind of had in common, they didn't have a lot of, you know, real war time, so to speak, when they were growing up, but their generation is really defined by AIDS, a lot, actually, multiple things commented on Sesame Street, that was a big part of their growing up. And then MTV as they got older, they tend to be direct and outspoken. They kind of unlike their predecessors were born into a nation with increasing debt and limited economic prospects. So they have a very different perspective than the previous generation. This is the generation that divorce rates kind of started expanding. And so a lot of them grew up in one parent households. Or if they did grow up in a two parent household, they typically grew up with two working parents in their household. And so because of that, they tend to tend to have a greater sense of family than the generation before them. And they also value a good mix of personal life and work. They're not quite quote, unquote, the workaholics that the previous generation was. And because of that, they're less likely to place their jobs before family or friends and may have a different response in terms of, you know, requirements for meetings and how that plays out and what they do after work. So how do they think through things within the realm of medical education? So I thought this first line when I found it in an article summed it up awesomely. So they work to live rather than live to work. And I think that that also is how they approach sometimes education and kind of academic medicine. They're loyal to themselves as well as their families rather than the institutions where they work. They tend to question authority and they don't love the hierarchy. So they tend, you know, tend to be the resentful of the top down management type folks. They want education to be fun and collaborative. They learn, they tend to be better learners in groups. They tend to be problem solvers. But at the same time, these were the folks that started having more technology in their lives. They're kind of the first generation that computers were relatively, you know, throughout their childhood, not as much as the coming up generations. But because of that, they tend to appreciate immediate responses, but they also really value face-to-face interactions. They absolutely believe that mentoring should happen all the time. They feel like they should, basically it should be a right rather than a privilege. And they tend to be the ones that even while their, you know, supervisors and mentors are evaluating them, they're also kind of flipping the scales and not evaluating them in their heads as well. And this generation tends to be fairly adept at technology, but I think it's probably fairly variable as well, is kind of, you know, because there is such a time span that Generation X covers, those that might be a little bit in the older part of the generation may not have had some of those same technology that were introduced earlier in their learning. Getting closer to the end, Generation Y or i.e. the Millennials, Generation Next, the Echo Boomers, the Net Generation, I had not heard any of these terms or at least many of these terms before I did this. I think typically they're known as the Millennials. So they also, you know, don't have as much in terms of binding them by war, but one of the biggest life-changing events for those in the Millennial generation was September 11th and how that sort of driven, you know, a lot of everything, you know, afterwards. So they also grew up at a time where gangs were really prevalent and the drug epidemic is raging as they grew up. So they also tend to be team-oriented. They like to work in teams. They tend to be because of that collaborative, optimistic. Technology is a huge part of their lives. I, you know, spoiler alert, I'm in the Millennial generation and so I don't remember really times without computers. I certainly remember them in elementary school. They were big boxes, but there's not really a time of my life that I don't remember having some form of a computer. But because of that, because technology binds them, they tend to be more globally oriented, culturally diverse, as well as connected than previous generations just because of the ease that technology makes that. But also because of that technology, and this is, I think, what Millennials are quote-unquote very well known for, but they really expect instant results. They're not the generation that likes delayed gratification. They want the information at their fingertips. They want that immediate feedback. They're driven by immediacy, but they they're driven by immediacy. But they also value family relationships and value being connected with others. So what does this mean for medical education? So, you know, this generation is the one, are the ones that are currently kind of spanning medical, most medical students, as well as residents, fellows, and some of the junior attendings. And things to just kind of keep in mind for them, they have multiple interests in addition to medicine. So they're the folks that are, you know, volunteering outside of the hospital. They definitely want to be doing things outside of science and outside of medicine. They tend to be more outspoken than the previous generation, but they, at the same time, are more respectful of authority than, say, the previous generation tends to be. They are rule followers, but they're also collaborators. They almost always feel that they should have input into the decisions being made in their workplace. So they're very vocal about that. And that kind of goes along with the next thing is they tend to be socially bold. They tend to speak their mind, and they don't understand why people would frown on them doing so. Also with that, they like clear expectations, and that's really important in terms of learning, and especially when you're thinking about getting grades for rotations and different things like that. They sometimes are less independent than Generation X. It's more that they just need structured learning, and just kind of keeping that in mind as you're doing teaching for this generation. They don't do well in didactic lectures at all. They like technology, or they like things in small groups, but, you know, they definitely don't appreciate big lecture halls with lots of people in one, you know, one person at the front spouting information. They're not big fans of textbooks. They prefer internet or web-based resources, and then some people will describe them as the most rewarded, recognized, and praised generation. And so how that kind of manifests is that they really do expect pretty frequent feedback, but they also tend to need some praise embedded within that feedback. And so kind of taking that into mind when you're working with Millennials as well. And then they, like their previous generation, also appreciate work-life balance, and so just kind of taking that into consideration when you're scheduling and kind of making things and delineating classes or courses. And last, but certainly not least, is the newest generation. This was new learning for me. I've done various versions of this presentation over the years, and this generation has just sort of recently been fully named, I guess. I don't know. But they're known as Generation Z. The only nickname I could find for them at the moment was the Zoomers. Many of you may not even know half the people on this screen, but they span a wide variety. So those are the, these are the folks that are somewhere between five and either, I saw either 21 or 25. So they are the, so some of our medical students are starting to kind of be in Generation Z and certainly high school and college age kids right now. They have had access to technology at the tips of their fingers very, very well for their entire lives. They tend to be more entrepreneurial. They tend to be less religious as a whole. So they've kind of deviated away from sort of religious-based activities. They tend to be very competitive, but also very communicated, communicative. They are extremely likely to enroll in college. They grew up in a time where diversity is appreciated and the expectation is diversity and inclusion. So they're very, very adept at navigating various situations related to that. But at the same time, they're very prone to psychological distress. And this is more so than any of the previous generations. They see themselves as compassionate problem solvers, and they tend to be more politically progressive regardless of their party affiliation. So how is this going to result in changes in medical education? And I left off at medical because there's not many of Generation Z in medical education, but this is what the thought process is at this point. So the expectation is that they are actually going to flip back to liking face-to-face interactions as opposed to more digital. They tend to prefer lecture-style videos or audio presentations. So kind of wrapping in that component of technology, but also really like case studies and simulations, as well as assigned reading. So kind of, again, going back to previous generations, they're more likely to use outside resources and other learning materials. So not just using, quote-unquote, the textbook that's assigned for the class that they're going to go look up their other resources and go beyond what's expected. They very much, and this came up multiple times in my research, they very much like to design their own course of studies. So they appreciate given the ability to kind of participate in that design and kind of participate in how they're navigating the course. And I think that might be an interesting concept as they start kind of going into medical school. But then they also sometimes require more guidance, especially when they're working in peers. They tend to be pretty critical. They are showing currently that this is a generation that may have decreased motivation to participate in volunteering activities. And so that may change kind of the shift, especially I was just kind of thinking, you know, residency applications. If these are folks that aren't going to be as likely to do volunteer activities, that may need to change how we think about them as program directors and committees. And then they also have the expectation of being mentored instead of learning independently through new experiences. So with that, I will turn things over to Leslie for our interactive part. All right. Thanks, Ashley, for that great talk about different generations. I will throw out there, I am a one of the younger Gen Xers. So I'm kind of on that bubble between Gen X and Gen Y, which means I have the characteristics of both in many ways. I'm functional with technology, but not a technology wizard. I really love the fact that the millennials said don't do well in didactic lectures. I think that I sit in didactic lectures well, and I can actually learn well from didactic lectures. I don't actually like giving didactic lectures, because I just feel like what I have to say is not that interesting to sit there and talk for an hour. So I actually love teaching and kind of the style that we think about may be beneficial for the millennial learners, because I think it just works better for my personality type or my borderline generation. So I think some of the things that really resonated with me about what you talked about with the millennial learners is really the experiential learning, right? So they do better with hands-on learning, face-to-face, that immediate feedback, that knowing right away how things are going, having expectations, things like that. So we're going to go through a couple of cases here, and I want to hear what everyone has to say, including our faculty here, to think about, you know, how you approach or how you could approach or how successful these techniques might be for you. So case one, go ahead in advance. So this is a resident in an outpatient clinic. So you're the preceptor for a neurorehabilitation clinic. You have a new patient who's seeing a physiatrist for the first time, and the resident evaluates a patient with history of stroke with left hemiplegia and spasticity, reporting left arm and shoulder pain. The resident sees the patient, performs a history and physical, and then comes out to present the case. So how are you, as the preceptor, going to assess that resident's clinical reasoning skills? So we have a poll here for slide 26. So how will you assess the clinical reasoning skills? All right, so seeing the results here, a couple more coming in. All right, so we have no one saying that they're gonna do pimping, which is probably reflective of our lack of people who are 75 or older, which is good. Oh, nope, someone picked it, all right. I think pimping can be useful in the right situation with a supportive learning environment, psychological safety, all of that. So number one here is listen to their patient presentation and make a judgment. Some people would observe the entire history and physical, and some people would use an educational tool to look at clinical reasoning. So in my personal practice in a busy clinic, I think it's hard to sit there and observe an entire history and physical. I think it's great if we could be in there, see everything they do, give them feedback on the entire history and physical, but it's really impossible to do that if you have more than one or two patients. So we can get a lot of information about the trainees' clinical reasoning from their presentation, right? But how can we assess this and how can we teach about this? And what prompts can we use to get the most out of this interaction in a reasonable amount of time? All right, so SNAP is one tool that we can use to look at this. So it's a learner-centered teaching approach that can be used in clinical education with six steps. So basically what happens is the learner is going to give their presentation. So we're asking them to take an active role in their educational encounter by thinking about things beyond the facts, right? So not just, okay, the patient had a stroke, they have shoulder pain, but actually engaging in the follow-up and the questioning process. So the preceptor is really not just the attending, but is also the educational facilitator to promote critical thinking, empowering the learner to have this active role and really serving as a knowledge presenter or coordinator as opposed to just a source. So kind of an example of this would be, so the resident summarizes the case, 60-year-old man with a history of stroke with left hemiplegia and spasticity with left arm and shoulder pain with any movement and ongoing weakness and tightness. And then they're gonna go through what's the physical exam? How are they doing functionally? And the preceptor might say, okay, what is your differential diagnosis of a shoulder symptom? So the resident can go through, okay, maybe it's rotator cuff dysfunction, spasticity-related pain, adhesive capsulitis, fibromyalgia, et cetera. And then the preceptor will go back with another question. Well, compare and contrast these possibilities for me. What do you think is most likely? What do you think is the least likely? And so then the resident can go back and discuss, okay, I think it's more likely this or less likely this because of these reasons. And then the faculty can say, okay, well, what are you uncertain about? Or what leaves you wondering with this? And so the resident could say, well, actually I don't know a lot about adhesive capsulitis. You know, what do I see in physical exam? How do I do imaging? And so it gives them a chance to admit what they don't know, which can open up discussion there. And then I think it's always important to have the trainee come up with a plan, right? So what's your plan for management of the medical issues? And so the resident may say, well, let's start with medications or imaging or et cetera. And then number six, so the learner and the faculty member can select a case-related issue to help continue learning. And so in this case, the resident has said, I don't know a lot about adhesive capsulitis. So that's a great topic for them to look up and bring back to the next clinic, okay? So let's hear from you. Does this seem like something you could actually implement in clinic? Does anyone use something similar to this? What steps do you think are the most important? And while people are answering Matt or Ashley, do you have any thoughts or comments on using SNAP? So I don't use this as a mnemonic, but I use various components of it when I'm in clinic. I think the one thing that kind of strikes me is like this could take a little bit more time than like a traditional thing, but I think thinking of it in terms of buckets, like, you know, for one patient encounter, you tend to focus on one through three, or, you know, in the next patient encounter, you're doing more of the three and the four, especially if you're in a really busy, like quick, quick, quick, quick, quick turnover clinic. It might be way easier to do this with inpatient or consults when you might have a little bit more time to round. And so I think, you know, I don't, I would just say like, you don't necessarily have to do the whole, every single step to make this effective. I agree. Yeah, I definitely agree. And I think, you know, I think given the fact that this specific one is trying to come up with kind of differentials, say oftentimes on inpatient, there may not be differentials and kind of just active management. But I do think like Ashley, you said, like I think trying to kind of chunk it up and for certain patients kind of figure out what's the best aspect of this teaching strategy to implement for each individual. One, and then kind of if you've progressed with different trainees and you kind of know where they are, kind of, you know, cuing them to advance as you go along, trying to kind of elevate them. So it's with initial ones, you may kind of have them kind of go through their differential or summarize, and then kind of more advanced as they continue on. Great. So I see Patrick, we do very similar as well as one with the one minute preceptor model. And it absolutely depends on if they're a PGY-2 or four in terms of what your expectations might be for them. Adam, I use this in medical school and it's helpful, but going through each is a bit clunky. So I agree with Dr. Bolger. Yeah, sometimes you are looking to get something different out of each encounter. And so you can kind of prioritize which question is the most important. Nate, I use various components of this and focus on smaller sections. Exactly. So, and various. So I think you can certainly focus on a different aspect depending on the patient encounter. Tailoring it to strengths and weaknesses is important and time efficiency is important. Absolutely done. The level of the learner impacts us not only in teaching strategy, but also in the amount of time we have to teach, we have available to teach. I agree, a PGY-4 is often much more efficient than a PGY-2. Great. All right, let's go on to the next slide. So you are on inpatient rounds. Your patient with a spinal cord injury has a temperature to 102. The medical student on your team assesses the patient first and comes out of the room to present her findings. Her presentation is a little bit disorganized. She thinks that it's probably an infection, either a pneumonia or UTI, but she isn't really sure. So how would you give her feedback on her presentation? So let's go ahead and launch the poll for slide 28. All right, I'll give you another couple of seconds. Answer. All right, so it looks like most people would ask her what her conclusion is and how she reached that conclusion. And a few people said they'd sit her down at a later time to go through her presentation point by point. All right. So let's go to the next slide here. All right, so one framework that we can use for this is the One Minute Preceptor, which I already know Patrick likes, so very good here. So it is a teaching model that we can use, providing five micro skills to organize a learning experience for students in the clinical environment. So really, the first step is get a commitment, right? Ask, what do you think is going on with the patient? And getting the commitment means that they have to throw themselves out there. And so it really probes them to think a little bit more because they know that they're going to have to come up with a specific answer. But this can provide the assessment of their knowledge or skill and teaches them to interpret the data. But then asking them, probing for that supporting evidence. So what's her conclusion and how she reached that conclusion can really look through that thought process and identify those knowledge gaps. So I always get the students or residents to, what do you want to do? What do you think is going on? Because sometimes they're happy to let me make all the decisions, and that's really not going to help them learn in the same way. And then going back and teaching the general rules. So when you see a patient with a spinal cord injury who has a fever, always consider XYZ. And so this is a really good point for your little teaching pearls that they can remember very clearly. And then reinforce what they've done right. So you did an excellent job with your physical examination. You did an excellent job coming up with a differential. You did an excellent job committing to your answer. You did an excellent job with your supporting evidence. So this gives that positive reinforcement that we know that many of our learners need. And then correct mistakes. So this is just giving that just-in-time, quick feedback. Next time, try to consider this. So this makes sure that they understand where in their thought process on the getting a commitment or probing for supporting evidence where they went a little bit wrong. So what do you guys think about this framework? Does this framework make sense to you? Do you already ask any of these questions on rounds when you're working with students or residents? And which question do you think gives you the best chance to assess performance? So, getting a commitment is important. I really like the one-minute preceptor, one of the biggest challenges is trying to teach new learners the how and the why of why of how we do something, so the clinical judgment. And so, this helps get it that efficiently. I agree, so getting the commitment and then how they got there is just a great quick blurb to look at their clinical judgment. Does anybody use this? I definitely do, especially on inpatient. I think it also helps me just, I think it's kind of an updated form of Socratic method or pimping where you're kind of trying to, in a way, figure out what's the kind of extent of their knowledge to then figure out how to kind of elevate them. So, I generally try, you know, to figure out kind of how they're arriving at their conclusion or where the roadblock is to kind of advancing to the next level, and I think this is a great model for that, both on inpatient as well as outpatient consults. Ashley, any comments? Yeah, I was going to say, I think the biggest, for me, the most important part of this is kind of those middle buckets, the probing for supporting evidence, because I think that's what, at least when I first started as an attending, I really struggled with, like, I wanted them to get to the answer, but I didn't know how to get to, like, how are you thinking about this? Because anybody can guess the right answer, and you may think, like, wow, this person is super smart. Like, they know what they're doing, but they may be just guessed, and they, in their head, picked from one of two choices, and they happen to get the right one and have no idea how they got there. So, I think that's, whether you're going to use this whole model again or not, I feel like that, those kind of questions to probe at that are super, super helpful to actually dig a little deeper for your learners. Great. All right, next slide. So, case number three, procedure clinic. So, you have a patient in clinic who's here for a knee injection. The resident working with you has never seen or performed a single knee injection ever, and you decide you're going to do the procedure while the resident observes, and then maybe you let him perform the next knee injection. So, thinking back to all of my learners, everyone loves the see one, do one, teach one process in medical education, and I maintain that we can do better than that, because there's so much more that goes into a knee injection than seeing one and immediately being able to do one, right? So, the consent, the safety, the procedure, the indications, the post-op complications or post-procedure complications, it's way more complicated than seeing one and then doing one, right? So, we obviously want to go to a little bit of a higher standard for procedure education, but in this case, you have someone who is just in your clinic seeing a procedure for the first time. So, let's go ahead and launch the next poll. So, can we improve upon see one, do one, teach one? All right, I'm gonna go ahead and end the poll here. Okay, so no one said no. So I guess I let my bias show a little bit before opening the poll. So I'm sorry about that. Yes, there are better ways to teach than see one, do one, teach one. And I don't know, but since you're bringing this up, I'm sure you have some suggestions. So we can certainly talk for a long time about procedures, right? So we could have a whole session. And I know there are some people on this call actually who are very adept at teaching procedures. So we're not gonna spend a lot of time on this, but this is just one quick technique that you can use called activated demonstration. So this is when you have someone who's shadowing with you, someone who's seeing a procedure for the first time. And so they can sit back and just watch. So for example, I get medical students who come see my EMG clinic. I'm gonna bet that they know nothing about EMGs and they have no idea what's going on. And they can sit there and watch an EMG for two hours and probably get nothing out of it, right? And so what you can do is an activated demonstration. When a patient's problem is unfamiliar to the learner, this is the time for the learner to observe the teacher at work. But you can assign specific things for them to complete while they're there, right? So watch how I do the informed consent, right? Keep an eye on how I prepare the skin before I do the procedure, right? Or watch how I angle the needle as I am doing the procedure, right? Or watch how I hold the ultrasound probe. And so really what you're doing is setting expectations for what they should be doing as they're observing or participating, right? And then after the demonstration, after the procedure, the teacher needs to activate the learner by asking him or her to describe what they saw. And so this really can make the observation much more meaningful so that they're getting more out of it. So I see in the chat, yes, I will find learners see, see me set up the field or ultrasound multiple times, but have no idea what to do on their own hands unless we have them actively practice the steps, right? So setting up for ultrasound, watch what is my first step, what is my second step, right? So get them to really think through the process of what you're doing. Use graduated transition, let them do consent, prep drapes, discuss approach, perhaps do local innocent. Exactly, so Patrick, I think it's great to do a graded responsibility, right? So once they've watched something in detail, then maybe they can demonstrate it the next time, giving them more responsibility as they go through. And Ashley, I think that's an important concept of picking one to two things, right? So they can do better with targeted learning compared with trying to teach the entire process at once. Yeah, all right. Any other comments, Ashley or Matt? Yeah, I'd say similar to kind of what we were talking about with either trainees that are new to you or just like more early in their training, trying to like prime them and move them along so that you can kind of say, okay, like this is gonna be our focus for this session. And then next week or the next patient we can advance is another way to kind of continue with this active demonstration so that you are hopefully progressing them towards more independent practice with these procedures. So someone is seeing their first botulinum toxin injection. What kind of a question might you ask a trainee? Please repeat the question. All right, sorry. So if you have a student or a resident seeing their first botulinum toxin injection, what might you ask them so they can watch what you're doing during the procedure? Who would need this type of injection? If using EMG for guidance, listen to the signal to sharpen up as you approach. Have you ever heard of spasticity? I hope you're referring to medical students and not residents, or we might be in trouble a little bit. How to set up the e-stem, that's a good one. How I'm going to determine I'm in the right muscle. It's also important that they critically think about the procedure. Why are we using this dose? Would you consider other muscles based on their gait? Ask them to analyze the why. Great, great answers. All right, and next case. All right, case number four. You are asked to give a one hour lecture to approximately 20 medical residents on a topic on which you are an expert and about which the residents have some basic knowledge. How will you make this lecture more engaging for the learners? Okay, let's go to our last poll. And I think you can pick more than one. I think it is a single choice, so single best choice. Single choice, all right. Unfortunately, sorry about that, y'all. There's definitely more than one right answer. And I know that Ashley would include cute pictures of her children. All right, I'll go ahead and end the poll there. So overwhelmingly include cases and ask thought provoking questions. So I think those are obviously excellent, excellent choices for this. I do argue that cute pictures of the children, and it looks like Emily agrees with me, we can include cute pictures of dogs. So I think that's helpful. And crack jokes. I mean, I have an eight year old and a 10 year old, and they tell some really awesome jokes. So I may have to start incorporating those into lectures. So go ahead to the next slide here. So thinking about interactive learning. So this is an old list of topics from the AMEE Medical Education Guide number 22, which I really enjoy. Although look at number four, set a brief multiple choice questionnaire and present it on the transparency. So if that tells you a little bit about how old this reference is. But I really like it because it really kind of sets the stage for ways to have interactive lecturing, right? So set a question or a problem to be discussed in buzz groups. So get the little groups together or a couple of students together and have them generate a buzz while talking about a question or a problem. And someone mentioned include different media options. Absolutely, people love videos or demonstrations, things that break up someone just up there talking, right? Demonstrate a task. So number three is activate a demonstration, right? So when we do some of our basic EMG lectures, we actually will perform a nerve conduction study and let them see exactly what we're doing. Include multiple choice questions, right? So having the poll questions, make sure that you're engaging people, getting their minds working on specific questions. Ask the students to frame questions, to come up with their own questions. Get the group to solve a problem collectively. Ask the students to get them back into the group and have them discuss a case, a research design, or a set of findings. Have students invent their own examples that apply to whatever case or roles you're discussing. Have the students think about advantages or disadvantages, strengths or weaknesses of a procedure or theory. So this is kind of going back to their critical reasoning and let them think through the process. So anything they can do to engage and use the information. And then towards the end of the lecture, ask them to review the key points that they've learned or need to learn and share with their neighbor. So this is active recall and can aid understanding there, okay? So do you use any of these currently when you give lectures? And do you see any options here that you're interested in including in your lectures? So I think these are, I'll just while you guys are chatting in the chat, I think these are all amazing options. It probably depends a little bit on what topic you're lecturing on. But one thing I also just wanted to kind of draw attention to or at least talk about a little bit is knowing your audience and knowing the goals of the talk. I think I see a lot of folks, especially in traditional quote unquote lectures, even if they're interactive, they're trying to get through so much stuff in the hour or 40 minutes or whatever, allotment you're giving. And I think you have to remember that learners only have a finite amount that they are going to retain. So if you really want them to learn something, pick like three topics and really drill them down. I think it's also really nice if you're able to kind of divide for the case of like residents, like by PGY year, EMG is a great example. Your PGY twos and threes, or depending on when you do EMG in your residency, are gonna be very different than your PGY fours. And I think some of us, I come from a program that has a very small residency program and that's just not doable. And I think that gives you a lot of challenges as a lecture because you're basically gonna touch on topics maybe for the first 10 minutes that are pertinent to the younger learners or the earlier learners that the other PGY fours are like totally spaced out and now they're not even paying attention. And then when you get to some of the other things, it's gonna be flipped a little bit. So just some kind of things to think about, even in addition to whatever techniques you're using to make it more interactive. Yeah. I'll wait for some more comments to come through, but I was gonna say kind of similar to the number 10, I am a big fan of like think, pair, share, which I think allows for additional collaboration, especially which is important as physiatrists because of the team-based aspect of so much of our care, but also allows for people to share ideas that they may not wanna share in a larger group setting. And then it kind of modulates from, I mean, this example of 20 residents is kind of a large, small group, but just kind of chunks it down to allow us for just different flow of ideas. So I think kind of having ability to break out into smaller groups would be helpful, which we were hoping to do for this, but unfortunately, because of the recorded nature, we wanted to make sure that people who are watching it after the fact would be able to benefit from the whole conversation with us here. So there's one question that came through about, you know, kind of Journal Club, which is not an example that we came up with here, but kind of thoughts or frameworks on how to present Journal Club in a more engaging manner. So I'm really curious to hear what others think. We just did a little revamping of ours this year because I felt like it was deviating a little too much to the presenter teaching or reviewing and kind of what we were trying to do. To the presenter teaching or reviewing the article. And so now we do it really like in a question-based format where they have to come up with however many questions they're gonna ask the group and their faculty review it beforehand. But I'm really curious if others have great ideas that they've found successful, because it's been a struggle. And I would say, especially with the virtual format, I feel like that's kind of led us even less interactive overall. And I realize we're coming short on time here, but we appreciate you sticking around. If anyone has any thoughts of kind of Journal Clubs or ideas, definitely feel free to put it in the chat. While that's going on, we just wanna make sure we have our contact info up here in case anyone wants to engage in discussion about kind of additional strategies. You know, we're happy to talk with anyone and definitely very interested in all things medical. So if you have any questions, feel free to put them in the chat. And we're definitely very interested in all things medical education. I can speak for kind of the whole faculty panel on that. Yeah, so there's a couple additional comments about kind of journal club using a point counterpoint which I think would be helpful to engage discussion kind of figure out kind of how to best apply the take on points for each article. Another one. Example journal club from Wash U emergency medicine program. So maybe some of us can look into that offline. So some of the faculty here will be sticking around if any of additional comments, I think we can end the recording now, but definitely people want to turn their cameras on and chat, definitely happy to stay around for a little bit.

teaching techniques

millennial learners

adult learning theory

learning styles

learning preferences

safe learning climate

specific interests

self-direction

problem-solving

interactive learning