Setting Expectations
Setting expectations is part of the “Setting the Table” for teaching, which is the first step of the “3T Teaching Blueprint” (see below).
Setting & Background
In order to have effective teaching, the learner must understand his or her teacher. This is especially important in terms of understanding the educational expectations. Expectations act as a guide map or a barometer for the medical learner, once they understand what is expected of them they can tailor their behavior and actions to fit and meet these expectations.
This is important because the students may not fully understand the level of autonomy and type of teamwork that is needed to thrive in the clinical setting[i] This is especially important for medical students who really need the teacher to control the learning environment.[ii] Several studies show the positive effect of expectation setting.
- Medical learners want preceptors to define expectations at the start of the educational experience (Kutzsche)[iii]
- Poor setting of learner expectations is a major factor for negative rotation experience and when this is addressed, the experience significantly improves (Cherry-Bukowiec) [iv]
- Expectation setting improves satisfaction for the staff, learners, and the attendings (Martha Regan-Smith).[v]
Expectation setting goes beyond just decreasing negative learner experiences; it is also needed for maximizing learning.
- Setting clear learner expectations is critical for fostering rotation learning and conversely, failure to set expectations leads to negative learning outcomes (Tim Dornan) This is further supported by finding that learners tend to favor instructors who set clear expectations.
- Learners commonly list setting specific objectives, setting specific expectations, and setting clear goals as traits of a good teacher (Gary Sutkin).[vii]
- Setting expectations was very important to create perception of a positive learning experience.[viii]
The Problem
Most residency rotations and medical school clerkships provide learners with rotation expectations at the start of the rotation. They are usually general, broad and not individualized. This is because, during a typical rotation, learners commonly work with several different attendings and thus, they experience a large variety of different expectations.
The pre-rotation list of expectations is usually generic and often fails to account for all of the different individual expectations that the learner will encounter on their rotation. The learner’s often become aware of these different expectations by means of negative feedback after they fail to do what is expected of them. This type of experience can form an overall negative feeling of the rotation due to increased level of frustration and increased sense of failure.
The only solution for this problem is for each attending to clearly define and explain their own individual expectations to the learner’s at the beginning of the educational experience.
The Solution: How to set expectations
Setting expectations is very important for less experienced learners.
Expectations should be set early in the teacher-learner relationship.
The attending must first know his/her expectations in order to have the ability to set expectations.
A lot of attendings don’t know what they expect. They have never thought about the specific actions and behaviors that they want from their residents.
Determining what your “resident expectations” are is actually pretty easy. Thinking about the following can help you formulate your expectations.
- Presentations: How do you like the residents and students to do their presentations?
- Communication: How do you like the residents and students to communicate?
- Behavior: How do you like the residents and students to behave?
- Orders: How do you like residents to put in orders?
- Appearance: How do you like residents and students to dress?
- Routine: How do you like to structure the day (rounds, admissions, sign-out)?
At the beginning of your time with the learner (resident or medical student) take 5-10 minutes to clearly explain your expectations to them.
Of course you will want to include a disclaimer that states you may adjust or change your expectations to fit the needs of the situation.
Below is an example of Dr. Stanley’s expectations
- Another tip is to write your expectations down. If you are too busy, you can contact Dr. Stanley at the Office of GME. Dr. Stanley will write your expectations down and will distribute them to the residents in a method that you are comfortable with.
References
[i] Atzema C1, Bandiera G, Schull MJ. Emergency department crowding: the effect on resident education. Ann Emerg Med. 2005 Mar;45(3):276-81.
[ii] Paukert JL1, Richards BF. How medical students and residents describe the roles and characteristics of their influential clinical teachers. Acad Med. 2000 Aug;75(8):843-5.
[iii] Kutzsche S1, Kutzsche H, Dornan T. What do paediatric trainees require from their clinical supervisors? Acta Paediatr. 2014 Apr;103(4):e169-72. doi: 10.1111/apa.12534. Epub 2014 Jan 3.
[iv] Cherry-Bukowiec JR1, Machado-Aranda D2, To K2, Englesbe M3, Ryszawa S4, Napolitano LM2.J Surg Res. Improvement in acute care surgery medical student education and clerkships: use of feedback and loop closure. 2015 Nov;199(1):15-22. doi: 10.1016/j.jss.2015.05.062. Epub 2015 Jun 5.
[v] Martha Regan-Smith, MD, EdD, William W. Young, MD, and Adam M. Keller, MPH, An Efficient and Effective Teaching Model for Ambulatory Education Acad. Med. 2002;77:593–599.
[vi] Dornan T1, Tan N, Boshuizen H, Gick R, Isba R, Mann K, Scherpbier A, Spencer J, Timmins E. How and what do medical students learn in clerkships? Experience based learning (ExBL). Adv Health Sci Educ Theory Pract. 2014 Dec;19(5):721-49. doi: 10.1007/s10459-014-9501-0. Epub 2014 Mar 18.
[vii] Sutkin G1, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med. 2008 May;83(5):452-66. doi: 10.1097/ACM.0b013e31816bee61.
[viii] Thurgur L, Bandiera G, Lee S, Tiberius R. What do emergency medicine learners want from their teachers? A multi-center focus group analysis. Acad Emerg Med. 2005; 12:856–61
