Diagnosing the Learner

Diagnosing the learner is part of “Setting the Table” for teaching, which is the first part of the “3T Teaching blueprint”. 

Below you will find out why diagnosing the learner is important. You will also discover the current problems around diagnosing the learner and you will learn how to diagnose the learner. 

The solution is simply learning how to diagnose the learner. Below details some general concepts about today’s learners, as well as a realistic approach for diagnosing the learner. 

Setting & Background

 

In order to optimize teaching, the teacher and the learner must understand each other. In “Setting Expectations (click for detail)” we discussed how to improve the learners understanding of what the teacher wants and needs. Now we will focus on improving the teacher’s understanding of what the learner wants and needs.

When the teacher understands the learner, they can tailor teaching towards the learner’s specific learning goals and learning needs.

  • Tailoring teaching is viewed by learners as a factor that leads to a positive learning experience.[i]
  • Tailoring the teaching has also been cited as a major strategy for effective teaching by expert clinical teaching attending’s.[ii]
  • Effective teachers understand that for maximum learning to occur, it is critical to tailor teaching to the level of learner’s current knowledge and experience.[iii, iv]
  • However, before teaching can be tailored, the teacher must first understand the learner’s current knowledge and experience[v]. The teacher needs to be aware of what the learner knows, as well as their specific educational wants and needs

The term “diagnosing the learner” is what experts use to define the process of actively trying to understanding the learner.[vii] 

Actively and intentionally diagnosing the learner increases the clinical teacher’s awareness and understanding of the student’s individual skills, interests, previous learning experiences, strengths and areas of weakness.[viii]

Beckman and Lee found that diagnosing the learner is an essential for effective teaching, maximal learning and a positive learning experience.

The link below sheds light on the current problem surrounding “Diagnosing the learner”

 

The Problem

 

Unfortunately, despite the numerous benefits, clinical preceptors commonly fail to diagnose the learner (Irby).  This is a major limitation to their ability to teach and it limits the learning for the learners.

Most preceptors use the “one size fits” approach with their learners.  A one size fits all approach does not work because learners all have varying backgrounds of experience, different strengths, different weaknesses and different educational goals.

In reality, when diagnosing the learner is omitted the teacher ends up understanding very little about their learner, and thus, is unable to tailor the teaching.

The Solution: How to Diagnose the Learner

Diagnosing the Learner Video

Dreyfus Model

 

The Dreyfus Model of Skill Acquisition was developed to outline the steps we take when leaning. The model shown below accurately reflects that stages that learners go thru while learning medicine. 

The ACGME Sub competency levels (1-5) correlate with the Dreyfus Model of Skill Acquisition. The milestones found in each level are based on what a medical learner should do for that Dreyfus stage. Below is an example, showing an emergency medicine Sub-Competency with each level. 

The Dreyfus model is for life long learning. Most people do not reach level 5 until they have been attendings for several years. 

RIME Model

 

The RIME model is similar to the Dreyfus Model but it is much simpler and it is easier to use in the clinical setting. The picture below gives an overview of the RIME model. 

The RIME model states that everyone starts as a Reporter. They then move thru the stages until they become and Educator. A good teacher determines what stage the learner is at and then tries to advance the them to the next stage. 

Past, Present, & Future

 

A good way to diagnose your learner is to look at their past, their present and their future. 

  

First, look at their past

  • Do they have any prior degrees or Training? Are they a former RN?, Paramedic?, Pharmacist?. Do they have a pHD or master’s degree in something?
  • How many days or shifts have they done on the rotation?
  • How many similar rotations have they done in the past?

Next, look at their present

  • What do they want to learn on this rotation?
  • What do they need to learn on this rotation?

Last, look at their future

  • What specialty do they want to go into?

Asking the following questions can be helpful when trying to figure out what the learner wants and needs to learn from you. 

References

[i] Kathryn N. Huggett Æ Rugmini Warrier Æ Anna Maio . Early learner perceptions of the attributes of effective preceptors Adv in Health Sci Educ (2008) 13:649–658

[ii]Karen V Mann,1 D Bruce Holmes,1 Vonda M Hayes,2 Fred I Burge2 & Patricia Weld Viscount3. Community family medicine teachers’ perceptions of their teaching role. MEDICAL EDUCATION 2001;35:278±285

[iii] Bandiera G, Lee S, Tiberius R. Creating effective learning in today’s emergency departments: how accomplished teachers get it done. Ann Emerg Med. 2005; 45:253–61.

[iv] David M Kaufman. ABC’s of learning and teaching in medicine. Applying educational theory in practice. BMJ VOLUME 326 25 JANUARY 2003

[v] Kay Mohanna, Ruth Chambers, and David Wall. Developing your teaching style: increasing effectiveness in healthcare teaching. Postgrad Med J. 2007 Mar; 83(977): 145–147. doi: 10.1136/pgmj.2006.054106PMCID: PMC2599988

[vi] Coates WC1, Gill AM. The emergency medicine subinternship–a standard experience for medical students? Acad Emerg Med. 2001 Mar;8(3):253-8.

[vii] Rob L. Rogers. Practical teaching in emergency medicine. 2nd edition. Chapter 24: Strategies for effective clinical teaching in the emergency department. 2013.

[viii] Diagnostic Teaching. The Preceptor Vol 1: No 4, spring 2013 Lincoln Memorial University-DeBusk College of Osteopathic Medicine CME and Preceptor Development Office

[ix] Thomas J. Beckman, MD and Mark C. Lee, MD. Proposal for a Collaborative Approach to Clinical Teaching Mayo Clin Proc. 2009 Apr; 84(4): 339–344. doi: 10.1016/S0025-6196(11)60543-0PMCID: PMC2665979).

[x] Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69(5):333-342

 


Faculty Development Home
Back to 3T Teaching Blueprint

Cardiovascular ICU Selective/Elective

Teaching Chief: Kartheek Nagappala MD

Description: Advanced Cardiovascular Critical Care rotation will allow residents to further develop their skills, knowledge and attitudes obtained during their previous rotations, specifically expanding on their critical knowledge to patients that are post cardiac surgery, major vascular surgery, and critically ill due to compromise of their cardiovascular system. The rotation will involve 21-22 12-hour shifts, similar to the EM core ICU experience. 

Availability: Generally available year-round and will occasionally share the experience with an Anesthesia co-rotator.

Scheduling: Schedule to be made by the rotator with final schedule approval by the teaching chief

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Community Emergency Medicine Elective

(PGY-3 only)

Teaching Chief: Various (depending on location)

Description: This is an opportunity to experience medicine across the care spectrum in a completely different cultural, social, and economic environment. From learning how to deliver sustainable care in critical access areas of the world, to experiencing Emergency Medicine as it is practiced elsewhere, the possibilities are endless. Previous residents have set up unique experiences in Uruguay, Thailand, Vietnam, and Tchad. Prior to thinking about an international elective the resident should consider travel, safety, health (vaccinations etc.), and financial concerns. Dr. Sukhija can help you guide you with strategies to set up an experience as each one is highly individual. 

Availability: Variable

Scheduling: Variable

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Palliative Care Selective/Elective

Teaching Chief: Ryan Howard MD

Description: The Palliative Care Selective or Elective is a 2- or 4-week inpatient rotation designed to expose the rotator to all aspects of inpatient palliative care. Residents will work alongside the palliative director and/or the palliative fellow along with the interdisciplinary palliative team throughout the rotation. The goal is to provide either PGY2 or PGY3 residents with an immersive clinical experience to learn more about inpatient palliative services.

Availability: Generally year-round, those interested in applying to Palliative Fellowship get precedence on the rotation as space is limited

Scheduling: M-F, 8am-5pm, with call shifts if required/desired per Dr. Howard

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Intro and Advanced Pharmacology Selective/Elective

Teaching Chief: Chadi Kahwaji MD, PhD and Savannah Lail PharmD

Description: A 2 or 4-week rotation where the resident works and learns alongside the ED pharmacists on assigned shifts. The Pharmacology rotation is designed to provide training concerning the application of pharmacology knowledge, pharmaceutics, drug information, medication safety, communication skills, critical thinking, pathophysiology, and therapeutics to the care of patients in an emergency department setting. The advanced rotation is for those who have already had the introductory Pharmacology rotation experience.

Availability: Generally year-round, but must contact PharmD teaching chief prior to choosing the rotation to ensure availability. 

Scheduling: Variable shifts, 10-shifts per rotation, to be assigned by PharmD teaching chief

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Pulmonary and Ventilator Management Selective/Elective

Teaching Chief: Leland Beggs MD

Description: This is a 4-week rotation based in the ICU, CVICU and ED. Residents will work side-by-side with designated respiratory therapists as well as core faculty physicians. The goal of this rotation is to focus solely on vent management and non-invasive ventilation techniques in patients with a wide variety of disease processes. Residents will be expected to manage vent settings for intubated patients in the ED, ICU and CVICU. Residents on service should gain an in-depth understanding of the events surrounding intubation, including strategies in pre oxygenation as well as the various drugs used for RSI and post intubation sedation. In addition, they will learn when to initiate, and how to manage non-invasive ventilation.

Availability: Generally year-round

Scheduling: M-F, 6am-4pm

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Radiology Selective/Elective

(Two-week experience) 

Teaching Chief: Ashkan Shahkarami MD

Description: The two-week Radiology rotation will provide the resident with an opportunity to learn normal and abnormal radiographic anatomy, recognize radiographic findings of common diseases, understand the indications for commonly ordered imaging studies, and learn the appropriate use of IR procedures. The goal of the rotation is to help the resident become competent in the use of imaging in the evaluation and treatment of disease.

Availability: Generally year-round, but must contact teaching chief before choosing the rotation to ensure availability

Scheduling: M-F, 8am-4pm, or as adjusted by the Radiology attending

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Wilderness Medicine Selective/Elective

Teaching Chief: Various

Description: The one-week wilderness medicine selective is offered twice a year at Kaweah Health, usually once in the Spring and once in the Fall/Winter. If not available during the allocated selective/elective block, previous residents have participated in 4-week experiences in Utah and Redding, CA. Experiences are variable and depend on the chosen course, so for this one touch base with Dr. Sukhija to see what is feasible both locally and away.

Availability: Highly variable, see description above

Scheduling: Highly variable

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Emergency Medicine Admin Selective/Elective

Teaching Chief: Kona Seng DO and Khoa Tu MD

Description: This is 2-4-week rotation in conjunction with the Department of Emergency Medicine Medical Director. The purpose of the ED Administration rotation is to provide an understanding of the administrative components of EM clinical services and operations. This will allow early exposure to ED administration to determine if the resident is interested in the administration and business of emergency medicine. The EM residents will attend all assigned meetings and participate in administrative projects. 

Availability: Generally year-round, will share the rotation with the PGY3 on their core admin rotation

Scheduling: M-F, 9-5pm, or as adjusted by the teaching chiefs

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Patient and Physician Advocacy and Street Medicine Selective/Elective

Teaching Chief: Kunal Sukhija MD, Omar Guzman MD, Lori Winston MD

Description: The Advocacy 2- or 4-week rotation is designed to be a self-directed customizable experience that will provide immersion into various aspects of physician and patient advocacy. The resident will be able to participate in local, state-wide, and national (schedule permitting) advocacy efforts while simultaneously learning about effective strategies to engage community leaders, legislators, and the local constituency. The rotation will offer experiences in both the legislative and community advocacy (the latter will be based in the Street Medicine program). 

Availability: Generally year-round, however certain months tend to be better given the yearly CMA, AMA, CalACEP, ACEP schedules. Touch base with Dr. Sukhija prior to choosing this elective in order to ensure you can get the individualized experience you desire.

Scheduling: Highly variable depending on advocacy events and meetings, Street Medicine tends to hold its events on Friday

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Performance and Quality Improvement (PI/QI) Selective/Elective

Teaching Chief: Chadi Kahwaji MD, PhD

Description: The Performance Improvement (PI)/Quality Improvement (QI) selective rotation will provide exposure to ongoing PI and QI efforts at KDHCD and provide opportunities for the PGY2 or PGY3 EM resident to become involved in PI/QI projects on an individual, departmental, or institutional level. The resident will join the Emergency Medicine PI director in the regular duties of chart review, M&M conference coordination and presentations, and committee meeting attendance as appropriate. It also offers time for the resident to work on their PI/QI project as part of residency graduation requirements. 

Availability: Generally year-round

Scheduling: Variable depending on meetings and current on-going projects

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Public Health Elective (PGY3 only)

(PGY3 only)

Teaching Chief: Karen Haught MD MPH, Tulare County Public Health Director

Description: This is a 4-week rotation with the Tulare Public Health Department designed to expose the rotator to all aspects of public health. Residents will work alongside the Tulare Public Health Director and/or the epidemiologist throughout the rotation. The goal is to provide PGY3 residents exposure to the role of the local public health department in the community. Residents will be expected to work at the Tulare Public Health Department and contribute to a community health project of the resident’s choice.

Availability: Generally year-round, though an interested resident should first contact Dr. Haught prior to selecting this experience (Dr. Sukhija will help you with contact information)

Scheduling: M-F, 9-5, though historically it’s been less than this as independence is given to work on the resident’s chosen project

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Research Selective/Elective

Teaching Chief: Chris Patty DNP, Director of Research

Description: The goal of the resident research rotation (2 or 4 weeks) is to improve the resident’s understanding of how new knowledge is created and translated into practice.  At the end of the rotation, the resident will present a deliverable which demonstrates ACGME competencies in knowledge development and translation. Many residents choose this rotation in order to work on their chosen Scholarly Activity as part of residency graduation requirements. 

Availability: Generally year-round, the resident must contact the director of research 4-weeks prior to the rotation in order to state deliverables and set up the rotational requirements.

Scheduling: Variable, generally self-directed independent work

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Simulation and Education Selective/Elective

Teaching Chief: Kim Sokol MD

Description: This is a 4-week rotation includes developing simulation scenarios, teaching simulation-based educational sessions, and assisting in daily operations in the simulation center. The rotation’s purpose is to develop skills associated with teaching. The rotation will provide an introduction to simulation with multiple adjuncts such as high and low-fidelity mannequins, task trainers, and the use of standardized patients.  A basic understanding of simulation-based education and debriefing will be taught along with basic principles associated with adult education. The resident must choose teaching shifts as their clinical experience.

Availability: Generally year-round

Scheduling: Variable, to be determined with the teaching chief prior to the rotation start date

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Teaching Elective with Dr. Stanley

(PGY3 only)

Teaching Chief: Michael Stanley DO

Description: This 4-week rotation is a highly-desired advanced elective rotation for PGY3 EM residents. It is intended only for those residents who are serious about improving their ability to teach AND lead. This rotation is as much about leadership as it is about teaching because both utilize the same skill sets. Residents will gain knowledge in effective communication techniques while learning about the underlying psychology of teaching, learning, and leadership.

Availability: Generally year-round

Scheduling: 12 10-hour shifts to be scheduled in accordance with Dr. Stanley’s clinical schedule, along with didactics (also to be scheduled with Dr. Stanley prior to the start date). If Dr. Stanley has less than 12 shifts, then the remainder can be completed with either Dr. Oldroyd, Dr. Sokol, or Dr. Alexeeva.

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Advanced Ultrasound Selective/Elective

Teaching Chief: John Hipskind MD

Description: This 4-week rotation is designed to augment the resident’s diagnostic (and therapeutic) skills in relation to the ultrasound, and to explore more advanced US modalities such as TEE. The resident will gain experience with nerve blocks, enhanced approaches to the core EM ultrasound studies, and explore novel ways to use the ultrasound in the ED setting. They will work alongside the teaching chief as well as the ultrasound fellows.

Scheduling: The expectation is to be scanning daily M-F, with weekends off. Due to PGY1 EM rotators and the popularity of this selective/elective, there may be many residents on rotation, and thus scheduling must be in conjunction with Mia Zavinovich and Dr. Hipskind prior to the start of the rotation. 

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International & Global Medicine Elective

(PGY3 only)

Teaching Chief: Various (depending on location)

Description: This is an opportunity to experience medicine across the care spectrum in a completely different cultural, social, and economic environment. From learning how to deliver sustainable care in critical access areas of the world, to experiencing Emergency Medicine as it is practiced elsewhere, the possibilities are endless. Previous residents have set up unique experiences in Uruguay, Thailand, Vietnam, and Tchad. Prior to thinking about an international elective the resident should consider travel, safety, health (vaccinations etc.), and financial concerns. Dr. Sukhija can help you guide you with strategies to set up an experience as each one is highly individual. 

Availability: Variable

Scheduling: Variable

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Patient Callbacks and PBLI form

Patient callback instuctions - complete 12/block when you are on the emergency medicine service

PBLI form - complete 4/year to reflect & self-evaluate your patient care

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