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Brief Reflections from the Teaching Service

For so many of us climbing up the rungs of the medical hierarchy from pre-med to med student to resident to faculty, we advance up those rungs and find that we have become educators. However most of us lack any formal education in how to educate. Often, we may not even realize that we are teaching or giving feedback. We find ourselves "teaching" by copying the styles of those who taught us. We embrace the "see one, do one, teach one" mentality. Today, Dr. Jennifer Caputo is sharing her experience as she changed careers from community medicine to academic medicine. She shares some insight that we can ALL use as we step into that unfamiliar place of "educator."

After four years as a hospitalist on the non-teaching service at my university, I decided to change things up this year and commit one quarter of my time to attending on the internal medicine teaching service. My first two weeks were assigned at the end of July. As the rotation approached I was nervous, questioning whether I would be an effective teacher and how I would manage a team that included brand new interns. Happily, the two weeks went smoothly and the feedback I received from the students and residents was overwhelmingly positive. What I learned and would advise for other junior faculty stepping in to the teaching attending role is that preparation is key.

Setting the tone for the team, anticipating major teaching points for the day, and planning how you will structure rounds and teaching sessions are all essential to successful teaching on the wards.

For residents and students my advice is to give honest feedback to your attendings about their teaching styles. There is a lot of focus in medicine on attending evaluations of trainees, but as the attending I found myself craving feedback from my team about my effectiveness as their teacher. Looking back, here are the top things that contributed to our team’s success:

Set expectations at the start

The first day on service set aside time for formal introductions and to discuss expectations for the rotation. I wrote a one document with my expectations for the students, interns, resident, and myself. This included basics such as my expectation that all patients would be seen prior to attending rounds (it may seem obvious, but I think it is still worthwhile to make clear) and expectations specific to my preference (wanting student notes completed prior to rounds that I will attest directly without the intern having to also write a note). Given our time together was short and that every attending has different preferences, explicitly telling the group what I wanted at the start freed up the remainder of our time to focus on patient care and learning.

Food goes a long way to boost team morale

I brought in breakfast to our first post call day and took the team to lunch on my last day on service. These small gestures created an opportunity to decompress and get to know each other. Most importantly, it showed the team that I cared about them.

Present teaching points in multiple ways

I made it a habit to bring an article to rounds or email out an article or podcast link about a topic that came up on rounds almost every day. This was the behavior every team member praised when I asked for feedback. It reinforced the bedside teaching, solidified their knowledge, and helped the team further define the treatment plans on subsequent days’ oral presentations and progress notes.

Make opportunities for direct observation

More often than not I allowed the intern or resident to lead the conversation with the patient during bedside rounds. This direct observation gave me a wealth of knowledge and insight into the learners’ bedside manner, rapport with patients and families, understanding of the plan, and ability to effectively communicate the plan and provide education to the patient.

At the end of the two weeks the feedback I received was that my team felt respected. They felt they had autonomy in their medical decision making while at the same time knowing I was always available for questions. They found that my experience as a hospitalist brought lessons of pragmatism and efficiency to the rotation that was different from, but complementary to their experiences with the full time teaching faculty. As it turns out, I was an effective teacher. I can’t wait for my next rotation on the teaching service.

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