Training in Medical Teaching

OVERVIEW:
Training in clinical teaching methods consists of (1) a core bi-weekly seminar on teaching methods and (2) a series of teaching practicums in which fellows perform supervised teaching in a variety of settings.

TEACHING SEMINAR:
GGIM fellows currently meet for 90 minute seminars, twice monthly in which address education theory and skill applicable to clinical teaching in a variety of clinical settings educational environments (one-on-one supervision, small group discussion and lectures). Preselected topics compliments fellow selected and presented topics. Table 1 contains a sample list of the topics the fellows may cover in one year of the seminars. The topics covered in the teaching seminars are covered over a two-year cycle. Fellows participate in the teaching seminar in both years of their fellowship.

TEACHING PRACTICUMS:
The teaching practicums for fellows take place at BMC and at the Boston VA, regardless of the fellows’ outpatient clinic or office site. At the medical school, all fellows participate in teaching physical diagnosis to second year medical students, under the guidance of the faculty coordinator at the clinical site. Opportunities also exist to precept small group problem-based-learning curriculum for one semester. In the clinical arena, in the ambulatory, primary care practicum fellows supervise a resident one half-day per week along with a senior faculty supervisor for 6- 12 months. Month-long teaching practicums may take place in the traditional inpatient (ward) settings or in the Ambulatory Diagnostic and Treatment Center (ADTC), an ambulatory block rotation at the Boston VA. Supervised teaching occurs daily in each of these practicums. Fellows may participate in additional ambulatory care or inpatient teaching practicums, if they and their mentors conclude that the additional practicums would be useful for their careers.

In all venues, supervising faculty and fellows frequently are both present during patient care supervision activities. They alternate roles in observing the “teaching” decisions made during the encounters. Early in the practicum, the fellow assumes the role of observer more frequently, later transitioning to the predominant “attending” supervisor for the trainees. Regular analysis and debriefing occur between the co-teachers in order to improve one’s understanding of teaching process and improve technical skills. The focus of the faculty-fellow interactions is to enhance observational skills, motivational techniques, pacing of teaching, and effective use of teaching methods. Altogether, fellows spend 10-20% time in teaching seminar and practicum experiences.

TABLE 1. CLINICAL TEACHING METHODS SEMINAR SESSIONS-Year 1

Family Medicine.

FM Fellows also participate in teaching through observed precepting, inpatient attending rounds, and didactic, workshop, and Web-based teaching during the FM six-week third year clerkship. Research fellows may take month-long inpatient medicine practicums where they conduct “Attending Rounds” under faculty supervision and take part in other teaching experiences such as “Morning Report.” Fellows are expected to participate in a three-session seminar for third year medical students on Evidence Based Medicine. They also attend the General Pediatric Fellowship educational seminar that is similar in style to that in the General Internal Medicine Fellowship, although with a somewhat different content. Finally, all fellows participate in practicums of medical student teaching, including courses for Medical Interviewing and Physical Diagnosis and Integrated Problem Solving (a seminar course that uses patient cases to illustrate issues in patient care and the application of biomedical knowledge to patient care). Optional practicums for all fellows include experiences in medical consultation, emergency medicine, and public health. Altogether, the FM Fellows spend 10-20% time in teaching seminar and practicum experiences.