So let's talk about the next session that we're going to be running. This is Nicole Roberts. Nicole, tell us what you do and what we're going to be learning. >> I'm Nicole Roberts. I'm from the Sophie Davis School for Biomedical Education. And today we're going to be talking about the briefing intraoperative teaching and debriefing model for clinical teaching. >> I brought Nicole to come and do this, because I think it's a very interesting model. Although it is intended for the operating room, it actually fits in all of the teaching that we will do, whether or not you're a pathologist or a radiologist or a nurse. It actually fits in all of the different settings, and we'll be talking about that as we go along. >> Hi. I'm Nicole Roberts. I'm assistant dean at Sophie Davis School for Biomedical Education. And I'll be joined by Cheryl Lee and Sally Sampton. And we're going to be talking to you about the Briefing, Itraoperative Teaching, and Debriefing Model for Clinical Teaching. First, I want to let you know that nobody wants to give me money, so I have no disclosures to make. And I'm going to tell you the session objectives for today. So the first thing we're going to do is we'll talk a little bit about the theoretical underpinnings of the BID model. And then we'll talk about developing a briefing focused on learning objectives. We'll talk about performing interoperative teaching focused on the learning objectives that you develop. And then we'll talk about how to do a short debriefing, again, based on the learning objectives. But first I want to tell you where this came from. I worked with Reed Williams, Michael Kim and Gary Dunnington on a several year long study of teaching in the operating room based on some video tapes. And we watched surgeons as they were doing their teaching, and realized that there's a ton of teaching that happens in the operating room, but part of the problem was that it wasn't particularly focused. And so we worked together to create this model that allows us to tell surgeons how to focus your teaching. And then we decided that this model could also be transported to other places where procedural teaching happened. So that's what we'll be talking about today. So I think that most of us know that the implicit theory of surgical training is that learning by doing is the way that people learn how to do surgery. And it's almost as if people believe that it's the experience alone. And so we still know that the mantra of a lot of surgery programs, it's see one, do one, teach one is how you learn to do surgery. And part of that is true, but we also think that there's a place for focused teaching. And we know this because we know that pure, unguided discovery learning is not necessarily very effective or efficient. So you can put people into an environment a,nd you can expect them to learn something, but you don't know exactly what that thing is. And we think that that's not the best practice for teaching. We know that expertise comes from deliberate practice, multiple opportunities for focus practice on things that need to be focused on and opportunities to observe and reflect on performance are essential to developing expertise. And we know that in order for a novice to become expert, they need to have explicit feedback by somebody who is expert. So explicit feedback by a coach. There are a number of practical reasons for having a more deliberate approach to teaching in the operating room. One of which is, of course, the restricted duty hours. So we figured that the restriction in the duty hours led to almost a one third decrease in the number of hours that a surgeon can have in the operating room in the training program. In addition, clinical demands on faculty limits their time for teaching, so we think it's really important that the teaching be focused and deliberate so that you're certain that when your learner leaves the operating room they have something new. They have learned something new. So, when we designed the BID model, our goals were, number one to be consistent with what we know about effective teaching and learning. And the second was to make sure that this was something that could fit into the every day life of a surgeon. So it had to be intuitive. It had to be consistent with current practices, had to be easy to remember and it had to be easy to use. We think that that's what we've been able to achieve with this model. But I don't want to act as though this came strictly out of our heads. Yes it did come from our observation of how surgeons do teach, but it also was based very heavily on the one minute preceptor and also on fighter pilot debriefing methods. So let's think about how we might apply some of these things to other settings. >> So let's try and think about how people learn works in other settings. So how do you think learners learn effectively? >> Well I think that learners learn effectively pretty much the same way regardless of the setting. So we know that they need some help figuring out what it is that they need to know. >> Mm-hm. They need to have some guidance in learning that. They need to have opportunity to reflect on what they've learned. And they need to have feedback of a variety of kinds in order to really learn, particularly a skill. >> And so when I think about, maybe communication skills as something that goes across all the different domains, students can learn about communication skills by reading or by watching videos. But they're really going to learn it best by doing it, so if a learner decides that they want to focus on listening to patient's perspectives, they might learn about what that means, watch some videos about what that means, but the way they really learn it is by doing it. >> Right, the expectation is not that your students or learners are going to be able to recite the steps of eliciting a patient's story. What you want them to be able to do is to do that activity. And so while it's fine to have them do that first part, so be able to tell me what those steps are, but what I really want to see is for you to do it. And your skill is going to develop as you have some deliberate focused feedback on your ability to do that. So you may ask a learner, what's your goal for eliciting a patient's story? The learner may say, I don't feel I'm understanding the patient's perspective very well. Can you help me do that? Then you would observe that and this might be a place where it's a little more difficult to do intraoperative or intraperformance teaching. You could do it, especially in a standardized patient setting. But maybe in a real patient setting it would be difficult to interrupt the flow of the interview. So you might do it in the standardized patient setting, and that would be a place where you're doing that intro-procedural teaching. But then the rest of the steps are essentially the same. >> I see what you mean, and I think sometimes, I think it depends on the patient. There's some patients who you have a senseful understand if you kind of of correct the student, and there's some patients obviously you cant. And so I think that might not be the best example or we're going to do interoperative teaching. It might be better in a resuscitation or a procedure at the bed side or something like that. >> Sure. >> But I think it's still the same model of the learner demonstrating something, the faculty member or the- >> Guiding and shaping as they're doing. And then providing the debrief. Providing some kind of feedback at the end. >> Okay. That's good. Thank you very much. >> Okay.
