Medical schools are not just experimenting with, but introducing problem based small group learning (PBSGL) either for as a supplement to learning, a stream for a group of the medical school class, or as the foundation for the entire curriculum. Post graduate physicians often join groups for ongoing learning in this style. C group facilitators that mediate these groups have access to problem units that are clinically based, on otitis media to nephrotic syndrome.
Sadly, CME events have been slow to follow suit. PBSGL demands full attention, participation, and active thinking, for solving that “problem”. There is interchange, sharing, learning from each other, more questions are produced which lead to more reading and research. No one falls asleep.
Not so with most rounds. Turn on the laptop, turn off the lights and push drone.
I’m sure this isn’t you. I’m sure you turn the thing off, walk around the room and engage the attendants. Ahem.
Here’s some simple ideas you can use to step up your rounds, and you can still use your powerpoint:
1) Leave the lights on.
2) Request that the coffee is brought 10 minutes early, and is plugged in somewhere so that people don’t walk in front of you for it. Remember that coffee is most attendee’s primary concern. Remember that without it, half the people that have been on call will be slumping off their chairs. Don’t fight the coffee, and get aggravated that people are getting up for it. This means they want to stay awake. Their movement will wake other people up. The fluids, sugar and caffeine will keep the neurons sparking! Embrace the coffee/ muffin cart!
3) If you’re on a cruise giving a lecture, remember what you know about state dependent learning. Don’t give a lecture with a glass of wine in your hand, and suggest that your attendees don’t drink while listening to you. How often do you do ward rounds drinking? Do you have a bottle in your desk? Show that for you, this is serious. This is health care, it is serious! I may have just offended you. Sorry. You’ll offend some people in the audience, too. So what. If they don’t want to learn something, then they can sit out on deck and drink.
4) Move about the room. So help me, I’ve been tempted to absolutely level podiums. That would really wake someone up, wouldn’t it! Imagine all the flying splinters! The noise! If I ever give a lecture on how to give lectures, I’ll have a mock up built out of balsa wood, come out and blast it to smithereens with a baseball bat! That will get everybody’s attention.
5) The “T” zone is where the keeners sit. The front row and down the middle. They won’t have a glass of wine in their hands. They’ll have a pen, and paper, and will occasionally put up their hands. Don’t worry about them. The back corners are where people hide, catch up on sleep, and collect their CME hours.
Walk up there. Go down the side aisles, and talk over there. If they have name tags, read a couple, and when you’re in front again, call out a question to one of them. (That’s a cold call. Considered impolite in medicine, it’s an excellent teaching strategy.) If you don’t know a name, put a cold call out there anyway. Ask for some clinical feedback: “In your experience, Sir, you in the back corner, how have you handled this situation?”
(Talk about beating the wheat from the chaff. Watch some people start to leave. That’s ok; they weren’t there to learn anything anyway.)
6) Start with a general, simple, simplistic, basic, (did I say simple enough yet?) overview. Teach a general skeleton that you may have previously assumed everyone knows. Ask someone to rephrase it, give it to you back in their own words. “In your experience, does this general overview make sense? Does anyone have a clinical example that could illustrate this?” Follow that up with some problem solving activity.
7) After that, you can try to hang some meat on the bone. Remember, attention span wanes fast. Ten minutes, max, then ideally they should try to summarize, write it down.
“Okay. What did I just say? Can anyone summarize it for me, and, or provide a clinical example?”
8) Try a bit of group work! End up with a clinical presentation, a problem, and ask some groups of MDs sitting together to work out a formulation, and a response.
9) Remember there is always something positive in any response. Break the “wrong” response down, take it down to fragments, and help them build it back up. If they can’t, get someone else to do it, then come back to that “wrong” group and see if they can re-summarize it, in a better way.
10) Talk about summaries… Summarize! Brief! Basic! Drop your pearl in there!