Practical didactics

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MaximusMDPhD

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SDNers,

I'm a psychiatry applicant with interest in didactic reform. On the interview trail I frequently heard that residents were dissatisfied with didactics and, "That's the norm everywhere." I wonder, for those in advanced residency training, fellows, and attendings: What was the best didactic session you had as a resident? What was the most useful? What do you wish you had learned in didactics? Alternatively, what were the crappiest parts of PGY1/2 that could be addressed by specific didactic sessions?

On one of my interview days the residents were talking about a helpful didactic session where the teacher played the role of various kinds of uninterruptible patients and the class discussed ways to interrupt the patient along with a role play session. The discussion was framed in terms of practical psychotherapy integration with PGY-1 responsibilities - interrupting the patient creates a rupture in the therapeutic relationship which, if repaired, ultimately strengthens the relationship. It seemed like a thoughtful didactic.

I figure with a smattering of topics/ideas, I can be pro-active about getting this built into my own didactic schedule as a resident maybe even take it on as a medical education project.

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One very helpful didactic would be on assessing medical decision making capacity. There is a lot of misinformation regarding this topic, and simple mistakes can lead to significant medicolegal consequences.

A common didactic that I have taught to residents that has gone over very well over the years is how to critically evaluate research, namely psychopharm research, using Aricept as an example.
 
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I would encourage anyone interested in this topic to drag yourselves (and your program Directors!) to the annual meeting of the Association for Academic Psychiatry*. TONS of workshops every year on simulation exercises, flipped classroom lesson designs, etc. (And you might even get the chance to quaff a beer with OPD and other past SDN notables!)

*Milwaukee this year, Sept 5-8, 2018.
 
There are people who are good at teaching in a didactic setting and people who aren't. I found this the biggest factor. Even if a topic was redundant or discordant, a good teacher was able to make it valuable. Separately, the biggest problem in my experience was integration between didactic lectures. Partly this is because each lecturer had a different idea and awareness of what we had already been taught or experienced. Partly it's because a bullet list of lecture objectives is not enough context to know if a lecture contains the right level of detail or interprets the objective in the way it was intended. And partly it's because some lecturers just want to talk about their own stuff.

What I found best was having specific teachers do a series of didactics. This way they had a better sense of what we knew and needed to know, and could build one lecture on the foundation of another.

During our residency, we worked to revamp our lecture feedback to highlight things like redundancy, usefulness, and depth of the material. We also found that instructors were very thankful and responsive to the feedback they received. We did struggle with getting residents to fill out the feedback forms, though. And another major problem was constantly having to rearrange the schedule to fit faculty availability and other conflicts, and this left a lot of things out of sequence.
 
I never know what to do with resident feedback, it usually reads like:
"Great lecture!"
"Needs to be more clinically relevant"
"Eye opening fresh perspective"
"We had a lecture last week that said the same things"
 
I never know what to do with resident feedback, it usually reads like:
"Great lecture!"
"Needs to be more clinically relevant"
"Eye opening fresh perspective"
"We had a lecture last week that said the same things"

Clearly, one of the things you can do is ask to do your lecture a week earlier next time. 🙂
 
Flipped classroom is ideal, but I'd take it a step further and actually provide a protected time to do the flipped part.

Personally, I've never benefitted from having things read to me. I can read them faster and remember them better doing it myself. Good lectures for my learning style should address conceptual issues. Yet about half of our lectures are just people reading things to us. Or discussing a reading that wasn't very conceptually difficult, so it really just is them reading the thing to us in their own words.
 
If you're interested in doing this at a serious level, I would strongly recommend the book Curriculum Development for Medical Education: A Six-Step Approach.

It's a total snooze, but the information is quite helpful, and if you have any interest in medical education in the long term it's a great reference text.
 
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