Tips for Teaching Med Students as an Intern

Discussion in 'General Residency Issues' started by hobbes007, May 7, 2008.

  1. hobbes007

    hobbes007 Member

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    Hello All.
    I thought it would be helpful to discuss how to deal with medical student education as an intern. I am going to be an intern this summer in Peds, and I find the whole idea of a med student following me around daunting, since I feel I don't have much knowledge to impart to them yet (i.e. lots has been forgotten 4th year). I was wondering if current interns/residents have any tips/ideas that worked for you regarding teaching med students. What did you teach them? When did you teach them? Did you come up with any creative ways to get across material to them? Stuff like that...

    Let the responses role.....
     
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  3. Top Gun

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    Yeah, I hear what you're saying. Depending on how much interest the student shows, and how much time I have, I may try to set aside some time to discuss a topic the student might be interested in. I can't guarantee that I'll be able to do it every day, but I'll try to set some time aside when I can.
    Also, I might do some friendly pimping regarding the disease process and management of a patient we happen to be following. Its not to make the student feel stupid, but I think the student might get more out of it if s/he understands what is going on with the patient, and why we're ordering the particular tests and treatments.
     
  4. Hurricane

    Hurricane Senior Member

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    You know more than you think you do. Remember, in July you'll be getting brand new 3rd year med students, straight out of 2nd year, with no wards experience, and they don't know anything.

    I'm pretty laid back and don't do a lot of formal teaching. Whenever there's some down time, I just do an impromptu discussion about why we're doing what we're doing, what's the evidence, what are some other things to think about, etc. Basically I free associate :) I may ask them if they know something, but not really in a pimping way. I've gotten good evals back, so I guess they like it and find it useful.
     
  5. Varmit22

    Varmit22 Junior Member

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    I usually just discuss the patients we are seeing. I have the students see some patients on their own and then we go over the case. I ask what they think we should do and then why they think that. Then we talk a little bit about why or why not we should do certain things. If we have time, I may take some time to teach about some things that I've been recently reading about so it's fresh in my mind. If we have lots of free time I may give the student a good article or guideline and have them read and we go over it the next day (so I can go over it also). Most of the students I've had seem pretty overwelmed, so I try to keep it pretty simple. I think if the 3rd years can write a good note and present the patient on rounds in under 5-10 min they are doing well.
     
  6. Dr Jboo

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    As a soon to be 4th yr, the best interns I had were the ones that tried to give an explanation for what they were doing, not necessarily the ones that sat down and formally taught subjects. The best intern/teacher I had let me write all of the orders, prescriptions and DC summaries and asked me why I did everything i.e. order a BMP, order a CXR give a certain type of fluids. He also explained little things like which pain med to give the pt or which laxatives were harsher than others. The most helpful things were the things that weren't in my books and weren't going to be covered in lecture. The pimping is also really helpful if its done in a friendly way. Especially in the beginning I think the best thing you can do is just talk out loud, your students will really appreciate it. Hope that helps, good luck with intern year!
     
  7. DarthNeurology

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    I think the best way you learn is when you are teaching a subject. You will learn a lot when you are forced to distill what you know and teach it, then you really remember the particulars of say that powerpoint on pyelonephritis you did. I think it would be best to ask each of the students to do a short 5-10 minute presentation each week concerning a topic that was related to a well-known service patient. Tell the students to read the charts and take advantage of access to patients.i.e. if you have a patient with cocaine chest pain, then you ask one of the students in one week to present a 10 minute talk, optional handouts, in the hallways. Otherwise you will just be talking randomly about patients and see who has forgotten pharm or pathophysiology the most . . . bring in new knowledge and analyze it. I don't think you need to explain much what you are doing, part of being a third of fourth year is that you may not understand every, but you soak up a lot just by being there. Your mother could carry you around until you were 13 years old, but you would never learn to walk then. If I had a question as a student I would google it. I wouldn't take an intern's word for it. If you ask for questions students will just ask a question to sound smart or something. Set boundaries, i.e. 10 to 15 minutes a day to have a student present then discuss with students how it related to a case. This is more than most medical students get in terms of direct teaching. Most of the other teaching will be when students have to present and attendings pimp. 75% of the time when interns pimp me they mess up what they are trying to say and look silly or they ask a basic question that everybody knows, and usually students question interns back which sometimes makes them look bad. So I would breakdown teaching to small amounts of work each day, impromptu lecutres suck as they are incomplete and usually not very productive, i.e. looks of people scratching their heads. I now think that it is best to break up teaching into grand rounds and formal lectures and do mostly work on work rounds, i.e. it is too distracting trying to remember the abstract study or obscure piece of knowledge about some disorder when you are trying to do work on the floor. If you schedule it and make students teach you then you win, hands down, and students aren't stressed as there isn't any random pimping.
     
  8. smq123

    smq123 John William Waterhouse
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    DarthNeuro - I'm sure that you have excellent points that will really help next year's interns become better teachers.

    But, seriously, nobody can read your posts when you don't break them up a little. A solid block of text is VERY difficult to wade through - think PARAGRAPHS. :thumbup:
     
  9. roja

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    Study after study have shown how terrible we, as physicians, are at shutting up when we are trying to teach. The average presentation is interrupted more than 5 times. We often ask for repititious questions because we aren't really paying attention.

    After years and years of teaching, and continual personal evaluation and education, here are a few things that I think help.

    1. Be quiet. Not just during presentations (this is so fracking hard, I still struggle with it) but ask a question and let the person think for a minute or two (painful but give them a second).

    2. When someone doesn't know the answers to the question, try and give them hints to it as opposed to launching into long 'mini-lecture'. If they don't get it, give a brief explaination an use it as a launching point for further questions/hints.

    3. Be willing to admit you don't know something. In essence, this gives your juniors permission not to know something and it actually gives you more credit as a teacher. We all know that no one knows everything, but we are less willing to listen and/or approach someone who makes us feel like we know *nothing*.

    4. Teach in cases. Doctors learn through cases. We need context to make things stick.

    5. Give positive feedback. Useful positive feedback.

    6. Give hints on 'how to do better for the senior resident/attending/chief'. Whoever is the next on your food chain.
     
  10. Tired

    Tired Fading away

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    From a "knowledge of medicine" standpoint, you probably aren't going to have a whole lot to offer, especially when you are doing rotations in services outside your chosen specialty. And anything you can teach them could probably be found in their Step 2 review book.

    Personally, I teach them how to do my job. Things that become second nature to an intern after a few weeks (how to write orders, what actually matters in an H&P or daily note, rationale for getting certain labs/studies, how to put together a coherent presentation that doesn't take 20 minutes, assorted offensive nicknames for non-surgical residents) are pretty foreign to students, and will be very useful to the students during their 4th year.
     
  11. Ypo.

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    :clap:
    :clap:
    :clap:


    Additional suggestions.

    1. Involve the student in the decision making process. You can explain the reasoning behind ordering which tests/labs as you are on the way to the next patient. During my IM clerkship, we had an attending who would always talk in a really low voice, and because there were always 5-6 people on rounds, I could almost never hear what he was saying.

    2. The decision of what to teach will depend on how far the student is along in their third year. At the beginning of the year, I really appreciated friendly advice regarding my SOAP notes (A good way to do this is to compliment the parts you like and then make suggestions for how to improve). At the end of third year, focusing more on the clinical reasoning is where I appreciate input.

    3. Making someone feel stupid or intimidated is never a good way to learn. Try to teach in a way that does not do this. I personally think that aggressive pimping has its limits in usefulness.

    4. It's a good idea to ask what rotations your student has had so far. This can give you an idea of how far along they are.

    5. INCORPORATE YOUR STUDENTS' RECOMMENDATIONS into the treatment plan. (as long as they are reasonable, of course!). Of all the things that get me interested and inspired, knowing that my input can be valued and make a difference to patient care motivates me the most and makes me feel like my presence is relevant (as opposed to being relegated to shadowing and pretending to look interested).

    6. Just be pleasant. Strive to make a cooperative team. I have been on teams where there was friction between people, and it definitely dilutes the learning experience and makes it less enjoyable for everyone.
     
  12. Ypo.

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    This is also really awesome. :thumbup:
     
  13. lowbudget

    lowbudget Senior Member

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    As an intern, I always approached it as "hey, let's learn about this together."

    As the year goes on, you'll learn that med students have different agendas:
    -Some are working on applying/synthesizing their knowledge to patient care.
    -Some are anxious about the multiple choice exam at the end of the rotation.
    -Some are looking/judging whether your field is a field for them.
    -Some are trolling for procedures.
    -Some are just serving time, genuinely disinterested or disengaged.
    -Some want everyone to like them for whatever reason
    -Some are just lost and maybe waiting/wanting to be inspired.

    Whatever their agenda is, if the student's affable, I'll cater to their agenda for better or worse. You'll know when gaps come up, and the opportunity to teach and bridge that gap will become obvious.

    If the student's not affable...
     
  14. roja

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    Its called transparency and is on of the things that experts or 'upper levels' are often terrible at doing. An intern taking the time to do this is an invaluable experience for a ms3/4.

    Often by the time one is a resident/attending, so many of the things that are done are second nature that one forgets to explain why or how.

    Even if you can't do many of the tricks, simply taking the time to explain what one is doing is immensely educational.
     

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