Tips for teaching

[agolden1]

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Transitioning to a new job in the coming month were I will have a role in teaching some pain medicine fellows.

While I do have some points that I think are important in teaching the young'uns, I was curious if the forum membership had any thoughts or anecdotes on phenomenal or subpar attendings you had the chance to work with. What made an amazing teaching attending for you?

 

[Baron Samedi]

The single most important thing you can do is to give constructive, nonpunitive, honest feedback. At the fellowship level so many are "pushed through" despite glaring deficiencies that the learners are never made aware of.

But never embarrass them.

 

[drrosenrosen]

Praise in public, criticize in private. Also, if you happen to criticize in public, you should also apologize in public.

I agree with Baron's statement above - best thing you can do for a fellow is give honest feedback. If they have things they need to work on, take the time to go over it with them. If they really suck at something, help create a specific plan for improving that, with measurable goalposts so they and you and the other attendings can mark progress, or lack of.

As it gets towards the mid-2/3 point of the year, and they have some pretty solid competencies, I would ask them to teach me through a procedure. Nobody does anything for them - they pull their own meds and equipment, line up the c-arm, tell you step by step what to do. It can be really easy to think you know what to do, but if the rad tech is always setting up the shot for you, you don't know how to tell somebody to give you what you want.

 

[Agast]

Loved it when attendings gave pearls of wisdom and little anecdotes. Since you did some time in private practice that gives additional insight into life after fellowship, that attendings who went straight to academia cannot offer.

There will probably be a little culture shock in how you feel about their work ethic compared to when you were in training….let’s be honest the most studious anesthesia residents lean towards cardiac fellowships. Pain tends to attract more work smart-not hard personalities.

 

[drrosenrosen]

Loved it when attendings gave pearls of wisdom and little anecdotes. Since you did some time in private practice that gives additional insight into life after fellowship, that attendings who went straight to academia cannot offer.

There will probably be a little culture shock in how you feel about their work ethic compared to when you were in training….let’s be honest the most studious anesthesia residents lean towards cardiac fellowships. Pain tends to attract more work smart-not hard personalities.

For sure. You will be super popular with fellows if you give these tips on how things work "in the real world".

 

[geauxg8rs]

For sure. You will be super popular with fellows if you give these tips on how things work "in the real world".

1. You should be Able to teach them loads more on billing/coding than your academic colleagues. 2. Hopefully you can increase their efficiency on procedures and clinic (as year goes on).
3. Teach them how to run the C arm? I bet most academic attendings have a full fledged X-ray tech and never had to do anything with the machine.
4. Can show them how to run things “cheaper.” How to help them set up their new practice if they start a new one on their own, etc
5. How to operate a private clinic; who you should hire for staff, what meds, what needles. Why you do such and such procedure and not others. How you will gain more from refining your bread and butter procedures than doing some disc procedure at the VA just cause they will let you do it there (okay these are still fun to learn I’ll admit).

We all learned far and away more during year 1 or 2 in private practice than during the fellowship year.

 

[DrSpine]

Honestly, my philosophy is always the same. Teach 'em to not be total losers. That applies in every facet, from clinical, to life.

 

[GlowInTheDark]

Patient selection and doing procedures safely.

 

[agolden1]

For sure. You will be super popular with fellows if you give these tips on how things work "in the real world".

There is definitely a fair amount of this I'll be bringing in. Going back to where I trained and some huge differences between the ivory tower and real life. Still, have to be careful not to step on too many toes while doing this.

 

[agolden1]

1. You should be Able to teach them loads more on billing/coding than your academic colleagues. 2. Hopefully you can increase their efficiency on procedures and clinic (as year goes on).
3. Teach them how to run the C arm? I bet most academic attendings have a full fledged X-ray tech and never had to do anything with the machine.
4. Can show them how to run things “cheaper.” How to help them set up their new practice if they start a new one on their own, etc
5. How to operate a private clinic; who you should hire for staff, what meds, what needles. Why you do such and such procedure and not others. How you will gain more from refining your bread and butter procedures than doing some disc procedure at the VA just cause they will let you do it there (okay these are still fun to learn I’ll admit).

We all learned far and away more during year 1 or 2 in private practice than during the fellowship year.

Thanks for these.

Agree I've picked up a tremendous amount in this first year (both good and bad). Lots to continue to learn as well. Will work to pass some of these along

 

[kstarm]

I would try to goal set with the fellow(s). You have what you think is important but they should have some input too. Thus if SCS is something they are really interested in you spend a little more time on pearls for that to help tailor the teaching. Really try to approach this as being allies working together for the same goals.

I think personal finance is also a super important topic that is usually avoided (maybe not as much now) but with all the incredible resources out there for physicians on how to practically approach personal finance I think it is really important to at least put this on the fellows radar. If you feel more comfortable in this space maybe you go a bit further.

One part of training that is a little tricky is that you don't typically go see the fellow interact with the patient in a clinic visit. Setting up a couple of times where you go in and observe how they do an exam and interview with a real patient will give you a much better idea of their capabilities. It is a little artificial if you are in the room but still gets you valuable data.

 

[drrosenrosen]

Forgot the most important pearl: turn them on to SDN forum!

 

[agolden1]

Forgot the most important pearl: turn them on to SDN forum!

Or steer them far away from it and lobel.

 

[drg123]

Soon-to-be pain fellow here. We have some superb clinical-teachers in my residency. I've spent time reflecting on the features that make them good. It's not magic but it's intentional:
1. Verbalize expectations
2. Provide explicit verbal direction, either in real time or afterwards, on how to do something. Many attendings just take over or show you how to do it but can't articulate the how and why. It's amazing how effective words can be. As a corollary, try to think even about the little details necessary for success and explicitly say them. It's hard because experts have internalized those details so much that they're unconscious. But for learners, they're not evident or internalized. Example: When I first started doing USIs, I looked up at the screen too quickly and would have poor needle alignment. My attending said 'keep your head down and eye on the needle and probe for a litle longer as you enter, make sure you're aligned, then look up at the screen'. It's amazing how helpful this tidbit was to my performance. But it had to be said in words. Non-specific grunts and looks of disappointment from the attending would not have helped. Explicit direction and feedback was key.
3. Discuss the game plan before a procedure, especially for a new one. When I go over the technique and any possible obstacles (based on imaging, habitus, etc), it helps so much in the procedure suite.
4. Reflect on the encounter after. Reflection after the procedure, both on what went well and what went wrong, has been incredibly helpful. Sometimes you do a good job and don't know why, and therefore it's hard to reproduce in the future. Similarly, sometimes things go poorly, and it's not immediately obvious. Discussion of these things and conscious reflection helps for the next time. If you don't reflect, the next repetition will not be fruitful.

Now, I want to be clear. We're adult learners. The onus is not entirely on attendings to spoon feed us knowledge or direction. We need to do our part too, reading and preparing beforehand and asking targeted questions and eliciting feedback. Sounds simple, but it's not. As an attending, I woudl say focus on having verbalized rationales and explanations for the things you do and put some effort into externalizing your thinking and actions in words for your trainees. Not magic, but requires effort above and beyond just doing stuff solo.

 

[drrosenrosen]

By and large, your trainees have little exposure to surgery. For the surgical procedures, I wrote out a step by step instruction sheet, to get the process in their heads. The other thing I always told trainees, especially for surgery but also for procedures, is to think ahead. Always know what your next two steps are, so you can anticipate, ask for things, make sure you have things. And also, as an assistant, if you don't have two instruments in your hands, think to yourself "what else can I be doing to be helpful? what is the surgeon trying to see or do? What are they going to do next" This helps them to start thinking ahead to next steps and anticipating. That's how you get to where you can do a 30 minute stim implant.

 

[BobBarker]

In January, challenge them to keep track of every cpt code they would bill and then figure out their collections. Then show them how much money they would
have lost if they were responsible for their own overhead with the bloated academic office staff.

 

[Ducttape]

in academic centers, it is not only about rvus in terms of overall financial success.

they get a good amount of money for the residents and fellows. some researchers may have an actual grant that brings in money.

 

[DrMDAware]

By and large, your trainees have little exposure to surgery. For the surgical procedures, I wrote out a step by step instruction sheet, to get the process in their heads. The other thing I always told trainees, especially for surgery but also for procedures, is to think ahead. Always know what your next two steps are, so you can anticipate, ask for things, make sure you have things. And also, as an assistant, if you don't have two instruments in your hands, think to yourself "what else can I be doing to be helpful? what is the surgeon trying to see or do? What are they going to do next" This helps them to start thinking ahead to next steps and anticipating. That's how you get to where you can do a 30 minute stim implant.

You do a 30 min stim implant? Impressive. Care to share how one can achieve this? Genuinely looking for common areas where people “waste” time.

 

[cowboydoc]

in academic centers, it is not only about rvus in terms of overall financial success.

they get a good amount of money for the residents and fellows. some researchers may have an actual grant that brings in money.

Residents can be RVU machines. Our chair basically ran 3 services and nearly every note met old criteria for a level 5 visit or consult. He’s the only guy I know that easily cranked out more RVUs than Dr. Barker (at least in a reasonably ethical manner)

 

[Agast]

You do a 30 min stim implant? Impressive. Care to share how one can achieve this? Genuinely looking for common areas where people “waste” time.

You can do it in 30 minutes if you don’t have to wake up the patient for paresthesias testing and there’s no schmutz in the spine. It’s not the norm because most of your patients have aged spines.

 

[Ducttape]

Residents can be RVU machines. Our chair basically ran 3 services and nearly every note met old criteria for a level 5 visit or consult. He’s the only guy I know that easily cranked out more RVUs than Dr. Barker (at least in a reasonably ethical manner)

the most ostentatious schedule i ever saw take advantage of this was an orthopedist specializing in knees.

2 residents, 1 fellow.. he had a patient scheduled for every 5 minutes, plus he billed for "supervising" his 2 NPs.