By: Emmeline Tran, PharmD, BCPS; Jonathan Thigpen, PharmD; Vibhuti Agrahari, PhD MPharm; Damianne Brand-Eubanks PharmD
“Let not your conceptions of disease come from the words heard in the lecture room or read from the book. See and then reason and compare and control.” These words served as the foundation of one of the greatest contributions to medicine made by Dr. William Osler; he recognized the importance of learning from patient interactions.1 The value of practice-based learning experienced by students through experiential opportunities is well recognized. However, faculty members who teach students in practice-based experiences are concurrently pulled in several directions placing constraints on time allocated towards non-clinical academic requirements such as didactic teaching and committee service. Many faculty members with clinical practice sites find insufficient time to fulfill academic needs outside of clinical service. The clinical setting presents unique challenges for faculty such as unpredictability in patient census and minimal control over the organization of time. With this in mind, revisiting the legacy of Dr. William Osler may mitigate these challenges by being intentional, using teaching scripts, and asking better questions.
“At a later clinic, Dr. Osler asked me how the patient was, and I replied, “I think he is about as usual. I visited him about two weeks ago.” With this, Dr. Osler, to my embarrassment, dramatically brought forth a tray containing a large liver and other organs, saying, “Christian, he did not continue to do so well. Dr. MacCallum autopsied him this morning.”
Preparation is a principle that carries heavy weight in the art of clinical teaching. Through preparation, one can be intentional in asking questions and can relay important educational points for specific patients making the teaching moment more meaningful for trainees. Furthermore, selecting patients that serve as classic examples to demonstrate specific knowledge or skills to learners may be preferred.1, 2 Constructing a baseline assessment of the clinical knowledge and skills of one’s learners is imperative. Patients who have valuable teaching points or who require learners to make clinical decisions should be prioritized in clinical teaching to optimize learning.2 Planning in advance may seem to initially add more time, but the intention is for the benefits to offset the time spent and make the learning moment more thoughtful.
“…[Osler’s] students carried away a knowledge of the essential facts of the disease practically always with several epigrams which long would linger in his mind against the background of a visually remembered patient.”
Teaching scripts are “mini” lectures on narrowed, commonly encountered topics pre-prepared to provide high-yield educational sessions when an appropriate clinical scenario arises. In automating the selection process and compiling information in a structured form, teaching scripts help reduce cognitive load.1 Examples of teaching scripts include strategies for the treatment of diuretic resistance or selection of needle size for various types of injections. Elements that create a good teaching script include frequently encountered concepts with clinical pearls, common misconceptions, applicability to learners at various levels, and conciseness. Over time, instructors naturally create a collection of teaching scripts that can be easily retrieved, adapted, and improvised for a specific patient. Issues related to a patient may prompt a particular script or a Socratic style of interchange with the learners to help facilitate improvisation.1
Asking better questions
““What are Blaud’s pills?” “Who was Blaud?” “When was iron first used in medicine?” I could give only very general and unsatisfactory answers; so Dr. Osler said, “Christian, look the subjects up and report to us at a later meeting.””
Questioning provides opportunities to use patient care to introduce a teaching moment; however, the manner in which questions are asked can impact educational efficacy. Questions that require learners to share their thought processes and for the instructor to assess, correct, or praise their thinking are ideal to promote critical thinking and reflection.3 For example, “what are things that need to be done for this patient?” can be reworded as “what do you think we need to do for this patient?”. Consideration of time, level, or experience of the learner is also important. For example, closed-ended questions or questions with a limited range of appropriate answers may be more suitable when time is limited or with less-experienced learners.3
Throughout this article, Dr. Osler’s legacy has been invoked as an example of how practitioners can use experiences with patients to increase teaching efficiency in the clinical setting. Although we acknowledge that teaching can innately be time consuming with the inclusion of proper planning, reflection, and instruction itself,4 there are strategies for faculty members to take advantage of every possible opportunity in clinical service to maximize education while decreasing academic burden. Even small moments of teaching can provide lasting learning opportunities for students.
How will Dr. Osler’s legacy inspire you to maximize clinical productivity and educational efficiency?
The authors would like to acknowledge members of the American Association of Colleges of Pharmacy Council of Faculties Junior Faculty Connect Community for their help in encouraging and guiding this effort.
- Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75(4):269-276.
- Irby DM. How attending physicians make instructional decisions when conducting teaching rounds. Acad Med. 1992; 67(10):630-638.
- Gonzalo JD, Heist BS, Duffy BL, et al. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med. 2013; 28(3):412-420.
- Smith JR, Lane IF. Making the Most of Five Minutes: The Clinical Teaching Moment. J Vet Med Educ. 2015; 42(3):271-280.
- Skeff KM, Bowen JL, Irby DM. Protecting time for teaching in the ambulatory care setting. Acad Med. 1997; 72(8):694-693.
Emmeline Tran is an Assistant Professor at the Medical University of South Carolina. Educational scholarship interests include experiential education, metacognition, and mentorship. In her free time, she enjoys baking and crafting.
Jonathan Thigpen is an Associate Professor at Notre Dame Maryland University School of Pharmacy. Educational scholarship interests include assessment, curriculum, admissions, and public health. In his free time, he enjoys spending time with his wife and two children as well as reading and watching football.
Vibhuti Agrahari is an Assistant Professor of Biopharmaceutical Sciences at Shenandoah University Bernard J Dunn School of Pharmacy. Educational scholarly interests include student engagement, professional development, and help students improve their skills in scientific communication. In her free time, she loves playing with her 21-month old daughter, enjoys cooking with her husband, and spending time with family.
Damianne Brand-Eubanks is an Assistant Professor and the Director of Student Success at the Yakima Extension campus of the Washington State University College of Pharmacy and Pharmaceutical Sciences. Her research interests are intrapreneurship/entrepreneurship and mental health care access. She is concurrently practicing at a rural, independent community pharmacy. In her free time, she enjoys hiking in the beautiful PNW and tasting wines of the Yakima Valley.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning