How to Teach in the Inpatient Setting

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CHICAGO—Teaching in the inpatient setting can be a tall task, hindered by a lack of time, an unpredictable environment and a variety of learners encountered at different levels. But a few techniques—based mainly on understanding who your students are and how they prefer to learn—can make a big difference, an expert said at the 2018 ACR/ARHP Annual Meeting.

With podium lecturing on the wane, learners want structure, support and community, engagement, discussion and feedback, particularly when in the swirl of the hospital, said Eli Miloslavsky, MD, assistant professor of medicine at Harvard Medical School in Boston.

A must, he said, is creating an informal “learning contract,” not just for establishing what the student is expecting to learn, but to create a plan for the flow of rounds and to assign roles that keep everyone engaged. If a fellow is presenting a case, for example, a student or resident might be assigned the task of observing a relevant finding, making a problem list or starting the differential diagnosis, while a fellow could be asked to propose the workup and assign probabilities to diagnoses to the other team members, Dr. Miloslavsky said.

Creating the right support system and a sense of community with learners, he said, depends in part on curiosity—“curiosity about your learners as people, curiosity about your learners as learners, curiosity about the patients and curiosity about our diseases.”

“I think [curiosity] as a faculty member is kind of critical to make your learners curious,” Dr. Miloslavsky said. “We’re not curious enough as teachers about what’s going on in front of us.”

Another aspect of promoting a positive learning environment while effectively assessing learners is asking open-ended questions, such as how to choose between therapies or interpret a certain case feature. Such questions can give teachers an idea about the learner’s gaps, which they can then try to fill.

“It’s hard asking these questions in a way that’s most effective, but I think it’s a key, key skill,” he said.

Teaching the primary team as a consultant is also an important aspect of inpatient teaching. Even short encounters can prove useful, Dr. Miloslavsky said, but they must be properly couched and structured. Just a simple, “I’d like to do a little bit of teaching, do you have three minutes?” can serve as a kind of “mini learning contract” and lay the groundwork for real learning to take place, he said.