Case Based Teaching

Implementation: Fellow Perspective

As a fellow, the experience of implementing the Bright Futures curriculum into our residency program has proven to be a very valuable experience. From making announcements to conducting coaching sessions, I found that multiple steps were required to interweave the curriculum successfully into the busy lives of residents. Although they always seem interested and motivated to teach their colleagues about the various topics included in the Bright Futures curriculum, their time and, sometimes, their energy, to follow through was limited by their demanding schedules. Therefore, frequent reminders, requests, and motivators are often needed to ensure that there is an assigned resident for each conference session and that the attendance at the coaching sessions is optimal. Having completed my residency only two years ago, I can still relate to their situation. There are not enough hours in the day to do all of the things in which you are interested. Yet, residents do recognize that teaching is an integral part of their residency training experience.

Residents at all levels are encouraged to become involved with teaching the case topics. The senior residents eagerly embrace the challenge in an effort to gain experience and hone their teaching skills. Pulling out their palm pilots, the junior residents accept the responsibility with confidence. For the interns, encouragement, support, and reassurance is needed. They are ever minded that perfection blossoms out of practice and that they, too, can be effective teachers.

The coaching session, which occurs one week prior to the case presentation, is an essential part of the curriculum. Even though I had many of the cases taught to me while I was a resident, my role as facilitator for these coaching sessions requires various phases of preparation. After reading the facilitator’s guide, reviewing some of the relevant literature, and seeking answers to my questions, I have an enhanced appreciation for the richness of the case and its powerful ability to teach clinicians at different levels of training. By mentally structuring an outline, envisioning myself teaching the case, and anticipating possible questions that may arise, my preparation continues. As a final step, I double check the date and time of the session, confirm which residents will be attending, and ensure that the conference room to conduct the session has been arranged. At this point, I feel fully prepared. To maximize attendance, the resident teachers are sent several email reminders notifying them of the upcoming session and receive a page one day prior to confirm their participation. The extent to which some residents will rearrange their schedules in order to attend the coaching session is impressive. One intern who was scheduled to be on-call in the Neonatal Intensive Care Unit for the first time negotiated with her colleague to stay an hour later while she attended the coaching session. In exchange, the colleague would be able to leave one hour early on another day.

The goal of the sessions is to review the case materials and model how the case presentation can be delivered. This informal setting allows the residents to ask questions about both the topic and the style of effective case communication. In our institution, the residents often have the unique opportunity to have their questions answered by the case author. From the lively exchange that occurs, it is clear that the learning process is activated as old myths are dispelled and new knowledge is acquired. I take great delight when the session has ended; yet, their private conversation about the completeness of the materials and how they plan to teach continues. For me, this helps define a successful coaching session.

Combined with individual preparation, the effort made to attend the coaching session is well rewarded. The day of the case presentation, the resident teachers facilitate the case discussion with confidence and enthusiasm. Using some of the techniques they have learned to enhance group discussion, their colleagues respond by asking questions and offering their opinions. The attending faculty can also add their clinical pearls of wisdom afforded by their many years of experience. The interactive nature of the case discussion allows active learning to occur on several planes. The residents learn new material presented by the facilitator, attendings, and their fellow residents. The forum also serves as a refresher course for the senior clinicians, helping them to keep abreast of recent findings in the literature and up-to-date intervention strategies. Finally, resident facilitators have the opportunity to test their fledgling skills as they learn to become effective teachers.

As a fellow involved in the Bright Futures case teaching project, I continue to learn. I have learned to sharpen my organizational skills as I balance the responsibilities required for this project with my other fellowship obligations. I have learned to become a more competent communicator. But most importantly, I have learned that with increased experience comes a new level of understanding and appreciation for teaching.

Celeste Wilson, M.D.

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