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How attending physicians make instructional decisions when conducting teaching rounds
1Department of Medical Education, University of Washington School of Medicine, Seattle.
Summary
Clinical teachers rapidly assess patient problems and learner understanding during rounds. They use this to tailor instruction, linking clinical and pedagogical reasoning through content scripts.
Area of Science:
- Medical Education
- Clinical Pedagogy
- Physician Training
Background:
- Attending physicians must make rapid instructional decisions during teaching rounds.
- Understanding the cognitive processes behind these decisions is crucial for effective medical education.
Purpose of the Study:
- To explore the instructional reasoning and actions of distinguished clinical teachers in general internal medicine.
- To develop a model of clinical instructional reasoning and action.
Main Methods:
- Qualitative study involving six general internal medicine clinical teachers.
- Data collected through interviews, a structured task, teaching round transcripts, and week-long observations.
Main Results:
- Teachers engaged in significant pre- and post-round planning and reflection.
- Simultaneous diagnosis of patient problems and learner understanding informed tailored instruction.
- Instructional reasoning and clinical reasoning were closely linked via content-specific scripts.
Conclusions:
- Clinical teachers employ a dynamic process of diagnostic assessment and script-based instruction.
- Findings offer insights into the integration of disciplinary and pedagogical reasoning in clinical settings.
- The study highlights implications for medical faculty development programs.