How do I keep overworked residents engaged and motivated?
January 5, 2012 8:04 AM Subscribe
Help me learn to be a more enthusiastic and engaging teacher.
tl;dr version: My learners find me an unexciting teacher in a seminar environment. Help me find strategies to engage and motivate them.
I’m periodically responsible for teaching a team of residents on my hospital’s inpatient service. While the actual work of taking care of the patients lasts all day, I spend 2 focused hours in the morning six days a week with the team (three residents +/- 1-2 medical students and me). This period is used for hearing about new patients and discussing the ongoing cases, seeing and talking with patients, and sitting down to discuss clinical questions, research articles, talk about diagnosis/therapy, wrestle with difficult cases, etc. It can be a real high point for the residents as a chance to feel academic and scholarly for an couple of hours in the midst of all the drudgery.
However, my evaluations from the residents have not been so great. In general, they think I know my stuff and I run the rounds efficiently and the patients get taken care of well, but my scores for enthusiasm as a teacher, rapport-building on the team, and “encouraging further learning/use of the scientific literature” are not so great. (Not awful, but definitely below the faculty average). No one has ever left specific comments, but I sort of get the feeling that they feel I’m being a little perfunctory and focused on getting the work done at the expense of the teaching and maybe that my personal style is somewhat unapproachable. I’ve tried to address this in the past in a couple of ways. I encourage the residents to do extra reading about their patients and at least several times per week someone (often me) brings in a research article to discuss. I’ve tried to prep some “impromptu” short talks about common illnesses. We identify clinical questions that someone will answer at the next day's rounds. I try to make sure everyone is engaged in discussion, not just the person whose patient it is. This doesn’t seem to have made a difference, so I’m doing something wrong.
Part of the problem, I think, is that I don’t really enjoy these months. I only do this 2 months a year and it takes a while to get used to a new team with different strengths/weaknesses and interests. I have found it hard to make and evaluate interventions given such intermittent teaching. I’m also doing it on top of my regular job, which involves significant administrative/managerial responsibilities that don’t go away when I’m in the hospital. Many of my colleagues are full-time inpatient teaching physicians who do this 9 months a year so they have a chance to optimize their teaching strategies (and obviously enjoy it enough to choose to do it full-time as a career). Finally, I definitely have a reserved personality and am a pretty strong introvert, and I find running these 2-hour meetings with complex and important content and where new information or questions often emerge on the fly to be incredibly draining to my energy level. I should say here that I do a lot of teaching in the outpatient setting as well and my evaluations are exemplary, but it’s a very different setting and style of teaching.
I do not have the option to simply not teach on inpatient teams. Not only is it an integral part of my job, but it also has a disproportionate effect on promotion and my ability to get a different job someday. Plus I like the residents and I want them to feel like they’re getting something out of the month. I need to find a way to do better. So—what techniques can I use to create a more dynamic atmosphere where the residents really feel like they’re learning something important? My feeling is that probably my issue has less to do with the specifically medical aspect of the rounds and more to do with overall strategies for maintaining enthusiasm and participation in a seminar-like setting. I also want to seem more approachable and involved. I need specific suggestions, though, not just “be more enthusiastic!” Changing my underlying personality is not an option. I’ve tried that, and apparently I’m doing it wrong. Pointing me towards books or literature or blogs on teaching strategies in other higher education areas would be helpful too. The last time I went to a workshop on this at a conference I got a recommendation for “Teach Like a Champion” which was helpful in some ways despite being aimed at the high school/elementary level.
tl;dr version: My learners find me an unexciting teacher in a seminar environment. Help me find strategies to engage and motivate them.
I’m periodically responsible for teaching a team of residents on my hospital’s inpatient service. While the actual work of taking care of the patients lasts all day, I spend 2 focused hours in the morning six days a week with the team (three residents +/- 1-2 medical students and me). This period is used for hearing about new patients and discussing the ongoing cases, seeing and talking with patients, and sitting down to discuss clinical questions, research articles, talk about diagnosis/therapy, wrestle with difficult cases, etc. It can be a real high point for the residents as a chance to feel academic and scholarly for an couple of hours in the midst of all the drudgery.
However, my evaluations from the residents have not been so great. In general, they think I know my stuff and I run the rounds efficiently and the patients get taken care of well, but my scores for enthusiasm as a teacher, rapport-building on the team, and “encouraging further learning/use of the scientific literature” are not so great. (Not awful, but definitely below the faculty average). No one has ever left specific comments, but I sort of get the feeling that they feel I’m being a little perfunctory and focused on getting the work done at the expense of the teaching and maybe that my personal style is somewhat unapproachable. I’ve tried to address this in the past in a couple of ways. I encourage the residents to do extra reading about their patients and at least several times per week someone (often me) brings in a research article to discuss. I’ve tried to prep some “impromptu” short talks about common illnesses. We identify clinical questions that someone will answer at the next day's rounds. I try to make sure everyone is engaged in discussion, not just the person whose patient it is. This doesn’t seem to have made a difference, so I’m doing something wrong.
Part of the problem, I think, is that I don’t really enjoy these months. I only do this 2 months a year and it takes a while to get used to a new team with different strengths/weaknesses and interests. I have found it hard to make and evaluate interventions given such intermittent teaching. I’m also doing it on top of my regular job, which involves significant administrative/managerial responsibilities that don’t go away when I’m in the hospital. Many of my colleagues are full-time inpatient teaching physicians who do this 9 months a year so they have a chance to optimize their teaching strategies (and obviously enjoy it enough to choose to do it full-time as a career). Finally, I definitely have a reserved personality and am a pretty strong introvert, and I find running these 2-hour meetings with complex and important content and where new information or questions often emerge on the fly to be incredibly draining to my energy level. I should say here that I do a lot of teaching in the outpatient setting as well and my evaluations are exemplary, but it’s a very different setting and style of teaching.
I do not have the option to simply not teach on inpatient teams. Not only is it an integral part of my job, but it also has a disproportionate effect on promotion and my ability to get a different job someday. Plus I like the residents and I want them to feel like they’re getting something out of the month. I need to find a way to do better. So—what techniques can I use to create a more dynamic atmosphere where the residents really feel like they’re learning something important? My feeling is that probably my issue has less to do with the specifically medical aspect of the rounds and more to do with overall strategies for maintaining enthusiasm and participation in a seminar-like setting. I also want to seem more approachable and involved. I need specific suggestions, though, not just “be more enthusiastic!” Changing my underlying personality is not an option. I’ve tried that, and apparently I’m doing it wrong. Pointing me towards books or literature or blogs on teaching strategies in other higher education areas would be helpful too. The last time I went to a workshop on this at a conference I got a recommendation for “Teach Like a Champion” which was helpful in some ways despite being aimed at the high school/elementary level.
This sounds like a tough teaching environment without much time to develop rapport with people who are likely exhausted. You say that changing your personality isn’t an option, and as an introvert who teaches full time, I understand that. However, it helps me immensely to think about teaching as a performance of sorts where I’m acting in the role of enthusiastic teacher. You’re right that teaching full-time has allowed me to “fake it ‘til I make it” and the enthusiasm comes pretty naturally now (though I’m often tired afterwards and sometimes have to psych myself up before a tough class).
For perceptions of enthusiasm, the first few minutes of class are really, really important. How do you enter the space? Do you greet them? Get there a couple of minutes early and make small talk before class starts? None of this was natural to me at first, but I’ve found that my entrance really can influence their perception of my enthusiasm. So now (as unnatural as this might seem for you) I’d suggest walking in confidently with a smile and a hearty “Good morning” to set the stage. I often ask, “How is everyone this morning?” while I’m setting up my materials even though they sometimes don’t respond or just smile weakly. Usually someone will say, “OK” or “pretty good” or something of that nature just to be polite. If they look particularly worn out, I even sometimes say, “Well, we could probably all use a nap (or an extra cup of coffee or whatever), but let’s get to work.” The “we” lets them know that this is a team thing. Depending on the class, this approach usually helps me transition from chit-chat to work more smoothly than just showing up and starting class abruptly.
One huge thing in your favor is that you say you like the residents. Start there and think about ways that you can really show them that this is true. They’ll interpret that as enthusiasm and rapport. Asking them how they are is one way. Talking about how important you thing the class is can be another way. Praising insightful discussion/answers with more than “Yes. That’s correct” can be another way. If you feel like they’re on the right track, something like, “Yeah, good. Can you explain more what you mean?” can keep them talking. You can even tell them you like them. This will also feel unnatural, and I usually save it for the last part of the course (prior to evaluations, though). When they hit a tough spot as a group, a little reminder of, “Hey. I know this is tough, but I really like you guys and want you to do well. I know you can do it” can help morale a lot. If someone seems down and you have a moment as you’re leaving class, you can ask, “You doing ok?” They may not say much in response, but they’ll remember that you asked.
I’ve also started incorporating more small-group work. Even with such a small class, you can have them divide into pairs or threes to work out some problem. While they’re doing that, I float to each group, eavesdrop for a minute, maybe ask a question or provide a bit of guidance, and then leave them to keep working while I move to another group. They get more individual attention that way, which can help with rapport and the interpersonal connections you’re looking for on the evaluations. With small classes, I try to sit more than stand as that helps promote discussion between students more and lets me be a facilitator more than lecturer.
Also remember that there are different kinds of teachers and you don’t need to be the most enthusiastic to be a good one. You’re really limited in the time you get with them and the amount of practice you get to teach, so it might be hard to compete with full-time teachers on that point. The fact that they aren’t leaving written comments about these issues says to me that you’re probably doing alright, the students don’t see this as a huge problem (you’re just somewhat less enthusiastic than some of their other teachers), and they’re getting out of the class what they need to get out of it. Those are good things, and you should spin them as such if you have to defend your evaluations at some point.
posted by BlooPen at 9:05 AM on January 5, 2012 [1 favorite]
For perceptions of enthusiasm, the first few minutes of class are really, really important. How do you enter the space? Do you greet them? Get there a couple of minutes early and make small talk before class starts? None of this was natural to me at first, but I’ve found that my entrance really can influence their perception of my enthusiasm. So now (as unnatural as this might seem for you) I’d suggest walking in confidently with a smile and a hearty “Good morning” to set the stage. I often ask, “How is everyone this morning?” while I’m setting up my materials even though they sometimes don’t respond or just smile weakly. Usually someone will say, “OK” or “pretty good” or something of that nature just to be polite. If they look particularly worn out, I even sometimes say, “Well, we could probably all use a nap (or an extra cup of coffee or whatever), but let’s get to work.” The “we” lets them know that this is a team thing. Depending on the class, this approach usually helps me transition from chit-chat to work more smoothly than just showing up and starting class abruptly.
One huge thing in your favor is that you say you like the residents. Start there and think about ways that you can really show them that this is true. They’ll interpret that as enthusiasm and rapport. Asking them how they are is one way. Talking about how important you thing the class is can be another way. Praising insightful discussion/answers with more than “Yes. That’s correct” can be another way. If you feel like they’re on the right track, something like, “Yeah, good. Can you explain more what you mean?” can keep them talking. You can even tell them you like them. This will also feel unnatural, and I usually save it for the last part of the course (prior to evaluations, though). When they hit a tough spot as a group, a little reminder of, “Hey. I know this is tough, but I really like you guys and want you to do well. I know you can do it” can help morale a lot. If someone seems down and you have a moment as you’re leaving class, you can ask, “You doing ok?” They may not say much in response, but they’ll remember that you asked.
I’ve also started incorporating more small-group work. Even with such a small class, you can have them divide into pairs or threes to work out some problem. While they’re doing that, I float to each group, eavesdrop for a minute, maybe ask a question or provide a bit of guidance, and then leave them to keep working while I move to another group. They get more individual attention that way, which can help with rapport and the interpersonal connections you’re looking for on the evaluations. With small classes, I try to sit more than stand as that helps promote discussion between students more and lets me be a facilitator more than lecturer.
Also remember that there are different kinds of teachers and you don’t need to be the most enthusiastic to be a good one. You’re really limited in the time you get with them and the amount of practice you get to teach, so it might be hard to compete with full-time teachers on that point. The fact that they aren’t leaving written comments about these issues says to me that you’re probably doing alright, the students don’t see this as a huge problem (you’re just somewhat less enthusiastic than some of their other teachers), and they’re getting out of the class what they need to get out of it. Those are good things, and you should spin them as such if you have to defend your evaluations at some point.
posted by BlooPen at 9:05 AM on January 5, 2012 [1 favorite]
Ask them which rotations they've gotten the most out of so far, from residency or internship. Ask them why those were the most informative rotations. Observe the other rounds if you can. Have lunch with your teaching colleagues to discuss what works in other (sub)specialties. dig deep back into your rounding experience and think about which preceptorship helped you the most.
Assign topics for presentations. Require 2 or 3 supporting (or better, conflicting!) papers to be found. Find some connection with each resident. Common fascination with a particular structure or function. Procedure. Trauma. Something medical.
Are you asking them tough questions during procedures or rounds? They may be used to this (I can't being myself to call it pimping) and if you're not putting them on the spot, maybe they feel unchallenged?
But yes, definitely talk to your colleagues and observe the ones who get the highest marks.
posted by bilabial at 11:23 AM on January 5, 2012
Assign topics for presentations. Require 2 or 3 supporting (or better, conflicting!) papers to be found. Find some connection with each resident. Common fascination with a particular structure or function. Procedure. Trauma. Something medical.
Are you asking them tough questions during procedures or rounds? They may be used to this (I can't being myself to call it pimping) and if you're not putting them on the spot, maybe they feel unchallenged?
But yes, definitely talk to your colleagues and observe the ones who get the highest marks.
posted by bilabial at 11:23 AM on January 5, 2012
This is indeed tough - I work with residents (and nurses, attendings, mid-levels, patients) year-round and have to constantly remind myself to be enthusiastic when I'm teaching. I use BlooPen's approach to teaching as a performance of sorts, which is more tiring than just stumbling through but (for me) way more effective.
As an introvert, these are the things I try to remember when teaching. You may do some/all of these already.
Humanize
BlooPen's suggestion of greeting the students (warmly!) is key.
The medical folks I work with can be very get-down-to-business, but nearly everyone loves talking about themselves. Take the time to learn a bit about each resident/medical student personally.
You might share a bit of something personal with them, in the proper context. I'm lacking the citation at the moment, but there's some evidence that teachers whom students feel an interpersonal connection with tend to be more effective (as a result of that connection, not the other way around).
When you're interested in the topic being discussed, remind yourself to show it. I know that I tend to deadpan, even when I'm completely fascinated, so I have to consciously remind myself to appear enthusiastic whenever I'm feeling enthusiastic. Ways I do this include smiling, body language, and verbally highlighting a particularly interesting part of the topic.
Body language is something I have to work on, to come across as friendly yet competent. Perhaps your posture/hand gestures/facial expressions are sending a different message than your words? The Definitive Guide to Body Language offers a lot of useful information on how particular gestures (etc) come across. Note that if you work with a lot of international grads, you may have to take cultural considerations into account.
Create curiosity
Similar to jckazor's point, try to reframe as many discussion topics as investigations. When I teach nurses database searching, nearly everyone nods off when it's presented as a set of concepts/skills to be learned. But when I frame everything within the context of a question they want to answer (e.g. "Should you wake patients to assess pain?"), attention, interest, and retention increase significantly.
I *highly* recommend reading the book Made to Stick. It provides helpful tips for communicating in an engaging, memorable manner. Some of the things will come across as common sense, but I have found it significantly helpful for improving my teaching.
Address practical limitations
Do your students know how to do an efficient Pubmed/Ovid search? Where to find Cochrane reviews versus case studies? This stuff may seem basic, but as a hospital librarian I come across 3rd- and 4th-year residents who don't know it. Even more common are those who aren't comfortable enough to look something up out of curiosity. If your hospital has a library, the staff may be able to help your students out with this. I have learned from experience that students and residents seem to become more curious and scholarly once they can find relevant articles within a few minutes.
My experience with residents and med students is that they are generally tired, hungry, and thirsty. If you sit down in a classroom for some part of your sessions, consider bringing in a Box-of-Joe or some snacks for a session, even bottled water.
When possible, try to structure each class so that the sitting down-discussing parts are broken up with more active movement, like rounding. At least get up for stretching/walking breaks to combat the effects of sleep deprivation with a little bit of exercise.
posted by brackish.line at 11:48 AM on January 5, 2012 [2 favorites]
As an introvert, these are the things I try to remember when teaching. You may do some/all of these already.
Humanize
BlooPen's suggestion of greeting the students (warmly!) is key.
The medical folks I work with can be very get-down-to-business, but nearly everyone loves talking about themselves. Take the time to learn a bit about each resident/medical student personally.
You might share a bit of something personal with them, in the proper context. I'm lacking the citation at the moment, but there's some evidence that teachers whom students feel an interpersonal connection with tend to be more effective (as a result of that connection, not the other way around).
When you're interested in the topic being discussed, remind yourself to show it. I know that I tend to deadpan, even when I'm completely fascinated, so I have to consciously remind myself to appear enthusiastic whenever I'm feeling enthusiastic. Ways I do this include smiling, body language, and verbally highlighting a particularly interesting part of the topic.
Body language is something I have to work on, to come across as friendly yet competent. Perhaps your posture/hand gestures/facial expressions are sending a different message than your words? The Definitive Guide to Body Language offers a lot of useful information on how particular gestures (etc) come across. Note that if you work with a lot of international grads, you may have to take cultural considerations into account.
Create curiosity
Similar to jckazor's point, try to reframe as many discussion topics as investigations. When I teach nurses database searching, nearly everyone nods off when it's presented as a set of concepts/skills to be learned. But when I frame everything within the context of a question they want to answer (e.g. "Should you wake patients to assess pain?"), attention, interest, and retention increase significantly.
I *highly* recommend reading the book Made to Stick. It provides helpful tips for communicating in an engaging, memorable manner. Some of the things will come across as common sense, but I have found it significantly helpful for improving my teaching.
Address practical limitations
Do your students know how to do an efficient Pubmed/Ovid search? Where to find Cochrane reviews versus case studies? This stuff may seem basic, but as a hospital librarian I come across 3rd- and 4th-year residents who don't know it. Even more common are those who aren't comfortable enough to look something up out of curiosity. If your hospital has a library, the staff may be able to help your students out with this. I have learned from experience that students and residents seem to become more curious and scholarly once they can find relevant articles within a few minutes.
My experience with residents and med students is that they are generally tired, hungry, and thirsty. If you sit down in a classroom for some part of your sessions, consider bringing in a Box-of-Joe or some snacks for a session, even bottled water.
When possible, try to structure each class so that the sitting down-discussing parts are broken up with more active movement, like rounding. At least get up for stretching/walking breaks to combat the effects of sleep deprivation with a little bit of exercise.
posted by brackish.line at 11:48 AM on January 5, 2012 [2 favorites]
I teach basic skills math and test prep to kids in grades 4-8. I'm EXTREMELY into my job, though, but I wasn't always.
Now here's my shot in the dark:
I find running these 2-hour meetings with complex and important content and where new information or questions often emerge on the fly to be incredibly draining to my energy level.
How detailed/rigid is your agenda/lesson plan for these things? Is there any way you can loosen it up in favor of fewer topics which your students are more interested in? I started doing this, and started letting my students direct the flow of things with their questions, and learning to monitor, adjust, respond, and prioritize in real time rather than trying to get through a ton of planned material.
My students are a lot more engaged since I'm now able to reward their curiosity more often with a discussion, whereas when I first started teaching, I'd say something like, "That's interesting, but we have a lot to get through" and move on. Now my mindset is more along the lines of, "I'm the one who originally said I had to get through all of this, and if I'd known this was what they were interested in I'd have planned for that instead. So I'll just change the plan."
You may also want to Google affective domain.
posted by alphanerd at 5:54 PM on January 5, 2012
Now here's my shot in the dark:
I find running these 2-hour meetings with complex and important content and where new information or questions often emerge on the fly to be incredibly draining to my energy level.
How detailed/rigid is your agenda/lesson plan for these things? Is there any way you can loosen it up in favor of fewer topics which your students are more interested in? I started doing this, and started letting my students direct the flow of things with their questions, and learning to monitor, adjust, respond, and prioritize in real time rather than trying to get through a ton of planned material.
My students are a lot more engaged since I'm now able to reward their curiosity more often with a discussion, whereas when I first started teaching, I'd say something like, "That's interesting, but we have a lot to get through" and move on. Now my mindset is more along the lines of, "I'm the one who originally said I had to get through all of this, and if I'd known this was what they were interested in I'd have planned for that instead. So I'll just change the plan."
You may also want to Google affective domain.
posted by alphanerd at 5:54 PM on January 5, 2012
This thread is closed to new comments.
Training/teaching is incredibly draining - so much so that I have an ever-increasing admiration for those who do it full-time.
As for dynamic atmosphere? Why not "share the load" - you are the facilitator, not the "teacher" - assign specific topics to individuals, and then have them research, prepare and present to the group. And then, correct them where they are wrong. This is a skill they should be developing anyways - as their learning should be on-going.
Perhaps try to make things situational/scenario-based - present a problem, have them determine the issue?
posted by jkaczor at 8:31 AM on January 5, 2012