Supreeya Wongtra-ngan,MD.,MHPEd

เรยน คณบดผมเขยนบนทกนดวยความเปนหวงคณภาพของ

นกศกษาปท ๖ในปจจบน ซงผมเพงสอบไปเมอเรวๆนเขาสามารถตอบคำาถามเกยวกบโรคและการวนจฉยแยก

โรคตางๆได แตไมสามารถรวบรวมขอมลจากผปวย การซกประวตและการตรวจรางกายกทำาไดแย อาการ

และอาการแสดงหลายอยางถกขามไป ทงการสบคน ทางหองปฏบตการ แสดงใหเหนวาเขาไมสามารถนำา

ความรทางทฤษฎมาประยกตใชในการแกปญหาผปวย ผมแนใจวาเกดจากการทมเวลานอยในชนคลนก

จงขอใหคณะฯขยายเวลาเรยนออกไปอกหนงปเพอเพมพนทกษะทางคลนกมากขน

ขอแสดงความนบถออยางยง

นพ. เพมพน เตมลน

What is Clinical Teaching?

Where does it take place?

When does it take place?

• Bedside teaching• OPD, OR, LR• Ward rounds• Independent patient contact• Simulation, Role play• Case discussion• Home visit• etc

ผเรยนของเราคอใคร

Principles of learningLearning climateInternal motivationMeaningful learningLearning objectiveIdentify resourcesPracticeReinforcement

Lecture

ReadingAudiovisual

DemonstrationGroup discussion

Practice by doing

Teach others

AverageRetention Rate

5%10%

20%30%

50%

75%

80%

National Training Laboratories, Bethel, Main,USA

The Learning Pyramid

• Be enthusiatic• Interested in the well-being of students• Prepare for your teaching• Authentic medical problems• How to improve teaching and students’ learning

Ronald J Markert, 2001

CLINICAL COMPETENCIES

FACTUAL KNOWLEDGETECHNICAL SKILLPROBLEM SOLVING SKILLCOMMUNICATION SKILLMANNERS & ETIQUETTE

RecallComprehension

ApplicationAnalysis

SynthesisEvaluation

Cognitive domain

Bloom 1956

CLINICAL COMPETENCIES

FACTUAL KNOWLEDGETECHNICAL SKILLPROBLEM SOLVING SKILLCOMMUNICATION SKILLMANNERS & ETIQUETTE

PerceptionSet

Guided responseMechanism

Complex overt response

Psychomotor domain

Simpson

ผปวยนนสำาคญไฉน???

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In what may be called the naturalmethod of teaching the student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.

Sir William Osler,1904

Clear understanding of the taskSupervised practiceDirect experienceRepetitionPersistence

Be on timeInsist that students arrive on time

Plan the clinical teaching session

Involve the patientsInform the charge nurseInvolve all the studentsInsist on a standard format

Use a problem –solving approach

Conduct discussion away from the patientDo not try to do too much

   การเตรยมพรอม 

ประเมนผล การทดลองฝกปฏบต 

สรปขอสำาคญหลงพบผปวย สรปขอสำาคญกอนนศ.พบผป. 

ชวงพบผปวย 

CLINICAL COMPETENCIES

FACTUAL KNOWLEDGETECHNICAL SKILLPROBLEM SOLVING SKILLCOMMUNICATION SKILLMANNERS & ETIQUETTE

You are driving a car.

On one big storm night.

You are passing a station.

There are three people who are waiting for the bus

One doctor who saved your life before.One guy/lady who is someone you have been dreaming to get married to.

One old lady who is dying.

You can only take one passenger, which one you will choose? Please explain your reason.

" Give the car key to the doctor, let the doctor take the old lady to the hospital and I stay to wait for the bus with the lady of my dream!"

Everyone I know think the above answer is the best answer, but there is no one (including myself) can think of this answer first.

Is that because we never want to give up any advantage we held in

our hands (the car key)? Sometimes, we would gain more if

we were able to give up our stubbornness, limitations, and

advantage.

CLINICAL COMPETENCIES

FACTUAL KNOWLEDGETECHNICAL SKILLPROBLEM SOLVING SKILLCOMMUNICATION SKILLMANNERS & ETIQUETTE

• Informed consent• Confidentiality• Truth telling• Maternal-fetal conflict• Quality end of life care• Conflict of interest• etc

Objective

Learning experience

Learner

Evaluation

Education cycle

• Multiple choice question• Modified essay question• Short/ Long case• Case report• Structured oral exam• Objective Structured Clinical Examination• OSLER• Direct observation: check list, rating scale• Standardized patient

To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all

Osler 1903

Good night