During the paediatric clerkship in the University of Alberta MD program, third year medical students spend two of eight weeks on the Clinical Teaching Unit (CTU) involved in inpatient paediatric care. During the paediatric clerkship in the Cumming School of Medicine, third year medical students are frequently assigned to spend one of six weeks on the paediatric gastroenterology and nutrition inpatient/consult service, and any Canadian or international medical student may also join our service as part of a pre-clinical observership or as an elective. Given my previous role as a senior paediatric resident at the University of Alberta, and current role as a paediatric gastroenterology clinical fellow, I have worked with anywhere from one to four medical students in this capacity during each week that I provide service. While the attending physician has traditionally been tasked with providing teaching for the junior learners, I have sought and assumed a larger role in teaching since senior paediatric residency.

 

Teaching is primarily informal in this setting and incorporated into inpatient rounds and review of consults and admissions. This type of teaching is time efficient, but more importantly, is contextually based on our patient population, to make the subject material more relevant to the adult learner. However, I always begin my interactions with more junior learners by inquiring about their background knowledge, skills, attributes, and experiences, as well as their personal goals for the rotation. In this way, I can provide resources and guidance to those who need further assistance in formulating their learning objectives, and can better provide learning experiences that will enable them to meet some or all of these objectives in the context of patient care. In this way, I attempt as an educator to incorporate both social cognitive and socio-cultural learning perspectives. I encourage students to take primary responsibility for their patients, and to learn and interact with their peers, patients and families, and other members of the health team. They are also encouraged to be involved in clinical decision-making and communication of information to patients and their families. I do have them observe my actions and those of more senior trainees, but allow them to reflect on them and practice for themselves with provision of feedback, so that they can discover what methods of practice work best for them as individuals.

 

Appreciating that students have differing preferences in terms of learning styles, I also attempt for them to grow in various ways. For instance,

I promote clinical reasoning skills by use of guided questioning techniques, in order to help students to develop approaches to clinical problems. They are encouraged to synthesize knowledge based on the review of the literature, and present this information to the team in order to provide better patient care or enhance understanding of others. Reviewing written and verbal communication to patients, families, and other care providers and then having the student reflect on this is another helpful exercise, which often leads to growth in a short time and can be continuously re-evaluated.

 

Above all, however, I find it most important to connect with the students on my team at some level, to provide them both with encouragement and support as well as challenging tasks to support their interest and enthusiasm in their medical education!

University of Alberta MD Program (2009-2013)

 

At the University of Alberta, I had been involved in a variety of instructional sessions for the medical student interns as they rotated through their paediatric clerkship -

 

OSCE Review Course: This was a review session that I had created as a junior paediatric resident, with the intent of assisting medical student interns in studying for their formative Objective Structured Clinical Examination (OSCE) at the end of paediatric clerkship. Stations were selected based on possible scenarios that the students were made aware of during their clerkship, and I developed the curriculum for a continually expanding number of topics throughout my residency, eventually reaching 19. Whiteboard sketching/writing and interactive group discussions were used to present pertinent background information and organized approach to common scenarios, with each group selecting 6 -8 potential topics to cover over a 3 hour session. Handouts were later distributed for students to keep as a template for their OSCE preparations. This review was delivered to every clerkship group during my residency as an optional session, which was well received and formally recognized by the paediatric undergraduate program directors. Its instruction was a collaborative effort for the most part with Dr. Jessica Foulds, and subsequently Drs. Mary-Pat Schlosser and Breanna Chen, who were some of our first students to attend the review, and who planned to continue the course as instructors after I completed the residency program.

 

Task Trainers: Incorporated with the paediatric clerkship students' weekly academic half-day series is the opportunity to practice procedural skills on task trainer models. It has continued to be a hands-on experience that the students appreciate. In groups of 6 to 10 students, using simulated models (task trainers), I would provide a demonstration on performing the following: lumbar puncture on an infant, intravenous (IV) access, hip examination on a newborn, and basic airway management. After demonstrating these skills, students were given time for hands-on practice, while I went around and made myself available for questions and guidance in performing the procedures. In my sessions, I also ensured that there were additional resources available for the students (e.g. IV starting manual with pictures) to supplement and guide their kinesthetic learning experience, and provided them with a handout at the end summarizing the salient points needed for the ideal performance of lumbar puncture, neonatal hip examination, and IV insertion - accessible by clicking the in-text links.

 

Core Topics - Headaches and Neonatal Chest X-Ray Interpretation: I had requested and was given the opportunity to create talks for the students as part of the more didactic element of their weekly academic half-day schedule during paediatric clerkship. Unfortunately, the topic of paediatric headaches was removed from the curriculum before it could be developed further, but over 2 years, I was able to modify the presentation involving "neonatal and paediatric Chest X-Ray (CXR) interpretation" to make it more interactive and informative. Many CXR were used to illustrate the differences in the systematic approach to CXR interpretation between adults and neonates/younger children, with many normal variants illustrated. This was followed by a variety of CXR illustrating common paediatric diseases producing abnormal findings. To make this session interactive, I divided the class into small groups to compete against one another at answering questions, which I had integrated throughout the talk, with each question leading into another disease or finding to review. Copies of the PowerPoint presentations used can be found by clicking the in-text links.

 

Cumming School of Medicine (University of Calgary), MD Program

 

At the Cumming School of Medicine, I have similarly begun to lead sessions for paediatric clerkship academic half-day. I have revamped 2 hours of its curriculum traditionally devoted to core paediatric topics in the areas of paediatric gastroenterology and general surgery, centering teaching around the clinical presentations of chronic diarrhea and acute abdominal pain/vomiting. I am currently delivering this teaching via traditional lecture-based methods, but will incorporate more classroom-based active learning strategies and educational technology as part of my research project in medical education.