Top tips for teaching – and learning – from one of Canada’s top medical educators

In most hospital settings, “infectious” is not considered a good thing. But when it comes to Vijay Daniels’ infectious enthusiasm for teaching, that’s exactly what the doctor ordered medical students at the University of Alberta Hospital.

Daniels has been recognized as one of the top 10 post-secondary teachers in Canada, winning a 2022 3M National Teaching Fellowship for his work as a professor, assistant dean and clinical educator in the Faculty of Medicine and Dentistry.

Daniels is an internal medicine specialist and almost always has at least one learner in tow when he sees patients.

“If you come to the U of A hospital with a medical condition such as pneumonia, confusion or multiple organ failure, you are likely admitted to internal medicine and then you are cared for by my team – students in medicine, residents and me as the attending physician,” says Daniels. “I simultaneously treat what the patient needs as well as what the learner needs. Of course, the patient always comes first.

Daniels’ ability to find teachable moments on the fly and give students constructive feedback prepares them for maximum learning, says Cory Meeuwisse, a pediatric emergency fellow who has benefited from Daniels’ insight at various stages of his medical training.

“It’s an environment where you don’t have to worry about making mistakes or not understanding or not knowing the answer to a question, because it’s not about ‘how do you know?’ It is focused on “how can we learn?” explains Meeuwisse.

In the field of evidence-based medicine, this learning attitude is something doctors need to follow throughout their careers, according to Meeuwisse.

“If you ever stop learning, that’s probably the day you should retire from medicine. It’s the culture of medicine — there are always new things to learn and new things to discover.

Find the “aha” moment

Growing up in Winnipeg, Daniels always knew he would become a teacher because he enjoyed tutoring friends who were struggling in the classroom. While doing his undergraduate studies in biochemistry and mathematics in Vancouver, Daniels was almost distracted by the allure of a career in rock music. But he went to medical school in Manitoba, and his postgraduate training in internal medicine took him to the University of Alberta. He earned a Masters in Health Professions Education from the University of Illinois at Chicago along the way.

Teaching clinical medicine while caring for real patients in the hospital means Daniels can’t predict when teachable moments will arise, so he uses the creativity he learned as a musician every day.

“We don’t control which patients can enter the hospital, so every day is a different patient and a different learner,” he says. “It’s exciting that you never really teach the same thing twice – daunting, but exciting.”

Daniels compares this to the “audible call” in American football, when the quarterback verbally makes a last-minute change to the game plan at the line of scrimmage.

“I walk into a patient’s room and I think I’m going to teach how to do a physical exam. Then I will notice that my elderly patient’s daughter’s face is very clear – she is upset about something. I call an audible. I turn to the girl and say, ‘Hi, I’m Dr. Daniels. What do you think of the care your mother receives? »

Instead of learning to examine a knee, students instead learn to talk to upset family members.

Daniels’ greatest satisfaction comes when he can see the light bulb go on in a student’s eyes.

“When a learner hears a heart murmur for the first time – these are abstract concepts that they hear in class – but in fact, to be at the bedside of a patient, they have their stethoscope on their chest and they don’t think not hear anything”, he explains. “And then I show them where the whisper is, and suddenly you can see in their eyes, ‘I heard it!’ It’s actually training your brain to hear different sounds.

Individual learners need individual attention

Daniels starts the week for each of his internship students with a question: What are your goals this week? Then he starts looking for personalized learning opportunities for each of them.

He says personal attention from the teacher is the key to success for future doctors and for students of all ages. Her three children are in elementary and middle school, where Individualized Program Plans, IPPs, were once reserved for students who needed extra help.

“Honestly, every student now has an IPP, whether they’re a kindergarten student or an adult learner in education, law, or engineering,” says Daniels, who has also been recognized for his teaching. , leadership and innovation by the Association of Faculties of Medicine of Canada and the Canadian Society of Internal Medicine. He was named one of Edmonton’s Top 40 Under 40 in 2018 and in 2019 he was awarded the U of A McCalla Professorship.

“All of these principles can absolutely apply to all levels of education,” says Daniels.

It’s all in the feedback

Medical students learn by doing during their clinical rotations. Constructive feedback is therefore at the heart of Daniels’ approach. Meeuwisse appreciates that.

“Sometimes I wish I could show up to work and totally relax because nobody’s going to look at me through a microscope today, but that’s part of being a medical student,” says Meeuwisse. “As uncomfortable as it is, this process allows you to grow as a clinician. And without that, I think there would be a lot of people practicing substandard medicine.

Daniels says giving students honest feedback is one of the hardest parts of her job. When giving a correction to a student, Daniels identifies the deficit and immediately focuses on strategies to correct it next time.

This is part of a conscious shift to an education model called “competency-based medical education”. That means there’s a checklist of skills aspiring doctors need to master — not just physical exams, but more complex tasks like leading a family conference or delivering a difficult diagnosis. The only way to achieve the skill is to try the skill, get feedback from an observing teacher, reflect on the feedback, then try again and get more feedback – a virtuous loop of improvement keep on going.

“One of the key tenets of competency-based medical education is to give learners more autonomy to seek out what they need, rather than following the old model where the teacher decides what is taught. says Daniels.

Make evaluation a way forward

Of course, there’s a test at the end, to see if you’ve learned enough to move on to the next level. For medical students, one of the most daunting is the Objective Structured Clinical Examination, or OSCE, where everyone is assessed on how well they cope with a series of standardized patient scenarios – delivering a cancer diagnosis, exploring a report of chest pain, examine a knee.

Daniels and a team of other clinical educators have won the 2021-2022 David Cook Award for making OSCE assessment methods more transparent, including adding an electronic grading system that lets students know how they did. succeeded in a few hours.

Even if students are successful, says Daniels, assessment guides students’ next stage of development.

“They write a new learning plan, and when we follow up in three months, we find that it’s actually predictive of behavioral change in the clinical environment with real patients,” Daniels says.

Practice makes perfect, though Daniels is quick to say that he never suggests to students that he knows everything. He humbly explains that he will provide strategies for finding information he does not have in mind.

Daniels feels a combination of excitement and apprehension at the start of the new school term. There are 162 new medical students at the University of Alberta this year, and he wants to make sure everyone gets what they need to become a future doctor he’s proud to call a colleague.

He thinks back to a quote from Henry Ford, who said he could produce cars of any color as long as it was black.

“It’s so easy to make a simple machine that makes a single product, but we’re trying to develop diverse medical students to meet the needs of a diverse population.”

/Release from the University of Alberta. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the author or authors. See in full here.