The Hospitalist as Teacher

The Hospitalist. 2007 November;2007(11):

November 1, 2007|The Hospitalist

In addition to being expert in acute care clinical issues, hospitalists are knowledgeable in the ways and means of the hospital.

As teachers, hospitalists are ideally situated to improve house staff’s proficiency in areas such as evidence-based medicine, effective teamwork, communication, and quality improvement.1 These areas meld with hospitalist core competencies, writes David M. Pressel, MD, PhD, director of Inpatient Service and General Pediatrics at Alfred I. duPont Hospital for Children in Wilmington, Del.

What makes a great hospitalist a great teacher? “I don’t think there is anything special about a hospitalist [that would make him or her] a great teacher as opposed to another kind of physician,” Dr. Pressel says. “The only caveat to that is that presumably the hospitalist has specialized knowledge that they can impart similarly to [how] another doc can [impart information] in their specialized knowledge.”

Good teaching in all specialties has the same core features. But the key component a hospitalist would want to impart, he says, is that the hospitalist should maintain a holistic view of the patient.

In Dr. Pressel’s view, a great teacher loves what he does, has a sense of humor and makes learning fun or enjoyable, makes his lessons interactive, continually learns alongside his students, and knows his strengths and weaknesses.

“A great teacher has a sense of self-awareness as to what they do well and what they don’t do well,” he says. “Some people can be dynamic speakers for a mass audience and hold a lecture hall of 200 in thrall, but one on one, they’re not that strong. Others are the opposite. It is easy to teach people who are smart, dynamic, and interested; it is more challenging for someone who is a bit slower and [finds it] harder to get it.”

A good teacher also models for his trainees, especially in more delicate conversations, such as when giving bad news or asking patients and families to make difficult decisions.

“Residents should be watching you have those kinds of conversations,” says Howard Epstein, MD, a hospitalist and the medical director of the palliative care program at Regions Hospital, St. Paul, Minn. “[Rather than saying], ‘I’m just going to go have a family conference so why don’t you go take care of this, that, and the other thing,’ we should be saying, ‘This is really important. You need to come in and watch me do this now. This is just as important as putting in those discharge orders or putting in that central line.’ ”

The Mind of the Teacher

Incorporating into your teaching all the concepts represented by VACUM is what Dr. Wiese refers to as Phase IV teaching: Teachers are motivated to fulfill the performance needs of the student. Self-awareness is the key to monitoring which teaching phase you are working from. Work toward teaching using the Phase IV paradigm. The four phases are:

Phase I: At this level, the teacher may be subconsciously thinking: “After years of not understanding this topic, I finally have got it and I’m going to need three or four witnesses to sit there while I prove to you and prove to myself that I understand it.” That teaching outlook is all about the teacher and the teacher’s ego; it is an attempt to show how much he or she knows about the topic.

Phase II: Teaching here is related to the subconscious lesson the teacher is likely to have learned during his or her teaching experience. That is, students will give you approbation for acknowledging that they even exist. When a teacher addresses an individual student: “Hey student, let me teach you something,” and the student thinks, “Oh, I love you, teacher, for acknowledging that I’m here and I’m a person,” the teaching is still being driven by the ego of the teacher rather than the performance of the student.

Phase III: The teacher is motivated by awards or financial promotion, and the interest is still based upon the teacher, not the needs of the student.

Phase IV: “This is the nirvana of clinical coaching,” says Dr. Wiese. “The simple goal is that some day, as a medical educator, you’ll turn the corner of some nameless, faceless ward and you’ll look down the hall and you’ll see a former student of yours doing the right thing—performing for the benefit of a patient—because of something you empowered them to do.” The focus has turned from the teacher to the good of the student’s performance for decades ahead. The teacher has empowered the student to do what is necessary to perform well for his or her patients.—AS