Teaching the Experienced Learner

Experienced learners have a different set of challenges compared to novice learners. Creating teaching moments might be more difficult here because this learner may feel like they know enough and are a little more resistant to learning. No matter the situation, this module will provide evidence-based strategies for approaching this type of learner, including techniques like one minute preceptor, effective questioning, and SNAPPS.

Key Takeaways

Experienced learners are at the "Manager" and "Educator" stages on the RIME framework. They should be able to:

• Defend diagnostic and therapeutic plans.
• Apply clinical reasoning to unique patient presentations.
• Demonstrate developed fundamental knowledge.

Experienced learners want to:

• Have evidence-based teaching.
• Convey reasoning to others.
• Gain knowledge related to uncommon scenarios.

One Minute Preceptor Model

• Commitment: "what is going on with this patient?"
• Probe: "what in the exam supports this diagnosis?"
• Teach Simple Rules: "these are common exam findings in CHF."
• Reinforce Positives: "you applied the PERC rule correctly to this case."
• Correct Mistakes: "you did not ask about worsening symptoms with exertion."

Effective Questioning

There are two approaches to effective questioning - "up the ladder" or "what ifs". Up the Ladder is where you should start a teaching point or questioning at the lowest level and then work up to more difficult points or questions. This approach allows senior learners to assist with teaching. The other approach for effective questioning is to incorporate "what if" questions, taking a simple case and making it more complicated by applying hypotheticals (change the setting, resources, patient demographics, etc.). This approach allows for broader learning from a single encounter.

SNAPPS

This technique is similar to the one minute preceptor but is more thorough:

• Summarize H&P
• Narrow to 2-3 differentials
• Analyze most and least likely
• Probe teacher about uncertainties/unknowns
• Plan next steps together
• Select self-directed learning topics