Podcast #27: Teaching Clinical Reasoning with Geoff Connors

Geoff Connors is our first guest from the Yale School of Medicine. He’s an assistant professor of pulmonology and teaches medical students how to reason and make decisions. He also teaches a class called “Teaching Teachers” through the Med School’s Teaching and Learning Center (not to be confused with the Yale Center for Teaching and Learning). In this episode Geoff explains how differently (and not so differently) education works in his world.

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Show Notes

0:00 ⏯ Intro

0:39 ⏯ Introducing Geoff. Riffing on lung ailments.

1:48 ⏯ What happens in med school? It’s pretty disconnected from the rest of Yale. The whole timeline of medical training: many years, lots o’ debt.

4:21 ⏯ Classroom-based ‘book work,’ followed by experiential learning. Doctors are in effect ‘graded’ constantly.

8:07 ⏯ Doctors get constant feedback, but they also need to understand the context. Statistical training becomes key for doctors to learn and improve on the job. It’s no longer all about memorization: problem-based and team-based learning.

12:39 ⏯ Looking for relevant knowledge rather than memorizing it first. “Why have a world’s expert come read you the first chapter of the textbook?” A flipped class isn’t a class and a half: it’s a course you can’t coast through. Yet the Boards are still about knowing a lot of facts.

16:34 ⏯ Edward argues against memorization.

18:07 ⏯ Teaching clinical reasoning and problem-solving to 100 students in six two-hour sessions per year. A case-based method starting with shortness of breath and comparing ‘scripts’ to align them. You don’t have to start with the basic facts.

21:13 ⏯ No tests in the Yale School of Medicine, aside from the standard national tests. Being motivated by the care of the patient. A complex form of learning.

24:01 ⏯ Teaching future doctors to elicit a patient history: a lot of checklists and asking a lot of open-ended questions. Making a personal narrative a medical narrative.

27:31 ⏯ An intermittent capstone course. “It’s always a mystery.” Starting with a story, improvising and keeping their attention for two hours. The learning objective is exposure to this method of reasoning.

31:07 ⏯ Learning diagnostic heuristics by play-acting diagnosing a patient: “What’s My Line?” with diseases.

33:07 ⏯ Once the teaching method is secure, it carries the whole process. Introducing a heuristic, then using it during the case to correct student mistakes. Triggering prediction error. “An audible groan.”

35:06 ⏯ Summarizing as you go. A modified Bayesian method. Nerd alert. “How likely is this to be a heart attack?” Experiential learning using and comparing heuristics against statistical knowledge.

39:06 ⏯ The student is never wrong. “If you knock somebody down…you lose him for the whole session.” Getting the student to think out loud. Knowing the students’ names. Person-centered teaching: “I think they know that I care.”

43:02 ⏯ Dividing the large lecture into ‘buzz groups’ of four to six. It’s a “warm call,” not a cold call. They tried splitting the class into 15 groups all in separate rooms. Sometimes using PollEverywhere, and why it’s useful. When they know the material, you can skip it.

46:09 ⏯ Co-directing a two-week course that teaches residents to become med school teachers. Yale School of Medicine’s Teaching & Learning Center, not to be confused with the Yale Center for Teaching and Learning. Stealing the idea for this class from Tulane’s Jeff Weiss.

50:23 ⏯ Edward: We fetishize methods and under-emphasize great communication. Teaching as communication is a professional medical skill–and it’s also a life skill. Being influenced by a great books class at the University of Michigan: you really can keep people’s attention for an hour-long lecture. It’s easier to do active learning in the classroom than to become a great lecturer. Active learning is an equity issue.

54:32 ⏯ Doug: Flipping isn’t a miracle drug; There are bad flipped classes out there. Research on flipping rarely uses a good placebo. Medical education should be flipped, because medicine really is a team enterprise. Teaching observation skills.

58:14 ⏯ A single home visit can reveal a lot that an interview never would. Watching patients use their inhalers so you can see if they’re dosing themselves right or not.

1:00:23 ⏯ Teaching fails. “It’s a shame I only get one of these.” Not realizing that the lecture you’re giving is very, very familiar to your students. Changing your topic every year. Doug gets confused about the time the class ended. Lecturing to an empty room.

1:04:32 ⏯ The difficulty of integrating teaching into the Intensive Care Unit.

1:06:44 ⏯ Are there still terrifying med school professors? “It’s become anathema.” One scary surgeon and why Geoff isn’t a surgeon now.