On Teaching Patient Assessment

[thegreypilgrim]

I have a question for the educators among us.

If you're doing patient assessment instruction - not for a particular test/practical or anything, but simply with the aim of teaching the student (whatever certification level or provider type) how to properly assess patients - is it generally better to interrupt the student and correct their errors as they make them or is it better to let them finish the scenario and then offer critique?

I'm always torn as to which approach is best as far as creating effective learning moments. Particularly if the mistakes they're making are...major...and often. Do you think they get more out of it if they're permitted to complete the objective, and then receive a kind of comprehensive criticism? Or is it better to just stop them right then and there when they make a mistake, and explain and correct?

 

[Luno]

I will generally let them continue, taking very quick notes, to observe their process, then work on the correction after I am able to understand their learning process and they assessment process

 

[Aidey]

I think it depends on how experienced the student is. During their first couple of exams step by step correction may be the most helpful. Later on when they are more experienced going over it after seems like it would be ok.

 

[AnthonyM83]

I think at the very beginning they should have a cheat sheet or a classmate (who is also learning by watching them) guide them off the outline.

As they start to get a feel for it, I would go lighter on the interruptions, unless it's a major issue. This forces them to learn the major major issues, but still allows them to develop a framework of what it feels like to do an assessment start to finish. If one is continuously interrupted, they never get the feeling of cohesiveness from start to finish.

As they improve and you're fine-tuning, I think little interruptions won't throw them off as much. They can incorporate your live feedback to the present scenario unfolding.

It might also depend on the student.

 

[Veneficus]

Generally I let them go through till the end. (there is always an exception to all rules)


By letting them get things wrong it helps to see thier thought process, which is more important to guide than a skill list.

It also gives them the opportunity and teaches them to recover, which I think is a very important skill in medicine because there are no do overs and you can't quit simply because you made a mistake.

Building confidence is also a major part of initial education, and once you call a person out as being wrong, not only will they lose that confidence in the moment, but it will take quite a lot of work in order to get them back to that point. Especially if they are not confident to begin with.

If they start to go down the wrong path, i do try to ask questions that will hopefully keep them engaged and get back to the desired route.

 

[Seaglass]

Wait until the end, unless it's really bad. Minor stuff waits.

One of the more frustrating experiences I've had was preparing for a new county test after moving. My new county trained people to use a different assessment acronym than my old one, and I had an instructor who kept stopping me to say "No, you ask that question after this one," or, "Oh, but you forgot to ask this question," because that's the way she'd been trained. We're not talking questions that logically follow one another, either.

 

[medicRob]

I have a question for the educators among us.

If you're doing patient assessment instruction - not for a particular test/practical or anything, but simply with the aim of teaching the student (whatever certification level or provider type) how to properly assess patients - is it generally better to interrupt the student and correct their errors as they make them or is it better to let them finish the scenario and then offer critique?

I'm always torn as to which approach is best as far as creating effective learning moments. Particularly if the mistakes they're making are...major...and often. Do you think they get more out of it if they're permitted to complete the objective, and then receive a kind of comprehensive criticism? Or is it better to just stop them right then and there when they make a mistake, and explain and correct?

I wait til they are finished. The reason why is because when I interrupt them as they assess, they are more likely to be nervous and screw up the rest of the assessment, so I can't really get a good grasp of whether or not they screwed up because I found a mistake or because they don't know how to do a proper assessment.

On a side note, I feel that EMS in a way leans too heavily on mnemonics in patient assessment. For instance, DCAP-BTLS.. While DCAP-BTLS does a good job at reminding the student to assess head to toe rather than one particular area for all these things (deformities, contusions, abrasions, punctures/penetrations, bruising, tenderness, lacerations, and swelling), it results in them going down a check list in their head and checking off the findings rather than thinking about injuries that can be related to those findings.

 

[Veneficus]

Wait until the end, unless it's really bad. Minor stuff waits.

One of the more frustrating experiences I've had was preparing for a new county test after moving. My new county trained people to use a different assessment acronym than my old one, and I had an instructor who kept stopping me to say "No, you ask that question after this one," or, "Oh, but you forgot to ask this question," because that's the way she'd been trained. We're not talking questions that logically follow one another, either.

Then she is a fool.

As long as the job gets done, the order doesn't matter. Any clinician worth their salt will tell you that you develop your own way after some experience.

 

[JPINFV]

Wait until the end, unless it's really bad. Minor stuff waits.

One of the more frustrating experiences I've had was preparing for a new county test after moving. My new county trained people to use a different assessment acronym than my old one, and I had an instructor who kept stopping me to say "No, you ask that question after this one," or, "Oh, but you forgot to ask this question," because that's the way she'd been trained. We're not talking questions that logically follow one another, either.

The funny thing is that assessments shouldn't be driven by an acronym anyways.

 

[medicRob]

The funny thing is that assessments shouldn't be driven by an acronym anyways.

Right! After having it recommended to me, I try to point students toward "Bate's Guide to Physical Examination and History taking".. That book is fantastic. Plus, you can find the assessment vids on youtube with a quick search of "Bates".

 

[Seaglass]

The funny thing is that assessments shouldn't be driven by an acronym anyways.

I certainly wouldn't argue that. I was just using it as an example of how it's not uncommon (at least in my experience) for an overly enthusiastic or new instructor to jump on minor details before giving major issues a chance to emerge.

 

[firetender]

If they miss something important, I'd wait until they are through, then ask; "Did you miss anything important?" If they hedge I'd just tell them; "Do it again and get it right this time."

If they DON'T miss anything important, I'd wait until they are through, then ask; "Did you miss anything important?" If they are at all unsure, I'd just tell them; "Do it again."

Needless to say, I was never made a Training Officer.

 

[Veneficus]

If they miss something important, I'd wait until they are through, then ask; "Did you miss anything important?" If they hedge I'd just tell them; "Do it again and get it right this time."

If they DON'T miss anything important, I'd wait until they are through, then ask; "Did you miss anything important?" If they are at all unsure, I'd just tell them; "Do it again."

Needless to say, I was never made a Training Officer.

One of the best, if not outright the best teacher, I ever had would see students do something and with the most penetrating glare, stone face, and cold voice simply say: "Do it again."

When she said that to a student it invoked almost irrational fear because you knew she didn't want to see if she missed something. (She was all seeing)

There was absolutely no inclination or clue if you did something great or horrible.

Some years later she let me in on the reason why she did that.

I was told that anyone can get lucky once, but if you can recreate something under stress, then you have it for sure.

If you did something wrong, it was your opportunity to realize it and make it right.