Module 6: Teaching in the Ambulatory Setting

Teaching Models

Several teaching models have been developed and tested for use specifically in the outpatient clinic. A few are presented below. Preceptors are encouraged to experiment with different models or styles. Remember that learners may perform differently depending on the type of teaching method used. If you feel the teacher-learner interaction is not working well, try something different.

1. Passive and Active Observation

Passive observation or shadowing is probably most appropriate for the most inexperienced learners. Passive observation of the preceptor by the eager, experienced learner tends to lead to frustration.

Active observation involves preparing the student for the interaction by directing the learner’s attention to one specific part of the doctor-patient interaction. After the interaction, the learner can be asked to describe what he/she observed, and any questions can be addressed. The next level is to observe the student and give feedback. For example, ask the student to watch you carefully do a knee examination and then question the student about what he/she observed. Allow the student a few encounters to practice the skill, and then observe the student doing a knee examination with immediate feedback.

Students/residents usually progress quickly from passive to active roles. The next level is for the student/resident to independently wee the patient and report to you.

Today, you will be precepting for Kimberly. Because this is her first clerkship, you use active observation. The first three appointments on your schedule are well-child checks. How would you set up active observation with Kimberly?