Friday, February 4, 2011

TAGteacher Tale - Teaching Lumbar Puncture to Medical Students

If you have ever had to (or ever will have to) undergo a painful and invasive medical procedure, you really hope that the doctor has been well trained and has had lots of practice before it is your turn. Dr. Karen McLean tells us about how she is using TAGteach to help teach medical residents to do lumbar punctures and also to help a colleague improve clinical reasoning skills:

The students who participated in the Lumbar Puncture / TAG study were in a linking week between their preclinical years and their clinical rotations.  They did this on Thursday and started on the wards on Monday.  It just so happened that I took over one of the clinical services for Internal Medicine the day after the study and one of my new students on Monday was one who had been in the TAG group – coincidentally we had to do an LP a couple of days later – the statistical probability of that happening were not high!

The junior resident was doing the procedure but the student (by now very excited to be even peripherally involved in the first real procedure of his clinical career!) was there so I asked if he could remember the tag points – which he did almost perfectly (we both sailed right past one of them and did not remember it till the procedure was over – he was the first to point out that we had missed one!).  He relayed and explained the tag points as the resident was doing the procedure, before each step where we had placed a tag point in the teaching session. He had the wording down pat and the order correct.

It was neat to see a week later that he had the points, the wording and the order still firmly embedded in his mind and was able to retrieve them very quickly with no prompting or cueing.

Unrelated to the study, I have been working with a senior resident who has been having some difficulties with clinical reasoning. One of his challenges is presenting information clearly, using appropriate language so that information can quickly and accurately be conveyed to his attending physicians (especially in the middle of the night when you have been awakened from REM sleep by the beeper!).

One of our sessions focused on getting him to use terms that convey “semantically meaningful chunks of information”.   In trying to convey what that might sound like, I gave some examples and suggested we could call these “sound bytes” - short phases that convey a lot of meaning and help the listener start to draw conclusions about the case.  He offered the term “high calorie phrases” as his preferred descriptor.  (Our sessions do usually start around coffee time!)  In any case ‘high calorie’ worked better for him and I tagged him every time he was able to use an appropriate ‘high calorie’ descriptor in his case presentation.

What impressed me about this was that he was clearly making a huge effort to reorganize information in his mind to assess where he could use appropriate terms – it made him really think and start to apply some of the skills we have been working on.

I won’t say it was a major breakthrough as he has been working hard and steadily making progress but I think it crystallized an important concept in a way that we had not so clearly been able to achieve up till then.

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