Making the IMPLICIT (Unconscious) EXPLICIT (Conscious)

I have been thinking about how we help students become aware of the thinking processes (pattern making, creative analysis) that we use everyday to solve problems. These processes have become habits that we rarely think about but students who see us travel from A-H see something magical or worse think we are taking shortcuts because we don't show them the underlying knowledge we use. The picture below comes from the article Role Modelling by Cruess and Steinert. I think its a great way to think about helping our students become aware of the implicit.

Before the student arrives

1. Pick two or three things you do very well and break these procedures/techniques down into steps that the student needs to know in order to replicate what you do.

2. Create two or three illness scripts for the most common issues students will see in your clinic.

3. List 5-10 attitudes that you think exemplify great physicians and think about how you are going to role model those attitudes while students are in your clinic. Pick some that relate to patients, some that relate to staff, some to other areas of you life.

While the student is in your care

1. Encourage the student to ask questions about why you made the decisions you made.

2. Pick one or two difficult cases a week and walk the student through how you made the diagnostic decisions; even if it seems obvious to you that A=F, it may not be as obvious to the student. Avoid asking students to read your mind.

3. Share your illness scripts with students before asking them to create their own.

4. Guard the appropriateness of your behaviour to patients and staff even when the day is trying.

5. Talk to students about working with patients whose values, behaviours, and illnesses can create issues for the physician. Try and reflect the guidelines of the profession even if they aren't your own (save those discussions for colleagues).

6. Demonstrate and encourage Deliberate Practice by giving students multiple opportunities to apply what you are teaching them with patients.

References

Role modelling—making the most of a powerful teaching strategy

An Intentional Modeling Process to Teach Professional Behavior: Students' Clinical Observations of Preceptors

Pathways to “Involved Professionalism”: Making Processes of Professional Acculturation Intentional and Transparent