Iterative method for learning skills as an efficient outpatient teacher.

Background: We sought to identity the choices and the methods used by ambulatory teachers in a qualitative study, using teacher-intern-patient role plays to improve ambulatory teaching.

Methods: We used repeated performances of a scripted role play; during each iteration, field notes were taken by the authors. Insights garnered at each iteration were incorporated into the next version of the role play. After 9 iterations, no further insights into outpatient teaching were forthcoming, and our observations were included into a qualitative study.

Results: The sequence of steps and major choices to be made in an outpatient teaching encounter were delineated. The goals of the initial opening phase were defined as setting a learning climate, gathering information about the case, and assessing the learner's level of knowledge. Alternatives posed for setting up the second phase of the interaction with the patient included the choice of being a role model or being a "coach." Three-way conversations between patient, learner, and teacher were described in this phase of the encounter. In the final or summary phase of the encounter, we described the choices between giving a "general rule" for learning, and/or exploring higher-level issues, such as patient-doctor communication skills, medical ethics, or feedback for the learner.

Conclusions: The sequence of steps involved in an outpatient teaching encounter, were defined, and the major choices to be made in the encounter were described.