1. Intentionally Role Modeling
2. Teaching students to think and act like physicians
3. Supervising student development in a safe working environment.

This section of the website will examine Intentional Role Modeling.

" Role modelling is a powerful teaching tool for passing on the knowledge, skills, and values of the medical profession, but its net effect on the behaviour of students is often negative rather than positive. By analyzing their own performance as role models, individuals can improve their personal performance." from Role modelling—making the most of a powerful teaching strategy by Sylvia R Cruess, professor of medicine, Richard L Cruess, professor of surgery, Yvonne Steinert, professor of family medicine

In order for role modelling to be effective, you have to make it intentional by consciously modelling how you think and act as a physician. This modelling allows the implicit to become explicit. So what does this mean?

_______________________________________________________________________________________________________________________________

Unintentional Role Modeling
Students closely watch us for cues about both our professional and personal preferences. Sometimes faculty role model behaviours they would never want students to emulate such as mistreatment of staff, prejudice against or neglect of certain types of patients, backstabbing of colleagues or disrespect for certain types of students. Sometimes faculty model very good behaviour unconsciously and through reflection can make that role modelling intentional.

A. Hidden Curriculum
Studies have shown that students arrive in medicine wanting to help patients, but by the time they reach residency, they have developed negative attitudes towards certain types of patients (gender, religion, race, drug & alcohol abusers, chronic illness, elderly etc.) because of unconscious messages they are receiving from attendings, other health care professionals and other students that certain patients are less deserving of care.

"Another woman with mysterious abdominal pain!" This was said to a male resident by the attending male physician. A week later after the resident had left, "the mystery" resulted in the patient's IUD perforating her uterus. The resident only heard that women frequently have mysterious abdominal pain; the physician probably was completely unaware of the message the student left with.

B. Automaticity
Practicing physicians move through their day without thinking about why or how they do what they do because they work primarily in a state of unconscious competency. This state is necessary for carrying out your day-to-day tasks but can confuse students who see you jumping from point A-F. You may have trouble explaining to them how you concluded F from A, because it was so spontaneous (based on previous learning).

_______________________________________________________________________________________________________________________________

Making the IMPLICIT (Unconscious) EXPLICIT (Conscious)

The picture on the right comes from the article mentioned above by Cruess and Steinert.

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 decision you made; 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.

_____________________________________________________________________________________________________________________________

Implicit and Explicit Knowledge Definition
	Implicit knowledge (U)	Explicit knowledge (E)
Example	The implicit knowledge used to recognize the face of a specific person.	The explicit knowledge (e.g., textual descriptions) that would allow to recognize faces of people (including a specific person).
Complexity, Context retention	Rich, grounded in reality. High retention of context in form of salient features.	Lean, more abstract, symbolic. Variable amount of context retention.
Acquisition	Detection, learning of correlations and regularities of environment.	Explicitation of one's implicit knowledge. Explicit acquisition of knowledge (e.g., through reading).
Representation	Unstructured, present implicitly in data recordings of the environment (e.g., image of a person).	Varies from less structured (e.g., natural language) to very structured (e.g., formal descriptions).
Transferability	Transferable only in implicit form through the data recordings (i.e., representations) of the environment.	Transferable through languages (natural or formal) and communication (e.g., verbal).
Applicability	Very well applicable to specific problem instances.	Applicable to both, specific and more generic problems.
Processing mechanisms	Pattern recognition, feature selection, associative memory.	Reasoning.
-excerpted from Pantazi et al. BMC Medical Informatics and Decision Making 2004 4:19 doi:10.1186/1472-6947-4-19

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




Use the back arrow to return to the previous page
or use the left hand menu to select another topic
or check the related content links at the bottom of this page.