4/5 YES!: Chalk Talks

April 05, 2024

ID11552

To CiteDCA Citation Guide

00:03So again, we're recording,
00:05if you can just give permission
00:07and hit the button to be recorded.
00:10Just want to welcome everyone on
00:12behalf of the Center for Medical
00:15Education that sponsors this series.
00:17It's for those of you who might be new to
00:20us and I do think I see a few new names.
00:23It's a Friday afternoon series
00:25that happens every several weeks.
00:28It's called Yes, For Sure.
00:30It's the Yale Medical Education Series
00:35and if you are with us for the first time,
00:36it's a faculty development series
00:38and the focus is on teaching
00:41and today is our 15th session.
00:44It's hard to believe this academic
00:47year we've had sessions that range from
00:51improving PowerPoint presentations to
00:53improving feedback to trainer trainees,
00:56from leading workshops to teaching
00:59and ambulatory settings.
01:01So we're winding the series down.
01:02This is our next to the last
01:05presentation today.
01:06The last one will be on May 3rd.
01:08So mark your calendars,
01:09the last one for this academic year at least,
01:12and we'll start up again in the fall.
01:14The Yes series is Co directed by
01:17doctors Dana Dunn and Andreas Martin
01:19of the Departments of Internal
01:21Medicine and Psychiatry,
01:23respectively and both are faculty associates
01:27at the Center for Medical Education.
01:29So I'm going to turn it over
01:31now to one of these directors,
01:32Doctor Martin,
01:33who introduced today's topic and presenter.
01:37Thank you so much,
01:38John and thank you all for being here.
01:40It's very exciting and I'm.
01:41I'm looking forward to today's talk.
01:44I'll be brief and tell you just a couple
01:46of things about Doctor Jeremy Mueller.
01:49So the first one is that he sports
01:52the fanciest bow ties in the campus
01:54so you can identify him quickly.
01:56You can see two two season favorite.
02:00So that's the silly one.
02:03The next not silly one is that he's
02:04in the Department of Neurology
02:06where he wears a couple of cats,
02:08including his advice chair for education,
02:11which is no surprise.
02:13He is, as far as I can tell,
02:16an epileptologist.
02:16I was trying to see if there's a
02:19certification risk but but he's
02:20done a lot of work in epilepsy and
02:22that's when I first met Jeremy,
02:24when we were both in the Medical
02:27education fellowship and he did
02:30something very fancy already
02:31was just ten years ago on how to
02:34instruct Chinese residents about.
02:37But the last thing that I'm going to say,
02:39he doesn't even know it because
02:41it doesn't appear in his CV,
02:42but only when was it last Thursday
02:46or something.
02:47Very recently someone came raving to me
02:49about this doctor wearing a bow tie.
02:52He was a neurologist. Did I know him?
02:54Because the care that he had provided
02:58to this gentleman, he was extraordinary.
03:02And that really changed the course
03:05of his family's struggles.
03:06And my colleague was so, so grateful.
03:09And then I could say, well, I know him,
03:13you know, so that gave me like street credit.
03:15But I think I wanna end on that because
03:17in addition to he's also Canadian.
03:20We won't hold that against him.
03:22So, you know, we, we balance each other out.
03:26So I think that, you know,
03:28that that's kind of an aspiration
03:29that we all have to be not
03:31just wonderful teachers,
03:32but to be the clinicians and
03:34clinicians with the heart.
03:35So I give you the man with the
03:38heart and the bow tie. Warren,
03:41thanks so much.
03:42Hopefully everyone can hear me OK.
03:45I'm I'm going to be using technology
03:48to talk about a topic that doesn't
03:51have to use technology at all.
03:53Anything more than markers or or
03:56a whiteboard or a chalkboard.
03:58But this is just what we do in this era.
04:02So first, I'm just going to
04:03share the screen on my iPad,
04:05do a few different things.
04:08Just give me a moment
04:13and I'll get rid of that and we'll
04:18open this talk and press play.
04:24So we're going to talk about chalk talks.
04:28I'm just going to make sure that I can
04:30see the chat because I would love for
04:32this to be interactive and we just always
04:37have to have the disclosure slide.
04:40So there is no corporate support
04:42for this activity and I have no
04:45relevant conflicts of interest.
04:47I do have a disclosure,
04:50and that disclosure is that I am deeply
04:54ambivalent about PowerPoint presentations.
04:56Deeply, deeply, deeply,
04:57and something that brings me great joy,
05:00the greatest joy in my
05:03educational activities.
05:04And I suppose getting back to this
05:06theme of heart is actually being in
05:09a room of learners talking about a
05:12case or going through some learning
05:15activities in a very informal way,
05:18using a whiteboard as our only technology.
05:22And so we're trying to thread
05:24the needle and we've,
05:26I appreciate the people at the Center
05:28for Medical Education helping me with
05:30this of threading the needle to try
05:32to talk about something that's very
05:34organic in a slightly less spontaneous way.
05:36But I think I think we figured it out.
05:39So. So here's my slide as a chalk talk
05:42slide and I drew a little drawing of a brain.
05:46You can see why the Medical
05:49education series is called.
05:50Yes.
05:50So I made that connection and the date
05:53and so on and a little illustration.
06:00Just give me one moment.
06:01Sorry. So at the Objective,
06:04I hope we can all think about developing
06:07a plan to deliver a teaching session
06:09without any sort of additional
06:12audio visual technology markers,
06:13maybe in a small group and talk a
06:16little bit about some best practices.
06:17I think there's some keys that I think
06:19will be very helpful for all of you and
06:20and I look forward to sharing them.
06:22Some things I've learned and some things
06:23I've found in the literature and talk
06:25about the most engaging ways to do that.
06:27And to start,
06:28I would love for you to think for everyone
06:31here to think for a moment and you can
06:34either unmute or do it in the chat.
06:36And it's going to take me a
06:38second to switch to a whiteboard.
06:39And so I'll buy some time.
06:41But I want to you all to reflect either
06:43on your experiences teaching or your
06:47experiences learning in with this setting.
06:50You know,
06:50broadly speaking what we say is
06:52a chalk talk and that would be
06:54anything where there aren't any
06:56slides and it it's simply a group of
06:59learners with facilitator in a room
07:01and and we've already got started.
07:02So I'm gonna switch here.
07:04What I said is I'm gonna switch to a
07:06whiteboard. So I'll do that right now.
07:08Just one second.
07:12So stop, share,
07:16and I'll go to my whiteboard.
07:20Just one second.
07:28And actually, just for fun afterwards,
07:30I'll show you one of the whiteboards
07:31that I did previously For now,
07:33we'll do a new whiteboard.
07:38All right. Can everyone see that?
07:40Great. So one of the things
07:44you've said is large letters.
07:52Everyone can see
07:57uncluttered.
08:02What else? Organized. I agree with that.
08:17Let's see good handwriting.
08:18I agree with that. Clear.
08:20Better with a small group.
08:23I agree with that.
08:30Emojis grouping topics along the top.
08:33Oh, what had just happened there?
08:35Something like shut down for a second.
08:37We can go back to it,
08:40Jeremy. I can't get my
08:42chat to work, but I was
08:43gonna say spontaneous.
08:46Agreed. Spontaneous
08:52and the the the
08:53audience gets us gets to kind of
08:55see your mind at work in the moment
09:06and anything else short. I agree with that.
09:17Yeah, students participate.
09:27I agree it's sort of real time speed.
09:31We're working through this
09:32problem together, right.
09:35And there's something about the
09:37way that writing sort of limits
09:38on how we write versus the pre
09:40structured slide that allows us to
09:42work through the problem together.
09:46So I'm going to show you actually
09:48that we're kind of organizing
09:50these into a few different things.
09:52So one is sort of the setting materials,
09:59you know just sort of where we are,
10:02what we're doing,
10:03what materials we're using.
10:05Some of it is about the actual
10:09topic or what is learned.
10:15And those you focused on a lot
10:16of that you know sort of what is
10:18learned and how is it it's learned.
10:23And I just you can all
10:24zoom out on the whiteboard.
10:25I don't know how much you can see,
10:26but you can all zoom out on
10:27the whiteboard so you see the
10:28whole thing on your screen.
10:32I want to hear a little bit more about
10:34what the student's responsibility or
10:36what makes it good when a student
10:38does a is involved in a chalk. Chalk.
10:41And then maybe a little more about
10:44the characteristics of the teacher.
10:45So any additional thoughts about that,
10:47about some of the characteristics of
10:49the teacher or the things that are under
10:52the control of the teacher and some of
10:54the characteristics of the students,
10:55both as individually in a group that
10:56might make for a more effective Choctaw?
11:04Well, you have to be prepared,
11:06obviously, right? Both, right.
11:11Have an idea of what it is
11:12that you want the students
11:14to to learn and have a plan in mind.
11:21Agreed. Totally,
11:27yeah. I think this is this works really
11:29well if you're enthusiastic about the topic
11:34and engaged. Always good to
11:37to prior knowledge also yeah,
11:41so build on prior knowledge, right.
11:51And this is where a chalk talk
11:52can be very effective too.
11:53Because the teacher can make
11:56as as Layla saying here,
11:58the teacher can make the topic
11:59relevant to the learner, right?
12:00So the teacher if they
12:02know the learner right?
12:04Or make an effort to know the
12:06learner and a chalk talks
12:07really nice for that, right?
12:08If you show up with a
12:10slide set on a topic right,
12:13then it's hard to adjust in real time.
12:14But if you go through a case based
12:17presentation with a chalk talk or
12:19a drawing and you want to adapt,
12:21you know you you start to get some
12:22feedback from the learners and
12:23you're like oh actually they know
12:25this really well and I don't need
12:26to spend so much time on this or
12:28they they actually need to go back a
12:30little bit more to the basics, right?
12:31You can adapt in real time.
12:33And as Ellie is saying, you know,
12:36letting the students choose
12:37the topic can really nice,
12:39nice that help that even further.
12:42And as Andres is saying,
12:43sort of not being gaze avoidance,
12:45sort of actually being engaged, right,
12:48seeking out, Drying in the expertise.
12:50So these are sort of the four main
12:53sort of categories of things that
12:54I would think about in preparing a
12:56shock talk or thinking about it.
12:58And I think you all did a really
13:01nice job of that.
13:02So I'm just gonna stop sharing
13:04and actually go back to my screen
13:15and I'm going to go back to the PowerPoint.
13:20And I'm so grateful.
13:22You did exactly what I wanted you to do,
13:25which is really put together your
13:28experiences, your knowledge, right?
13:29We kind of illustrated a lot
13:31of the principles. I mean,
13:32say what you want about my handwriting,
13:34but I think the rest we
13:36illustrated reasonably well.
13:37And so I could have started a presentation
13:41with all of you with this slide, right.
13:43And I could even have nice animation
13:45and go through them one by one,
13:46you know, learner, teacher,
13:47material setting or something like that.
13:49And these are some things I came up with
13:51based on my experiences in the literature.
13:54And it's fine.
13:55You know,
13:55I I think all of this is valid information.
13:58I think it would be hard
14:00for you to absorb this.
14:01I think it would be hard for you to
14:03engage with it in such a meaningful
14:05at such a meaningful level.
14:07And I gave you a demonstration of a
14:10very simple way to start a chalk talk,
14:12right,
14:12which is that I was prepared for the
14:14things you might say or the categories
14:16of things you might say based on my
14:19experience and knowledge of this topic.
14:21I put together a structure that
14:23I hope to get to, but I dropped.
14:25I drew as much of the material
14:27from you as possible,
14:27so we can build on that.
14:28And I think that's a much more
14:30effective and engaging experience
14:32than me just showing you this slide.
14:34I hope that I've demonstrated that
14:38and you know, I'm so grateful that you
14:41were so engaged because I think Zoom has
14:44many advantages in terms of convenience,
14:47in terms of accessibility,
14:48in terms of fitting in some
14:50learning with your busy lives.
14:52But there are tremendous temptations
14:54to engage in other ways.
14:56And one of the big takeaways with
14:58effective chalk talks is that people
15:01are relatively not distracted,
15:03engaged with the material, engaged with you.
15:06And if you saw this with nobody responding,
15:09that would be a big problem.
15:11And actually,
15:12this is reliving a prior traumatic
15:14experience of mine where I did a
15:17teaching session for residents in
15:18another program at 3:00 PM on a Friday
15:21afternoon in the midst of the pandemic.
15:24Absolutely the worst experience I've I've,
15:25I've had. And.
15:27And all of the cameras were off.
15:29Of course they were.
15:30They were residents at 3:00
15:32PM on a Friday afternoon,
15:33except for one person who forgot
15:34that their camera was still on
15:35and had their back to me talking
15:37to the rest of the staff.
15:38During the whole time,
15:39I tried to do an interactive chalk
15:41talk and it was absolute disaster.
15:42So, you know,
15:43you have to start with a hope
15:45and some anticipation that you're
15:47going to have an engaged audience.
15:49If you don't, you know,
15:50I don't see much point in trying on
15:52a chalkboard for your own amusement.
15:55And I think you, you all said this,
15:58right? Chalk talk does not
16:01mean no preparation, right?
16:02I mean you have to be very prepared
16:06to deliver a good chalk talk and and
16:08some of the things you said right.
16:10You have to be enthusiastic
16:11about your material.
16:12You have to be highly knowledgeable of
16:14the material if you have drawings or
16:20or I don't. I don't know if
16:22anybody's had the experience of
16:24somebody working through a complex
16:26diagram for the what seems like the
16:28first time during a chalk talk,
16:29and that could be a bit of a problem.
16:31So chalk tuck does can be spontaneous,
16:34it can be highly interactive,
16:35but it does not mean that
16:36there's no preparation.
16:44In terms of planning your session,
16:45there's a few hints that
16:47I'll give you and again,
16:48you can use some of these as you see fit.
16:53Of course, think about the space.
16:55If it's a physical board,
16:58sort of plan ahead in terms of how
17:00big you're going to write and make
17:02sure that you know your general
17:07that space. If you have diagrams,
17:09make sure that you're going to
17:10have room for labels for extra
17:12annotations that might come up.
17:15But, you know, always leave a little
17:17bit extra room around the edges
17:19for spontaneous circling diagrams,
17:21making connections and things like that.
17:25But if you didn't plan ahead,
17:27you know, making some humor about
17:28the whole thing is is perfectly fine,
17:30as I've done here.
17:32People find that very engaging, actually.
17:34If you sort of are able to make fun
17:36of yourself because something's not
17:37working well and actually it doesn't
17:39hurt the learning, I don't think.
17:41And we always have erasers if we need to.
17:46And so I am going to use
17:47some animations here, right?
17:48So if you're planning a session, you talked,
17:51you all talked about having learners who
17:53have some level of preparation, right,
17:55Previous experience with the material
17:57or at least some some knowledge before
18:00they start of knowing what they're,
18:02what they're getting into.
18:04And so you could consider sending pre
18:07or question prompts to the learners
18:10acknowledging that for medical learners,
18:12especially residents,
18:13but certainly Med students
18:14and their clerkship years,
18:16they're very busy and they
18:17might not have time to do that.
18:19I think you all did a really
18:21good job of mentioning that,
18:22taking some time to understand the
18:24level of the learner's really nice.
18:25So if you develop a case prompt
18:27or a question prompt or something
18:29like that for your chalk talk,
18:31start with the learner you know,
18:32start by asking them their understanding
18:34of the topic and build from there.
18:36And again a chalk talk I think is far
18:38more effective at doing that than a
18:40straight up PowerPoint presentation.
18:42And as much as possible considering
18:44how you could leverage that
18:46learner's experiences,
18:47right,
18:48always root this in the experience
18:49of the learner themselves.
18:51I I did that at the start here,
18:52rooting this in your experiences or at
18:55least your consideration of of your your
18:58prior experiences with the chalk talk.
19:00And similarly in in clinical settings
19:01rooting it in a clinical case or
19:03calling back to somebody's case
19:05or talking about a case they might
19:07have seen to highlight a point is
19:08always going to be very powerful.
19:13The teacher has to understand the
19:14material well, as I said before you
19:16have to understand the material better
19:18than if you're doing a PowerPoint
19:20presentation and and you know it's a
19:22little bit like doing the the net, right.
19:25Get out there and smart students
19:27and residents start asking you
19:29questions and start to realize what
19:31the limits of your own expertise are.
19:32Again, you can use that right you you
19:34start to leverage the expertise of the
19:37team and that can be very helpful.
19:39I'll get back to this to practice
19:41any drawings ahead of time.
19:42Have some experience doing that.
19:44And drawing on a board is a little bit
19:46different than drawing on a piece of paper.
19:48It's less control.
19:49The ergonomics of it are a little
19:51bit different.
19:52So actually,
19:52if if you are doing this for the first time,
19:56practice the drawings on a board,
19:57not just on paper,
19:59and think about your pacing and think
20:02about ways that you can buy time.
20:03And that, for example,
20:05is a strategy I just used,
20:07which is to give somebody a question
20:09for reflection why while I made those
20:12technological switches using that time
20:14to ask a question using that time.
20:17To point people to a case that you might
20:19have prepared or something like that,
20:21think about ways that you can buy time
20:23without their feeling like there's this
20:24gap while you write or Draw Something.
20:29I think a lot of you said, you know, short,
20:32digestible bits of material are really good.
20:35Think about prepared cases,
20:37think about what diagrams you might have,
20:40and be really thoughtful about your
20:42ambitions with these shock talks.
20:44So when it when going in,
20:46if this is a structured chalk talk
20:48or even if it's spontaneous, right,
20:50whatever you initially think you're
20:51going to be able to cover in the time
20:54you have allotted, cut it in half.
20:56And one of the nice things
20:57about a chalk talk,
20:58about the spontaneous chalk
20:59talk you can always add, right.
21:01If you have a little extra time at
21:03the end and somebody wants to have
21:04some questions you want to add,
21:06add to that, great.
21:07And if it's a more structured didactic,
21:10if you're going to use a chalk talk based,
21:12case based presentation for a
21:14clerkship lecture for example,
21:15or one of your,
21:18consider having a handout afterwards.
21:19And most medical learners in my experience,
21:24are anxious perfectionists.
21:26And anxious perfectionists benefit
21:29from the illusion of control
21:32and and handouts are nice.
21:34I I don't know if people actually read
21:36them but people just like having them.
21:38It's just like a comfortable blanket.
21:40So one thing I do for with a session
21:44I do for the the clerkship on on
21:49seizures is I actually ask the clerkship
21:52coordinator to e-mail the quote,
21:55UN quote answers to our cases 5
21:58minutes after the start of the
22:00session and everybody calms down.
22:01I say something like don't worry,
22:03all the answers are in your e-mail
22:05right now and everybody looks at
22:06their phone and sees that e-mail and
22:08they just feel so much better and and
22:09then they can relax and fully engage
22:11in it without feeling like they're
22:13missing something important, right.
22:14There's always that tension of feeling
22:16like with a spontaneous chalk talk
22:18because it feels more spontaneous,
22:19that maybe it's not as complete
22:21or as thorough,
22:22when in fact I would argue it's a much more
22:25effective way of of generating understanding.
22:27It could be a much more powerful experience
22:29than a straight dissemination of information.
22:34In terms of the setting,
22:36really think about this a lot,
22:38arrive ahead of time,
22:39make sure the chairs are where you want them.
22:41So one of the places I present
22:44has the board on the side,
22:45not not at the front of the room on the side.
22:48So I actually asked people to move
22:50around at the start so they can
22:52all see the board and stand there.
22:54You can capture.
22:55Judy asked can you capture the whiteboard.
22:57So again,
22:58my preference is real life rather
23:00than a a virtual board.
23:02But if I do a virtual board,
23:03I'll show you you can actually save
23:05them on zoom and you can e-mail them
23:07or get the coordinator to e-mail them.
23:10I always let the students photograph
23:12them a lot.
23:13A lot of them kind of have a Mac
23:16of what we're doing. Yeah.
23:18Oh, sorry. So it's it's a good question.
23:21I think having the students allowing
23:23the students to photograph the diagram,
23:25they really enjoy that and and
23:27I I'm certainly OK with that.
23:32You know, we think about the types
23:35of information or the types of
23:37learning tasks we engage in, right?
23:39We start with facts,
23:40then we move towards understanding,
23:43then analysis and then synthesis, right.
23:45Making connections and facts are a very
23:48closed ended kind of communication,
23:50right, the dissemination of facts.
23:53The top five reasons for new onset
23:55seizures in an elderly patient are these.
23:58They're just facts, right?
23:59You could look them up soon will be
24:02replaced by artificial intelligence
24:03in terms of getting these facts.
24:05If we haven't been already
24:07understanding analysis, synthesis,
24:08you know, making those connections.
24:10That's where I think is the
24:13sweet spot for the chalk talks,
24:14and that means leaving some of the learning
24:17objectives and certainly leaving the
24:19question prompts relatively open-ended.
24:21And so in thinking about your
24:23preparation or a case prompt or
24:25some other prompt for a chalk talk,
24:27the more open-ended you leave it,
24:29the better.
24:30What's interesting and really
24:31fun is if you do a lot of them,
24:32or if you do the same presentation
24:34year after year or month after month,
24:36You'll notice that patterns emerge in
24:38learners because the learners often have
24:40similar responses to the same material.
24:45In terms of facilitation,
24:49you know, one way is to start with the.
24:51So here's an example of a case prompt
24:54that I use for for a session that
24:57I do with the medical students.
24:58I allocate about 25 minutes
25:00for this discussion.
25:02So to start with engagement,
25:04I asked for a volunteer to read this case.
25:06I've distributed ahead of time.
25:08Most people haven't looked at that,
25:09which is fine.
25:10I'm not bothered by that at all and
25:12this actually is a is a real case or
25:15or you know with some facts changed
25:17for anonymity but it's is is basically
25:19a patient I've seen and again that
25:23adds to the authenticity and and and
25:26to the interest you know so this is
25:28a 45 year old Yale professor who
25:31had an episode of collapse and then
25:33shaking she had been feeling unwell
25:35before that with some vomiting exam
25:38and and vital signs are normal pretty
25:42unremarkable history occasional
25:43alcohol doesn't smoke cigarettes
25:46And then I have two questions so I
25:48allocate 25 minutes for two questions
25:49and those are what are some other
25:51information that would guide can
25:53help confirm that this was a seizure
25:54and what information might guide
25:55the decision about whether or not to
25:57start an anti seizure medication.
25:58That's it.
25:59And this is very rich, this,
26:00it's actually hard to keep this
26:03in 25 minutes.
26:04And again,
26:04you're hoping that the students
26:06have some preconceptions or previous
26:08thoughts about seizures and what
26:10they are and what's going on in this
26:12case is just enough information to
26:14think about that in in the real world.
26:16And then you go from there.
26:17And so the students might start by saying,
26:20well,
26:21some other information would be
26:22if they have an aura or if they
26:24have febrile seizures or other
26:25risk factors for seizures.
26:26They might ask about that
26:27stiffness or shaking.
26:28They might ask about a tongue bite.
26:29They might ask about confusion afterwards.
26:32They might about ask about incontinence.
26:33Right.
26:33So I start just writing those on the board,
26:35just like I did with all of you, right.
26:36We just start with this.
26:37And again, probably done this session
26:4130 or 40 times at this point,
26:43maybe more.
26:45And it's interesting it's it's
26:47very similar year to year.
26:50And the then I start adding some structure.
26:55So I planned this out.
26:57So I say, OK,
26:58what you're talking about are things
26:59that might have happened before the episode,
27:01you know,
27:02the episode of the shaking,
27:03things that might have happened during
27:05or things that might have happened after.
27:06And I think that's a great way
27:09to structure this.
27:11So, so the way to structure this is
27:14to think about what happens before,
27:16what happens during,
27:17what happens after.
27:18And that's going to help you remember
27:19the types of questions you're going to
27:21ask and the types of considerations.
27:23And then I say, well, you know,
27:24what else could it be?
27:25What?
27:26What?
27:26What are some possible
27:27differential diagnosis for this
27:29episode? And they usually come
27:30up with this list, right?
27:31They come up with a bilateral tonic,
27:33clonic seizure, new new terminology.
27:34BTC used to be GTC,
27:36but we say BTC for reasons I can get into
27:39with you and the students if you want.
27:41And then they say syncope, you know,
27:43that could make you fall down and
27:44shake or a psychogenic attack,
27:46you know, those are the big three.
27:48And then we start filling out,
27:49OK, how are they different, right.
27:51This is the synthesis piece, right?
27:52OK, How is the BTC different?
27:55And you start filling in well syncope,
27:57you have Lightheadedness,
27:58it could happen with the chip additional
28:00change you get pre syncopal symptoms,
28:01it's shorter duration,
28:02you'll cover more quickly afterwards.
28:04We can elaborate on that.
28:05Psychogenic attacks have those
28:06different features and so on.
28:08But you see how I'm using
28:10the students experience,
28:11but building out,
28:12leveraging their experiencing and building
28:14out a structure and making some connections.
28:18And you notice this bottom
28:19part about the incontinence.
28:20This is a great point because
28:23incontinence can be seen with both
28:25psychogenic attacks and with syncope.
28:28Sorry, I'm just going to go back to that.
28:30And so again,
28:31you can make these simple connections.
28:32So this is not complex,
28:35this is not, it doesn't require
28:38any particular artistic ability.
28:40My handwriting's just OK,
28:41but students love it.
28:43They really love this.
28:44And then at the end,
28:45sort of the metacognitive part is,
28:47I say, this is all you know,
28:49right?
28:49And then we can add a few pieces and
28:51we can make these connections and
28:53we can elaborate and we can decide
28:55why certain things are more or less
28:57important when taking a history or
28:58evaluating somebody with a new episode,
29:00Right.
29:03If you're going to do anatomical diagrams,
29:05keep it simple. And so I'll just
29:08demonstrate on this just one second.
29:10So I've, I've drawn this one,
29:12I don't know, 500 or 1000 times.
29:15This is the horizontal gaze pathway.
29:17So basically I can draw
29:21this in a few seconds.
29:22This is the midbrain.
29:24This is, this is medulla.
29:26This is the brain stem.
29:28And then the eyeballs and my my
29:30drawings are a little, hilariously bad.
29:32But people love that.
29:34And again, the idea is not to
29:36show my artistic brilliance,
29:38but actually to show how an understanding
29:40of the anatomy of the horizontal
29:42gaze pathway is attainable, right.
29:44There's a certain I'm showing
29:45the students look, it took me.
29:48It took me 10 or 15 seconds to draw this.
29:52Then we can say, OK,
29:53where is the third nerve nucleus?
29:56Where is the 6th nerve nucleus?
29:59What do they connect to, right?
30:04And how are they connected?
30:06And how do they control horizontal gaze,
30:08right. They talk through this.
30:09So this is a really simple diagram,
30:12but it's much more powerful to let
30:14the students see it in real time,
30:15to see me thinking about it,
30:17to see that I don't have any
30:19particular artistic talent.
30:20This is not a particularly
30:21sophisticated diagram.
30:22It's attainable and it's something
30:25that has high clinical applicability.
30:29And then, you know,
30:30you start drawing in how the vestibular
30:32input might affect that and you
30:34know what what an intranuclear
30:36ophthalmoplegia might say and so on.
30:38And let me just give you an example,
30:40just so you know that I'm not lying
30:42about this or or just showing this as
30:45something in the abstract that I never do.
30:48I'll actually show you an example of
30:51something I did with the residents
30:53for Morning Report yesterday morning.
30:56And I thought it went really
30:57well and it was very simple.
31:02So I just pulled out my iPad
31:04because some of the residents are
31:05on zoom and some are in person.
31:07Or let's just learn loading.
31:17I'm actually going to go back
31:18and try that one more time.
31:29There it is. OK, so you can see the diagram.
31:34A couple of my residents were really
31:36amused by this picture of somebody with
31:40subtle right hemiparesis in a facial drip.
31:43I drew the diagram of the horizontal gaze
31:45paresis and we worked through this together.
31:48We put together the cardinal elements
31:52of gaze that's that's this section over
31:55here and sort of looked at a patient
31:57video and and drew how that connected.
31:59And this took about 20 minutes.
32:02This was a 20 minute discussion showing
32:05how it's attainable and we were able to
32:07conclude that the only sole explanation
32:09for this patient in this clinical
32:12scenarios clinical setting had to be
32:14a acute infarct in the medial ponds.
32:16There was really no other explanation
32:18based on our knowledge of neurotomy.
32:20So it's a very powerful tool.
32:21You know, again,
32:22I have some expertise and some
32:23comfort in doing this,
32:24but it was very engaging and not
32:27particularly complex or sophisticated
32:28on on the scale of things that you know,
32:31the complexity that we can see in neurology.
32:32And
32:35I'll just go back to sharing my screen
32:56here. Here's a rule I would go by,
32:58which is that any diagram or drawing
33:00should be simple enough so that
33:03a student could recreate it from
33:05memory with a bit of practice.
33:07And I don't know if this is hard or fast,
33:09but again, this should not be
33:11an exercise in you demonstrating
33:13your artistic brilliance, right?
33:15This is about there's a learning activity
33:18and showing how actually when we worked
33:20through this together in real time,
33:22this is attainable information.
33:23This is this is the place you could get to.
33:27Here's another example so you
33:29can build structure into lists.
33:31So I I made the example of the of
33:37the causes of new onset seizures
33:39in elderly patients and I I saw
33:42in the chat the ChatGPT was able
33:44to come up with a list Actually
33:46I wanted to look at GP TS list
33:54pretty good, pretty good.
33:55I might have put it in a
33:56different order but that's good.
33:58So there you go.
33:59Right that's that's not what we're at right.
34:01We're about so you can get chat GP
34:04ChatGPT to come up with the list.
34:06This in this case is a list
34:08of causes for NI secoria.
34:10So causes for a dilated pupil on one side.
34:13And so the students might come
34:14up with this list, right.
34:15It would be very common to say, OK,
34:17you have fixed eyelid pupil on one side.
34:18What are what are some of the causes and
34:21people know about uncle herniation or
34:23aneurysm or an ischemic third nerve palsy.
34:26And then you start,
34:28you form a structure around that, right?
34:30You're right.
34:31OK, that's the differential
34:32diagnosis of dilated pupil.
34:33Here's how I would organize them.
34:35And so you've drawn it from the students,
34:37but then you start to organize
34:38it in the order, you know,
34:40right, based on your expertise.
34:41So I said, I drew these from the
34:43students and I put them in organized.
34:45And I'll say, OK, yeah,
34:46aneurysm and uncle herniation
34:47are causes of the dilated pupil.
34:50They're actually much less common,
34:51but they're important to consider
34:52because they can't miss,
34:53right.
34:54And then we leave a space at the top,
34:57which in my experience students
34:58might forget about,
34:59but it's the most common cause and a
35:02common cause of cancelled stroke alerts
35:04across the hospital all the time.
35:07Does anybody know?
35:09And I see Ariel and maybe Claire Lambert,
35:11So they can't answer.
35:12No, no neurologist can answer this question.
35:14Does anybody know most common cause for
35:17a dilated pupil, Unilateral dilated pupil,
35:21the prior eye surgery.
35:24Good thought.
35:24Yeah.
35:25So a prior eye surgery,
35:26I guess what I would say Shannon
35:28would be a new dilated pupil, right.
35:30So that's a good point.
35:31The common cause of NS Acorio
35:33Beach prior eye surgery,
35:34I'll put that in there.
35:37But this is with the chalk talk,
35:39so I'll put new see how I did that.
35:43This is spontaneous.
35:47Yeah. So Catherine nebulizer.
35:49So I would put drugs
35:53pharmacological.
35:56So in the inpatient setting,
35:57right, you have a nebulizer
36:00mask with Ipratropium, right?
36:02Which is anergic, which is going
36:04to cause dilation of the pupil.
36:05The mask doesn't quite fit,
36:07blows a little asymmetrically into one
36:08eye and you get a fixed dilated pupil.
36:10There are lots of things in in the
36:13world that are dilating to the eye.
36:15Scopolamine patches,
36:16they put a patch on and then rub it.
36:18Nurses doing a code and using
36:21atropine and then accidentally
36:22getting some in the eye and then
36:25fun things like gardener's pupil,
36:27which is from
36:32what's it called, Oh my God,
36:33I'm blanking on the name.
36:34But there's a plant that's sort
36:36of an endemic and actually all
36:37all over Connecticut which can
36:39cause a gardener of pupil it has a
36:41strong edge of cholinergic effects.
36:45So you see how we learned something new.
36:47It was kind of fun.
36:48I used your experience and then
36:49built on it and I think this is
36:51much more likely in this setting
36:52using this structure for you to
36:54remember that A cause for a new
36:56fixed dilated pupil would be
36:57pharmacological than if I just told you
37:03so. As I said,
37:05it's not really about a structure,
37:07you can even go a little bit simpler.
37:09So this is another epilepsy
37:10example because as Andre says,
37:12I am an epilepsy Dr.
37:14So this is another basically real case or
37:17could be real common enough to be real.
37:19A 17 year old girl referred to clinic after
37:21a generalized compulsive event five days ago,
37:24sleep deprived the night before,
37:26occasional twitching, usually after sleep
37:28preparation for the last two years.
37:31And this would occur while she was on
37:32the school bus in the morning along
37:33a stretch of the road where the sun
37:35would flicker through the trees.
37:36This is my artistic poetic component
37:38of the of the story.
37:40Medical history is unremarkable.
37:42Exams normal, developmentally normal.
37:43CT head with normal.
37:45This is a straight up closed ended question.
37:47What's the diagnosis?
37:48Because I think this is when
37:49medical students should at least
37:51have some familiarity with.
37:52So again, I'm not going to ask you,
37:54but this is they're usually
37:56by halfway through clerkship
37:57they're able to come up with JME.
37:59So this time of year,
38:01January, February, March,
38:02probably not most of the time by June,
38:06July, it's interesting,
38:07almost always somebody's able to come up
38:09with this and then I say, OK, well it's JME.
38:12Why?
38:13And we can just start to flesh out the terms,
38:16right?
38:16The J is because of the time of onset,
38:20not necessarily when the timer
38:21of the seizures are happening.
38:22You could have a 50 year old with JME,
38:24but it's the onset of the seizure.
38:26So there's a key point, right?
38:27Pretty simple.
38:28Myoclonic is because of the types of
38:31seizures that this patient has most common,
38:34the type of generalized onset seizure.
38:36They can also have absence
38:37and bilateral tonic,
38:38clonic and photoparoxysmal response.
38:39So we can build on that.
38:41Let me say,
38:42why do they call it epilepsy?
38:43And then we get into the
38:45diagnosis of epilepsy,
38:46the what that means and what that means
38:48is recurring unprovoked seizures.
38:50And then we could get into what
38:51unprovoked means and we,
38:52you know,
38:53we could make again another good 1520 minutes
38:56out of this just with these three words.
38:59And so it doesn't have to be complicated.
39:02And I want to show you all that this is
39:04just a very attainable kind of thing.
39:09In terms of wrapping up,
39:10This is where a few moments
39:14spent reminding everyone what
39:16happened really helps a lot.
39:18And sometimes you just have to remind
39:21students that they learned for them
39:23to perceive that they have learned.
39:25I'm sure you've all had
39:27this experience yourselves.
39:28And So what I'll say is what we've
39:30done today is talked about the
39:32differential diagnosis of a new spell.
39:34And we talked about ways we
39:36can organize our thoughts.
39:37And then we talked about the
39:38most common generalized onset
39:40epilepsy syndrome and young normal,
39:42neurologically normal what young
39:43adults and why that is and then
39:45we talked about seizures in
39:47elderly people and and so on.
39:49And you have amazing information about
39:51that and you now you understand it
39:53better and you can go back to that.
39:55Those notes whether they do or not
39:57is not my concern but they might
39:58that I just emailed you right.
40:00So you were sort of reminded what
40:02happened and and again that.
40:03Ability to remind somebody that
40:05this wasn't spontaneous,
40:06that this was planned out,
40:07that there was some thought put into
40:09this and into the students learning
40:10objectives and what they might want
40:12to know really kind of seals the deal.
40:15And so here's an example of the
40:18handout with the answers to that
40:20first case right the the BTC,
40:22the PNES and and Syncope.
40:25And it it has probably more information
40:27than the students would come up with
40:29in terms of that before, during,
40:31after and the three differential diagnosis.
40:35But this is,
40:36and I think you would,
40:39I hope you would all agree that
40:41if I showed this at the start,
40:42the likelihood that students
40:44would remember one or many of
40:46these elements is much lower,
40:48much lower than if if we work it
40:50through it together And then I
40:52give them to this afterwards so
40:54that they don't have to feel like
40:56they're missing anything, right.
40:57But they don't have to feel like
40:59they've gotten short shrift.
41:00In fact,
41:00they've gotten a deeper dive and
41:03and and they have this to refer
41:05to in the future
41:10in the spirit of knowing that talking about
41:14chalk talks means that we want to be brief.
41:17I'm just going to open it up for discussion.
41:19So I'm actually going to stop my
41:21slide share and actually I'll leave
41:24this on for the moment and I hope
41:28nobody will complain about a few
41:31minutes back if you have that.
41:32But I'd love for people to reflect.
41:35So Linda, it looks like I
41:36has put in the in the chat
41:44and I'll stop the share.
41:48And
41:51any thoughts, comments,
41:56Sharon? Yes, that was the complaints
41:59department slide the classic.
42:01They're actually all on Netflix now,
42:03right? Monty Python's Flying Circus.
42:08Again, medical students may
42:11or may not get that reference.
42:14The first word he goes into was the
42:18argument department been misdirected,
42:20was supposed to be the complaint.
42:22All right, Michael,
42:25thanks a lot, Jeremy.
42:27So your example was very
42:32structured and very planned out ahead. Is
42:37there a role for chalk
42:40talks to be much more
42:42spontaneous and improvisational?
42:46What do you think? I I think
42:50so. I mean, I think the
42:53person's got to be skilled,
42:54but I I don't know, I think the
42:57students really get something
43:01to see somebody's mind at work,
43:04you know, a good clinician who can
43:08do a sort of a hypothesis
43:10driven history and physical and and draw
43:14them in, draw them into it. I mean that's
43:18something that I enjoy, you know,
43:21watching and I think students do
43:24as well. But
43:25I think it's just a different
43:26flavor of a chalk talk.
43:30Yeah, I think, I think you said
43:32a few things that are probably
43:33important in that, right.
43:35And and hold to some of
43:36the principles, right.
43:37This is somebody who's expert who
43:40has some skill or facility or
43:42comfort in this type of presentation,
43:45right, Who's done it before,
43:49You know, you have to. Even then,
43:53I think that's actually in some ways harder.
43:55It can be in some ways harder,
43:56in some ways easier because there
44:00is an element of a prior experience
44:01being the preparation, right.
44:03OK. I've done this one before.
44:05I've thought through this problem before.
44:07I know it's going to take me 15 minutes,
44:09right. You know,
44:10one of the one of those things is.
44:12So I would argue it's not a
44:14complete lack of preparation,
44:15but maybe it's a little bit more spontaneous.
44:17I don't know.
44:17What do you think about that, Mike?
44:20Yeah, I think there's
44:21probably a a little bit of
44:26planning out in there subconsciously I guess.
44:33Yeah. And I I take your point that it
44:35doesn't have to be fully structured.
44:36You know, what I will say is people are busy,
44:40and if you don't have any structure,
44:42unless you're really good at
44:43this or really experienced,
44:44you'll run into time management issues.
44:47I think a lot of people run
44:48into time management issues,
44:49which can be really tough,
44:51'cause that can be very disengaging too.
44:53So I like it.
44:53I like the idea of in a morning report,
44:56right? A little diagram about your
44:58approach to whatever problem is
45:00being presented at morning reports.
45:02Really powerful, really nice, right?
45:03And can bring people together.
45:05But even then that that person's
45:06kind of thought it through and put
45:08some structure in it ahead of time,
45:09you know, in some way or other.
45:13Ellie,
45:16hi, Thank you so much.
45:18That was a lot of fun to
45:19watch and made me want to
45:21learn all about neurology.
45:22And I'm a big proponent.
45:24I'm a big fan of cha talks,
45:26Cha talks myself.
45:27I have my little board in here,
45:29my office too.
45:30And I try to do that as
45:32much as possible with my
45:33students and and residents.
45:35I think one
45:36of the things that I sometimes
45:37feel awkward about, and I well
45:39this is might be more of a meat
45:40problem that I need to work on on,
45:42on on my own therapy at my due
45:44time. But I I have a issue with other
45:47people feeling uncomfortable or making,
45:49you know, putting putting them on the spot.
45:51And I also know that it's a
45:52big part of learning, right?
45:53Like the idea of pimping
45:55and quizzing Med students.
45:56And so I wonder if you had
45:57any tips with your, you know,
45:58in your experience and expertise about how
46:00to do so in a way that's not, you know,
46:03awkward or uncomfortable but that's still,
46:07yeah, I'm gonna,
46:08I'm gonna use the strategy that
46:10I would use in these types of
46:12presentations and ask you what,
46:13what things have you noticed work better
46:16in terms of overcoming that bearing
46:21for me, You mean, Yeah.
46:23Yeah. End up doing is sort
46:25of asking the question and kind of
46:27guiding them towards the answer
46:29so they don't have to sort of
46:30fumble and feel a bit awkward.
46:33Yeah, you know, you know,
46:36one one thing that can help is just
46:39simply being very clear about your
46:41intention and asking the question, right.
46:43So I've even said something like
46:47I'm going to ask you questions,
46:49'cause I 'cause I really am
46:51passionate about this and want
46:53you to learn and I'm not judging,
46:55but it helps me sort of meet you where
46:57you are and achieve your objectives.
47:00So I've.
47:00I have found that a a very effective way
47:03to do that is to ask question prompts.
47:06But this is not a test. You know,
47:08I'll I'll even say something like that,
47:09you know, even then, yeah.
47:10You know,
47:11sometimes it's a generational thing.
47:12And I'm seeing some things in the
47:14chart about comfort or discomfort.
47:15But as clear as you can be about
47:17the intentions and then how you
47:18respond to the answer, right.
47:20Is going to make all the difference, right.
47:22That can set the tone.
47:23So you know if the answer is not exactly
47:27what you were looking for and you say wrong,
47:30how could you think that you know that
47:31you're going to kill somebody by doing that.
47:33You know you're not going to invite
47:36further discussion if you can say
47:38if you know the best strategy
47:39and very effective teachers,
47:40I envire this and I think they do it well.
47:43Find something,
47:44right.
47:45Find bridge the students answer to what
47:48they're looking for their thought and
47:49sort of make that connection right.
47:51So you can ask a a probing question,
47:54you know. Oh, that's interesting.
47:56I wonder why, you know,
47:58tell me more about that. Right.
48:00Something very open-ended.
48:00Tell me more about what you're thinking
48:02and maybe you'll get them closer right
48:04to to what you were thinking about.
48:05And then you can say,
48:06yeah,
48:07I think your thought about this part is good.
48:10And then in my experience that
48:12here's something else that
48:13you could think about it.
48:14It's
48:17two strategies I'd love to hear if
48:18anybody else has some good ideas.
48:20But. But those are two things I
48:22do that I find very effective. I
48:24do something similar, Jamie, like,
48:26and I've started just doing this in the
48:27last year or so because I think that
48:29the culture of like, medical training,
48:30there's maybe like it's not as intense
48:33with the quizzing as when we went through.
48:35So at the beginning of like,
48:36when I work for on a block with a fellow,
48:39usually usually it's a fellow when
48:42we're talking about like goals for
48:44the block or like what they are.
48:45And I always tell them sort of like
48:47this is my style, this is what I do.
48:48But like let me know if it's like not
48:50working for you and I do the same thing.
48:51I'd be very explicit.
48:52I'm like, I ask a lot of questions when we're
48:54talking about cases on rounds or whatever.
48:56And I'm like, it's never a test.
48:58I'm never angry if you don't know the answer.
49:00Like I say this very explicitly,
49:01I'm not upset if you don't know,
49:03you know, like I'm like,
49:05it's really a like a chance for to
49:08get conversation going to like,
49:09for me to like see where you're at.
49:11So if I'm like,
49:12so I'm not telling you stuff
49:13you already know, you know,
49:14But I can like add to what you do know
49:17and then I tell them something similar
49:20to what you were saying, Jeremy.
49:21Like I that I like.
49:22I think that when you have to think
49:24through something yourself and try to
49:25come up with the proposed you know,
49:27answer or plan,
49:28you'll learn it better than when
49:30you just like if I just tell you,
49:32you know what I think and what the answer is.
49:34And so I kind of explained to them that,
49:35like,
49:36it's gonna be helpful for their
49:37learning to like,
49:38try to think through something.
49:40If I ask them, like,
49:41what do you think is going on here or
49:42what do you think about this or that?
49:44But that they're never in trouble
49:46if they don't know.
49:47And I try to put that as like a
49:49baseline so that they understand.
49:51And then I try to kind of what
49:52you were saying, too.
49:53Like if like they say something that's
49:54not quite what I was getting at,
49:55I'll be like, OK,
49:57like that can happen sometimes,
49:59you know, or like, oh,
50:00that's that's something that we see
50:02more in patients like with X syndrome,
50:04not Y syndrome that we're talking about.
50:05And then try to like bridge it
50:06over so that they know.
50:09And I tell them like, you know,
50:10feel free to ask me questions.
50:11It's a give and take like.
50:12And so that I can make it a better
50:14learning experience for you.
50:16And how does that go for you, Shannon? I I'm
50:20still learning 'cause I just
50:21started doing it over the last year.
50:23I think overall it goes,
50:26it goes OK or well.
50:28I think it somewhat depends on the
50:30personality of the trainee, right.
50:31Like some of them really get
50:33that and they get really engaged
50:34and they ask lots of questions.
50:36I think some who are quieter,
50:38it can be a little hard to read,
50:40you know, like, yeah,
50:42yeah, well, you know and that
50:43that's why with the chalk talk,
50:45having a group is very helpful.
50:47You know, nobody has to talk.
50:49Some people prefer to sort of engage
50:52by listening and and I never force
50:55anybody to talk for that reason.
50:58But but at least, you know,
50:59it's a one minute preceptor, right?
51:00You know, get it,
51:01get a commitment to then teach, you know,
51:04refine that and and teach general rules.
51:06That's what we're doing, right.
51:09You know it never hurts to be as explicit
51:11as possible of what but what your goal is.
51:13I think, you know,
51:13again this is sort of the meta
51:15teaching kind of thing but I always
51:16tell people exactly what's happening.
51:17There's no secrets here and
51:19I tell them you know what,
51:20I just like this more.
51:22I'm sorry,
51:22I just believe it's more effective.
51:24So bear with me.
51:25And most people see that as
51:27authentic and are OK with it.
51:28Ariel asked about engaging
51:30learners with different levels.
51:32And I actually think chalk talks,
51:35much like any other clinical case discussion,
51:37could be great for learners
51:38of different levels, right?
51:39Because you can.
51:41A common approach would be to seek that
51:44commitment from a more junior learner first,
51:47and then maybe even point to a more
51:50senior learner and say, hey, what do you,
51:52what do you think about this?
51:53Right.
51:53Again,
51:53you have to make sure there's a
51:55safe learning environment and the
51:56senior learner's not gonna, you know,
51:57do that negative thing of saying.
51:59I don't know why the junior learner
52:00would have possibly said that,
52:01'cause it's ridiculous.
52:02You know, you don't want that to happen,
52:03so there has to be some control there,
52:04but you can leverage the the
52:07knowledge of the group and you know,
52:09that's that's another point.
52:10Maybe I didn't emphasize enough
52:12with the chalk talk or something
52:14more spontaneous
52:17is facilitating and being part
52:18of a discussion in which learners
52:20can learn from each other just as
52:22much as they learn from me, right.
52:23I mean, that's what we're doing here in
52:26in this question and answer discussion.
52:28So if you start with that and allow
52:29learners to learn from each other
52:31even if they're at equal levels or
52:33if they're at different levels,
52:34it's very powerful and it can go really,
52:37really well.
52:37And on that sort of aspirational point,
52:40right. I think when you have
52:42different levels of learners,
52:43but they're close, you know,
52:45only a year or two apart,
52:46it really allows that junior learner
52:49to see how that knowledge might be
52:51attainable at some point, right?
52:52And and and seeing how that
52:54person came to it.
52:59Any other comments or questions?
53:04Jeremy, using your this last example,
53:07I wonder if you could I I like the
53:09idea of starting with the younger
53:11learner or the newer learner.
53:12But I wonder if you could also do
53:15it in reverse and have the more
53:19experienced learner talk out of a
53:21case or a problem and then have the
53:23newer learners ask them questions.
53:27Or you know, have have the newer learners
53:30then reflect on what they might have
53:33learned from the discussion of the case.
53:36So that might avoid you know the risk
53:40of an older learner saying you know
53:42I don't know why the newer learner
53:45said that if you do it reverse.
53:47So I don't know. I just brainstormed up.
53:49I I'm just curious of what
53:50you think I mean.
53:53No, I I think what I would encourage all
53:54of you to do is to try and practice stuff.
53:56And I I've done lots of things
53:58that have not worked out right.
53:59You try something, you draw a diagram
54:01and it's just more confusing.
54:02You know or you explain something
54:05in a way that's not clear. Right.
54:07And you're like oh I won't
54:08do that again the next time.
54:10But I think that's a valuable experience.
54:12I've I've just gotten over
54:13the fact that it's OK,
54:15and I think that's very different
54:17from a PowerPoint.
54:18I think you have to be much
54:19more comfortable with the idea
54:20that you might fail,
54:21that you might explain something
54:23and it's confusing,
54:23or you might run out of time,
54:25or you might not quite have
54:28your facts straight,
54:29or a student might ask you a question
54:30that you don't know the answer to
54:31and you feel like you should, right.
54:33You just have to be OK with that.
54:36But I don't think that's bad.
54:38I actually think that can strengthen the
54:40bond between you and a learner to be honest.
54:42Another question I love when you have
54:44the senior or the junior learner,
54:46if it's a case based discussion
54:48and somebody asks another question
54:50as this is any clinical teaching,
54:52but for chalk talks works is why,
54:56Why would you have,
54:58why do you ask that question, right.
55:00So you have a case and somebody asks
55:02for more details about that case,
55:03especially if they're more senior learner.
55:05Why did you ask that?
55:06What are you thinking?
55:07You know,
55:07something like that And that can
55:09really be very powerful and can
55:12help explain to the junior learners
55:13why a more senior experienced
55:14clinician might ask that question.
55:19Can you see nasagmus in normal people?
55:20Yes, but I I can't elaborate.
55:23And then along the same lines,
55:25do you have any thoughts about
55:26employing bites like chalk talk during
55:28bedside rounds with a patient present?
55:30I this is a totally different I
55:33actually love to the physical exam
55:35at the bedside which is a neurology
55:38thing I think although you can do it
55:40in other settings and there I think
55:42some strategies that's a whole other
55:45talk rarely you know I have done
55:49drawings at the bedside for patients
55:51to teach patients and that can be
55:54very instructive for the learner.
55:55So a common drawing that I'll show
55:58is spreading cortical depression
55:59with migraine to explain why a person
56:01with migraine aura might have visual
56:03and then sensory and then language
56:04dysfunction you know and why that wasn't
56:06a stroke and why we understand that.
56:07Well and it very reassuring for a
56:09patient to hear that and know that
56:11that's not a stroke and that's
56:13actually really common to have with
56:15migraine aura And I draw a little
56:17picture simple brain and and you know
56:19if a learner's there that's great
56:20you know they can learn that too.
56:21So I I guess I do that I I draw
56:24diagrams for patients a fair bit
56:35I just love the speed of this.
56:36You know it's just Andre said that I I
56:40think you're just thinking of the speed
56:41that everybody else is and and you're
56:43just making a much deeper connection.
56:45And you know we talk about burnout
56:47and and wanting to feel fulfilled
56:49in our jobs and so on.
56:51And I I really think that this type
56:54of teaching and learning is for me
56:57very energizing and empowering and
56:58generally strengthens my connections
57:00with my learners because there's just
57:02there's no technological barrier there.
57:11You're muted on Trace,
57:22OK. The 3rd is a charm
57:24that as a cohort, I think that we're
57:26just so burned out by PowerPoint
57:28because 90% of PowerPoint is so bad.
57:31And it's just refreshing to go
57:33back to some of the comments.
57:36Note, go back to our roots and you know,
57:39so thank you for taking us back
57:40to our roots and the double
57:42whammy of doing it through Zoom.
57:44Wow, very, very meta, Very meta.
57:49I like doing it like,
57:51during rounds sometimes, too.
57:52Kind of like you alluded to,
57:54like, there are certain topics
57:55that come up a lot in my like,
57:58'cause I do transplant infectious diseases.
58:00So like CMV and CMV treatment and
58:03prophylaxis comes up a lot. And like,
58:05whenever there's a new learner, it's
58:06almost like easier. I do it on paper,
58:08'cause we're usually like on the wards,
58:11pull out a piece of paper and
58:12go through and be like, OK,
58:13let's just take like 10 minutes and
58:15talk about like CMV status and you know,
58:18and prophylaxis and transplant.
58:19And that's kind of,
58:21I think, a nice way to like,
58:22connect and feel like you're throwing
58:23some teaching into the mix too while
58:25you're walking around on the hospital.
58:31We still like going to watch live music,
58:33right? Even if we've heard the song before.
58:36Something different about the experience.
58:45Well, I think it's time to say goodbye.
58:48We don't want to leave,
58:48Jeremy, but, you know, goodbye.
58:51So thank you for a wonderful,
58:53wonderful presentation.
58:56Bye. Thanks.