The Fellow's Chalk Talk: Tips For Efficiency and Impactful Learning
Fellows in Training (FITs) hold a unique position in the multidisciplinary patient care team – often responsible for "on-the-fly" teaching with residents and medical students. This role is easy to overlook yet invaluable on busy inpatient rounding services and in the clinic. Taking time to teach residents and students not only demonstrates your investment in their growth but also, if done correctly, can leave lasting impressions on their knowledge base and career trajectories. Cardiology as a field is particularly supported by evidence-based practice and complex physiology, which can be overwhelming to any physician. Breaking down relatable topics into palatable "chalk talks" takes planning and inherent flexibility. After being approached by several others who wished to improve their chalk talk proficiency, I sought to put together important keys for success when intentionally giving a digestible talk to learners:
- Take advantage of a teachable moment. Fascinating topics are demonstrated on rounds and in the clinic every day. FITs have a duty as educators and role models to not misclassify common concepts as mundane. Our experience measuring jugular venous distention, gaging pretest probability of acute coronary syndrome, or obtaining vascular access and knowledge of catheters, for example, may not be as straightforward to more junior members of the team. While working with learners, try to find one topic relevant to a patient encounter to focus on and teach about. This is the topic to plan for and return to for your chalk talk.
- Obtain a safe setting – time, place and distractions. Set a time and location to meet for protected educational time after patient care duties are done. This time and place should be as free from distraction as possible – a task which is becoming increasingly difficult but also increasingly rewarding when accomplished. Residents and students will have difficulty focusing on learning if many other tasks are piling up to be completed.
- Keep the topic focused and the audience engaged. A comprehensive discussion on a topic should be no longer than about 15-20 minutes, and constant engagement with each member of the group is encouraged. One easy way to accomplish this is to ask questions as you introduce a topic which also has the advantage of gaging the audience's knowledge base if not already known. For example, when discussing interpretation of right heart catheterization results, one may ask what pressures may be considered normal in each chamber of the heart, pulmonary artery, and the aorta before talking about PA saturation, waveforms, or estimating cardiac output. Ideally, the complexity of such questions is customized to the experience level of the student or resident participating in the discussion.
- Use tangible tools. Props can provide rich supplementation to any chalk talk and many learn better if they can hold an object related to the topic at hand. If discussing PA catheterization, try bringing a PA catheter to demonstrate how the balloon inflates/deflates, and show how different ports are positioned to allow CVP and PA pressures to be transduced simultaneously. If talking about ECGs, bring a model of a heart to demonstrate the vectors of each lead. If teaching basic echocardiographic findings, find a clear example of a case demonstrating a normal (or abnormal) echo and allow learners to navigate or even practice performing the echocardiogram themselves.
- Restate key points. Explaining the same point several times using different wording reinforces the importance of a key fact and may help people who learn differently understand through a different perspective. Do not be afraid to stay on one topic until everyone is understanding, particularly if it is a prerequisite to the remainder of the discussion. At the end of the talk, summarize the key points.
- Allow time and space for exploration. After 15-20 minutes of teaching, allow another 10-15 minutes for questions and for exploration of related topics. Questions may not reveal themselves until learners realize they have gaps in basic knowledge of physiologic principals. Give time for processing of what has been discussed before concluding the session and be comfortable with silence while learners are rationalizing. Questions should always be encouraged in a safe and respectful environment.
- Relate the topic back to a clinical experience. Link the chalk talk back to a clinical scenario or patient encounter from earlier that day. This potentiation of the clinical experience can help learners remember the topic discussed that day. Always try to reinforce the topic should it come up again in subsequent patient encounters.
This article was authored by Anthony J. Mazzella, MD, Fellow in Training (FIT) at the University of North Carolina at Chapel Hill in Chapel Hill, NC. (Twitter: @MazzellaMD)