Throughout the module is a script, designated by the star icon, which can be used to introduce issues, ask reflective questions, prompt discussion, elicit feedback, and summarize important take-home messages. The script can be read or preferably paraphrased by the educator(s) facilitating the teaching sessions.

The World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Bright Futures embraces this broad definition of health — one that includes not only prevention of morbidity and mortality, but also the achievement of a child’s full potential. In the Bright Futures concept of health, providing the capacity for healthy child development is as important as ameliorating illness or injury. Recognizing and acknowledging the strengths and resources of the child, family, and community are essential to promoting healthy growth and development.

To build that capacity, the Pediatrics in Practice curriculum focuses on six core concepts: Partnership, Communication, Health Promotion, Time Management, Education, and Advocacy. The curriculum also includes a companion module (Health) and videotape that present an overview of Pediatrics in Practice and the Bright Futures approach.

Today’s session is the first of two that comprise the Pediatrics in Practice Education module. We are going to explore a teaching model you can use with the children and families you encounter each day. The model is based on a concept called Teachable Moments.

Opportunities to promote learning occur many times a day but often go unrecognized. Identifying daily teachable moments and knowing how to improve the health education of children, families, and communities is critical to fostering health promotion. Teachable moments can occur any time that children and families are ready to learn, and the health visit presents the ideal opportunity for the child health professional to teach. The pediatric provider must not only recognize teachable moments but also respond to them by using suitable and effective teaching strategies.

In today’s session, our objectives will be to:

• Define teachable moments.
• Identify the six steps in the Teachable Moments model.
• Describe a variety of teaching strategies.
• Apply the six-step teaching model to a case vignette.
• Practice using teaching strategies based on the case vignette.

When we have completed the session, you should be able to answer the following question:

• How do I identify teaching opportunities during my health encounters with children and families?

Let’s begin by taking a look at the definition of a teachable moment. Next, we will identify the six steps of the Teachable Moments model.

A teachable moment is simply any time during the course of a health visit when the child health professional identifies an opportunity to teach the child and family. Teachable moments are the moments when the child and family are ready to learn.

These teachable moments occur many times each day but often go unrecognized.

There are six important steps in the Teachable Moments model. These steps will help us take advantage of those teaching opportunities that are sometimes missed.

1. Recognize teachable moments in the health visit

The child or the family will often express a need to learn during the health visit.

2. Clarify the learning needs of the child and family

Assess and clarify the family’s learning needs. Determine what the family knows and needs to know.

3. Set a limited agenda and prioritize needs together

Plan for the appropriate teaching strategy by setting a limited agenda and prioritizing the learning needs together with the family.

4. Select a teaching strategy

Select and implement the appropriate teaching strategy or combination of strategies.

5. Seek and provide feedback

Seek and provide feedback about the information you’ve presented. Did the family understand? Can they affirm the knowledge you’ve provided? Were there any misunderstandings that need to be corrected?

6. Evaluate the effectiveness of the teaching

Obtain the family’s perspective on the teaching you’ve provided. Will they remember the information after they leave the visit? If learning a new skill was involved, were they able to demonstrate the skill for you?

Now, let’s look at the four characteristics of the teachable moment.

The teachable moment:

• Provides “information bites” or small amounts of information.
• Is directed at the child’s or family’s specific need.
• Is brief, requiring only a few seconds of time.
• Requires no preparation time.

Do you have any questions about the Teachable Moments model?

We’ll use this case vignette as we apply the six steps of the Teachable Moments model. Would someone like to read the vignette for us?

The focus of this discussion is the implementation of each step of the model. Please suggest elements of the case vignette that illustrate each of the six steps as we go through the list.

1. Recognize teachable moments in the health visit

• Mei and Li are not sure how to use the thermometer properly.

2. Clarify the learning needs of the child and family: What is it they need to learn?

• The mechanics of using a thermometer
• When to take a temperature
• What the readings mean
• When to call for help based on the reading

3. Set a limited agenda and prioritize needs together: What information does the family want?

• They need help with all of the topics (above).
• They want to learn how to use and read the thermometer now.
• They are worried they will not remember what the readings mean.

4. Select a teaching strategy: From the list of six teaching strategies noted in the model, which strategies could apply in this case?

• Telling—explaining and giving directions on the use of the thermometer
• Showing—demonstrating the use of the thermometer
• Providing resources—giving the family an information sheet on the use of the thermometer

5. Seek and provide feedback: For the method(s) you selected (telling, showing, providing resources), how might you receive feedback?

• Mei and Li thank you and tell you that they understand how and when to use the thermometer.

6. Evaluate the effectiveness of the teaching: How would you assess whether the teaching was helpful and effective?

• Ask Mei and Li to practice in front of you and demonstrate the proper use of the thermometer.

Imagine that you are Mei or Li and ask yourself what you would want and need to know. Be very explicit with the details you provide as you teach.

Each team has 5 minutes to work together on its assigned task. One person from each team will then act as the “teacher” for the other teams of learners who will assume the roles of Mei and Li. The “teacher” must use only the teaching strategy his or her group worked on. Imagine that your strategy will be the only way Mei and Li will receive the information.

Was this teaching strategy effective in teaching Mei and Li how to use a thermometer?

Why or why not?

What could be improved?

Under what circumstances would the strategy have been successful? What circumstances would make it less effective?

Teaching strategies are often used in combination. For example, you might provide the child and family with information verbally and also give them a handout to take home after the visit.

Combining strategies helps families remember the information better. They can “experience” the learning in more than just one way. Different strategies used together help accommodate the family’s different learning styles.

Some teaching strategies are reinforcing and enduring. Handouts provide the opportunity for the family to look at the information from a different perspective and to refer to the material again later.

Another reinforcing and enduring option is to give an “information prescription” for families. Families can then find additional resources for themselves (e.g., books, videos, or Web sites).

What were some problems the teams encountered in developing or presenting their strategies?

How did you decide which teaching strategy (strategies) to use?

What combination of strategies would have ensured that Mei and Li learned what they needed to know?

During this session, we’ve discussed recognizing teachable moments and using effective teaching strategies after the teachable moment has been identified. We have also seen that each teaching strategy has strengths and weaknesses and that combining teaching strategies often works best.

Before we conclude, what questions remain about what we addressed today?

This handout summarizes various teaching strategies, their advantages and disadvantages, and examples of situations where they might be effective. Although not all of these strategies would be appropriate to use with families, you may find yourself in other situations where this information would be helpful. It is a more comprehensive reference on teaching strategies than what we have presented today. Please take some time to review the chart. We can take time during clinic today or at another time to go over any questions you may have.

Now that we have completed this session on Education, you should be able to answer the following question:

How do I identify teaching opportunities during my health encounters with children and families?

• Learn to recognize teachable moments during the course of a health visit.
• Focus on the family and listen actively to what they ask or say.
• Look for moments to teach when the child and family are ready to learn.

In the next session, we will take an in-depth look at the Teachable Moments model and explore the use of questions and wait time as they apply to the Teachable Moment.

In your health visits today and over the next week, practice identifying the teachable moments you experience, either as a teacher yourself or as an observer of another person teaching.

Keep a list (in a journal or on 3" x 5" cards) and briefly make notes about the teachable moments as they occur. Also note the teaching strategy (or strategies) you or the other person used in response to the teachable moment. Make notes right away or as soon as possible later in the day.

During the next week, set a goal to use at least one teaching strategy you would not normally use during your health visits with children and families.

Make notes about the strategies you used and how effective you think they were.

Review and critique patient education materials on taking temperatures (or using a metered-dose inhaler). Practice using various types of thermometers (or equipment such as spacers).