How do I know my teaching is good? As an educator, do you grapple with this question like I do? Following a recent hands-on musculoskeletal point of care ultrasound (POCUS) session I taught to internal medicine residents, a handful of learners approached me to bestow praise. “That was awesome!” I basked in the glow of their comments but found myself reflecting afterward. Was the session (and more specifically my teaching in the session) effective? Did the residents’ abilities to perform a bedside POCUS exam actually improve? Will they retain the new knowledge? Did the teaching affect their practice patterns? Or was the session simply 2 hours away from clinical responsibilities? I knew I needed to learn how to study my own teaching.

I recently attended my first Harvard Macy Institute course, the Program for Educators in Health Professions, and had an epiphany during a session on medical education project planning and assessment. Teachers need not wonder about effectiveness of teaching. We can observe and measure it! But this breakthrough was followed immediately by a cascade of even more questions. What is the desired outcome? How can it be observed? How can curriculum be constructed and delivery of content tailored to achieve the desired outcomes? The key to solving this nearly unthinkable riddle lies in selecting a conceptual framework.

Conceptual frameworks are “theories that describe the complexities of educational and social phenomenon.” Hence, a conceptual framework serves as a foundation upon which to build objectives and outcomes, which in turn shape curricular content and delivery. This allows a teacher to proceed as the King of Hearts instructs, “Begin at the beginning […] and go on till you come to the end: then stop.” There are numerous conceptual frameworks, and selection should be driven by the type of material (behavioral change, problem-solving skills, or procedural skills) and the setting (simulation center, classroom, or clinic/hospital practice). For my POCUS sessions, the theory of deliberate practice presents itself as an ideal model given the emphasis on real-time instructor feedback and improvement of skill performance via repetitive hands-on practice.

Armed with a deeper understanding of the process by which learners advance from novice to expert status with skills performance, I can evaluate the elements of my POCUS teaching session with a particular end in mind. According to the theory of deliberate practice, learners make the greatest strides in expert level skill performance when given immediate, actionable feedback from a teacher or coach. Concrete goals that represent a portion rather than the entirety of the desired skill set that advance incrementally in difficulty also lead learners to progress in skill performance. 

I had managed to craft a POCUS skills session by intuition that incorporated some important elements of deliberate practice. The residents each performed a limited diagnostic ultrasound under the direct supervision of an expert coach (in this case, me). I assigned a short list of discrete images for which to practice acquisition rather than requesting performance of the entire diagnostic procedure all at once. I gave specific, real-time feedback. However, after studying this conceptual framework, I recognized that I had omitted opportunity for arguably the most important component of deliberate practice – the practice! The advancement and retention of skill will be promoted by including a structure for subsequent individual practice of the skills, and I can observe their accuracy in obtaining and recognizing pathology in the assigned standard views as a way to measure effectiveness. I will work to arrange time in the simulation center for self-led individual practice and schedule subsequent teacher-led sessions for step-wise progression of discrete skills. Brilliant. My knee POCUS teaching session just elevated from “fun” to scholarly. This approach can be extrapolated to other organ- or specialty-specific POCUS content, and via application of a conceptual framework to my humble teaching session, a POCUS curriculum is born.

What important teaching work are you currently “winging” that could be made both more effective and scholarly by incorporating a foundational conceptual framework? Comment below and join the conversation!


Did you know that the Harvard Macy Institute Community Blog has had more than 245 posts? Previous blog posts have explored topics including, the Hy-Flex option, designing programmatic assessment structures to support learning, and engaging students virtually.

Beth Scholz

Beth Scholz, MD (Educators ’20) is a medical educator and rheumatologist. Beth currently holds a position as Division Director for Rheumatology and curriculum director for GME Point of Care Ultrasound (POCUS) education at Baylor Scott and White Health. Beth’s areas of professional interest include musculoskeletal POCUS, quality improvement, and mentoring future rheumatology professionals. Beth can be followed on Twitter or LinkedIn or contacted via email.