(From the EiC: Today’s post comes from Kyla Caners, a fourth year resident in Emergency Medicine who is completing a fellowship in simulation and medical education. The post is not intended to cause distress by setting a standard expected of clinical teaching. Rather, it provides pearls – learned the hard way – that you can immediately incorporate into your practice, to up your game.– Jonathan (@sherbino))
By Kyla Caners (@drcaners)
As a junior Clinician Educator, I have been surprised how challenging it is teach while on shift in the Emergency Department (ED). I am still learning the art of running a department. Teaching is often the first thing that slips when things get busy.
So how do successful educators maintain the balance? Glen Bandiera and colleagues surveyed ED physicians acknowledged as excellent teachers to find out their teaching strategies. (Details here.)
Lisa Thurgur and colleagues built on this work, surveying medical students and residents and mapping their responses to the responses of expert teachers about effective methods. (Details here.)
Informed by this research and other education literature, the EDSTAT (Emergency Department Strategies for Teaching Any Time) course was developed as a practical framework to enhance bedside teaching in a highly dynamic (i.e. frequently interrupted, non-scheduled) environment. The EDSTAT framework involves six key steps:
- Expectations: orient the learner to the environment, yourself, and shared expectations.
- Diagnose the learner: figure out who your learner is and what areas to address in your teaching
- Set-up: give clear instructions for the learner’s task, prepared resources to optimize education.
- Teach: using a variety of useful techniques, label teaching moments
- Assess and give feedback: give brief, behaviourally-based, balanced, real-time feedback.
- Teacher always (role model): remember that your actions speak louder than your words. Teach by example and reflect on your teaching practice.
To broaden the perspective beyond the ED, the “Teaching on the Run” series, authored by Fiona Lake, offers helpful tips and tricks for a multitude of clinical environments.
Borrowing from these resources and reflecting on my own teaching, I have decided to incorporate the following new techniques into my clinical teaching practice:
- Spend 5 minutes at the beginning of a shift getting to know new learners. Where are they from? Where are they at in their training? What are their learning interests, needs, and goals?
- “Prime” the learner. Highlight the important points of a particular presentation before the learner sees the patient. Help make cases relevant to off-service residents by anecdotally demonstrating how similar patient presentations will appear in their practice.
- Get the learner to commit. Obtain commitment to a salient case summary. Obtain commitment to a differential diagnosis and plan. Obtain a rationale. Teach based on their responses.
- Actively seek out learners when an interesting case occurs. Get them involved!
- Label the teaching moment. This is as simple as telling the learner “I am going to teach now” or “Let’s do some teaching while we wait for that bloodwork.”
- Use pre-prepared teaching aids such as interesting x-rays, important articles, and teaching scripts on key topics. (Do you have a 90 second bit on dangerous rashes yet? Make one!)
- Assess the learner “behind the scenes” in order to provide meaningful feedback. Listen behind the curtain while the learner is performing their assessment. Check in with patients and their families about encounters with learners.
- Acknowledge when I don’t know the answer and role model how to problem solve together. “Let’s look that up.”
- Show excitement and a positive attitude. Acknowledge when fatigue and/or cynicism are interfering with enthusiasm.
- Have realistic expectations around teaching. A few, brief, targeted teaching points (labeled as such!) make all the difference.
What tips do you have? Share them below.
Image belongs to The Royal College of Physicians and Surgeons of Canada.