The challenges of effective teaching in Emergency Medicine are well documented. The ED is not a comfortable learning environment. Time is limited and this creates a significant barrier to education. There are books, blogposts, tweets, research papers and podcasts that all attempt to answer one question: How do I become a more effective teacher in the Emergency Department? My recently concluded teaching elective was an attempt to experience these challenges first-hand. My month was cut short by a vacation as well as being scheduled for 5 shifts in the department by everyone’s least favorite chief resident, Christopher Sponaugle. This blog post will discuss some of the more important aspects of bedside teaching and the tools that we have at our disposal.
Whatever your motivation might be, accepting your role as a clinician-educator is extremely important. This role is not limited to those of us pursuing academic interests post-graduation. Regardless of what environment you will be practicing in, you will have some degree of teaching responsibilities; as an educator, you have a professional and ethical obligation to your learners.
Successful teaching in emergency medicine (EM) begins with enthusiasm and a desire to positively influence the learner. Learner-centered teaching has been repeatedly shown to be the most effective method of teaching in EM. Taking a few minutes at the beginning of your shift to get to know your learner is key. This helps to establish your relationship, determine their goals and set expectations. One of the most powerful questions that you as a teacher possess is, “What are you hoping to get out of this shift today?”
One of the more useful tricks to being an effective teacher comes from Amal ‘put the mess in Messman’ Mattu. Something he likes to do, which I see a lot of attendings do as well, is play the “what if” game. Playing this game can make routine patient encounters become a productive conversation that allows you to explore differential diagnosis, pathophysiology and treatment options for a variety of diagnoses. Every case can provide a teaching point. Train yourself to ask questions that promote critical thinking in a non-threatening fashion. Make an effort to deliver a clear, concise and focused message. Avoid “over-teaching” or providing an excessive amount of information that obscures the original teaching point.
There are several, widely adopted frameworks that educators use in emergency medicine. One- Minute Preceptor is a 5-step model of clinical teaching that acknowledges the hectic nature of Emergency Medicine. The acronyms SPIT and SNAPPS are other teaching methods that have been adopted quite widely. These were featured during our MedEd Grand Rounds and discussing them in further detail would be beyond the scope of this blog post. A quick Google search and review of the references at the end of this post will provide everything you need to know about these and other teaching techniques.
Providing feedback is just as vital to the educational process as effective teaching. Feedback should be provided consistently, objectively and in real-time. We have all received the proverbial “shit sandwich” during the course of residency and while this is a well-known method to provide feedback, there are other important aspects of providing effective feedback. Allowing self-evaluation at the initiation of the feedback process can provide valuable information to the educator regarding the effectiveness of their teaching methods. Similar to over-teaching, avoid giving too much feedback as this can diminish the effectiveness of your message. Always finish the conversation with a positive or encouraging summary.
“I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.” While asking you to uphold yourselves to the lofty standards set by the great Sir William Osler in the above quote is impossible, I only ask you all to take a more methodical and refined approach to teaching your learners. This will serve you well for not only the rest of residency, but for the entirety of your careers.
Berger, Todd J., et al. “The impact of the demand for clinical productivity on student teaching in
academic emergency departments.” Academic emergency medicine 11.12 (2004): 1364-1367
Practical teaching in emergency medicine / chief editor, Robert L. Rogers; associate editors,
Amal Mattu … [et al.].–2nd ed
https://www.aliem.com/2016/09/idea-series- asynchronous-curriculum- for-resident- as-