Episode 98 Teaching on Shift

This is EM Cases Episode 98: Teaching on Shift. As if EDs weren’t chaotic enough, many of them are staffed by a revolving door of medical learners. Yet, to each of these learners, the ED doc has a critical responsibility: To teach. This is a central tenet of what we do, and has been since the days of Hippocrates teaching his two sons. To some, it comes intuitively, to others, it’s the most difficult part the job. Either way, we can all use some teaching on how to teach. Gone are the days of see one, do one, teach one. By analogy, learning the skills of effective teaching on shift isn’t dissimilar to learning how to put in a central line. It takes thoughtful preparation, knowledge and practice. In this episode, with the help of two master educators, Amal Mattu and Rick Penciner, we cover the how, the when, and the why we teach. We discuss some quick, easy tips on how you can take your educating skills to the next level, from orienting the learner and establishing expectations at the start of the shift, to key questioning techniques to use in case presentations, to the lost art of active observation, to the One Minute Preceptor model, to giving effective end-of-shift feedback, medicine’s white whale. We end with a surprise appearance by another master educator who gives his top pearls on teaching on shift. This podcast is about how, on your next ED shift, you can make the most of every teachable moment... Podcast production by Anton Helman, Andrew Cameron and Rick Penciner, Written Summary and blog post by Alexander Hart and Shaun Mehta, edited by Anton Helman and Rick Penciner July, 2017 Cite this podcast as: Helman, A, Mattu, A, Penciner, R. Teaching on Shift. Emergency Medicine Cases. July, 2017. https://emergencymedicinecases.com/episode-99-highlights-emu-2017/. Accessed [date]. Meeting the learner There are a few key steps that our experts recommend prior to seeing patients on shift: orienting the learner, setting expectations, diagnosing the learner and priming the learner. Orientating the learner: Learn about your learner. Ask your learner some background questions like what program they are from, their level of training and experience, previous clinical experiences and their special interests. What do they hope to learn from you? What areas of medicine do they find difficult or confusing? What skills do they want to practice? Explain their role in the department, patient flow, and what work needs to be done. Setting expectations: A mutual relationship. Discuss the learner’s responsibility during the shift and encourage them to ask questions. Tell your learners that you will act like a coach helping them to fine tune their skills. Lay out your expectations for case presentations, encouraging them to commit to a plan, clear charting and that you will be providing feedback during and at the end of the shift. Let them know that you assess them by direct observation by listening in to their interactions with patients and staff. Diagnosing the learner: Understand and tailor their experience. One of the most common pitfalls is to teach based on a poor understanding of the learner and their needs. Teaching at a level of understanding greater or less than that of the learner is unproductive, frustrating, or both. Once you get a sense of your learner, you can better teach at a level appropriate for them. There are 4 types of learners: * Unconsciously incompetent * Consciously incompetent * Consciously competent * Unconsciously competent (ie. staff/attending) Priming the learner: Prepare them for success. Encourage your learner to review the chart before g...