By Alim Nagji (@AlimNagji) and Krista Dowhos
You are just starting an evening shift in your local emergency department. Its 6:40 pm and your colleagues are swamped, the waiting room is full and a bright-eyed 3rd year medical student walks up to you and tells you she’s with you today. It’s her first shift in the ED. She’s interested in a Family Medicine residency and would like to incorporate Emergency Medicine into her practice.
For some physicians, managing having this learner on shift is intuitive, while for others it can seem more difficult than managing the sickest patient. Some physicians are more seasoned teachers and have developed a gestalt for how to teach, while others just starting out may need frameworks and guidelines to follow. Whatever your situation might be, we all have the duty to teach, and to do it well. We rely on up-to-date evidence to guide every decision we make in the emergency department, so why should teaching be any different? Similar to the management of ailments we see in the emergency department, there exists an abundance of research and evidence on how to best manage teaching learners on shift, and sometimes we need quick a quick reference or pathway to follow when time is limited.
Physicians teach in the ED all the time, but unless they take the time to review medical education literature or complete extra training in medical education, it can be difficult to know what works and what doesn’t when it comes to teaching. We decided to bring the research to our teachers by developing infographics that highlighted practical tips for bedside teaching in a way that is quick to consume and easy to understand.
When compared to text-only summaries of medical literature, infographic representations have been shown to decrease cognitive load and tend to be a more preferred method of reviewing medical literature. Keeping in mind the already enormous cognitive load emergency physicians carry on shift, we decided an infographic would be a perfect vehicle to deliver our message. Each month, we posted a new infographic in the physician charting area in our local ED, where much of the interactions between learners and preceptors occur. This ensured preceptors were conveniently able to reference it on shift. The infographics also help create discussion around teaching innovations or the application of these methods, allowing educators to share their own experiences or challenges with bedside teaching. Finally, they also serve to highlight to learners the commitment of faculty to improve their teaching methods.
We received positive feedback on the initiative, and the idea quickly spread to other shops in the region. Since the onset of the project, we have posted it in eight departments in the area, and there is growing interest from other communities. It became clear that physicians in our community of practice were keen to enhance their bedside teaching skills, and that there was a need for an accessible resource to guide them in doing so. We have started to share the resources outside the ED, recognizing that many of the skills and teaching models translate across specialties. Furthermore, with CBME approaching, many clinicians are looking for guidance on how best to give feedback, observe EPAs and evaluate learners within a new framework.
In a profession where physicians are expected to make tough decisions about sick patients, manage department flow, stay up to date on the latest evidence in emergency medicine, and simultaneously teach learners, we must find innovative and approachable ways of nurturing clinical teaching excellence. As a clinician, you are constantly teaching, however, it is mainly informal and rarely provides protected time. The “Teaching that Counts” infographic series takes the teaching you do on every shift, refines it in a way that is evidence based, and depicts it in a way that people can understand, even when time is limited.
This project represents just one of many ways we can promote excellence in bedside teaching in the ED. The infographics are attached below – feel free to use them in your hospital to highlight bedside teaching. And let us know if you do!
How does your community of practice facilitate quality bedside teaching?
- The One-Minute Preceptor Model
- Tagging your Teachable Moment
- Tailoring your Teaching to the Individual Learner
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Krista Dowhos, MD, is a first year resident in Family Medicine at McMaster’s Kitchener-Waterloo distributed campus. She is a representative to the Ontario College of Family Physicians and the College of Family Physicians of Canada Section of Residents. Her current research focuses on Family and Emergency Medicine Education as well as Simulation Based Education.
Alim Nagji is a Family and Emergency Medicine Physician, who practices in several hospitals in Burlington, Hamilton, and Kitchener. His passion for global and public health have led him to work in several countries including: Afghanistan, France, Malta, Namibia, Tanzania, Uganda, and rural Canada. He maintains research interests in theatre and humanism, medical education, and simulation.