Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Abstract

Background: Busy environments, like the emergency department (ED), require teachers to develop instructional strategies for coaching trainees to function within these same environments. Few studies have documented the strategies used by emergency physician (EP)-teachers within these busy, chaotic environments, instead emphasizing teaching in more predictable environments such as the outpatient clinic, hospital wards, or operating room. The authors sought to discover what strategies EP-teachers were using and what trainees recalled experiencing when learning to handle these unpredictable, overcrowded, complex, multipatient environments. Method: An interpretive description study was conducted at multiple teaching hospitals affiliated with McMaster University from July 2014 to May 2015. Participants (10 EP-teachers and 10 junior residents) were asked to recall teaching strategies related to handling ED patient flow. Participants were asked to describe techniques that they used, observed, or experienced as trainees. Two independent coders read through interview transcripts, analyzing these documents inductively and iteratively. Results: Two main types of strategies to teach ED management were discovered: 1) workplace-based methods, including both observation and in situ instruction; and 2) principle-based advice. The most often described techniques were workplace-based methods, which included a variety of in situ techniques ranging from conversations to managerial coaching (e.g., collaborative problem-solving of real-life administrative dilemmas). Conclusions: A mix of strategies are used to teach and coach trainees to handle multipatient environments. Further research is required to determine how to optimize the use of these techniques and innovate new strategies to support the learning of these crucial skills. E mergency department (ED) crowding is a persistent international phenomenon. 1,2 Concurrent management of multiple ill patients is a vital skill in emergency medicine (EM), especially given increasing ED patient volumes 3,4 and acuity. 5,6 Recently, research has led to a proposed conceptual framework for physicians' thinking in such complex multipatient environments; 7 however, there is little formal teaching or faculty development around these skills in EM. 4 With the advent of graduated responsibility models such as

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

“…We embarked upon this investigation to describe and further conceptualize swarming, a new model to improve both efficiency and education in the academic emergency setting. The unique challenge of balancing these priorities in the ED has given rise to multiple innovative teaching strategies, which have been described in previous literature . Correspondingly, the results of our qualitative data reflect a general consensus that swarming improves education.…”

Faculty‐lead Opinions on Workplace‐based Methods for Graduated Managerial Teaching (FLOW MGMT): A National Cross‐sectional Survey of Canadian Emergency Medicine Lead Educators

“…Endorsement for the use of experiential teaching strategies increased significantly in Core of Discipline and for most techniques was even more strongly endorsed in the final stage of training, Transition to Practice. As clinicians gain more experience they develop more advanced heuristics enabling them to more efficiently flow patients in the ED 17,20,21. This facet is important to factor in when trying to teach flow and efficiency to trainees 14.…”

“…An electronic survey was made in Google Forms (Mountainview, CA, USA) was created based on findings from a previous research study undertaken by Chan et al17 which identified different flow and management teaching strategies that are employed in the ED (see Data Supplement S1, Appendix S1 [available as supporting information in the online version of this paper, which is available at http://onlinelibrary.wiley.com/doi/10.1002/aet2.10429/full], for details). The survey was a 21‐item questionnaire that encompassed five different subgroups of teaching techniques.…”

“…Additionally, in situ ED instruction involved experiential learning with varying degrees of supervision. Finally, heuristic‐based advice generally took the form of informal conversation around “lessons learned” and team/system‐level advice 17…”

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

“…first-impression vs. direct search for a diagnosis) rather than any actual domain of accuracy or efficiency (Ilgen et al, 2013). Furthermore, given the variety of educational approaches to multi-patient care in the ED (Chan et al, 2019), this domain of critical thinking may be difficult to encapsulate into a single variable. Peters et al noted that clinical reasoning is highly contextual and even social, interactions for which this game did not provide (Peters et al, 2017).…”