Excellent emergency medicine educators adapt teaching methods to learner experience level and patient acuity

Abstract

Objectives: This study investigates whether instructional methods used by excellent emergency medicine residency teachers change with changing conditions of learner level of training, patient acuity and department census. Methods: Four excellent, purposively selected, emergency medicine teachers consented to participate in this non-participant observational study. Teachers were observed for 32 hours in the emergency department, using a structured observation form focused on: teaching methods used, context learner level of training, emergency department patient census and patients' illness severity. Data was analyzed qualitatively using constant comparative analysis. Results: Fifteen (15) categories of teaching methods were observed. The 4 most frequently observed methods were: Questioning (used in 47of teaching encounters), Advice Giving (33, Limited Teaching Points (31 and Patient Updates (22. Patient Updates were more often used with senior residents. Multiple methods were used in most encounters. Teaching methods did not vary significantly with increased emergency department volume, but faculty and residents relied more heavily on a single method of teaching per encounter as patient acuity increased to Triage levels One and Two. Conclusions: Excellent emergency medicine teachers teaching methods were classified into 15 categories. They typically rely heavily on four methods, adapting to resident training level and patient illness severity, rather than patient volume. The observed teaching methods provide teachers who have high clinical productivity expectations and/or demanding emergency care settings with an enriched repertoire of teaching strategies

Teaching Methods Utilized During Medical Resuscitations in an Academic Emergency Department

“…They found that questioning, advice-giving and limited teaching points were the most frequently used teaching methods. 8 This study sought to establish which methods of teaching are most commonly used during resuscitation, in an effort to guide further evaluations of effectiveness.…”

“…Advice-giving, first described by Grall and his colleagues, is a rapid way for the teacher to guide the resident in the next stages of care (e.g., “I would intubate the patient next’) in the time-sensitive situation of a coding patient. 8 Bedside teaching in this situation was most commonly procedurally based (e.g., bedside ultrasound, placement of central line).…”

“…Multiple studies have been published on effective bedside teaching in the ED and other environments where time is limited. 4 – 8 Other research describes teaching residents during critical resuscitations; however, the majority of these are done in the setting of simulation. 9 – 11 Less is known about what teaching methods are used during actual medical resuscitations in the ED.…”

“…They discovered that in addition to previously described teaching methods, such as questioning and limited teaching points, up to six previously undescribed strategies were used by teachers in this setting, including advice-giving and affirmatives ( Table 1 ). 8 This study, however, was not limited to the environment of an acute medical resuscitation, and the type of teaching strategies used in this more dynamic situation may differ from those used in other situations in the ED. The purpose of this study was to further elucidate the type of strategies that are used to teach learners during medical resuscitations in an academic ED.…”

Strategies for improving clinical teaching in the emergency department: Applicable to clinical teachers and especially emergency medicine

“…Improving the level of clinical teachers in teaching knowledge and skills will improve the quality of teaching and learning, as well as their professional duties (21). Coates (2003) states that continuous faculty development and firm mentoring relationships help the educational advancement of clinical teachers (22).…”