Teaching Techniques in the Clinical Setting: the Emergency Medicine Perspective

Abstract

The emergency department (ED) provides a unique educational experience that is distinct from both inpatient and ambulatory care settings. Because of the high acuity, interesting pathology, and rapid patient turnover, the ED is an ideal location to train medical students. Numerous teaching opportunities exist within the domain of the ED. In the preclinical years, the ED setting provides medical students with an introduction to clinical medicine and may serve as a venue for teaching basic history and physical examination skills. In the clinical years, medical students are exposed to a wide range of undifferentiated patients. Besides common medical and surgical complaints, many medical students will encounter clinical scenarios that they otherwise would have little direct contact with. Encounters such as the acutely poisoned or intoxicated patient, environmental emergencies, interaction with out-of-hospital providers, and patients requiring emergency procedures are just a few situations that make emergency medicine a distinct clinical specialty. These and other studentpatient encounters can provide the teaching physician an opportunity to focus case-based teaching on a number of elements including complaint-directed medical interviewing and physical examination skills, development of casespecific differential diagnosis, diagnostic evaluation, implementation of patient management plans, and patient disposition. In this review article, the authors discuss various ways to approach and improve clinical teaching of medical students, including: opportunities for teaching in the ED, teaching procedural skills, student case presentations, clinical teaching styles, qualities of an effective clinical teacher, and barriers to effective clinical teaching.

Teaching procedures: improving “see one, do one, teach one”

“…To teach procedures successfully, medical educators must focus on teaching both a thorough understanding of the cognitive aspects of the procedure and the ''hands on'' component (Table 1). [1][2][3] Procedural skill acquisition is best addressed by first mastering simple procedures such as suturing or incision and drainage and then building on those skills to perform more complicated procedures.…”

Medical Student Professionalism Narratives: A Thematic Analysis and Interdisciplinary Comparative Investigation

“…The patient population is heterogeneous, their problems are acute and undifferentiated, and the number of new patient encounters is high. The work environment is somewhat chaotic and unpredictable and patient care is provided in a multi-disciplinary, team-based manner [11,12]. Perhaps this unique setting and its contrast to the IM clerkship setting accounts for the differences noted in narrative domains.…”

Case Cards: A Novel Learner-Centered Initiative to Improve Resident Education in the Pediatric Emergency Room

“…Clinical experiences can be augmented by effective on-shift teaching but are often limited due to competing demands and responsibilities in the PED. Furthermore, the quality of teaching depends on individual faculty member comfort and knowledge of specific topics and their teaching skills [1][2][3][4]. Structured preceptor models, including real-time resources, provide faculty with frameworks for case-based teaching in a timely and learner-centered fashion and have been shown to enhance teaching performance, collaborative learning, and critical thinking [5][6][7][8].…”

“…Despite a wealth of patient care and learning opportunities, resident education in the pediatric emergency department (PED) setting may be challenging due to variability in cases, volume, acuity, time, and resources [ 1 ]. For these reasons, learners may not be afforded the opportunity or exposure to the breadth of pathology comprising the core and required content.…”