On shift teaching is a common practice in emergency medicine and other specialties. Unlike reading, or attending conference, this time is an opportunity for learners and educators to engage 1 on 1 to fine tune both their medical knowledge and practice of medicine. This article aims to discuss some old and new methods to help educators best reach their learners while on shift.
Post It Pearls
Pioneered by Michelle Lin from Academic Life in EM (ALiEM), but used by many of the “greats” in EM education, these allow for 4-5 short “knowledge offloads” that you can discuss with residents (1-2). These allow you cover a wide range of topics over the course of a shift without having to do “deep dives.” I typically look through one of the many board review question books I have purchased over the years for topics I could cover. That way they are both engaging, but also “high yield topics” for learners.
Build a Medical Infographic
The idea here is that many EM textbooks have tables/infographics summarizing key points over a topic. These can be created one of few ways.
- Create a blank table with several rows. For each row, designate an EM topic. Throughout the shift students and residents can fill in the blanks. At the end of the shift I summarize the topic and provide key learning points that may have been left out. This works great to have an organized discussion about treatment strategies for specific diseases (for example; thrombolytics in PE)
- Build an infographic that includes a human body cut out, asking learners to focus on the physical exam findings for a specific disease. This will allow learners to describe what they are looking for when evaluating a patient for the specific disease state and also allows attendings to fine tune their physical exams.
- Build a Hybrid of the above two techniques to discuss the entire evaluation, workup and treatment of a specific disease state.
I have found this empowers learners to 1) realize they know something 2) build foundational knowledge of medical problems and disease state 3) help residents target their home studies and areas to improve on.
The Game of Probables, Possibles, and Zebras
This teaching method is great for medical students and junior residents. This exercise is designed to broaden differentials and reduce the easy trap of early diagnostic anchoring. For every patient they see I require that the learner make a list of 9 potential diagnoses: 3 probable diagnoses we should consider, 3 possible life-threatening diagnoses we cannot miss, and 3 zebras or rare diagnoses a patient could be presenting with. This educational game allows for learners to verbalize their thoughts during a patient encounter and allows for educators to individualize bedside teaching in the moment. If the student or resident is having difficulty widening their differential, try prompting them with a systems based or problem based approach to the patient’s complaint. Not only is this an easy way to build rapport, but it is fun!
Made famous by the educator Amal Mattu, whiteboard teaching is a traditional, but tested teaching method (3). Place a whiteboard somewhere in your department, accessible to all of your learners. This creates another visible platform to share pearls or foundational material for learners at all levels. An added bonus of having a visible teaching model is ancillary staff can participate. Many techs and nurses are eager to learn. This is a great way to develop a department wide culture of learning. These can be done with learners present or not.
All of these techniques are worth incorporating into your current on shift teaching, however, I would recommend incorporating one technique at time. That way, you can self-assess which techniques are most suitable to your learning environment. Once you’ve found the one that works best with your on-shift flow then run with it!
Thanks to Andy Little DO and Gregory Tanquary DO for this awesome post!
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