CAEP FEI | Teaching Rotation for Emergency Medicine Residents – MERIT

In Featured Education Innovations (FEI) by Brian Chung2 Comments

Delaney is a first year Emergency Medicine resident. Over the course of her first few months, she works a number of shifts with Dr. Pan. Most of the ED staff really like whenever Dr. Pan works, because he treats a high volume of patients, “moves the meat,” and keeps patient waiting times low. Conversely, Delaney dislikes working with Dr. Pan because it seems that every time she works with him, he is too busy seeing patients to properly teach and she feels abandoned. Other physicians see similar amounts of patients but seem to have a knack of throwing in a great teaching pearl here and there throughout the shift. 

In academic Emergency Medicine, staff physicians are often tasked with running the department while simultaneously managing a learner. These tasks are often at odds and can compete with each other–in many instances, the learner’s experience is sacrificed when the department gets busy. Training programs across the country have long been successful in producing great clinicians, but far less attention is paid to producing great teachers.   This Feature Educational Innovation (FEI), titled “Medical Education for Residents In Training (MERIT)” was originally posted by the CAEP EWG FEI Team on October 30, 2015 and answers the question: “What is the potential and value of a 4-week dedicated teaching rotation for EM residents?” A PDF version is available here. A CAEP cast is available here.

Description of the Innovation

Background

Residents are often expected to teach fellow learners, and may not have received any formal instruction about educational theory or specific teaching methods or techniques. The methods of teaching about how to teach vary in each program’s curriculum, and often consist of lectures or workshops of various duration.
We developed an innovative four week elective rotation for RCPS EM residents to introduce the concepts of educational theory, bedside teaching techniques, feedback, and teaching approaches (e.g., lectures, procedures, small group tutoring). Residents were given the opportunity to practice their bedside teaching skills during scheduled teaching shifts that were observed in the ED.

Needs Assessment

The MERIT teaching rotation was developed based on an environmental scan of other “residents as teachers” programs and a needs assessment with emergency medicine residents at UBC. Based on the results of the needs assessment and environmental scan, a pilot was developed and introduced in January 2011 and repeated in November 2011. Since then, it has become a regular rotation for the RCPS residents in their R5 year (2013 to present).

The Innovation

Four RCPS EM residents participated in January 2011 (one R5, one R4, two R2’s), and three participated in November 2011 (two R5s, one R4). There were five R5’s in each block in the fall of 2013 and 2014. During the four week rotation, each week begins with a small group interactive session led by an EM faculty member. Based on the needs assessment data, session topics included: learning theory, effective bedside teaching techniques, one minute preceptor, providing feedback, teaching procedural skills, effective lectures, etc. These interactive discussions provided a foundation for residents to learn about and reflect on approaches to effective teaching.

 

In addition to the small group discussions, residents completed teaching shifts in the ED each week. The objective of these shifts was to integrate the weekly discussions into practice, reflect on action, and obtain feedback on their performance. During these teaching shifts, residents interacted with both junior residents and medical students. Throughout the week some of these shifts were directly observed by a faculty member involved with the MERIT curriculum who provided formative feedback to the MERIT residents to improve performance. In addition, MERIT residents were asked to self-reflect on their own performance.
Finally, each week ended with a debriefing session during which faculty members provided constructive feedback and discussed residents’ progress. As well, this “end of week” discussion allowed residents to discuss with each other their lessons learned, challenges and reflective thinking.
The four week block began with a four station Objective Structured Teaching Exercises (OSTEs) adapted from validated OSTEs for an internal medicine curriculum, and modified to appropriate emergency medicine scenarios. Junior residents and medical students were recruited as standardized learners (i.e., actors) for each station, and emergency medicine faculty were trained as assessors. Validated assessment tools were used to rate MERIT residents on their teaching approaches and each station was videotaped and scored for the first two iterations in 2011. This process was repeated at the end of the rotation in order to compare pre/post teaching performance. A paired-samples t-test was used to evaluate the pre/post OSTE scores (2011 only).
In addition, the “end of week” discussions were also used to collect perspective data from the residents. This included debriefing with residents about reactions to the overall rotation, the challenges and opportunities faced during the week as well as any feedback or suggestions on improvement for the future. This data was collected in a focus-group style discussion.
Based on the “end of week” focus groups, residents felt that their teaching skills improved as a result of the MERIT rotation. In addition, residents felt the OSTE stations’ scenarios required further modification to more closely mimic the ED environment. Overall they felt that MERIT would be beneficial for senior residents, and that it prepares them well for successful teaching while addressing the challenges of running a busy ED.

Conclusions

Feedback from residents was positive and they felt that MERIT provided a valuable opportunity to learn more about how to effectively teach in the ED. The implementation of MERIT also provided needed departmental support and recognition of the critical role residents play in the education of colleagues, fellow residents and medical students. Whereas very few residents are naturally gifted teachers, it is widely understood that teaching can be learned and refined over time as long as it is responsive to residents’ level of training and integrated into their daily work. Being an effective educator is foundational to being a competent physician, and programs to improve resident teaching skills should be mandatory for all postgraduate trainees.
In addition, the OSTE pre/post analysis in 2011 revealed a significant improvement of residents’ teaching over the course of the four-week rotation.

Limitations

There has not been any further analysis of the pre/post OSTE data since 2011, and the actual impact on teaching skills after graduation has not been assessed.

How does your institution ensure its residents become good teachers? What formal or informal training methods have you used? Share success or failure stories!

More About the CAEP FEI

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers. 

Brian Chung

Brian Chung

Brian Chung is a Clinical Associate Professor at Vancouver General Hospital. Since 1998, he has been the Program Director of the FRCP Emergency Medicine Program at UBC.
Daniel Ting
Daniel Ting is an Emergency Medicine resident at University of British Columbia. He is the 2017-18 CanadiEM Digital Scholars Fellow and the inaugural Editorial Intern at the Canadian Journal of Emergency Medicine. Daniel leads the “Great Evidence in Medical Education Summary” and "Feature Educational Innovation" series on CanadiEM.
Daniel Ting
- 20 hours ago
  • Karima Khamisa

    Hi – we thought we’d start early at U Ottawa with our fourth year students – see published article;
    “The development of a novel medical education elective for fourth-year medical students”
    Khamisa K, Bandeali S, Fellus I.
    Int J Med Educ. 2016 Oct 22;7:342-344. doi: 10.5116/ijme.57f8.be5e

    • This is a fantastic initiative! I think it’s great that residents are involved in supervising medical students in this way as I would expect they receive great reciprocal learning by being involved.