Like many institutions, we have a mix of EM resident learners rotating through our departments. Expectations and competencies of junior learner differ greatly from that of a senior learner. For Example:
- PGY 1 – Focus on clinical skills e.g. Xray reading and procedures
- PGY2-4 – Focus on more challenging patient encounters e.g. medical and procedural management of the septic patient
- PGY 5 – Focus on managerial roles e.g. taking referrals from family doctors
At our recent Faculty Development Workshop my brilliant colleague – Dr Rob Woods gave an engaging presentation on teaching senior learners in the ED. He subsequently facilitated an impromptu crowd-sourcing of the participants. The result was the derivation of an easy-to-apply rubric for expectations for trainees at different levels in the ED. We hope you find it useful.
Expectations for Trainees at Different Levels working in the ED
| BASIC CLINICAL TRAINEE | JUNIOR RESDIENT | SENIOR RESIDENT | |
|---|---|---|---|
| EXPECTATIONS | Exposure to the breadth of EM patients & complaints, procedural experience | See as many critically ill patients as possible, with support & supervision, on-shift follow-up and disposition of own patients | Carry trauma pager, manage critically ill patients, handle surges in patient volume, review lab reports + call patients, take handover |
| PATIENT PRESENTATIONS | Complete history & physical exam, explanation of clenical reasoning, rationale for DDx and diagnostic and treatment plan | Abbreviated H&P, key pertinente negatives essential, management plan to disposition at first encounter | Abbreviated H&P with likely diagnosis and management plan |
| CLINICAL REASONING | DDx for COMMON chief complaints | DDx for MOST chief complaints | DDx for ALL chief complaints |
| REVIEWING PATIENTS | After every patient, unless very straightforward, confirm H&P at bedside for MOST patients | After a few patients, unless complex/uncertain, confirm H&P at bedside for SELECT cases | At the point of disposition, batched (3-5 at a time), unless complex/uncertain, confirm H&P for SELECT cases |
| GOAL NUMBER OF PATIENTS PER SHIFT | 8/shift (1 patient/hour) | 12/shift (1.5 patients/hour) | 16/shift (2 patients/hour) |
| LEVEL OF SUPERVISION FOR CRITICALLY ILL PATIENTS & PROCEDURES | Close supervision or assist/observe if little prior exposure | Variable depending on level of comfort/experience of resident | Minimal supervision unless resident uncomfortable |
| CONSULTATIONS | Listen in on consultation requests by attending, request consultation with supervisor present | Request consultations after reviewing case with supervisor, supervisor may or may not be present | Manage outside consultations to the ER, call consultatns without prior review with supervisor if comfortable |
| SUPERVISING ADDITIONAL TRAINEES (students, PGY1s) | Sporadic teaching of cases or procedures or interpretive skills, depending on comfort level of trainee | Tag team supervision between resident and attending OR resident supervises trainee with reduced patient load | Supervise trainee with a full patient load on some shifts, at the discretion of the resident OR tag team supervision |
| TIPS FOR SUPERVISORS | Explore clinical reasoning, give feedback on both effective and ineffective clinical reasoning strategies | Explore clinical reasoning in select cases, share experience around professional issues (sleep, exercise, nutrition, time management, finances) | Push limits of knowledge: change details of cases to ensure depth of knowledge on every topic, teach around transition to practice skills (billing, professional expectations, CME) |
Adapted from Rob Woods, University of Saskatchewan, 2013
This post was copyedited by Dat Nguyen-Dinh (@dat_nd) and reviewed by Rob Carey (@_RobCarey)
Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.
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