Terrific T6 talks – Teaching in a Busy ER

In Education & Quality Improvement by Nadim LalaniLeave a Comment

The Learning Context:


  1. Physical climate
  2. Emotional climate
  3. Intellectual climate

Has definite effects on:

  1. Academic achievement
  2. Satisfaction
  3. Aspirations

It’s therefore important to foster a positive learning environment:

  • Absence of hunger and sleep deprivation.
  • Learning is perceived to be a priority.
  • Safe environment.
  • FUN environment.
  • Individual needs and goals met.
  • Learners are part of the team.

Two recent publications by the Bandiera et al highlighted the following:

The above publications showed that highly effective teachers all do similar things. More importantly learners are attuned to the busy nature of the ER and the demands on faculty. So you don’t have to sit down and create a Prezi on chest pain, but as long as you a) SET EXPECTATIONS [that include a “learning statement” b) TRY to teach c) Succeed in dropping one or two pearls – most learners walk away with a sense of achievement.

Tips to Maximise learning in the ER:

Pre-Shift Priming:

  • Email the learner beforehand to identify learning needs
  • Print out cutting edge article/ blog that you’re reading
  • Bring Journal Club Materials for the current/recent JC
  • Bring your arsenal
    • Memory Stick
    • EKG’s
    • CXR’s
    • Image files

I have all my notes on Evernote: I can access these on the fly and print them off for the learner

Shift Expectations:

  • Brief orientation [bath rooms]
  • Diagnose the learner [see previous post]
  • Agree on expectations
  • Provide your learning statement [this is your chance to show that learning is important – My spiel goes something like:

” We’re going to work as a team (with you as the apprentice). Feel free to signup for interesting stuff, but I may nudge you onto certain cases. We will try to teach around cases, but if it gets busy I may only be able to share one or two pearls. If it gets reaally busy – we may have to take a tag-team approach where we see patients together”

Use SNAPPS (see earlier post):

The Learner as Apprentice:

We often forget that learners are apprenticing. The plumber doesn’t sic his junior apprentice on tasks that are beyond their means – so why should we? Next time try to:

  • Diagnose the learner.
  • Agree on goals [ONE teaching point/shift]
  • Have a “team approach” to the patients
  • Select patients for the apprentice
  • Seek out teachable moments
  • Divvy up the scut [have learner learn how to write consults, and notes to the GP]

If it get’s crazy busy and the learner is functioning at a very basic level:

  1. May be better to set homework around a case.
  2. See patient and read around the case
  3. Have the learner shadow you

Ever heard of a Parking Lot?

I always grab a piece of paper and “write out” or “park” things that I am teaching. If you also set aside time each hour [e.g. work for 50 mins, teach for 10 … repeat] you can check off the concepts on your parking lot. Lastly – some of these can also be set as “homework”.

Identifying the teachable moment:

Not all your teaching needs to center around the “medical expert” role. Seek out opportunities to round out the learners’ education on all the CanMEDs Roles.

  • Signover is a teaching opportunity. [Senior can take signover]
  • Have the learner do your phone consults while you listen on speakerphone. [You can teach SBAR]
  • Have them “collaborate” with Social Work/Pharmacy/RT’s
  • Give them feedback on their Charting

The Royal College of Physicians and Surgeons of Canada created a handbook of teachable moments centred around the CanMEDs roles. For now I think you can download it here.

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.