Recently participated in a Faculty Development workshop with some brilliant colleagues – Dr Rob Woods together with Sean Polreis and Deirdre Bonnycastle [see her work on my fav links page] .
Below I will share the pearls that I gleaned. Some of the concepts derived from the ED STAT course put on by the Canadian Association of Emergency Physicians.
“Smartest person in the room is THE ROOM”.
Train the trainer [or “T3” if you speak Instructional Design] sessions can sometimes suffer from poor instructional design themselves so – this was a good reminder to minimise the “didactic” and maximise the [what’s the opposite of didactic?] … umm … let’s just say keep it interactive!
Training programs are getting bigger and there is relative shortage of preceptors. This means that increasingly you’re seeing learners on shift [> 90% of the time for me]. Although the ED is a rich learning environment [diverse cases, procedures, use of other skills [EKG’s/CXR’s, closure on cases, one-on-one teaching with some really cool docs], there is a role to improve the quality of on-shift education. This may seem at odds with departmental need to address patient load and through-put. Enter your educational experts/your most effective teachers …
Biggest teacher mistakes:
- Failing to tailor teaching
- Too much/too little autonomy
- Missing the teachable moment
Orienting and Diagnosing the Learner
If you forget everything else – this is the most important part of setting up positive learning in the ED.
Orienting the Learner
- biologic needs [washroom, breaks etc]
- introductions and orientations to the environment
- expectations [learner-centred]
- their role
Diagnosing the learner
- background experience
- home program
- level of training
- learning goals
Diagnosing and treating learners with issues
Overconfident and unmotivated learner
- Stress the importance of repeated exposure normal. This way they can discern the subtle differences of “not sick”
- Focus on infrequently encountered features of cases
- Turn it on them [ “I notice that you have been selectively seeing only trauma cases” …]
- Bring it back to the patient [so if this was your mom …]
Mentally checked out unmotivated learner
- tell them that you notice
- try and understand why [may have exam stress]
- try and tailor learning/ make it relevant/select encounters for them
- explain benefits /explain that they are being evaluated
The rock star learner
- DON’T PUNISH THEM for being brilliant – they need teaching too
- Identify weaknesses
- give them more reign/ challenge them more
- bring the “B-side”! [you know that can of whoop-ass that you usually reserve for R5 residents? Use a toned-down version for this learner or change it up to other important non-medical expert stuff e.g. Croskerry’s ideas on decision-making (below)]