Terrific ‘train the trainer to teach trainees’ (T6) talks – Diagnosing the Learner

In Education & Quality Improvement by Nadim LalaniLeave a Comment

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:

  1. Failing to tailor teaching
  2. Too much/too little autonomy
  3. 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)]

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.