“The worst thing about busy shifts is that I never learn anything.”
My junior resident and I were contemplating the many difficulties of residency, especially when working at a busy urban ED where patients are plenty, but teaching during shifts may be harder to come by. We discussed the importance of coming up with at least one learning point or clinical question during each shift, and making a point of following through and reading up on it after. (That shift we both learned about fat emboli s/p extremity fracture.)
But even with self-initiated learning adventures, I think that it is important that faculty and senior residents take the lead and actively work to ensure that learning occurs for every resident and every medical student during every shift, throughout all years of residency. Some educators actually say that something can be taught on just about every case seen with a resident if approached correctly.
2013 New Year’s Resolution:
Create 1 teachable moment, for every resident and every medical student, during every shift!
Create 1 teachable moment, for every resident and every medical student, during every shift!
Wait!
Don’t get overwhelmed with that resolution.
It is completely do-able!
Don’t get overwhelmed with that resolution.
It is completely do-able!
What is a teachable moment, and how to teach for that moment? First off, a teachable moment is exactly that, A TEACHABLE MOMENT! Not hour, not lecture, not thesis statement. But, by allowing the thought of the teaching to overwhelm the teacher, we create mountains and mental barriers. How often have we felt that it was too exhausting to explain to the junior the intricacy of the discriminate zone of beta-hcgs regarding work up of ectopic pregnancies, especially with a wait time over 6 hours?
I remember one attending that I worked with who would actually write down a checklist of three items for every patient that I would present to him. This checklist was not a To-Do list, but instead was solely dedicated to three learning points that he wanted me to have for each patient that I presented to him. We all know about the checklist manifesto for getting tasked completed… why not a checklist manifesto for teaching points?
I asked a few experts via Twitter for their thoughts on teachable moments.
Lets resolve for 2013 to incorporate more time for bedside teaching, any tips on how to accomplish this?
— Nikita Joshi (@njoshi8) December 30, 2012
Dr. Mallemat (@CriticalCareNow) and Dr. Gharahbaghian (@Sonospot) mentioned that bedside ultrasound is a great opportunity to not only teach about pathology, but also anatomy! Which means it is perfect for teaching the medical student at the beginner level, and all the way up to senior resident at expert level.
@TheSGEM felt that ALL moments were teachable moments.
@BobStuntz stated that the key is to limit the teaching moment to 1 pearl or point only. Think back to when you learned about that topic. Was there a learning point or pearl that stuck out for you? If so, focus on that point during your short discussion.
@TheSGEM felt that ALL moments were teachable moments.
@BobStuntz stated that the key is to limit the teaching moment to 1 pearl or point only. Think back to when you learned about that topic. Was there a learning point or pearl that stuck out for you? If so, focus on that point during your short discussion.
There is a caveat to all of this… don’t forget that we all are in a constant state of learning, even if we don’t appear to be so. A senior resident once told me it was particularly difficult to learn anything during shifts because attendings were so willing to defer to her judgment. This is a great amount of responsibility, but always remember that as doctors, there is always room for more.
Lets resolve to bring more learning and teaching on!
Happy New Year!
Great new year's resolution. For me:
ReplyDelete1. I make sure that everyone leaves the shift with at least ONE teaching point. "What did we learn today?" is often how I end a shift.
2. Practice the art of think-aloud. At the bedside of the patient, talk out your thought process. I've always found it useful to hear my attending's clinical reasoning when I was a resident.
Great post!
I'll try to keep some of these points in mind if I get to the residency stage. Perhaps if you're finding it difficult to learn anything, despite the given points, keep in mind that the hectic experience is a learning experience in its own way. There's probably many times in the hospital when it seems almost impossible to keep up with everything! Maybe by paying attention to how the doctors handle their intense situation, you could learn something about managing stressful situations in the hospital, even if the material isn't completely understandable.
ReplyDeleteHi Nathaniel, thanks for the comment! You are right, there is always a learning opportunity even in stressful situations, and we can definitely learn by repetition which eventually makes material learnable. Good luck with medical school! Nikita
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