What do learners want from their teachers?
If they really want to learn or just get the posting over and get their degree and start earning
Gone are the days of ‘‘see one, do one, teach
one’’ in the emergency department (ED). As in other medical specialties,
the value of refining, standardizing, and devoting study to
specific educational practices has become increasingly important.
Benefits enjoyed and challenges faced when educating in the ED
are often two sides of a coin. This setting has a large daily volume
of patients (providing a breadth of conditions) but a higher degree
of regular interruption than in a clinic or a hospital ward. Learners
come from a wide variety of specialties rather than a monospecialty
team, bringing not only diverse experience but also a variety of styles
and needs. Learning opportunities are available around the clock,
rather than just during normal business hours, but shift times may be
asynchronous among levels of training, leading to ‘‘no good time’’ for
dedicated learning. In many settings in the world where EM is new or
developing, the number of trained EM physicians may be limited, as
is the opportunity to devote time to teaching. Learners and educators
must be aware of these constraints while maximizing opportunities
and advantages in the ED setting.
To fully understand what makes an EM teacher
great, one must explore what learners want from their teachers and
what established EM teachers consider good practice.
meta-analyses of the characteristics of effective clinical teachers and their teaching methods
revealed that educators take on several important roles:
Effective supervisors, dynamic teachers, role models, supportive helpers, and successful planners and resource users . These roles shift in preference depending on the learner’s level: medical students generally prefer traditional instructors (teachers who control the environment),
whereas residents more frequently describe good teachers as those who are supervisors and supportive of their autonomy.
From each specific educational experience, learners value those
who teach with enthusiasm, state answers and objectives clearly,
offer opportunities for problem solving, and provide true mentoring
The teacher’s level of training (resident, junior staff, or
senior staff) was found to be unimportant if teaching was tailored to
the learner’s needs.
Great teachers
possess both cognitive (academic or methodologic) and noncognitive
(personal or relational) attributes that contribute to success
all the following contributed to their educational success: learnercentered
activity, tailoring teaching to the situation and environment,
acting as a role model with a good attitude, and efficient use of all
available resources
What do learners and educators think makes a great teacher?
Learners Educators
Learner centered Learner centered
Role model Role model
Ability to ‘‘seize the moment’’ Ability to ‘‘seize the moment’’
Enthusiasm/positive attitude Enthusiasm/positive attitude
Efficient and organized Direct involvement in patient care
Overcomes educational barriers Adaptability
Strong knowledge base
An interactive style of teaching, with a steady flow of questions
and answers between teacher and learner, is more engaging and
often more appropriate for the ED. To stimulate learning, superior
educators are skilled at maximizing the yield from a series of focused
questions. These teachers ask clear, targeted questions appropriate to
the learners’ levels; allow for multiple correct responses; use queries
that require more sophisticated thought than a simple yes/no; and,
perhaps most importantly, allow sufficient wait times (3 s or more)
for a response
A model of best bedside teaching practices has been proposed and provides strategies for
three distinct domains: patient comfort and involvement, focused
teaching, and group dynamics [17]. First, permission is asked of the
patient and after it is granted, all learners are introduced. The primary
caregiver provides a brief overview, and the case is discussed with
clearly defined teaching points. Throughout the experience, patient
understanding is ensured and a team member follows up individually
with the patient to clarify misunderstandings. After the bedside
encounter, focused teaching applies the microskills model (described
later), role modeling, and practice. Both the goals and time spent are
limited, and all members are included in teaching and feedback.
The microskills model of clinical teaching.
Get a commitment
Probe for supporting evidence
Teach general rules
Reinforce what is right
Correct mistakes
‘‘WALKing the TALK’’ for effective clinical teaching.
WALK alternating with TALK
Wear gloves Promote hands-on care
Think out loud Teach the process, not just the outcome
Adapt (enthusiastically)
See clinical uncertainty as opportunity Activate the learner
Promote learner’s initiative and autonomy
Link learning to caring
Show and expect empathy and responsibility
Listen smart Assess the patient, then the learner’s interpretation
Kindle kindness Establish a standard of generosity
Keep it simple Teach efficient communication and decision making
Adapted from [20] The Lancet, Reilly BM. Inconvenient truths about effective clinical teaching.
2007; 370: 705–711
some have proposed a ‘‘one-minute
teaching’’ strategy, in which learners and teacher perform history
taking and physical examination together and then learners commit
to a diagnosis while the teacher assesses their reasoning and
focuses on a single teaching point, corrects mistakes, and reinforces
correct thinking [4]. Even a busy ED shift is permeated with multiple
‘‘one-minute’’ opportunities for the successful teacher to identify.
Summary points
1 The ED is a learning and teaching environment like no other, and
educators must be aware of the unique advantages of and
constraints to imparting information.
2 EM learners value teachers who ‘‘seize the moment,’’ are
enthusiastic role models, and can adapt to various learner
backgrounds and styles.
from
Improving as an Educator in Emergency Medicine
If they really want to learn or just get the posting over and get their degree and start earning
Gone are the days of ‘‘see one, do one, teach
one’’ in the emergency department (ED). As in other medical specialties,
the value of refining, standardizing, and devoting study to
specific educational practices has become increasingly important.
Benefits enjoyed and challenges faced when educating in the ED
are often two sides of a coin. This setting has a large daily volume
of patients (providing a breadth of conditions) but a higher degree
of regular interruption than in a clinic or a hospital ward. Learners
come from a wide variety of specialties rather than a monospecialty
team, bringing not only diverse experience but also a variety of styles
and needs. Learning opportunities are available around the clock,
rather than just during normal business hours, but shift times may be
asynchronous among levels of training, leading to ‘‘no good time’’ for
dedicated learning. In many settings in the world where EM is new or
developing, the number of trained EM physicians may be limited, as
is the opportunity to devote time to teaching. Learners and educators
must be aware of these constraints while maximizing opportunities
and advantages in the ED setting.
To fully understand what makes an EM teacher
great, one must explore what learners want from their teachers and
what established EM teachers consider good practice.
meta-analyses of the characteristics of effective clinical teachers and their teaching methods
revealed that educators take on several important roles:
Effective supervisors, dynamic teachers, role models, supportive helpers, and successful planners and resource users . These roles shift in preference depending on the learner’s level: medical students generally prefer traditional instructors (teachers who control the environment),
whereas residents more frequently describe good teachers as those who are supervisors and supportive of their autonomy.
From each specific educational experience, learners value those
who teach with enthusiasm, state answers and objectives clearly,
offer opportunities for problem solving, and provide true mentoring
The teacher’s level of training (resident, junior staff, or
senior staff) was found to be unimportant if teaching was tailored to
the learner’s needs.
Great teachers
possess both cognitive (academic or methodologic) and noncognitive
(personal or relational) attributes that contribute to success
all the following contributed to their educational success: learnercentered
activity, tailoring teaching to the situation and environment,
acting as a role model with a good attitude, and efficient use of all
available resources
What do learners and educators think makes a great teacher?
Learners Educators
Learner centered Learner centered
Role model Role model
Ability to ‘‘seize the moment’’ Ability to ‘‘seize the moment’’
Enthusiasm/positive attitude Enthusiasm/positive attitude
Efficient and organized Direct involvement in patient care
Overcomes educational barriers Adaptability
Strong knowledge base
An interactive style of teaching, with a steady flow of questions
and answers between teacher and learner, is more engaging and
often more appropriate for the ED. To stimulate learning, superior
educators are skilled at maximizing the yield from a series of focused
questions. These teachers ask clear, targeted questions appropriate to
the learners’ levels; allow for multiple correct responses; use queries
that require more sophisticated thought than a simple yes/no; and,
perhaps most importantly, allow sufficient wait times (3 s or more)
for a response
A model of best bedside teaching practices has been proposed and provides strategies for
three distinct domains: patient comfort and involvement, focused
teaching, and group dynamics [17]. First, permission is asked of the
patient and after it is granted, all learners are introduced. The primary
caregiver provides a brief overview, and the case is discussed with
clearly defined teaching points. Throughout the experience, patient
understanding is ensured and a team member follows up individually
with the patient to clarify misunderstandings. After the bedside
encounter, focused teaching applies the microskills model (described
later), role modeling, and practice. Both the goals and time spent are
limited, and all members are included in teaching and feedback.
The microskills model of clinical teaching.
Get a commitment
Probe for supporting evidence
Teach general rules
Reinforce what is right
Correct mistakes
‘‘WALKing the TALK’’ for effective clinical teaching.
WALK alternating with TALK
Wear gloves Promote hands-on care
Think out loud Teach the process, not just the outcome
Adapt (enthusiastically)
See clinical uncertainty as opportunity Activate the learner
Promote learner’s initiative and autonomy
Link learning to caring
Show and expect empathy and responsibility
Listen smart Assess the patient, then the learner’s interpretation
Kindle kindness Establish a standard of generosity
Keep it simple Teach efficient communication and decision making
Adapted from [20] The Lancet, Reilly BM. Inconvenient truths about effective clinical teaching.
2007; 370: 705–711
some have proposed a ‘‘one-minute
teaching’’ strategy, in which learners and teacher perform history
taking and physical examination together and then learners commit
to a diagnosis while the teacher assesses their reasoning and
focuses on a single teaching point, corrects mistakes, and reinforces
correct thinking [4]. Even a busy ED shift is permeated with multiple
‘‘one-minute’’ opportunities for the successful teacher to identify.
Summary points
1 The ED is a learning and teaching environment like no other, and
educators must be aware of the unique advantages of and
constraints to imparting information.
2 EM learners value teachers who ‘‘seize the moment,’’ are
enthusiastic role models, and can adapt to various learner
backgrounds and styles.
from
Practical teaching in emergency medicine
2nd ed. / Chichester, West Sussex : John Wiley & Sons
2013
Improving as an Educator in Emergency Medicine
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