Creating effective learning in today’s emergency departments

Journal Club Article: Bandiera, G., Lee, S., & Tiberius, R. (2005). Creating effective learning in today’s emergency departments: how accomplished teachers get it doneAnnals of Emergency Medicine45(3), 253-261.

Background: The Emergency department (ED) should be an ideal place for learning but due to the unpredictive nature of the workload, significant impediments occur which can effect teaching opportunities. The wide variety patient presentations balanced with an array of learners in crowded and compromised ED departments.

Aim: To investigate the ambulatory teaching techniques that ED clinical teachers demonstrate in terms of prerequisites, behaviour and impediments for good teaching to occur.

Methods: A qualitative grounded-theory analysis using a structured telephone survey. Participants were current Canadian emergency medicine teaching faculty (N= 33, participated out of potential 43].

Results: 12 strategies used during clinical teaching, 8 prerequisites to being an effective ED teacher and 6 impediments to teaching were identified.

Strategies for Good ED Teaching Practices:

  1. Tailor teaching to the learner
  2. Optomize teacher-learner interaction
  3. Tailor teaching to the situation
  4. Actively involve the learner
  5. Actively seek opportunities to teach
  6. Agree on expectations
  7. Demonstrate a good teacher attitude
  8. Make use of additional teaching resources
  9. Use teaching methods beyond patient care
  10. Be a role model
  11. Provide and encourage feedback
  12. Improve the environment (private space for learning; access to resources; learner-friendly schedule).

Prerequisites for Good ED Teaching Practices:

  1. Competing demands
  2. Time
  3. Lack of resources
  4. Lack of interest
  5. Educational structure
  6. Poor preparation

Impediments to Good ED Teaching Practices:

  1. Attitude
  2. Environment
  3. Enthusiasm and motivation
  4. Receptive student
  5. Role model
  6. Skills
  7. Confidence
  8. Knowledge base

Key Messages: Accomplished ED teachers identify strategies and prerequisites for improving teaching, however impediments to good teaching occur. Adult learning strategies of learner-centredness, contextual relevance and active learning are key in ambulatory teaching.

Additional Resource: One Minute Preceptor by Nursing Education Network