How to Teach in the Midst of the Crazy

Image Credit: Common Sense

Author: Molly Estes, MD FAAEM
YPS Board of Directors
Originally published: Common Sense January/February 2019

We’ve all seen our waiting rooms on an “average day.” And we’ve all read the studies about annual census numbers. And we all dread every approaching flu season with increasing levels of anxiety as we try to imagine seeing even more patients with no beds or room to speak of. And in the middle of the administration meetings about flow, setting up tents and triage units in parking lots and hallways, and trying to prevent patients from dying in the waiting room, those of us who work at academic institutions are also expected to impart our hard-fought knowledge onto the next generation. Now how in the world is that possible?

For those who work in academics, we tend to have some kind of special soft spot for the learner, whether that be a medical student, PA or nursing student, EM or off-service resident. Part of us likes the challenge of trying to get our learner to understand a concept and takes joy when the lightbulb moment of realization occurs. And yet, we are under ever increasing pressure to move our departments, to see higher and higher patient volumes and meet door-to-disposition times. One would think that these two desires, to do well at our jobs and to fill the role of teacher, to be in opposition to each other. After all, explaining something to another person takes longer than just doing it yourself. There is some truth to this, it does take extra time to engage in the teaching process. But I would like to make the argument that it doesn’t have to completely disrupt your day. Here are some tips and tricks to continue your instructor legacy while making hospital admins happy.

Think bigger, teach smaller.
When presented with a broad topic, most of our inclinations is to settle in to a thorough explanation. “What is on your differential for chest pain? Well, let me tell you about the six can’t-miss differential diagnoses for chest pain, compare and contrast PERC and Wells, explain how the HEART score relates to cardiac events, and discuss patient disposition depending on access to stress testing.” In the busy department, this is waaayyy too much information and takes too much time. Instead, try breaking your go-to lectures into mini, bite-sized pieces. Piece #1: what are the absolutely top, 100% can’t miss diagnoses for chest pain? Piece #2: what is the HEART score? Piece #3: how is the HEART score calculated? By doing this, you can stretch one single massive discussion into tiny pieces that take no longer than 60 seconds each to discuss.

Teach one person and then have them teach the next. 
See one, do one, teach one, is still a mantra of emergency medicine. Why shouldn’t we also apply it to teaching? Especially in a department with a mix of residents and students, this can be a valuable technique for getting more distance out of a single teaching moment. Take one to two minutes to explain to one learner your teaching point. Then, when another learner needs the same information, call out your first learner to teach it to them. It will reinforce your teaching as well as save you a few minutes until you can cross-check their explanation. Rally the troops. If a great case rolls through the door, capitalize on a few minutes to do a general teaching session. Quickly call for all your learners in the vicinity, spend two to three minutes talking about what makes this presentation, lab result, image, etc. so special, then send everyone on their way. You will save time in trying to share the awesomeness on an individual level.

Have a handout or picture.
The saying, “a picture is worth a thousand words,” absolutely applies to many standard teaching topics. Find a blog or podcast about one of your favorite teaching topics. For example, Life In The Fast Lane’s blog post on how to read a chest X-ray. Then, when presented with the chance to discuss the topic, refer your learner to the post, handout, picture, etc. You can briefly discuss the topic afterwards, but it won’t take as much time as teaching de novo.

Have the learner look it up.
The tried and true method of high school teachers everywhere. There is nothing wrong with encouraging your learner to find the answer to their question themselves. Check their results but have them teach themselves.

Assign “homework.”

Inevitably one of your learners will find a broad topic or complex management question that is simply impossible to address in the middle of a busy shift. In that case, it is completely fine to admit you don’t have time to discuss the answer. Give them the short pearl of knowledge, then ask them to look up or read more about it after the shift. You can even refer them to a journal article, blog post, or book chapter that you yourself have used to learn the topic. Then you can continue the discussion either on your next shift, next conference day, or via email. This way you encourage their learning while giving the time needed for the complexity of the topic.

Hopefully these ideas will help you fulfill your teaching role at the same time as helping you keep your sanity in the midst of the ever-crazier months to come.