Creating Effective Learning in Today's Emergency Departments: How Accomplished Teachers Get It Done

Study objectives

Significant impediments to effective emergency department (ED) teaching compromise what could otherwise be an excellent learning milieu. There is little literature to guide faculty development around specific emergency medicine teaching techniques. We determine what recognized experts in emergency medicine teaching consider to be the important clinical teaching behaviors that make them good teachers, the main impediments to good teaching in EDs, and important prerequisites for a good ED teacher.

Methods

This was a structured telephone survey with qualitative grounded-theory analysis. Participants were current Canadian emergency medicine teaching faculty who have won awards, been promoted, or received persistent excellent evaluations according to their ED teaching. Participants underwent a 45- to 60-minute standardized structured telephone interview. Interviews were transcribed and independently coded by 2 investigators using a grounded-theory approach. The codes were merged by consensus, and the data were recoded. Twenty percent of data were then coded by both investigators to estimate interrater reliability of final coding. Discrepancies were resolved by agreement.

Results

Of 43 potential participants, 33 were still in practice, available, and willing to participate. Twelve ED-specific, practical, implementable strategies representing the general themes of learner-centeredness, active learning, individual relevance, and efficiency emerged. Participants collectively identified 6 significant impediments to teaching and 9 prerequisites to being an effective ED teacher.

Conclusion

Accomplished emergency medicine teaching faculty identify with common impediments to ED teaching yet are able to describe practical, easily implemented strategies that they believe make them good teachers. They also take advantage of basic prerequisites for good teaching.

Introduction

The emergency department (ED) should be an excellent learning environment, but it often is not. Perceived advantages include the wide variety of patient demographics, illness, and triage severity; the opportunity to treat undifferentiated patients from initial interview to disposition decision; and constant supervision by staff physicians. Perceived challenges include the unpredictable variability in workload, adapting to the diverse backgrounds of trainees, inconsistent longitudinal exposure to a given trainee, teaching around the clock, the imperative to maintain tolerable patient waiting times, and teaching in crowded and physically compromised departments. Little is known about how some emergency physicians become accomplished teachers despite these limitations.

There is a paucity of research on ambulatory teaching techniques.1, 2, 3 Most studies have looked at teacher qualities rather than specific behaviors.¹ Furthermore, there is no published original ED research on clinical teaching. Research-based faculty development on ED teaching must use teaching models adapted from other practice environments.4, 5, 6, 7, 8, 9, 10 It is unclear how implementable these models are in the ED. Despite limitations to effective ED teaching and notwithstanding the lack of research in the area, faculty development for those interested in improving their ED teaching must be provided.

We ascertain what accomplished clinical teachers in emergency medicine identify as teaching behaviors that make them good teachers, what they consider to be important impediments to good teaching in the ED, and what characteristics they regard as prerequisites for good teaching.