About Andy Little, DO

Associate Program Director, AdventHealth EM Residency
Host/Co-Founder, EM Over Easy Podcast
ALiEM Blog Editor

How I Educate Series: Andy Little, DO


This week’s How I Educate post features Dr. Andy Little, the Associate Program Director at AdventHealth Florida in Orlando. Dr. Little spends approximately 90% of his shifts with learners, including emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a busy community EM residency program that sees over 100,000 patients per year. Below he shares with us his approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Malleable, understanding, fun.

What delivery methods do use when teaching on shift?

Post its and fill in the blanks.

What learning theory best describes your approach to teaching?


What is one thing (if nothing else) that you hope to instill in those you teach?

That there is always something you can learn from your patient.

How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?

There is a time to teach and a time to see patients. When we don’t have a specific topic to discuss, we see patients and focus on specific parts of the history and physical one cannot miss for that complaint. It comes at some sacrifice to charting, but that’s the gig.

What is your method for reviewing learners’ notes and how do you provide feedback on documentation?

I do a mix of on-shift and after-shift notes reviews. I focus on finding trends about how learners chart, and give feedback accordingly.

Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?

Yes. But being malleable allows me to again teach with what comes through the door and let each patient we see teach us something.

It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?

This may sound funny, but I count down from 20 in my head. So if I see things going wrong, I count down and then take over. I have found even the learner with the worst struggles can usually course correct in that time.

Do you start a teaching shift with certain objectives or develop them as a shift unfolds?

Develop them as a shift unfolds. Remember, malleable.

Do you typically see patients before or after they are presented to you?

It’s a mix. For my PGY 1’s I want them to see the patient first and ask them to present them as soon as they have so we can focus on their ability to rapidly access and formulate off of their H and P. For my seniors I try to see them first, so when they tell me their plan I can use that time to discuss what they did or didn’t pick up on and how I would change their plan. And everyone else falls somewhere in that spectrum.

How do you boost morale amongst learners on shift?

Focus on the little things they are doing well.

How do you provide learners feedback?

A mix of real-time verbal feedback (towards the end of the shift< post-shift evaluations) and then monthly reviews.

What tips would you give a resident or student to excel on their shift?

Be willing to be wrong. Learning doesn’t happen otherwise.

Are there any resources you use regularly with learners to educate during a shift?


What are your three favorite topics to teach during a shift?

EKGs, procedure tips, and reading plain films.

What techniques do you employ when teaching on shift?

Post it notes, custom made fill in the blanks, and coaching

What is your favorite book or article on teaching?

The Coaching Habit

Who are three other educators you’d like to answer these questions?

George Willis, Jenny Beck Esmay, and Jessie Werner.
How I Educate Series logo

Read other How I Educate posts for more tips on how to approach on-shift teaching.


By |2022-09-04T15:33:51-07:00Sep 14, 2022|How I Educate, Medical Education|

ALiEM Stands in Solidarity with Our Asian American and Pacific Islander (AAPI) Community

We at ALiEM wholeheartedly condemn the xenophobia, intolerance, and hate crimes directed towards Asians and the Asian American and Pacific Islander (AAPI) communities. Recent events spurred by the COVID-19 pandemic are hurtful, “othering,” and simply unacceptable.

Anti-Asian hate crimes across the country since the onset of the COVID-19 pandemic have increased 833% in 2020, compared to 2019, in cities across the United States [1]. This heart-breaking trend of violent assaults against individuals in the AAPI community is misguided and counter to the healing and building that our country direly needs as a result of the global pandemic.

Last week’s shootings in the Atlanta area that claimed the lives of eight people, including six Asian women, have had devastating effects on the AAPI community. For some, it has sparked recollections of previous incidences of bias they themselves have experienced. For others, it has been a call to action, on how to be better advocates and allies for all people of color.

We stand in solidarity with our AAPI communities and allies. These hate crimes continue to highlight the ongoing and longstanding structural anti-Asian and anti-immigrant racism in our country. Each of us has the capacity to show kindness, compassion, and respect for one another. Each of us has the capacity to stand up for those tormented and racialized. Let us work together to overcome the hate and bigotry that plague our nation.


What can you do to be an ally?



  1. VOA News: Hate Crimes Targeting Asian Americans Spiked by 150% in Major US Cities

AAPI solidarity statement

By |2021-03-28T10:19:46-07:00Mar 26, 2021|Life, Public Health|

IDEA Series: Homemade Escharotomy Kit

Normal knee radiology AP

Although escharotomy is rarely performed by emergency physicians during the initial management of burns, it is a life and limb-sparing skill important to know as a trainee and provider in emergency medicine [1,2]. There are few models made to accommodate procedural training, and the ones available are often cost-prohibitive. It is critical to have a method for learning and practicing this important procedure [3,4].


By |2020-07-03T15:50:13-07:00Jul 6, 2020|IDEA series, Trauma|

Introducing: GroundED in EM a 4 week asynchronous curriculum for 3rd year students

A group of educators from our ALiEM Faculty Incubator 2020 class has created a 4-week virtual introduction to Emergency Medicine curriculum for 3rd-year medical students called Grounded in EM!

Think back, back to March 2020: you were a medical student, happily rotating through core specialties, considering Emergency Medicine, and then WHAM! The coronavirus pandemic pulled the rug out of your regularly scheduled 3rd year. Or, you were a program looking forward to a “business as usual” approach to your 3rd-year EM clerkship. Now, you’ll have limited face to face time, and are wondering “How do we provide the same general em content?”

Are you still considering emergency medicine? Are you worried that your fragmented clinical experience is leaving you unprepared for your rotations in an Emergency Department near you? Are you a program looking for an answer to provide a great EM learning experience? This is the curriculum for you!

Target Audience: Third-year medical students who haven’t committed to Emergency Medicine, but are interested in being introduced to the field AND programs looking to have a comprehensive and ready-made EM related content for MS3’s rotating this academic year.

What: A 4-week completely asynchronous and virtual curriculum containing FOAM resources, including blog posts, podcasts, webpages, and interactive modules, based on the ACGME core competencies. Each module includes a short quiz to test immediate knowledge retention, and the end of the week choose your own adventure case.

Where: Hosted on ALiEM.com

When: Curriculum release on July 1st

Benefits: Walk into your EM rotations feeling confident that you will know how to approach the undifferentiated patient, make a differential, talk to people about it, and write it down, in a compassionate and patient-centered way! Programs can have their students do this curriculum in parallel with their clinical shifts during their 4-week rotation.

Over four weeks, we will cover:

  1. How to approach undifferentiated and acutely ill adult and pediatric patients (Patient Care and Clinical Reasoning)
  2. An introduction to the flow and system of the Emergency Department (System Based Practice)
  3. Communication strategies in Emergency Medicine, both with written and verbal and with EM physicians, consultants, and patients (Interpersonal and Communication Skills)
  4. Professionalism, medical ethics, and patient-centered issues that arise in the Emergency Department (Professionalism)
  5. Creating a differential diagnosis for both common and life-threatening patient presentations (Medical Knowledge)
  6. Exposure to key Emergency Medicine content areas such as resuscitation, evaluation, diagnostics interpretation, and management of common ED presentations (Medical Knowledge, Practice-Based Learning and Improvement)
  7. Development of procedural skills, including suturing, vascular access, as well as EM tricks of the trade. (Medical Knowledge, Practice-Based Learning and Improvement)

We can’t wait to have you join us on GroundED In EM!

By |2020-06-30T14:48:03-07:00Jul 4, 2020|Academic, Medical Student|

LVAD Part II: Diagnostic Evaluation

lvadLeft ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart failure. Although their use in the general public has increased, they still provide a challenge to the emergency medicine (EM) physician This series aims to cover the basics of how the EM physician approaches the care of these patients. Last week we covered the physical exam. This week: the diagnostic evaluation.


By |2020-03-22T13:31:23-07:00Mar 23, 2020|Cardiovascular, Emergency Medicine|

LVAD Part I: Introduction

Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart failure. Although their use in the general public has increased, they still provide a challenge to the emergency medicine (EM) physician. This series aims to cover the basics of how the EM physician approaches the care of these patients.


By |2020-03-16T08:39:41-07:00Mar 16, 2020|Cardiovascular, Emergency Medicine|

Book Club: Forget a Mentor, Find a Sponsor

Forget the Mentor, Find a Sponsor book - sponsorshipOne of the most common themes in advice for career advancement is “find a mentor.” But we are rarely told HOW to find a mentor, WHY we need mentors, or WHAT ROLE mentors are supposed to play in our careers. In addition to the lack of direction regarding mentorship, when you start to research “what is mentorship,” it becomes clear that there are several limitations to the benefits of this popularized mentor-mentee relationship. To see results, the key may be more than mentorship and the answer is likely sponsorship.


By |2020-01-25T19:22:37-08:00Feb 7, 2020|Book Club, Incubators|
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