About Guy Carmelli, MD

Assistant Professor, University of Massachusetts Medical School
Department of Emergency Medicine
UMass Memorial Medical Center

How I Educate Series: Guy Carmelli, MD

This week’s How I Educate post features Dr. Guy Carmelli, who is an Assistant Professor at UMass Medical School and co-leader of their EM Sub-I rotation. Dr. Carmelli spends approximately 80% of his shifts with learners which include emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a tertiary care academic center with trauma, stroke, and cardiac cath capabilities. Below he shares with us his approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Enthusiasm, excitement, and engagement

What delivery methods do use when teaching on shift?

I love a blank sheet of paper. I can list out a differential or better yet, I can draw out a mindmap of a certain topic. I can do this anywhere, at the bedside, in the hallway, or at the computer. I also can give the learner the paper so they can frame it and keep it forever (or at least that is what I imagine happens to this literary gold?)

What learning theory best describes your approach to teaching?

My approach to teaching fits in with a sociocultural theory of learning. I like to not only talk about medicine but to show how medicine fits into actual concrete practices. I give real-world examples of situations I have been in, along with showing learners how these situations and approaches might change when I worked in alternative institutions. A topic I love to teach specifically is workflow efficiency. I feel I can teach this topic as it fits into the actual culture of different practice patterns of different institutions well with sociocultural theory. I also love to invite learners into various communities of practice so that they can further learn topics along with other like-minded individuals who share their passions!

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

That you should never stop striving to continue to learn. Medicine is not just a job, but a way of life. It’s called the art of medicine. You are always learning, growing, developing, and creating art in what you do. Your practice today will not (and should not) be your practice pattern in 10 years. Therefore, I hope that through my excitement to learn, grow and teach, others will share that excitement in themselves!

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

Definitely, my documentation suffers. But I find spending more time thinking about and caring for a patient is more important to me than documentation. Teaching is part of that time spent thinking about and caring for patients, which is why I prioritize it. I am also not afraid to open up my remote access while at home to catch up on notes.

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

I especially love teaching workflow efficiency, which is the art of departmental flow and metrics. So I use real-world in-the-moment examples to help motivate learners to improve, which directly helps protect against my metrics getting adversely affected. I also find that spending extra time explaining why you do or don’t think something is necessary can save time in the future, which aids in overall efficiency.

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

I like to ask my learners what they hope to accomplish during a shift and what I can specifically help them on. How hands-on do they need me to be? This helps provide the objectives they wish to achieve during their shift.

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

I prefer to see them before. If I can catch EMS as they bring in the patient that is my preferred. Unfortunately, this isn’t always possible.

How do you boost morale amongst learners on shift?

I find that when a learner understands that you are there for them and their learning and betterment, it helps with the overall mood. They are not just worker bees, trying to churn through an endless line of patients. They are there to grow and find meaning in their shift. Therefore by focusing on what they need and showing that you care for them to improve and grow, they often have more gratification from their shifts as a result

How do you provide learners feedback?

My feedback is typically throughout the shift. I try to provide a summary of feedback at the end if time permits.

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

Efficiency, EKG/cardiology, and procedure tips

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

By Guy Carmelli, MD|2022-07-29T07:21:45-07:00Aug 24, 2022|How I Educate, Medical Education|

Improving Your ED Efficiency ALiEMU emergency department

No specialty in medicine requires “efficiency” more than Emergency Medicine (EM). Being able to seamlessly and quickly move between tasks is a necessary skill to function in the Emergency Department (ED). The controlled chaos and many moving parts can be overwhelming to new learners in the department and takes dedicated time and experience to overcome. Along with learning the necessary medical knowledge, efficiency expertise is crucial to becoming a high-performing emergency physician. Unfortunately, there is minimal formal training on how to maximize efficiency skills, leading many new EM learners (e.g. medical students and junior residents) having to troubleshoot and create these skills for themselves.

ED Efficiency Themes

Research and anecdotal tips on being an efficient healthcare provider are sprinkled throughout the literature, but there are no established efficiency guidelines or consensus recommendations. Parsing through all available smattering of information in the literature, we identified 3 distinct “themes”:

Efficiency in workflow practices: This means learning skills that maximize a practitioner’s ability to see more patients throughout the shift. These skills work to help providers navigate patients quickly through the department, maintaining constant flow and maximizing resource utilization. By improving one’s workflow practices, tasks can be completed quickly and more patient’s can be seen overall.

Anticipating roadblocks: Situational awareness of potential hurdles allows providers to more easily find workarounds to keep patients on a forward path. Understanding the intricacies of the health system and the functionality of a hospital allows for better anticipation and planning for future impedances to patient care and progress toward disposition.

Effective team communication: Communication is an integral part of being an EM physician. By improving communication and learning to effectively work in a team, a provider can improve their overall efficiency in the department and can decrease provider mental burden.

The ALiEMU 3-Course Series

As educators, we believe all skills can be taught. This includes efficiency skills. After distilling the available efficiency literature, we designed 3 courses, based on the above themes to best teach efficiency to new EM learners.

ED Efficiency ALiEMU badges emergency department

Our FREE curriculum uses the ALiEMU platform to simulate real-world scenarios, integrating the lessons in an interactive and fun way. Learners will discover strategies to optimize their time in the ED and begin their journey toward optimal efficiency.

Examine how your ideas of efficiency fit with the strategies. These concepts may be new, or may already be a part of your EM practice. While operations vary for hospitals and EDs, the content taken as a whole represents the best practices found in the literature. These 3 themes should begin and guide your journey toward efficiency mastery.

ALiEMU: Improving Your ED Efficiency Courses

What are some of YOUR best tips for efficiency on shift? Contact us on Twitter (Dr. Guy Carmelli @GuyCarmelli) with any suggestions or feedback.

By Guy Carmelli, MD|2021-12-16T14:34:48-08:00Dec 17, 2021|Academic, Life, Medical Education, Medical Student|

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:

How to approach undifferentiated and acutely ill adult and pediatric patients (Patient Care and Clinical Reasoning)
An introduction to the flow and system of the Emergency Department (System Based Practice)
Communication strategies in Emergency Medicine, both with written and verbal and with EM physicians, consultants, and patients (Interpersonal and Communication Skills)
Professionalism, medical ethics, and patient-centered issues that arise in the Emergency Department (Professionalism)
Creating a differential diagnosis for both common and life-threatening patient presentations (Medical Knowledge)
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)
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 Guy Carmelli, MD|2020-06-30T14:48:03-07:00Jul 4, 2020|Academic, Medical Student|

Now more than ever, medical educators are excited about the flipped classroom, defined by Bishop and Verleger as “a new pedagogical method, which employs asynchronous video lectures and practice problems as homework, and active, group-based problem-solving activities in the classroom” [1]. The premise is that students will learn basic concepts during self-study, at their own pace, and come to the classroom ready to dive into small groups and problem-based application [2].

This approach may be unfamiliar and you may find yourself asking:

Why should I care?
and
How do I get the most out of it?

Let’s begin with the first question. Several studies looking at the flipped classroom conclude it is good for your learning. Though it may initially be perceived as extra work, once the student realizes that the work just replaces the after-class homework they used to do, students’ report a generally high satisfaction, and high engagement with the in-class activity [3-6]. The flipped classroom can make you a more effective “lifelong learner.” While assessing learning efficacy is challenging, some studies have shown improvements in analytical and problem-solving skills in students who come prepared and fully engage in the in-class activities [3,7].

As for the second question, to ensure that you get the best flipped classroom experience, we compiled a list of must-do steps to engage with this educational strategy successfully.

Tips and Tricks:

Prepare (yes, really)

The proverbial wisdom that “by failing to prepare, you are preparing to fail” holds true with this pedagogy. Don’t walk through the door if you haven’t done the prep work. Assigned videos and podcasts are not just “suggestions,” but rather the building blocks for your in-class time. The point of the flipped classroom is for you to do the “easy stuff” at home and the harder, application-type activities, with your educator present. It’s essential that you complete them prior to class. Think of it as doing the classwork at home, and the homework in class! By reviewing material ahead of time you will be ready to ask clarifying questions and grasp higher-level concepts, in order to make the best use of your teacher’s direct attention.

Don’t skip ahead (or you’ll end up behind)

With access to the learning material online, you may be tempted to “skip ahead” to answers. However, the course will often build on itself and part of the learning process will be to work through application problems with only the information you have at the moment. Future sessions may allow a second-look with a new lens, so staying true to the current schedule is best. Similarly, allowing yourself to fall behind and expecting to catch up later will put you at a disadvantage during the in-person sessions.

Commitment (like any good relationship)

In order to bring a complex topic to a class, there are often multiple moving parts for a flipped classroom activity. If you’re set up in a team, designate 1-2 classmates to hold the rest of your team accountable for the work that you need to get done and the deadlines that you need to complete. Rotating responsibilities part of the way through the course will allow every member to experience different roles. If you’re not working in a team, find an accountability buddy and commit to keeping each other on task and on schedule, so that you can come to your in-class sessions as prepared as you can be.

Feedback (talk to me!)

Let’s face it, you’ve spent a lot of time searching for useful learning resources and have probably found some gems. Instructors may not have known about a great new video or podcast when the material was compiled. Let them know what you’ve found and why you think that it’s a helpful resource for your classmates. Sometimes what you’ve found will help make the next class better, or can be added as supplemental material. Remember that you appreciate high-quality feedback and your instructors aren’t much different.

How do you get to Carnegie Hall? (Answer: practice, practice, practice)

It may be the case that concepts being discussed during a flipped classroom setting seem far removed from clinical practice, especially in the pre-clinical years when you are fully immersed in the basic sciences. The key is practice. In the flipped classroom, the skills acquired through dedicated medical topics, learning how to navigate the vast amount of resources available, working as a team, and dissecting problem-solving challenges will help you in the clinical setting. Be intentional about the skillset you’ve acquired and apply it to past/present/future patients.

For example, if you learned about risk stratification tools for chest pain during a class, the next time you encounter a virtual case, a standardized patient, or a real patient with chest pain you’ll know if you can apply the TIMI/HEART/Well’s/PERC scores and how to access them online. After calculating the score, you will be able to convey to your attending, admitting team, and consultants your clinical decision-making and application of evidence-based medicine. Bringing your knowledge to the bedside helps solidify the classroom learning and connect it to real live patients which will help you grow as a clinician.

Want to learn more about the pedagogy of the flipped classroom? And here’s a great example of curated resources for an emergency medicine intern level flipped classroom by @EMFundamentals.

What do you think? Are there other ways that you as a student have made flipped classroom successful for you? Leave us a comment below or @ALiEMFac on Twitter to let us know!

Blog post edited and curated by:

Mark Ramzy, DO
Faculty Incubator Multimedia and Communications Editor

References

Bishop, J., & Verleger, M. A. (2013). The Flipped Classroom: A Survey of the Research. In 2013 ASEE Annual Conference & Exposition. Atlanta, Georgia.
Huu Anh Vuong, Nguyen et al. Students’ Perceived Challenges of Attending a Flipped EFL Classroom in Viet Nam. Theory and Practice in Language Studies. 2018.
Sait MS,et al. Advances in medical education and practice: student perceptions of the flipped classroom. Adv Med Educ Pract. Published May 2017; PMID: 28496377
Young TP, et al. The Flipped Classroom: A Modality for Mixed Asynchronous and Synchronous Learning in a Residency Program. West J Emerg Med. 2014. PMID: 25493157
King AM, et al. Flipping the Classroom in Graduate Medical Education: A Systematic Review. J Grad Med Educ. Feb 2019; PMID: 30805092
Smallhorn, M. The flipped classroom: A learning model to increase student engagement not academic achievement. Student Success, 2017.
White PJ, et al. Student Engagement with a Flipped Classroom Teaching Design Affects Pharmacology Examination Performance in a Manner Dependent on Question Type. Am J Pharm Educ. 2017; PMID: 29302082

By Guy Carmelli, MD|2019-11-29T18:31:31-08:00Nov 29, 2019|Academic, Incubators, Medical Education|