About Jailyn Avila, MD, RDMS (She/Her)

Creator of the Core Ultrasound Website/Podcast/Courses
Associate POCUS Director & Director of Faculty Development, UHS SOCal MEC EM Residency
Clinical Associate Professor of EM, Western University Health Sciences
Director of the Ultrasound Leadership Academy
Member of the Ultrasound GEL podcast

How I Educate Series: Jacob Avila, MD

This week’s How I Educate post features Dr. Jacob (Jailyn) Avila, core faculty at Southwest Healthcare EM Residency and creator of Core Ultrasound. Dr. Avila spends approximately 70% of his shifts with learners which include emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a hybrid academic/community practice that is about to start its 3rd year of EM residents. Below he shares with us his approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Focused, contentious, applicable.

What delivery methods do use when teaching on shift?

Mostly verbal, with supplementary images/media usually pulled up on my computer/phone. Occasional hand-drawn illustrations and gestures.

What learning theory best describes your approach to teaching?

My learning theory is that I should match whatever learning theory best fits the person I’m trying to teach.

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

There are always things to learn and there are patients attached to the diseases.

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

The amount that I teach definitely depends on patient volume. I live to teach, but I don’t sacrifice patient care in the moment to orate. That being said, on shift, I try to give at least one teaching pearl to the learner assigned to me per patient. If I’m able to give more thorough teaching that’s a great thing!

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

I usually text them if it’s after shift, or talk to them on shift about their documentation.

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

Definitely. Since I work at a hybrid academic/community shop, I have to be diligent of overall ED flow (although I could also argue this is important in a purely academic shop). When it’s busy, I teach less. When it’s normal/less busy I teach more to make up for those times I can’t teach as much. Also, I make sure to acknowledge/apologize to the resident/learner when it’s one of those busy days.

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

I rarely take over early, but if I do it’s because the patient is at high risk for an imminent bad outcome. If that happens, after the fact I will try to have the resident run through what they would’ve done to try and salvage the learning opportunity. That being said I believe that slight discomfort can go a long way to help the resident/student learn and solidify their knowledge. I never do this in an antagonistic way, but rather to make sure I hold the resident accountable (in a kind way!) for the knowledge I think they should know. However, I try to never let that discomfort progress into a zone in which it is counterproductive to learning.

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

Develop on shift, most of the time. I think about it like surfing a wave. I know I’m catching a wave, but until I paddle into I don’t know exactly what the best way to approach the wave is.

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

Either or both, depending on ED volume, patient acuity, and resident speed.

How do you boost morale amongst learners on shift?

Acknowledging tough patients, feeling associated with good/bad patient encounters. Additionally, I try to always maintain a cheerful and kind attitude on shift even when everything is burning down. You can’t help that it rains, but you can definitely carry an umbrella with you.

How do you provide learners feedback?

Verbal on shift if positive, phone call/debrief after the shift, and written feedback.

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

Write down one thing you learned per patient on an electronic document and add to it as residency/your career progresses. I started writing documents on specific topics (like heart failure treatments, common pediatric medication dosing, etc) that I still use and add to now.

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

ALiEM of course! Some other sources: EMRAP HD for procedures, EMdocs EMCrit, Rebel EM. Core Ultrasound :) and POCUS atlas for ultrasound stuff.

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

EVERYTHING. I love critical care topics, procedures, and of course ultrasound. I have recently developed an interest in MSK topics that traditionally aren’t focused on in emergency medicine, such as arthritis, carpal tunnel, etc.

What techniques do you employ when teaching on shift?

Just-in-time learning, asynchronous (tell the learner to look up certain topics after shift and to tell me about it next time we see each other), at the bedside.

What is your favorite book or article on teaching?

How to change your mind.

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

Michael Macias, Ben Smith, Arun Nagdev.
How I Educate Series logo

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

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear pediatricEar irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.1 Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.2 In this trick of the trade, we present a low cost and effective way of  “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.

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Trick of the Trade: Squeeze test for confirmation of IO placement

IO needlesVenipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. 2–5  Success rates rise after multiple attempts, but what happens when you don’t have the luxury of time? What happens when your patient will die if you don’t get life saving medications into their circulation promptly?  There are a few options when you can’t get IV access through traditional means, among them external jugular vein cannulation, central line, ultrasound-guided IV, and the intraosseous lines (IO).6 However, when managing the crashing patient, a wise decision is to use the quickest option, which is often the IO.

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Trick of the Trade: DIY Finger Traps

Fx_RadiusUlnaPadding copyDistal radius fractures are among the most commonly encountered fractures in the emergency department (ED). They have been reported to account for around 25% of pediatric fractures and up to 18% of fractures in the elderly.1 Reducing minimally displaced distal radius fractures is a procedure that can be greatly facilitated by the presence of finger traps, which help hold traction while you reduce the fracture.2 Often While working in small 5-bed, free-standing emergency department (ED), I found myself needing to perform this vital procedure and finger traps were unavailable.

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Small bowel obstruction: Diagnosis by ultrasonography

SBOuprightA 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because you suspect a bowel obstruction, you bring an ultrasound machine to the bedside prior to the completion of any laboratory testing or other imaging. A curvilinear probe in the abdominal mode setting was used to scan in all four quadrants of the abdomen looking in both the sagittal and transverse planes.

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