This week’s How I Educate post features Dr. Jessie Werner, the Clerkship Director and Medical Education Fellowship Director at UCSF Fresno. Dr. Werner spends all of her shifts with learners which include emergency medicine residents, off-service residents, medical students, physician assistants, nurse practitioners, and fellows. She describes her practice environment as a busy (120,000 patients/year) ED in the central valley healthcare desert. Below she shares with us her approach to teaching learners on shift.
Name 3 words that describe a teaching shift with you.
Educational, hands-on, and accessible.
What delivery methods do use when teaching on shift?
I’m a visual learner so like to draw on paper or make lists, outlines, learning points, etc; I also love looking up helpful images on the computer.
What learning theory best describes your approach to teaching?
Maybe a combination of humanism and constructivism? I try to meet learners at their level and help them achieve their own goals, but I also believe that a lot of learning happens from seeing something/doing something/experiencing it, and problem-solving.
What is one thing (if nothing else) that you hope to instill in those you teach?
You can never know it all (and that’s ok!). We all need to keep up-to-date, look up answers, and ask for help. I like it when learners ask questions because it helps me learn too!
How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?
I try to teach when a patient is being presented, when we’re running the list, or if new information becomes available. That grounds the teaching in a patient and *hopefully* makes it more memorable.
What is your method for reviewing learners’ notes and how do you provide feedback on documentation?
I mostly pay attention to the physical exam and the MDM. There’s so much that we do during the shift for patient care that we don’t always document. I try to encourage learners to use dot phrases, time stamps, and the ED Course whenever they do anything.
Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?
They definitely can. It can sometimes feel like there isn’t enough time for quality teaching when the department is really busy. Sometimes I go to the bedside with my learner or have them round with me in order to be more efficient. It’s also nice to hear them interview the patient or watch them do a procedure in real-time.
It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?
I try to remember how I felt when I was a fourth-year resident. :)
Do you start a teaching shift with certain objectives or develop them as a shift unfolds?
It depends. If a learner expresses certain goals, then we try to achieve those during the shift. Otherwise, it usually unfolds more organically.
Do you typically see patients before or after they are presented to you?
Again, it depends. I like to try to see patients ahead of time so I can more easily give thoughts/feedback about the patient as they’re presented to me. Sometimes that just isn’t possible and I see them after the presentation. I *try* not to say much about management until I’ve seen the patient for myself.
How do you boost morale amongst learners on shift?
The doc box vibe is real. If a member of the team is grumpy and negative it’s transmitted to everyone. I think it’s important to come in with positivity and energy so the whole team benefits. Encouraging breaks or snack time can be helpful too.
How do you provide learners feedback?
I usually give verbal feedback in real time.
What tips would you give a resident or student to excel on their shift?
Be positive, work hard, and go the extra mile.
Are there any resources you use regularly with learners to educate during a shift?
I love online resources and FOAM. I use EMRAP procedure videos a lot.
What are your three favorite topics to teach during a shift?
Procedures, post-intubation care, and running a room.
What techniques do you employ when teaching on shift?