About Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University

New Years Resolution: More teachable moments please


From: https://www.flickr.com/photos/mercyhealth/7142786853/in/set-72157629601050726/

“The worst thing about busy shifts is that I never learn anything.”
– anonymous resident

A junior resident and I were contemplating the many difficulties of residency, especially when working at a busy urban ED where patients are plenty, but teaching during shifts may be harder to come by. We discussed the importance of coming up with at least one learning point or clinical question during each shift, and making a point of following through and reading up on it after.  (That shift we both learned about fat emboli s/p extremity fracture.)


By |2016-11-16T09:37:57-08:00Jan 4, 2013|Medical Education|

Physical exams: A relic of the past?

Why do most of us dread patients who complain of dizziness in the ED? Because it is so vague, and the differential is so broad from elusive posterior cerebellar strokes to ear wax clogging up our ear canals. And this is one of those diagnoses where the differential really depends upon performing a thorough physical examination. 

Think really hard, when is the last time you focused upon getting a complete and accurate physical examination? In medical school, there are courses dedicated to the art. I always laugh when I think of my neurology attending who just loved to bang on different parts of the body with his reflex hammer to elicit cool reflexes.


By |2016-11-11T18:42:30-08:00Dec 21, 2012|Medical Education|

To debrief or not?

StopwatchLearners have limited time. Residents have work hours restrictions, practicing physicians have work / life demands, and the list goes on. Time is valuable. Therefore, educational interventions must be hard-hitting, effective, and worthwhile.

We discussed previously “What is debriefing?” Debriefing is a facilitated discussion and reflection about objectives previously chosen by the educator. Dr. Ernest Wang (NorthShore Center for Simulation and Innovation) states that it’s about getting learners to that “aha!” moment.


By |2016-11-11T18:42:32-08:00Dec 14, 2012|Medical Education|

Teaching internationally: More than just a language barrier

JoshiUltrasound1I recently traveled to San Salvador to help teach a pediatric and adult ultrasound course. The course was well received and it was wonderful traveling around San Salvador.

I wanted to share some of our experiences, and discuss some challenges to educating internationally. More importantly, I want to engage you, the readers to share some of your experiences when educating internationally as well.


By |2016-11-11T18:43:05-08:00Dec 7, 2012|Medical Education, Ultrasound|

The secret to patient presentations

“So there’s a patient, and umm…  they are in the hallway, they came to the ED today for breathing problems, I mean dyspnea.  They also don’t speak any English.  So, uh the respiratory rate is normal, and they had a blood clot, er… I mean PE, in the past, but not on coumadin anymore.  Shoot, I forgot to tell you my exam…they had pitting edema for 3 months.  By the way, the labs came back on that other anemic patient in the other hallway, and they are really anemic…” – Anonymous medical student

Sounds familiar? Imagine working in a hectic ED while listening to this chaotic presentation. 

What’s the secret to presenting patients?


By |2013-06-12T19:57:57-07:00Nov 30, 2012|Medical Education|

What is debriefing in simulation education?

Medical education high-fidelity simulation allows for deliberate practice in a safe environment. We are able to miss the intubation repeatedly or botch up the management of aspirin overdose without the demise of the patient.  At the end of each session, we gather in a pow wow and debrief….

I have been involved with debriefings, and often wonder what residents are thinking:

  • Do they understand what debriefing means?
  • Do they think this is the time where they are scolded for mistakes?
  • Do they think it is a valuable part of the simulation?

What does debriefing even mean? 


By |2016-11-11T18:43:14-08:00Nov 16, 2012|Medical Education, Simulation|

New blog section on Medical Education by Dr. Nikita Joshi


“I desire no other epitaph…than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”  – Sir William Osler, renowned physician and believer in bedside medical education

MedicalEducationStethoscopeAnd with this quotation I would like to introduce a new segment to Academic Life in Emergency Medicine. One of the most important job descriptions we have as physicians is to be a clinical instructor… while simultaneously running cardiac arrest codes, managing agitated altered mental status patients, and avoiding documentation errors.


By |2016-11-11T18:43:16-08:00Nov 9, 2012|Medical Education|
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