Your capable resident comes to you, looking frustrated. He says, ‘What a difficult patient. I think you need to get involved.’
This article provides a framework for teachers to allow learners to appreciate these encounters in the Family Medicine. Their points are highly relevant to Emergency Medicine. Strategies include:
Abscess drainage can be painful and time consuming in the ED. Can this article help? 1
Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D).
In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children.
A health care worker hurried in to the ED after being poked with a needle.
‘It was an old 18G needle with dried blood’, she said. Her puncture had drawn blood. You discussed the very low risk of contacting HIV and the side effects of postexposure prophylaxis (PEP). She asked, ‘What does very low risk mean?’
Is there another way to covery risk for patients?
It is 2 a.m. You, the resident, have just spoken to your staff/attending, who told you to do a task. You have seen one, but don’t feel comfortable doing one independently.
This study examines the perception of EM trainees of their competence and adverse events and how they feel about reporting them.
We often do lumbar puncture in the ED. Patients get warned about the potential of a post LP headache.
The literature reports 15% of ED patients have a post LP headache.
After a shift, we often review the day’s case with our learners. We sometimes ask them to self-reflect.
I often used Demian’s ‘Plus/Delta’ approach and ask ‘What did you like /what would you change?’
This approach works well mostly. But, when the answer is ‘I don’t think I would change anything’, it is hard to target teaching and feedback to the learner’s need.
After a chaotic shift, you and your learner sit down to complete the daily evaluation card. There are no significant issues with the learner. Is there anything else to write except ‘great shift’ or ‘read more’?
Can we learn from excellent motivators such as sports coaches? This article by LeBlanc and Sherbino outlines coaching as a teaching technique in the ED.