This week’s How I Educate post features Dr. Stephanie Lareau, the Wilderness Medicine Fellowship Director and Medical Director of Emergency Services at Virginia Tech Carilion Clinic. Dr. Lareau spends approximately 50% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. Her practice environment is split between an academic and community hospital. She spends 25% of her time at the academic level 1 trauma center that is home to an EM residency and medical school. The other 75% of her clinical shifts are at a 12-bed community ED which also has both resident and student learners. Below she shares with us her approach to teaching learners on shift.
Name 3 words that describe a teaching shift with you.
Acuity, black cloud.
What learning theory best describes your approach to teaching?
There can be more than one right way to approach a complaint. I like to give learners a chance to develop their approach, not try to “think what this attending would do”. I try not to jump in too early, unless it’s a critical situation, to change the learner’s plan.
What is one thing (if nothing else) that you hope to instill in those you teach?
Remember the patients are people, who have mothers and children. It’s easy to get jaded in our practice environment, but humanizing the people we care for, makes us care. Patients can tell when we actually care.
Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?
I try to see the patients with less teaching potential primarily and encourage the residents to see the more interesting and complicated patients. This seems to keep the department moving. I also try to steer the residents from just signing up for everyone – things flow better if I see some primarily too. For medical students, I try to steer them to things that are a bit more straightforward. Sometimes I’ll go with the residents to see patients, especially non-english speaking ones.
It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?
Not putting on sterile gloves during a procedure keeps me from jumping in too quickly. If they struggle I joke they’ll get it before I can put gloves on – and sometimes they do!
Do you start a teaching shift with certain objectives or develop them as a shift unfolds?
Depending on the learner sometimes I’ll ask if they have objectives, typically more for the medical students. Usually, with residents, the patients will provide learning points.
Do you typically see patients before or after they are presented to you?
Typically see patients after they are presented to me, in our environment attending also see patients independently, so if I find something interesting or someone critically ill I often “share” these encounters with residents.
How do you provide learners feedback?
I try to provide feedback in the moment or verbally after the shift. Timely feedback makes a bigger impression than reading evals days later.
Are there any resources you use regularly with learners to educate during a shift?
I encourage learners to look up things on shift that they don’t know. Sources vary – anything from Corependium to PubMed to Emedicine – I like to see what resources learners go to first and why.
What are your three favorite topics to teach during a shift?
DKA, Hypothermia, really any environmental emergency.
What is your favorite book or article on teaching?
Make it Stick – a great book to examine how we learn, which helps improve teaching
Read other How I Educate posts for more tips on how to approach on-shift teaching.