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Coaching for Faculty: The Secret to Unlocking Professional Success

coaching for academic faculty unlock professional success

Dr. Garcia is a freshly minted faculty member at Big Name University Medical Center. She’s excited to have finally finished residency and dive into her career as a full time (and fully paid) attending. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. She heard that “saying yes” to opportunities is important, but after a year of “saying yes,” Dr. Garcia feels swamped: she is serving on the residency clinical competency committee, a department committee for managing boarding, and collaborating on a departmental research initiative. Despite this, she receives no salary support to lower her clinical time, and is starting to feel like there is no real forward progress in her career.

It ain’t easy being an attending

Attending life has its challenges.

New residency graduates suddenly have to adjust to the daunting responsibility of independent practice and meeting clinical performance metrics. Those who take the academic route face unclear promotion expectations, uncertainty about their niche, and a double-whammy of high clinical burden and a tacit expectation that you “prove” your worth as a teacher by taking on more tasks before being rewarded with salary support. Senior faculty face entirely different challenges; once-sharp clinical skills may have dulled over time, or the academic career hits a dead end – be it through stagnation, boredom, or waning interests. And as study after study tells us, everyone is susceptible to burnout. It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2].

Systemic changes are undoubtedly needed for these system-wide issues. But what can Dr. Garcia – or you – do? Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment. And that’s exactly the purpose of a coach.

A coach? Aren’t they for learners, or leaders, or long-jumpers?

Yes… and also for faculty just like you. Each of those groups has their own flavor of coaching (academic, executive/leadership, and performance, respectively). But in your case, professional development coaching might be just what the doctor ordered.

Let’s start with the obligatory definition of coaching. The International Coaching Federation defines a coach as partnering with clients:

“…in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. The process of coaching often unlocks previously untapped sources of imagination, productivity and leadership.”

Personally, I like keeping it simple:

When you’re stuck in life, a coach is a great tool to help you get unstuck.

By working in partnership with you, they ask thought-provoking reflective questions; help you discover your core values and develop valuable personal insights; guide you to creating authentic and actionable goals; and help you be accountable to achieving those goals. This Journal of Graduate Medical Education article “Choosing When to Advise, Coach, or Mentor” [PDF] provides a succinct review [3].

But isn’t coach just another name for “mentor?”

In short, no.

Mentorship can be incredibly beneficial to one’s career, and many mentors use coaching skills while guiding their mentees. But mentorship differs from coaching in a number of ways.

Mentors are typically senior, have shared expertise in a content domain, and serve as a font of knowledge for their benefit. Unfortunately, evidence shows that many, if not most, faculty struggle to find, receive, or maintain satisfactory mentorship [4, 5].  What’s more, what happens when you’re more established? When you’re advanced in your career, correct answers are less clear, and there might not be any senior mentor to guide your hand.

Coaching, by comparison, starts from the premise that you are the world’s foremost expert on your own life, and that within you lies all the creativity and resourcefulness to overcome any challenge. Sometimes, though, we can’t see the forest from the trees. A coach helps you gain insight and illuminate the obstacles in your way. Once your perspective is clear, you can create a plan to succeed. A coach, then, acts as a partner (not a guide), helping you think, reflect, and act. Figure 1 is a helpful idea of how a coaching partnership will look, but the key difference from mentorship is that you are the source of all insight and action, not the coach.

coaching analysis flowchart

Figure 1: The Coaching Partnership

Clearly there can be overlap between these important academic relationships, but, at its core, coaching is distinguished by: [3, 6]

  1. Being driven by an agentic coachee that is ultimately responsible for choosing to take action
  2. Not requiring the coach to be in the same field as the coachee
  3. Not being centered around transfer of expertise from a more knowledgeable or experienced party to the recipient

So what should coaching be used for?

The most supportive data for coaching in medicine is for physician wellness and mitigating burnout [7]. Beyond that, evidence suggests that coaching is positively associated with:

  • Achievement of professional goals and personal empowerment [8]
  • Self-confidence [9]
  • Stress management [9]
  • Reflective capacity for interpersonal interactions [9]
  • Better teaching skill transfer [10]
  • Teacher identity development [10]
  • Better learning environment [10]
  • Faculty academic productivity [11]

The breadth of associated outcomes here show the multifunctional and flexible nature of coaching. When you’re stuck, a coach is a great way to help you get unstuck.

What should I look for in a coach?

Before jumping into details, it’s important to share 2 important and interrelated points.

  1. The bedrock that undergirds the work of coaching is the relationship between the coach and coachee. Thus, think of a finding a coach as akin to finding a partner. You wouldn’t settle down with the first person you go on a date with, right? Seek out multiple coaches, talk about your needs with them, and see which one is the best fit for you specifically. Similarly, successful coaching requires you, as the coachee, to feel psychologically safe with your coach. Internal coaches may be free and easy to access, but you may not feel comfortable being truly vulnerable with someone at your institution or, worse, to whom you report. Conversely, external coaches may provide complete anonymity and psychological safety, but they will require some kind of financial remuneration – be it from you, your CME funds, or your department/institution.
  2. There is very little regulation in the coaching world. You, after reading this article, could think this coaching thing sounds swell and launch a business tomorrow calling yourself a coach. In order to make sure you’re working with someone who has received specialized training or has sufficient coaching experience, ask for a certificate from a training program and/or accreditation by one of the governing bodies of coaching, like the International Coaching Federation or Center for Credentialing and Education.

The following table provides a brief guide of the responsibilities that can also help guide your search for a prospective coach:

CoachCoachee
Communication StrategyPose probative, open-ended questions to build professional rapport and stimulate coachee reflection.Provide answers stemming from open, genuine, vulnerable self-reflection.
Goal SettingEncourage effective coachee goal-setting practices (e.g., SMART, WOOP).Assume responsibility for crafting and monitoring progress on their own goals.
OwnershipKeep the coachee at the center of the experience, striving to help them arrive at their own answers whenever possible.Acknowledge ownership and control over the quality and outcome of the experience
MindsetPositive psychology:

  • Provide nonjudgmental empathy
  • Encourage learners to identify and engage in their strengths
  • View coachee with positive regard

Acknowledge when an issue is outside of their skillset (and recommend appropriate assistance).

Continuously strive to be more self-aware and accountable.

Be open to new advice, suggestions, or input that may not immediately align with existing perspectives.

Reframe struggle as an indicator of growth and not failure.

Professionalism
  • No conflict of interest between parties (e.g., assessment, advancement, allocation of resources)
  • Open, honest, respectful communication
  • Meeting punctuality and responsiveness to communication
  • Commitment to tasks that are collectively agreed upon during sessions
  • Maintenance of confidentiality

Ok, I’ll bite. How do I go find a coach?

Because coaching is still in an “early adoption” phase within medicine, you’ll have to be proactive to find a suitable coach. This short Journal of Graduate Medical Education article, Coaching for Clinician Educators [PDF] covers how to prepare for, find, and succeed with a coach [12]. Full disclosure: I am one of the authors, so take my recommendation under advisement!

With that aside, here are some general tips for finding a coach:

  1. Look internally: Many institutions are starting internal coaching programs. Ask around within your department to see if this is an option.
  2. Contact a coach training programs: There are numerous coaching programs that train professional coaches, possibly even at your home institution. Coach trainees are required to accrue many hours of practice, and often do so at a discount from market rates. This could be an excellent way to have a coach outside of your immediate orbit, but also not have to pay a significant amount.
  3. Look online: A casual internet search will connect you to any number of coaches. You can seek coaches who are emergency physicians, physicians of other specialties, or have no affiliation or background within healthcare. The more you look, the more options you’ll find.
  4. Ask around: Some of your colleagues may have used a coach, know a coach, or are themselves a coach, without you ever knowing.
  5. Remember your CME stipend: Check with your institution, but in most instances coaching is an acceptable form of CME or professional developmet expenditure.

The Takeaway

Coaching is one of many tools at your disposal to unlocking success in your career. It’s especially useful when you’re stuck, be it through gaining a new perspective, making a hard choice, or breaking the paralysis of analysis. Give it a try and see if it can help you!

References

  1. Chapman AB, Guay-Woodford LM. Nurturing passion in a time of academic climate change: the modern-day challenge of junior faculty development. Clin J Am Soc Nephrol. 2008;3(6):1878-1883. PMID 18945997
  2. Elster MJ, O’Sullivan PS, Muller-Juge V, et al. Does being a coach benefit clinician-educators? A mixed methods study of faculty self-efficacy, job satisfaction and burnout. Perspect Med Educ. 2022; 11(1):45-52. PMID 34406613
  3. Marcdante K, Simpson D. Choosing When to Advise, Coach, or Mentor. J Grad Med Educ. 2018; 10(2):227-228. PMID 29686766
  4. Jordan J, Coates WC, Clarke S, et al. The Uphill Battle of Performing Education Scholarship: Barriers Educators and Education Researchers Face. West J Emerg Med. 2018 May;19(3):619-629. PMID 29760865
  5. Bentley S, Stapleton SN, Moschella PC, et al. Barriers and Solutions to Advancing Emergency Medicine Simulation-based Research: A Call to Action. AEM Educ Train. 2019 Nov 27;4(Suppl 1):S130-S139. PMID 32072117
  6. Wolff M, Deiorio NM, Juve AM, et al. Beyond advising and mentoring: Competencies for coaching in medical education. Med Teach. 2021; 43(10):1210-1213. PMID 34314291
  7. Boet S, Etherington C, Dion PM, et al. Impact of coaching on physician wellness: A systematic review. PLoS One. 2023 Feb 7;18(2):e0281406. PMID 36749760
  8. Pearce MJ. Professional Development Coaching for Health Professions Graduate Faculty: A Pilot Implementation. J Contin Educ Health Prof. 2022; 42(4):291-293. PMID 34966110
  9. McKnight R, Papanagnou D. Coaching junior faculty for the uncertainties of academic professional practice. Int J Med Educ. 2021;12:179-180. PMID 34592715
  10. Bajwa NM, De Grasset J, Audétat MC, et al. Training junior faculty to become clinical teachers: The value of personalized coaching. Med Teach. 2020; 42(6):663-672. PMID 32130055
  11. Schulte EE, Alderman E, Feldman J, et al. Using the “Coach Approach”: A Novel Peer Mentorship Program for Pediatric Faculty. Acad Pediatr. 2022;22(7):1257-1259. PMID 35381378
  12. Branzetti J, Love LM, Schulte EE. Coaching for Clinician Educators. J Grad Med Educ. 2023;15(2):261-262. PMID 37139204

Disclaimer: The author, Dr. Jeremy Branzetti, is the founder of Academic Educator Coaching and is a certified professional coach.

By |2023-10-27T01:00:27-07:00Oct 30, 2023|Academic, Medical Education, Professional Development, Wellness|
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IDEA Series: Specialised Lectures in Emergency Medicine (SLEM) – A virtual conference to strengthen EM education in the developing world

Specialised lectures in emergency medicine, virtual conference, developing world
The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. As the specialty evolves in Pakistan and other countries, there is a need to improve and assimilate novel learning methods to elevate education standards. The COVID-19 pandemic catalyzed the routine use of video-conference platforms such as Zoom. Virtual educational programming offers the opportunity to leverage educational resources across space and time, foster collaborations, and improve knowledge, clinical and evidence-based practice globally.

The Innovation

Specialised Lectures in Emergency Medicine (SLEM) is a virtual program for learning, collaboration and social engagement. The program invited experts from internationally acclaimed institutes with varying interests to present their experiences, observations, opinions, and protocols. It is an innovation that is based on a community of practice merged with the need-based assessment of a young EM residency program in a developing country.

The Learners

The target learners were EM residents and physicians practicing in the emergency department. The presenters were selected based on their experience, Free Open Access Medical (FOAM) educational materials, research, blog posts, and presentations from reputable conferences.

Group Size

SLEM accommodated 50-100 participants.

Materials

Our activity utilized simple, readily available resources. The following materials are needed:

  1. Video-conference platform: We used Zoom, a proprietary video-conferencing software program. The free plan allows up to 100 concurrent participants, with a 40-minute time restriction. Users have the option to upgrade by subscribing to a paid plan. The highest plan supports up to 1,000 concurrent participants for meetings lasting up to 30 hours. For SLEM, the paid subscription was necessary to accommodate up to 1 hour long lectures for some topics. Because of the risk of disruptive, non-invited participated, we recommend enabling the waiting room function, whereby only registered participants could join.
  2. Internet connection: A stable internet connection is a must. In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer.
  3. Engagement team: We formed a team including 5-6 residents to engage other participants and ask questions of the speakers relevant to local practice. This effort enhanced psychological safety for other participants to speak up, ask questions, and participate in the conversation following lectures.
  4. Security squad: We formed a separate team of 4 residents to oversee any non-registered participants joining the video-conference, who may generate security issues.
  5. Video library: All the lectures were recorded so that they can be referenced later by the residents.

Description of the Innovation

Speaker Identification: SLEM lecture presenters were individually approached through a defined methodology depicted in Figure 1. The program started in April 2021. The selection of the presenters was based on their published FOAM resources and scores of each were reviewed on an objective grading system that was adopted from Academic Life in Emergency Medicine (ALiEM) [2]. In addition to their content, additional factors considered included: the supporting evidence cited in their content, the referencing of their content in peer and non-peer reviewed publications, their content gradation as per the Social Media Index, and review of their faculty profiles and areas of expertise from the university website. The presenters also recommended their peer faculty who were similarly reviewed and assessed prior to the designation of the topic followed by the talk.

Topic Selection: Topics were selected based on the speaker’s previous academic lectures and area of expertise, although occasionally the presenter chose a different topic approved by the organizers based on their academic profile. Topics were selected based on disease prevalence in Pakistani EDs, published literature describing gaps in resident education and expertise, and gaps identified during academic core meetings. The presenters were then approached through either their official email address, the email address from their FOAM website, Twitter, Facebook, publications, or institution website. Upon confirmation of the lecture, an online calendar invitation including a Zoom link was shared with the presenter.

Publicity: The conference was widely advertised with promotional materials [brochure, video]via Twitter, WhatsApp, and the national EM society listserv.

Video-conference Schedule: Sessions took place virtually, starting with a 5-minute introduction of the presenter, followed by a 45-minute talk, and closing with a 15-minute question and answer session.

Lecture Evaluation: Post-session evaluation forms were shared with the residents and faculty after each session to gather feedback. Each SLEM lecture’s quality was evaluated through the internationally validated, reduced version of the Students’ Evaluation of Educational Quality (SEEQ) [3]. Originally developed by Marsh et al., this tool assesses the level of student satisfaction with teacher effectiveness to improve teaching quality. It has an excellent reliability, internal consistency, validity, and quality and has the flexibility to fit into individual teaching contexts. Reduced SEEQ is useful for quickly gathering data and decreasing the risks of item nonresponse and has been extensively studied at the postgraduate level. The variables weighted most heavily for SLEM included:

  • Learning
  • Individual rapport
  • Enthusiasm
  • Organization
  • Breadth
  • Group interaction
  • Overall rating

At the conclusion of the overall event, each participant had the opportunity to complete an online evaluation developed using Google Forms to provide feedback to the organizers. Several participants were selected for a brief, follow-up interview to explore their reactions and gain additional feedback.

The first SLEM virtual conference was successfully held July 20, 2023. Additional materials for the activity are available upon request by contacting Dr. Shahan at [email protected].

SLEM virtual conference flowchart design

Figure 1: SLEM Conference Planning and Design

Lessons Learned

SLEM has played an important role in strengthening the academic component of our developing residency. Despite the sessions being held virtually and after hours, the resident and faculty were engaged and reported increased knowledge and clinical practice improvement. Our target audience of trainees and junior to mid-level faculty especially appreciated the SLEM conference, as they appreciated tips from more senior clinicians. Additionally, the planning team developed strong bonds through the process, paving the way for future collaboration. The sessions overall contributed to the formation of a global community of practice by engaging speakers at different institutions around the world.

During planning, we faced challenges coordinating across time zones. Sending electronic calendar invitations explicitly stating the time zone along with the time was important for avoiding errors. Deploying our security teams, a robust registration system, and the waiting room function in Zoom were important strategies for avoiding disturbances to the event. Our engagement team also helped keep our participants active despite the large audience and virtual format.

IDEA series SLEM organizers

Figure 2. Team SLEM after successfully executing the SLEM conference

Theory behind the innovation

The educational theory supporting our initiative was community of practice [4]. The underlying principle highlights that learning occurs through social engagement in authentic contexts. The SLEM presenters and audiences (EM residents and faculty) were all individuals with shared interests and personal experiences relevant to the practice of EM.

Closely related, social cognitive theory also underpins the SLEM innovation. This theory postulates that learning occurs in social contexts and involves the reciprocal interaction of the individual, behavior, and the environment [5]. SLEM provided learners with the opportunity to receive experiential and tacit knowledge directly from clinical experts, which can then be applied, tested, and adjusted in their own environments. SLEM created a venue for dissemination of perspectives, discussion, and international practice change.

Idea Series Logo debriefing

Led by series editor, Dr. Mary Haas, the IDEA series showcases examples of what programs worldwide have been doing to make residency conference more entertaining, engaging, and most of all, educational for residents. Read more publications from the series.

References

  1. Waheed S, Ali N. Chief Resident Election of Emergency Department (CREED)–An innovative approach to fair and bias-free chief resident selection in a residency program. Pakistan Journal of Medical Sciences. 2022;38(6):1717. PMID 35991269
  2. Brindley PG, Byker L, Carley S, Thoma B. Assessing on-line medical education resources: A primer for acute care medical professionals and others. Journal of the Intensive Care Society. 2022;23(3):340-4. PMID 36033246
  3. Coffey M, Gibbs G. The evaluation of the student evaluation of educational quality questionnaire (SEEQ) in UK higher education. Assessment & Evaluation in Higher Education. 2001;26(1):89-93.
  4. Schwen TM, Hara N. Community of practice: A metaphor for online design? The Information Society. 2003;19(3):257-70.
  5. Bandura A. Social cognitive theory of self-regulation. Organizational behavior and human decision processes. 1991;50(2):248-87.

By |2023-10-27T00:58:52-07:00Oct 26, 2023|IDEA series, Medical Education, Professional Development|
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Mismatch: Why were there so many unfilled emergency medicine residency positions in 2023?

The Study

In an Annals of Emergency Medicine paper, Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2].

The Findings

The authors identified 6 program characteristics associated with unfilled EM PGY-1 positions in the 2023 Match:, smaller program size (< 8 residents), Mid-Atlantic or East North Central location in the United States, prior accreditation by the American Osteopathic Association, unfilled positions in the 2022 Match, and corporate ownership structure. Program type, length, proximity to other programs, and first accreditation year were not predictive characteristics. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4].

Match 2023, mismatch, emergency medicine residency programs unfilled positions

Match Data

The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. In 2022, unfilled PGY-1 positions totaled 219 (7.9%), and 554 (18.4%) positions were unfilled in 2023 [2,5]. In contrast, the greatest number of unfilled PGY-1 positions in the last decade was 30 (1.2%) in 2019 [6]. A staggering 131 (47%) EM residency programs had unfilled PGY-1 positions among in 2023 [7].

What does this mean for the future of EM?

Who knows? We can’t make such predictions based on data from only 1 Match cycle. We need to closely follow these numbers in the coming years to fully understand trends in student behavior and program expansion. EM was once considered a competitive specialty, but the current supply/demand mismatch of positions to applicants now suggests otherwise. Without a significant influx of additional applicants, the high unfilled rate for EM is likely to continue for the next several years. This has implications for the composition of the EM physician workforce and its adequacy to meet the rising demand for emergency services.

Is student disinterest the problem?

Many have focused on changes to specialty preferences by students as the major driver in these dramatic Match results. However, the decrease in applicants to EM programs may not be the whole story. 2021 was an unusual outlier in the EM Match, likely fueled by the unique circumstances surrounding the COVID pandemic. Comparison of today’s applicant numbers to data from 2021 gives a false impression of applicant numbers. In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923). However, between 2015 and 2023, the number of available EM positions grew, with an annual addition of 149 PGY1 positions. Although the establishment of new EM programs is often cited as the source of this growth, anywhere from 25-50% of these new positions were due to the expansion of existing residency programs over several different years. With these data in mind, it makes sense to consider the program factors associated with unfilled residency positions and ensure that we don’t exclusively focus on improving recruitment.

What can residency programs do in this upcoming Match cycle?

Programs that have one or more of the characteristics identified in this study are at risk of being unfilled in the Match once again in the next cycle. Many of these characteristics are immutable. Deliberate actions are required to mitigate the risk:

    • Interview more candidates
    • Submit a longer Rank Order List
    • Optimize program website and digital presence
    • Broaden online recruitment efforts to target students in other regions of the country
    • Enhance marketing efforts for medical students at nearby schools
    • Improve the ‘brand experience’ for visiting students and applicants on interview day

What can we do to help recruitment for our specialty?

Excerpted from the paper, “The most impactful elements of student recruitment to our specialty remain unchanged: student mentorship and exposure to the elements of emergency medicine that make for a rewarding career.”

  • Mentor pre-clinical medical students to build early interest in the field
  • Describe your love for the specialty during ED shifts with students
  • Remain positive when interacting with students
  • Don’t role model burnout on shift
  • Explain the limitations of recent EM workforce projections

Conclusion

In conclusion, the landscape of the EM Match is shifting, evidenced by the startling numbers of unfilled PGY-1 positions in recent years. Our deep dive into the factors contributing to these outcomes shed light on several program characteristics associated with unfilled positions. It’s important, however, not to let these figures contribute to a panic regarding the future of EM.

Sure, the increase in vacant spots seems unnerving at first glance, but there’s context to be considered. The surge in EM positions and the relatively steady number of applicants speaks volumes about the supply-demand dynamics at play, something that will require a detailed exploration in its own right. Data points like these do not exist in a vacuum. They’re part of a larger, interconnected system influenced by myriad factors — from medical school experiences to external forces like the pandemic, the changes in the employment structure of many emergency departments, and the current landscape of the healthcare system in general.

Absolutely, the key mission of EM – providing quality care to everyone, at any time – stays constant even as we face these challenges. Remember, even though there were 554 unfilled positions from the 2023 Match, an impressive 90.4% (501 positions) were filled during the Supplemental Offer Acceptance Program (SOAP) [5].  For now, the current workforce and pipeline of new emergency physicians appears stable.

While it’s important to understand and address the dynamics of recruitment, our main goal should always be the training of new doctors. Right now, there are 2,957 interns just starting out who need our guidance and support. They’re the future of our specialty, and our priority should be to help them become the best emergency physicians they can be. Despite the ups and downs of the Match process, let’s not lose sight of our most important job: training the next generation of EM physicians.

References:

  1. Preiksaitis C, Krzyzaniak S, Bowers K, Little A, Gottlieb M, Mannix A, Gisondi MA, Chan TM, Lin M. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023 Jul 11:S0196-0644(23)00429-8. PMID: 37436344.
  2. National Resident Matching Program. 2023 Main Residency Match: Advanced-Data Tables. Published March 17, 2023.
  3. Murano T, Weizberg M, Burns B, Hopson LR. Deciphering a Changing Match Environment in Emergency Medicine and Identifying Residency Program Needs. West J Emerg Med. 2023;24(1):1-7. PMID: 36735008.
  4. Pupazan, Ionut MD; Cook, Thomas P. MD. Unfilled Residencies were Newer, Rural. Emergency Medicine News 45(7):p 1,22, July 2023.
  5. National Resident Matching Program. 2022 Main Residency Match: Results and Data. Published May 2022.
  6. National Resident Matching Program. 2023 Main Residency Match By the Numbers. Published March 2023.
  7. National Resident Matching Program. NRMP Program Results 2019-2023 Main Residency Match. Published March 2023.

By |2023-07-16T17:20:33-07:00Jul 17, 2023|Academic, Medical Education, Medical Student|
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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.
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By |2023-03-22T12:12:43-07:00Apr 5, 2023|How I Educate, Medical Education|
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How I Educate Series: Sara Dimeo, MD

This week’s How I Educate post features Dr. Sara Dimeo, the Program Director at East Valley Emergency Medicine. Dr. Dimeo spends approximately 70% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. She describes her practice environment as a busy, level 1 trauma center in the East Valley of Phoenix, Arizona with an annual patient volume of ~70K. Our sister hospital Mercy Gilbert has a new Women’s and Children’s pavilion where a pediatric ED will be opening in conjunction with Phoenix Children’s hospital. The program is a community-based EM program with all of the bells and whistles of an academic program, and the culture of the hospital makes it a great place to work. Below she shares with us her approach to teaching learners on shift.

What delivery methods do use when teaching on shift?

“What if”…I like to pose hypothetical situations to mentally prepare learners when a critical patient is arriving. For example, a patient who is in cardiac arrest is due to arrive; “What if they just had an orthopedic surgery recently?” “What if they are in refractory v-fib?” “What if the nurses are struggling to get a line?”

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

It can be difficult to provide note feedback while on shift, depending on the shift. I like to open an email while I sign my charts and take notes to send to learners; particularly if I notice a pattern of difficulty with documentation.

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

I aim to be somewhere in the upper end of the middle of the pack in regards to patients per hour, etc. I think that choosing opportune times to teach, and running the list with residents frequently to divide and conquer between myself and them which tasks need to be done helps a lot. For example, if we have a sign out list of 3 patients and there are 2 new patients to be seen, I’ll “take” the sign out patients and have the resident go see the 2 new ones.

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

YES- this can be so hard! I was once given the advice that everyone will know you’re an attending if you stand at the foot of the bed to guide the resuscitation. I try to guide my learners to assume this position and encourage them to consciously lead the team. I physically will stand next to them or at the side of the room and put my hands in my pockets. I try to speak up only if I see a patient safety issue or if the learner truly needs help.

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

I think that the entire idea of developing an objective to learn before a shift can be flawed because often you will see very different presentations of patients than what you desire. However, making sure your learners know how you work is important. Also, creating broad objectives such as: “I want to work on completing my notes in real-time”, or “I want to try to see every patient in the pod” is a sure way to go.

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

Depends. If possible, I like to see them before because I can synthesize their presentation and give them better real-time feedback. I also like to directly observe learners because it gives me the best insight into their H&P and decision-making skills, and also kills two birds with one stone (where I don’t have to see the patient later). It also allows you to model certain behaviors or add focused questions, though I think this is best done at the end of the learner’s questioning because otherwise, I’d feel I was interrupting them.

How do you boost morale amongst learners on shift?

Residency is really hard. Medical school is hard but in different ways. For students, involving them as much as possible so they feel they are truly part of the team, and showing them my enthusiasm for learning and discovering is my approach. With residents, I encourage them to get food, coffee, etc. and just try to be a supportive ally in what they’re going through.

How do you provide learners feedback?

I used to struggle a lot with giving feedback, so I made an effort to practice it often and now I don’t think it’s such a big deal. It pains me so much when a resident receives a scathing evaluation and they tell me no one has discussed it with them. It really takes a toll on their mental health. I think the cool thing about residents is that they want to improve, and they usually are the hardest on themselves. I always start with an open-ended question such as “How do you think that went?”, which gives me the opportunity to clarify their thought process about their performance.

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

(1) Put in your orders, then dictate your HPI and PE of your note right after seeing a patient
(2) Run your patient list frequently
(3) Try not to put off procedures or difficult cognitive decisions to the end of your shift….it will just make you stay over!

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

Life in the Fast Lane for EKGs, EMRAP procedural videos, EMRA guides

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

(1) Love eye stuff! it’s an often neglected topic
(2) STEMI equivalents (though now the guidelines are finally catching up!)
(3) How to give a death notification/difficult patient encounter approaches

What is your favorite book or article on teaching?

If you haven’t read the original Dunning-Kruger paper, I found it to be really fascinating.

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

Christina Shenvi, Andy Little, and Molly Estes.

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By |2023-03-22T07:41:13-07:00Mar 22, 2023|How I Educate, Medical Education|
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How I Educate Series: Whitney Johnson, MD

This week’s How I Educate post features Dr. Whitney Johnson, the Director of Education at UHS SoCal Medical Education Consortium. Dr. Johnson spends approximately 50-60% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. She describes her practice environment as two high-volume community hospitals. Below she shares with us her approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Cerebral, practical, inquisitive.

What delivery methods do use when teaching on shift?

Open discussion.

What learning theory best describes your approach to teaching?

Deliberate practice primarily, but also aspects of constructivism and socio-constructivism.

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

Individualized care is the best way to serve our patients/communities. We are all working to improve daily and avoid cook book medicine, anchoring bias, and premature closure that can contribute to healthcare disparities.

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

I care a lot about on-shift teaching so that typically means slowing down my own workflow (likely seeing a few fewer patients to focus on the residents’ growth/learning). It definitely comes at the expense of my documentation but I haven’t found a way to improve that yet.

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

My review is post-shift. Formal feedback is provided by written surveys, but I also try to follow up with the resident the next day or shift if there are significant areas that need improvement.

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

It can adversely affect teaching because many of these metrics are behind trends in clinical practice and EM literature. My approach is to acknowledge departmental flow and metrics but also review with the resident any of our own growing EM literature that might provide further insight as to where the standard of care and state of practice is moving.

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

This is very hard for me because I don’t want my residents to feel like I’m leaving them hanging but there is also just as much learning in our struggles as there is in our successes. If it does not compromise patient or staff safety I give them a chance to troubleshoot. Residents also have to be humble enough to know their limitations and when they should reach out for help. It’s a balancing act that I’m still working on. The residents I know well and have worked with I have generally grown aware of their limitations and am comfortable waiting for their nonverbal cues of struggle.

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

I ask the resident what they would like to work on for the given shift and try to look for opportunities to fold that into our day-to-day grind

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

For stable patients, I will wait for the resident to present. Any unstable patient or patient an RN has expressed concerns about I will see earlier, often just taking the resident with me

How do you boost morale amongst learners on shift?

I try to encourage clinical autonomy so they feel like the smart physicians they truly are.

How do you provide learners feedback?

Verbal on shift and a more summative written assessment post shift.

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

First, have a goal for each shift for your own personal growth. It will make it more engaging for you as a learner. Second, be a steward of your own education. Don’t expect EM knowledge to be spoon-fed to you by your attendings. Third, don’t be afraid to ask your attending questions about their clinical practice or decisions, in a professional manner. Some residents feel like they have to just order what the attending wants, but know that there is practice variation in our specialty and more than one way to work up a complaint. Consider picking your attending’s brain on what made them choose a given workup or what they saw in the patient that made them change your plan. Bring your own readings and insights into the discussion. Attendings learn from residents just as residents learn from us. Last, have a few go-to resources that you like, and don’t be afraid to pull them up on a shift. No one expects you to remember all the information, but know where to find it on shift.

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

CorePendium!

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

Post-ROSC care, approach to orthopedic imaging, high yield DDx “worst first”.

What techniques do you employ when teaching on shift?

Deliberate practice primarily.

What is your favorite book or article on teaching?

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

Dr. Xian Li, Dr. Jacob Avila, and Dr. Leah Bauer.
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By |2023-03-03T13:08:04-08:00Mar 8, 2023|How I Educate, Medical Education|
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How I Educate Series: Tarlan Hedayati, MD

This week’s How I Educate post features Dr. Tarlan Hedayati, the Chair of Education at Cook County Hospital. Dr. Hedayati spends approximately 90% of her shifts with learners, including emergency medicine residents, off-service residents, and medical students. She describes her practice environment as a large, public, urban, Level 1 trauma center. Below she shares with us her approach to teaching learners on shift.

What delivery methods do use when teaching on shift?

Some of the other attendings joke that they know when I’ve been working because the garbage can is full of paper towels I’ve used to write on when I teach on shift.

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

Post shift. I usually send an email to the resident if there is something in the charting that can be improved upon or if the documentation is especially excellent.

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

Flow and metrics absolutely impact teaching and learning. If it’s too slow, the experiential component of education is lost. Too fast, and there isn’t time to make sure concepts and ideas are properly recognized and absorbed by learners. I try to verbally summarize things we have seen and learned toward the end of the shift as a recap so that learners are reminded of topics they should investigate further when they go home. I also incorporate specific cases in my written feedback so the resident can read it and remember notable pearls.

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

As long as there is no risk to the patient, I let things play out. I am pretty confident that I can bail out of a bad situation and know that I need to let them practice. Learners have to figure out how to troubleshoot, how to think on the fly, how to correct their own errors, and how to learn from mistakes. I have to remind myself that the safest place for them to make mistakes is while I am by their side.

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

Both. I look ahead to see who I am working with and which areas I am covering. That way I can figure out whether I need to mentally access more fast-track topics, more critical care topics, or more bread-and-butter EM topics. I also look to see what year the resident is that I am working with so I can tailor my teaching to the appropriate level. Ultimately bedside teaching is dynamic though so I also need to be prepared to improvise on the fly.

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

Before. It helps me organize my thoughts so I can drive the teaching in a more organized meaningful way.

How do you boost morale amongst learners on shift?

Food! Seriously though, I firmly believe there is a boomerang effect to outlook, mindset, and mood. Good morale has to start with me.

How do you provide learners feedback?

Verbal in real time on shift, written after shift

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

Stay curious–keep asking questions of your patients, co-workers, and attendings.

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

LITFL (ECGs), YouTube and EM:RAP HD (for procedures), Google images (rashes)

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

ECGs, chest pain, and rashes.

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

Anna Kalantari, George Willis, and Jenny Beck-Esmay.
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Read other How I Educate posts for more tips on how to approach on-shift teaching.

By |2023-03-22T12:12:57-07:00Feb 1, 2023|How I Educate, Medical Education|
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