Anyone who teaches medicine asks students to list their differential diagnosis when discussing a new clinical case. It’s also part of several models for education including the One-Minute Preceptor and SNAPPS.
For the most part, students are good at coming up with answers to the differential, but what do you do when they strike out? Or what if the answer is always the same, i.e. chest pain = myocardial infarction?
Asking effective questions is a valuable skill for any teacher. As a junior faculty member working to improve my teaching, I’m often in awe of my more experienced colleagues when I have the chance to watch them teach. At times, it’s quite easy to pick out the skills that they put into action but occasionally, their expertise is much more subtle.
Effective questioning falls into this category.
I’m in the middle of an intense weeklong course on debriefing for medical simulation here in Cambridge, MA. One of the goals many of the participants share is our desire to improve our skills in the art of debriefing after clinical simulations. Although the course focuses on “Debriefing with Good Judgement” 1 today the faculty also offered a simple tool to structure a brief debrief when time is very limited.
You are taking care of a patient, who frequently presents to the ED for polysubstance use. You are pretty sure his altered mental status is from polysubstance use again. He was found in his home next to drug paraphernalia. He intermittently becomes severely agitated, and so you give him sedatives. He has a low-grade fever, but you attribute that to his psychomotor agitation and likely stimulant use. Because he remains confused and lethargic after 8 hours, you admit him to an inpatient team to await further metabolism of his recreational drugs and your sedation medications.
The next day, you learn that had meningoencephalitis.
As I was going through the free EM-RAP Educator’s Edition podcasts, somehow missed the March 2010 podcast on how to teach procedures in the Emergency Department. In the 36-minute podcast, Dr. Mak Moayedi (Univ of Maryland) discusses a framework to teaching procedures. Check it out.
More specifically, Dr. Moayedi talks about how teaching procedures has moved beyond the antiquated “see one, do one, teach one” philosophy. Instead, we should follow principles based on accepted adult learning theories.
Evaluations of clinical faculty typically incorporate comments from rotating medical students and residents regarding their teaching ability. In the Emergency Department (ED), how do you balance your pressing clinical responsibilities with teaching?
Kudos to Dr. Vineet Arora (Univ of Chicago) on creating a great video on the importance of clear, concise, and updated hand-off information on patients. This is especially important in the Emergency Department where patients are constantly being “signed out” to other residents for continued acute care. Whatever hand-off process you are using now, we can always do better.