Bottom Line 1 This study tells us what we might already suspect: in the busy, hectic and loud Emergency Department, patients we discharge often lack comprehension of their hospital course. Additionally, they are frequently unable to report their diagnosis, a discharge plan or reasons they should return to the ED.
The following compilation of the Most Interesting Articles in 2012 is the work of the EM residents at the Jacobi/Montefiore Emergency Medicine Residency Program.
Standing at the intersection of patient care and academics, we Emergency Medicine residents have overwhelming expectations. We’re the ones dropping NG tubes, popping abscesses, and pushing stretchers, while also expected to remain up to date with current research and trends in our field. With all these lofty expectations, not to mention the ever-present requirement of sleep and caloric intake, how does a resident pick which papers to read in this sea of literature?
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.
Learners 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.
I 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.
“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?
Andragogy refers to learning strategies which help adults to learn more effectively.
It is a term that was first used by Alexander Kapp in 1833 and later expanded by Malcolm Knowles to fit the needs of adult education. The concept is contrasted with pedagogy in which the child is lead through the learning process by the teacher. In andragogy most of the learning is self-directed and the teacher is a facilitator in the learning process. (more…)