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The Most Dangerous 10 Minutes of Your Shift: Mastering the ED Hand-Off

Handoffs are everywhere, from shift changes to trauma transfers. Each one is a chance for error. A standardized, structured sign-out protects patients, supports teamwork, and makes you a safer, more effective emergency physician.

Why Sign-Outs Matter

In emergency medicine, handoffs are constant and high-risk. Nearly a third of healthcare workers report an adverse event tied to a poor handoff.

When communication falters, patients suffer: delayed results, missed diagnoses, duplicated work, or forgotten tasks. The stakes are higher in the ED, where the pace is quick, interruptions are constant, and boarding patients stretch the system thin.

But there is good news. You can build muscle memory for safer sign-outs.

The Chaos Factor

The emergency department (ED) environment is noisy, unpredictable, and distraction-heavy. You are juggling multiple patients while fatigue creeps in. Add in the rising tide of ED boarding, where admitted patients linger for hours or days, you are effectively doing hospitalist work from the ED.
The fix? Structure beats chaos. When you use a repeatable framework, you do not have to rely on memory alone.

Your Secret Weapons: SBAR and I-PASS

Two tools have changed the game for transitions of care:

SBAR: Situation, Background, Assessment, Recommendation

  • Situation: Who and what — name, room, complaint, severity
  • Background: Past medical history, meds, vitals, exam
  • Assessment: Results, consults, differential
  • Recommendation: Next steps, unresolved issues, “If X, then Y” plans

I-PASS: Illness Severity, Patient Summary, Action List, Situation Awareness, Synthesis by Receiver

  • Illness Severity: Stable, watcher, unstable
  • Patient summary: One-liner, hospital course, treatment plan
  • Action list: To-do list with ownership
  • Situational awareness: Situational awareness & contingency plans
  • Synthesis by receiver: Oncoming doc repeats key points back

Example:

  • I: Mrs. Aung is stable.
  • P: 24 YO Burmese speaking female with no prior medical or surgical history here with missed period (LMP 07/15) here with positive pregnancy. Very mild pelvic pain, no bleeding or discharge. POCUS cannot confirm IUP, pending a transvaginal ultrasound (TVUS).
  • A:  If TVUS shows IUP, overview bleed and return precautions. If no IUP, consult OBGYN for repeat 48-hour quant HCG and TVUS scheduling. Will need Burmese speaker.
  • S: This is a desired pregnancy. The patient is already on prenatal vitamins. She has an obstetrician she has chosen for the remainder of her prenatal care. Pain is 0/10 after tylenol. Burmese speaking only and wants to call her husband for final results.
  • S: So we have a stable 24 YO G1P0 about 6 weeks pregnant with resolved pelvic pain. Normal speculum, no discharge or bleeding but pending TVUS to confirm IUP vs pregnancy unknown location. Pending TVUS results, either DC or OB/GYN consult for 48 hour re-assessment. Will close loop with her with a burmese interpreter, and call in her husband via phone for this update.
  • Pro tip: The best sign-outs end with questions. “Anything unclear?” is your final safety net.

“Structure beats chaos. Every handoff is a procedure — and your patients’ safety depends on how you perform it.”

How to Crush Your Sign-Out

  1. Prep early. Use your last hour to update labs, imaging, and consults.
  2. Run the list with your senior or attending. Identify what is pending and who’s admitted.
  3. Label patients. Stable, unstable, watcher, and whether they have been admitted or are actively being managed. Active cases need the most detail.
  4. Reassess before handoff. Do not hand over outdated data. Recheck vitals, meds, and nursing updates.
  5. Pause for quiet. Two minutes of focus beats ten minutes of confusion later.
  6. Meet the patients when possible. After sign-out, take time to go introduce yourself to each patient, and make sure the plan still holds and that the patient has not clinically worsened since the last check.

Special Populations = Special Attention

Psychiatric patients, nonverbal or critically ill patients, and those with language barriers need deliberate communication. If you could not complete a full history or exam, say so. Handoffs are only as good as their honesty.

The Cognitive Trap

It is easy for the oncoming physician to anchor on your impression. Counter that bias by encouraging independent reassessment, and do the same when you are on the receiving end. Verify labs, imaging, and the story yourself. Resasses the patient to see if they need more medications, or if their symptoms have changed or progressed.

Bottom Line

A clean sign-out is a procedure, not paperwork. It demands attention, structure, and mutual respect. Whether you use SBAR, I-PASS, or your department’s own system, the goal is the same: continuity, clarity, and safety.

Because in the ED, those ten minutes at shift change might be the most important ten you spend all day.

Bridge to Emergency Medicine

Want to master more critical ED skills? This article is part of the Bridge to EM Curriculum—a comprehensive, self-guided learning platform designed for emergency medicine residents. Complete the accompanying ALiEMU quizzes to earn residency conference credit and track your progress through essential EM topics.

Further Reading

  1. Cheung DS, Kelly JJ, Beach C, et al. Improving Handoffs in the Emergency Department. Ann Emerg Med. 2009. PMID 19800711
  2. Horwitz LI, Meredith T, Schuur JD, et al. Dropping the Baton: Failures During Transition From ED to Inpatient Care. Ann Emerg Med. 2009. PMID 18555560
  3. Leonard M, Graham S, Bonacum D. The Human Factor in Safe Care. Qual Saf Health Care. 2004. PMID 15465961
  4. American Academy of Emergency Medicine. Position Statement on Physician-to-Patient Staffing Ratios. 2023.
  5. Smith C, Buzalko R, et al. Evaluation of a Novel Handoff Strategy. West J Emerg Med. 2018. PMID 29560068
By |2025-10-29T10:38:34-07:00Oct 30, 2025|Medical Education, Professional Development|
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The First Pulse Check: How to set yourself up for success in EM residency

physician pulse check
“Are you ok?” My wife asked as I flopped onto the bed, which was still just a mattress on the floor. I (KL) had just finished my first shift as a resident and was overwhelmed. We still had furniture to buy, boxes to unpack, and countless things to repair. The house we were so excited to move into had not lived up to our expectations when we saw it for the first time in person. Despite all the housework we had to do, I felt paralyzed by the incompetence I felt on my first shift. The mountain between myself and some semblance of a doctor seemed insurmountable. I had been told about 15 different resources by 15 different residents since Match Day and had no idea how to start learning. Plus, my wife and I had just moved 1,000 miles away to a place where we had no community and no family.

Depending on where you match, you may be dealing with some, all, or even more challenges and issues as those described above. While nothing can fully prepare you for your first day of residency, consider us your big brothers/sister who can share tips and tricks that we have learned, heard, and gleaned along the way.

Preparing for residency requires a lot more than just brushing up on Tintinalli’s. Some medical knowledge is a pre-requisite, but it is by no means enough to help you make it through residency with your personality, relationships, and your soul in one piece. You can start preparing mentally, personally, and interpersonally for what will likely be one of the hardest (and best) jobs of your life.

This guide, while not comprehensive, hopes to spark your thinking about major points you should consider between Match Day and your first shift as a doctor.

First things first… Celebrate!

You made it! Regardless of where on your list you landed, you are on your way to learning and honing your craft. It is now time to start taking care of real patients who are going to call YOU doctor. While some things on this list need to be started soon after Match Day, don’t forget to slow down and smell the roses- make sure those trips or family visits are planned and reflect on your current journey and next steps forward.

Prepare to Move

While the academic year begins on or around July 1st, it’s important to note that you will have responsibilities as early as late May with your residency program. All programs will have at least one week of orientation prior to July 1. If you are planning a big trip or vacation, then make sure you know when you are expected to be on campus. Give yourself 3-4 weeks prior to your orientation start date to move so that you will have time to get unpacked, explore the area, and, most importantly, meet and bond with your new co-residents before you get busy and disperse around the hospital.

Prepare a New Place to Live

Should you rent or buy?

While all of us are in different financial and family situations, perhaps the most important thing to consider when answering this question is: What are your plans after residency? Most financial planners will tell you that you should own a home for at least 5 years for the value increase to offset things like closing and realtor costs [1]. This is important given EM residencies are all 3 or 4 years.

Questions to ask yourself include:

  • Am I planning on fellowship?
  • Is it a competitive fellowship, or a fellowship not offered by my program?
  • Is this somewhere I want to live after residency AND a place with a reasonable job market?

If you feel confident that you will be in a location for the long run, then buying a home might be the right decision for you. If you plan to buy, then finding a realtor should be one of the first things on your list. Purchasing a house is a very lengthy process, on average around 44 days [2], so you should be prepared to sign a contract within a month or so of Match Day. Keep in mind, you can also use a realtor to help with renting, often at no cost to you, but they won’t always be as quick or responsive as with clients looking to buy, as their financial return is much lower than for purchasers.

Another thing you can do is ask graduating residents about homes or apartments to rent as they move out, which may make the transition and finding a vetted location easier.

Pro tip: If your significant other works from home or will spend a lot of time at home, save both of your sanities and ensure you have enough space so you can sleep after a night shift while they work.

Prepare Your Finances

Congratulations! You’re about to be RICH (er). While it’s true that MAKING money is a lot better than PAYING money to be in the hospital, there are some worthwhile financial questions to consider prior to starting residency. Most importantly, make sure you have a plan for how you are managing your loans. While the loan landscape is constantly shifting, the AAMC provides a good starting point to think through your options [3].

Additionally, keep in mind how many expenses are associated with moving and starting residency. Depending on your contract, you will potentially be responsible for two rents while in limbo, a security deposit, applying for your medical license, in addition to the usual living expenses. Just because your orientation starts in June, you should not anticipate receiving your first paycheck in June. Often orientation pay is included in your first paycheck of the academic year and may not come until mid or late July. Also, in order to make a budget and understand what you can afford, you will need to know how much of your income will be taken out in taxes and benefits before it hits your bank account.

Now is a great time to level up your adulting and your budgeting skills. There are plenty of budgeting apps available [4]. Honeydue, is a favorite for author KL.

Prepare to Get Plugged into Your New Community

Undoubtedly one of the things you considered when you made your rank list was the location you would be traveling to and the things you could do there. Whether you find yourself in the Smoky Mountains, Miami Beach, or downtown New York City, you’ve chosen a place that will allow you to pursue new or old hobbies. Make a list of hobbies and activities that have helped you de-stress in medical school and learn how they can best be applied to your new area so that you have a prepared plan to unwind before the stress even hits.

Early on is a good time to also get plugged in with medical and community services that you might need. Waiting to try to find a primary care physician (PCP) when you are about to run out of your daily prescriptions, or when you have an acute medical need, is not a good idea. Find one and have a visit early, so that you can make sure you have access to someone who can refill your medications, see you when you are sick, or place referrals when you need them. Doctors are notoriously bad patients. Don’t let that be you. Follow the advice you will find yourself doling out almost every shift, and get plugged in with a PCP.

Your needs and interests will vary, but a good starter list of services and communities you may want to explore and get plugged in with include:

  • PCP (this can take several months, so get started early) [5]
  • Therapist
  • Dentist/orthodontist for you and any family members
  • Gym
  • Coffee shop
  • Church or other religious
  • Community or activity group, such as hiking or running groups

Prepare Your Friends and Family

You’ve worked hard in med school, but as much as we hate to say it, residency is when things actually start to get tough. It’s important to let your family, non-medical friends, or significant other know what to expect. For example, walk through your schedule with your significant other so that they know when you will be in the hospital. Make sure you have a shared calendar and that they can see your shifts. Discuss how you will manage sleep when you are post-call. Explain the importance of day-time sleep on night shifts and figure out what you can do to make it quiet, dark, and uninterrupted. This will take the support of your significant other or family. Let family and friends know that given the time commitment of residency that it’s helpful to know in advance as possible about events like weddings, group trips, family events, and that you may have limited availability and flexibility depending on the times of the year and your workload.

Prepare to Do Your Paperwork on Time

Don’t be the resident who causes trouble. For starters, pay attention to your email, and do your paperwork on time. Don’t make them email you reminders or hound you to get basic things done. Seemingly simple things like this could keep you from getting future positions like being a chief resident, or even getting hired later, if you have a reputation for being late or unreliable with basic things.

Prepare Your Calendar

More than other jobs, even more than other medical specialties, your calendar will now control your life. Your schedule will have very little consistency, and you will need to constantly be checking to recall when your shifts begin and end. Our program, for example, has shifts beginning at 0700, 0900, 1200, 1300, 1500, 1700, 1900, and 2300. These shifts are any combination of 8, 9, 10, and 12 hours long and could be at one of four different hospitals. Find out what calendar system works best for you and get good at using it.

Additionally, get an early understanding of what time you have guaranteed off.

  • Do you get a golden weekend every month?
  • How many weeks of vacation can you request?
  • Are there any off-service rotations you can anticipate having the weekend off?

These are all important questions to have answers to when it comes to planning things like weddings. Depending on how your schedule works you may have to take one of your vacation weeks to ensure you can make it to important events like weddings. You will undoubtedly receive a text from one of the current residents shortly after match day, these are great questions to ask them about.

One of the “hidden curriculum” items is to understand the culture around requests and shifts. This information won’t be written in any of your policy guidebooks, but it has to do with the culture of work. Is the culture that you arrive 10 minutes early and take sign out then? Or does sign out start right on the hour? Is the culture to sign out any active patients, or to try to complete most of the dispositions before signout? Is the culture to try to swap shifts when you need it, or to do whatever possible to set your schedule up from the start. These types of things are norms that you can ask about and also observe the upper-level residents to see how they function.

The start of residency is a great opportunity to learn how to automate EVERYTHING. Rent, utilities, and credit card payments should not be part of your cognitive burden. Anything that cannot be automated needs a reminder (i.e., take the trash out). Working a schedule of nights, weekends, and holidays means that while the rest of the world knows Sunday as the day after Saturday, you just know it as a day you work or don’t. This can make it difficult to remember scheduled weekly events like trash pickup.

Prepare to Embrace the EM Community

Since you have matched in EM, that will become a core part of your identity as a physician. However, you will come to find out there is a whole world of alphabet soup and niches/interests to explore in our broad world of EM. There are many ways to get involved and explore both at a national level as well as locally in your residency that will help “fill your cup” for the non-shift parallel to practice that gets you excited!

Starting with alphabet soup, know the big organizations and see if you want to get involved.

  • American College of Emergency Physicians (ACEP): Emergency medicine’s primary professional organization- ACEP publishes practice guidelines, covers breaking news related to EM, advocates for EM physicians nationally and at the state level, and provides high quality conferences and education.
  • Emergency Medicine Resident Association (EMRA): Run by EM residents and for EM residents- EMRA publishes on-shift clinical books, publishes resident perspective articles, advocates for residents to other organizations, and houses multiple interest committees from education, POCUS, Critical Care, EMS, and more.
  • Council of Residency Directors in Emergency Medicine (CORD): EM’s education-focused organization involving pre-clinical educators, clerkship directors, residency faculty, program directors, fellows, and involved residents
  • Society of Academic Emergency Medicine (SAEM): Organization focused on advancing EM research and education including department chairs, researchers, faculty, residents, and more. Includes Residents and Medical Students (RAMS) board which is the resident specific sub-organization of SAEM.
  • American Board of Emergency Medicine (ABEM): The governing organization that creates and oversees the board certification process for EM physicians
  • Accreditation Council for Graduate Medical Education (ACGME): The organization that sets the standards and requirements that a resident of any specialty must meet to graduate as well as standards for a program to meet to be accredited. They govern multiple specialties, but you will hear about them a lot in coming years due to EM program requirement changes.

Additionally, you will see your faculty wear different hats from EMS director, Emergency Ultrasound Director, ED Operations team, Toxicology expert, nocturnist, research PI, and so much more.

Ask for mentorship, but understand mentorship is a two-way street. Mentors and advisors prefer residents who are both invested but also self-motivated to move projects forward or complete tasks. This is also a great way to get plugged into communities that interest you, such as simulation or global health. Ask early, because although individual ED shifts feel long, time otherwise flies in residency. Graduating with an area of expertise and a community for your niche can help you be more successful and satisfied with your career in the long run.

Prepare Your Knowledge

Every intern will arrive with different levels of knowledge, procedural experience, and soft skills. Multiple landmark educational studies have shown learners universally suffer knowledge attrition during large breaks, a phenomenon termed “summer learning loss” because of its origins in research surrounding primary school [6]. Students who continue to engage with content minimize this knowledge loss, build more knowledge, and perform better [6].

You can turn the time between Match Day and the start of intern year from a “summer learning loss” time to period of continued learning. Fortunately, you do not have to navigate this time on your own. There is an ALiEM curriculum, sponsored by EMRA, specifically designed to help prepare medical students for the start of intern year in EM, called Bridge to EM [7]. The curriculum is excellent, self-paced, and free. It maps out a multi-week program that guides you through the best educational resources that are not purely textbooks. It includes core content areas of EM knowledge, POCUS, soft skills for interns, and image interpretation in small bites during the weekdays with intentional spaced repetition to help you recall the knowledge better. The goal of this program is to help you feel more prepared when you walk into the ED on day 1.

Once you start intern year, the C3 series from EM:RAP is a great podcast to help you learn approaches to chief complaints and presentations. 98%+ of residency programs provide EMRA membership for their residents, and EMRA members can access EM:RAP for free.

Lastly, we recommend waiting to invest in question banks until you get to your program. Educational question banks and tools such as PEER, EMCoach, Rosh, and more are often provided by your program. As with any big test, the yearly In Training Exam (ITE) that you will take each February rewards consistent daily studying as opposed to cramming.

Prepare Yourself: Check Your Own Pulse First

There is a saying in Medicine that when there is a patient who is coding or who has vital signs that make you sweat, that you should check your own pulse first. Take stock of yourself. Make sure you are not spiraling out of control mentally or physically, so that you can perform at your best and take care of the patient. Similarly, now that you are about to start residency, it is a good time to get into the habit of checking your own pulse. That could be through more structured methods, such as counseling, therapy, coaching, journaling, or writing down your thoughts regularly. It could be a semi-structured approach, like checking in with yourself as you drive to work each day. Find small habits that you can start and maintain that will help you grow your own personal awareness, resilience, and strength.

Welcome to the specialty!

You’ve got this.

References

  1. Cahill E. How Long Should you Live in a House Before Selling. Experian, Jan 2023.
  2. McMillin, Petry, and Moore. How long does it take to buy a house. Bankrate, Nov 2024.
  3. Loan Management Options. American Association of Medical Colleges.
  4. McMullen L. The Best Budget Apps for 2025. Nerdwallet, Jan 2025.
  5. Consumer Reports. How to get in to see primary care physicians and specialists quickly. The Washington Post, Oct 2023.
  6. Quinn and Polikoff. Summer learning loss: What is it, and what can we do about it? Brookings Research, Sept 2017.
  7. Bridge to Emergency Medicine curriculum. Academic Life in Emergency Medicine, May 2024.
By |2025-04-07T00:56:34-07:00Apr 9, 2025|Medical Student, Professional Development|
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How to Cite Videos, Podcasts, Apps, Media, and Blogs in a Publication or CV (AMA style 11th edition)

cite AMA 11th edition reference blog media podcast

As medical education podcasts, videos, and blogs continue to grow in popularity it is crucial that we cite them correctly, both in publications and on our CVs. We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. The American Medical Association (AMA) Manual of Style released its 11th edition in 2020. This blog post provides an update to our 2018 blog articles to reflect these changes.

Video Publications

Last Name First Initial. Video Title. Publication Title. Year of publication. Date accessed. URL.

Example:

Podcasts and Other Audio

Last Name First Initial. Podcast Title. Episode Title. Date Published. Date Accessed. URL.

Example:

Apps

App Title app. Version number. Creator/Publisher. Date of last update.

Example:

    • CorePendium app. Version 1.24.2. EM:RAP. Updated February 2024.

Photographs, ECGs, Radiology Images

These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media.

For Media Used as a Supplement in a Publication:

Last Name First Initial. Media title. Date Published. Date Accessed. URL. Brief Description for: Article Title. Publication. DOI (if available).

Example:

For Media Without an Associated Publication:

This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. In the example below, there is no specified date of publication for the image.

Last Name First Initial. Media title. Date Published. Date Accessed. (if available). URL.

Example:

Blogs

Last Name First Initial. Article Title. Blog Title blog. Date Published. Date Accessed. URL.

Example:

References

  1. Iverson C, ed. American Medical Association manual of style: a guide for authors and editors. 11th ed. Oxford University Press, 2020.
By |2024-02-24T21:08:37-08:00Feb 28, 2024|Academic, Professional Development, Social Media & Tech|
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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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Teorías de la Educación en la Práctica (Education Theory Made Practical): An International Collaboration

spanish language book Teorías de la Educación en la Práctica

The vast majority of medical education materials (free or with cost) are available in the English language, a consequence of its hegemony as the language of science at a global level. In the world there are about 560 million people who speak Spanish, 460 million are native speakers, so Spanish is the language that has the second largest population of native speakers in the world after Mandarin. Although written English is understood by the Spanish-speaking community of health professionals, the best way to fully understand a text is reading it in the mother tongue!

It is therefore important to thank Teresa Chan from ALiEM and the clinical educators’ team that collaborate in the development of several texts on how to make educational theories practical, for their willingness to translate their material into other languages. The series “Education Theory Made Practical” (ALiEM Library) presents, with a simple but powerful strategy, educational clinical cases and reviews of the main educational theories for the consumption of students, resident physicians, and medical teachers around the world. These heroes and heroines of medical education have made this material available in free digital format, and with the Spanish translation of the first volume of this series (available at the Apple Bookstore and in ResearchGate) will help the community of Spanish-speaking medical educators with high-quality material for use in our countries. There is a great need for similar materials in Spanish, it is our fervent desire that the process of translation of these books continue, to help improve the quality of medical education globally.

 


La gran mayoría de los materiales de educación médica (gratuitos o con costo) están disponibles en el idioma inglés, consecuencia de su hegemonía como el idioma de la ciencia a nivel global. En el mundo hay cerca de 560 millones de personas que hablan español, 460 millones son hablantes nativos, por lo que el español es el idioma que tiene la segunda población de hablantes nativos en el mundo después del mandarín. A pesar de que la comunidad de profesionales de la salud hispanoparlantes entienden el inglés escrito, ¡no hay como leer un texto en la lengua materna para entenderlo cabalmente!

Es por ello importante agradecer a Teresa Chan de McMaster, Canadá y el equipo de clínicos educadores que colaboran en el desarrollo de varios textos sobre cómo hacer prácticas las teorías educativas, por su disposición para realizar la traducción de su material a otros idiomas. La serie “Teorías de la educación en la práctica” presenta, con un esquema sencillo pero poderoso, casos clínicos educativos y revisiones de las principales teorías educativas para consumo de estudiantes, médicos residentes y profesores de medicina de todo el mundo. Estos héroes y heroínas de la educación médica han puesto este material en formato digital y gratuito, y con la traducción al español del primer volumen de esta serie (disponible en la librería de Apple y en ResearchGate) ayudan a la comunidad de educadores médicos hispanoparlantes a tener un material de excelente calidad para su uso en los países hispanoamericanos. Hay una gran necesidad de materiales similares en español, es nuestro ferviente deseo que continúe la traducción de estos libros para mejorar la calidad de la educación médica en el mundo.

 

By |2021-11-29T19:45:55-08:00Dec 10, 2021|Academic, Medical Education, Professional Development|
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Reading from the Silver Linings Playbook: The ALiEM Connect Project

ALiEM Connect graduation

It feels like yesterday that we were sheltered-in-place, staring at our computers, wondering, “So now what?” 

As COVID-19 paused all in-person educational sessions, the early morning residency conference we used to begrudgingly join quickly became something that we profoundly missed. While we can now be “present” while wearing sweatpants and a button-down shirt, we miss the human connection. Many of us would gladly even suffer through traffic just to be a part of this morning conference tradition.

As educators and innovators, we know what a disruptive force the COVID-19 pandemic has been to the medical community. It has strained our medical and healthcare systems and has irrevocably altered our day-to-day lives. Without a doubt, the pandemic also changed how we delivered educational content to our learners over the past year.

Scholars have written about how likely this pandemic will likely precipitate the much-needed digital transformation of healthcare and health professions education that many of us have expected and hoped for. But while some of these innovations are born out of necessity, they may also inadvertently isolate us from the experiential aspects of education and human interaction that provide meaning to our work. For the ALiEM team, we cherish the opportunity to be part of some of these significant innovative and positive “disruptions,” further aligning our goal of creating an impactful and fulfilling academic life in emergency medicine. 

The Backstory

As a remote team working across continents, the ALiEM team has thrived on digital connection for over a decade. With excellent collaborators and volunteers representing different parts of the world, our daily operations require us to stay connected and work asynchronously to achieve our goals and deliverables. When the lockdowns hit, we leveraged its impact on physical distancing and leaned into connecting with each other even more! They say “chance favors the prepared mind,” and there we were, already on Slack and yearning for the opportunity to harness the power of teamwork using our shared passions, individual creative strengths, and enthusiastic and supportive emojis. There were moments of creating, moments of celebration, and moments of simply being with each other – often through an evening #WifiAndWine.

By the Ides of March 2020, an auspicious time indeed, we knew we were at a turning point. Our friends and work families had been working on the front lines combating the pandemic locally, gathering PPE, and studying the effects of a virus we knew next to nothing about. New information was coming in daily, and the signal-to-noise ratio was low. In some ways, to escape the disruptions going on all around us, we banded together to focus our unique energies toward creating something as novel as the virus itself in the realm of free open-access medical education.

At a time where everyone was feeling alone, we asked ourselves how we could support the joy of learning from and with each other? In truly whirlwind fashion, the first ALiEM Connect conference went from idea to execution in less than 2 weeks, a record-breaking time even for ALiEM. Thank especially to the American Board of Emergency Medicine for sponsoring these events.

We recently made it to the semi-finals at the CORD/ACEP Innovator of the Year competition, where we shared the below video capturing the fun, collaboration, and innovative outcome of our efforts. Oh, and the familiar ratatat of Slack.

Making this a Multiple Win

The secret sauce of the ALiEM team is that we have a diverse group of people, each of whom brings their own perspective and that we are able to share with one another liberally. Dr. Michelle Lin encouraged an environment that is psychologically safe and supportive since the inception of the ALiEM enterprise. It is out of this space that our diverse team was able to successfully bring a massively successful project to fruition amid a global pandemic. What started as a small brainstorming session blossomed into ALiEM Connect – 3 distinct remote conferences featuring nationally-recognized educators and thought leaders enjoyed by residents across the country.

It’s difficult to express as a linear narrative, but looking back, it seems as though our team divided into unique roles without a second thought. Just like a production company, we had the front and back of the house. Those in the front made sure to help get people in the seats to watch; stage managers and coordinators ensured that every part of each of the ALiEM Connect experiences was phenomenally smooth. We had talented individuals who acted as hosts and speakers to ensure that each of these experiences was top-notch and engaging. In the back, Drs. Mary Haas, Yusuf Yilmaz, and Teresa Chan sprung quickly into action to create a program evaluation strategy for our ALiEM Connect program, including a formal institutional review board exemption! All the while, testing and vetting platforms and methods to distribute the material were ongoing. We built upon each technological skill, learned new platforms, and trialed different features. We had barely decided on an open, free, and accessible platform (which was, in fact, no individual platform but an amalgamation of many!) before sending out the invites.

But the fun didn’t stop there! We’re the “academic” life in emergency medicine! How could we not also share our results with the traditional academic community? Within days of finishing our first ALiEM Connect experience, our program evaluation team generated the scaffolding of a manuscript to put together our thoughts and analyze the evaluation data collected. We harnessed the power of metrics from social media platforms (YouTube, Slack, Twitter), website analytics, and end-user experiences. Harnessing all of these analytics and communicating the right message with our academic medicine community was important to inform and help others to replicate similar approaches to their residents. Our team used ready to use metrics which came from YouTube analytics. But we did not stop there as we needed more reports of how the residents and programs interacted during the Connect events in the backchannel, Slack. We developed Python supported software to export and analyze all the messages happening in separate channels. We developed a “Emoji Cloud” to see how the reactions happened, and closely analyzed the messages during the event.

Given the true novelty of the experience, we figured we might as well shoot for the moon, as they say, by submitting our innovation description paper to Academic Medicine. After all, even if they didn’t accept it, we might get some constructive reviews, to say the least. As innovators, we are comfortable with the possibility of failure. We understand the value of the saying, “You miss 100% of the shots you don’t take,” and were prepared to accept “no” as an answer. With that, we took a calculated risk, making use of the same collaborative strategy to craft a manuscript, and clicked submit.

…And we’re glad we took that shot! We are excited to share that what we sent was indeed accepted and express our gratitude for the chance to share our low-cost approach to a large-scale, nationwide residency conference! You may read the Published Ahead-of-Print version of our paper.

Moral of the story…

You might be asking yourself, “What’s the moral of the story here? Of course, with enough academics and experts, yeah, you got a paper published. Cool…” But the papers aren’t the point. In fact, during the COVID-19 pandemic, more papers have been published than ever before – more research is being done, and our whole field is changing. The point is… this is how we got to ENJOY the academic life during a pandemic! We made lemonade (and several other desserts!) out of the lemons we were handed. New knowledge comes from thinking big and trying new things. Turns out, sometimes you also have to write about those experiences and share them with others.

As emergency physicians, we know we’re good in a crisis. But this experience reminded us that by surrounding ourselves with amazing people, we could get a surprising amount of work done (at record speed) and have a fantastically memorable time along the way. The moral of this story is that when you bring great people together and give them a chance to get to know each other, magic happens. ALiEM Connect happens. And we impact more people than we can possibly meet at the touch of our keyboards. We are so grateful for the chance to work alongside all the wonderful people at each of our institutions every day. Still, also, we are indebted to those who are our digital family. Thank you to all of you who make initiatives like ALiEM Connect possible. Academic life in emergency medicine is all about bringing a great team together.

So is the ALiEM team.

By |2021-04-23T11:02:57-07:00Apr 26, 2021|Academic, Beyond the Abstract, Education Articles, Medical Education, Professional Development, Social Media & Tech|
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