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.