This week’s How I Educate post features Dr. John Casey, the Program Director at OhioHealth Doctors Hospital in Columbus, OH. Dr. Casey spends 100% of his shifts with learners, including emergency medicine residents, off-service residents, medical students, nursing students, physician assistants/nurse practitioner students, and EMS students. He describes his practice environment as a busy community teaching hospital located on the city’s edge, with a diverse patient population and many socioeconomic challenges. Below he shares with us his approach to teaching learners on shift.
Name 3 words that describe a teaching shift with you.
Use. The. Force.
What learning theory best describes your approach to teaching?
Deliberate practice. I think it’s so very important to identify an area of weakness and target it. I try and focus my teaching energy on areas where learners have blind spots and get them to engage in very targeted practice in that specific area.
What is one thing (if nothing else) that you hope to instill in those you teach?
Always be curious, and not be afraid to challenge your own beliefs – or to have them challenged!
How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?
I try and teach my more senior residents how to incorporate junior learners and students into their workflow. When a learner locks on to you for a shift you don’t know if you’re getting a parachute or a knapsack…don’t jump out of the plane until you have identified which they are.
Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?
Nope. Department flow and metrics are part of the learning process. A lot of our job is more than medicine. To be happy and successful in this career long term you have to have a plan to manage these stressors – so better to learn it in residency while you have support from experienced emergency physicians. There will always be faster shifts, slower docs, efficient nurses, and lab slow downs – learn to work through them.
It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?
Be confident in your own abilities to manage situations, and remember you learned to be better through practice. As long as you are available to support them, and recognize the boundaries of what is safe for the patient and the learning environment, then most learners appreciate this on the other side. Earlier in my career, I probably let learners struggle a little more than I should have, and this is a place where I have learned – and grown – through feedback.
Do you start a teaching shift with certain objectives or develop them as a shift unfolds?
I think it’s better to let them develop as the shift unfolds. I will often ask if the learner has something in mind, and if they do I am happy to cover it – but no guarantees!
Do you typically see patients before or after they are presented to you?
I deliberately shake this up. When I see them before, I will often engage the patient in helping me get feedback on the learner. I will ask that they not specifically mention I have seen them, and give them an area to focus on (like did the resident ask similar questions to what I asked, or did they make them feel comfortable, etc.). I will then circle back and get feedback – you can learn a lot about how residents interact with patients using this method. Also – I love to go into the room while they are doing the exam and interview. Hawthorne effect aside, you can learn a ton about how the learner is doing overall!
How do you boost morale amongst learners on shift?
I work hard to pay attention to the overall mood of the shift and try and throttle accordingly. I am by nature a storyteller and like to share experiences. It’s more than just lip service when we talk about cases where we didn’t do as well as we wanted at something. Human nature is to feel like we are totally responsible for mistakes when almost always there is a substantial mix of exogenous events that lead to failure. Also – I remind learners that whatever they feel in the moment is OK – those feelings about an event change with time and perspective. Windshields in a car are big for you to look forward, and rear-view mirrors are tiny so you can remember past lesions – but focus on what’s next. Additionally….dad jokes.
What tips would you give a resident or student to excel on their shift?
Be nice. Work hard. Stay humble. If you only have enough energy for one on a given day, be nice.
What are your three favorite topics to teach during a shift?
ECG interpretation, anaphylaxis, and reading a room
What is your favorite book or article on teaching?
Thanks for the Feedback: The Science and Art of Receiving Feedback Well by Stone and Heen. I guess it’s not really a book on teaching per se, but if you can help people learn this skill (and master it yourself) it can make for a great learning environment!
Who are three other educators you’d like to answer these questions?
Dr. Katie Holmes, Dr. Deena Bengiamin, and Dr. Kristy Schwartz
Read other How I Educate posts for more tips on how to approach on-shift teaching.