This week’s How I Educate post features Dr. Tarlan Hedayati, the Chair of Education at Cook County Hospital. Dr. Hedayati spends approximately 90% of her shifts with learners, including emergency medicine residents, off-service residents, and medical students. She describes her practice environment as a large, public, urban, Level 1 trauma center. Below she shares with us her approach to teaching learners on shift.
What delivery methods do use when teaching on shift?
Some of the other attendings joke that they know when I’ve been working because the garbage can is full of paper towels I’ve used to write on when I teach on shift.
What is your method for reviewing learners’ notes and how do you provide feedback on documentation?
Post shift. I usually send an email to the resident if there is something in the charting that can be improved upon or if the documentation is especially excellent.
Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?
Flow and metrics absolutely impact teaching and learning. If it’s too slow, the experiential component of education is lost. Too fast, and there isn’t time to make sure concepts and ideas are properly recognized and absorbed by learners. I try to verbally summarize things we have seen and learned toward the end of the shift as a recap so that learners are reminded of topics they should investigate further when they go home. I also incorporate specific cases in my written feedback so the resident can read it and remember notable pearls.
It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?
As long as there is no risk to the patient, I let things play out. I am pretty confident that I can bail out of a bad situation and know that I need to let them practice. Learners have to figure out how to troubleshoot, how to think on the fly, how to correct their own errors, and how to learn from mistakes. I have to remind myself that the safest place for them to make mistakes is while I am by their side.
Do you start a teaching shift with certain objectives or develop them as a shift unfolds?
Both. I look ahead to see who I am working with and which areas I am covering. That way I can figure out whether I need to mentally access more fast-track topics, more critical care topics, or more bread-and-butter EM topics. I also look to see what year the resident is that I am working with so I can tailor my teaching to the appropriate level. Ultimately bedside teaching is dynamic though so I also need to be prepared to improvise on the fly.
Do you typically see patients before or after they are presented to you?
Before. It helps me organize my thoughts so I can drive the teaching in a more organized meaningful way.
How do you boost morale amongst learners on shift?
Food! Seriously though, I firmly believe there is a boomerang effect to outlook, mindset, and mood. Good morale has to start with me.
How do you provide learners feedback?
Verbal in real time on shift, written after shift
What tips would you give a resident or student to excel on their shift?
Stay curious–keep asking questions of your patients, co-workers, and attendings.
Are there any resources you use regularly with learners to educate during a shift?
LITFL (ECGs), YouTube and EM:RAP HD (for procedures), Google images (rashes)
What are your three favorite topics to teach during a shift?
ECGs, chest pain, and rashes.
Who are three other educators you’d like to answer these questions?
Anna Kalantari, George Willis, and Jenny Beck-Esmay.
Read other How I Educate posts for more tips on how to approach on-shift teaching.