This week’s How I Educate post features Dr. Andy Little, the Associate Program Director at AdventHealth Florida in Orlando. Dr. Little spends approximately 90% of his shifts with learners, including emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a busy community EM residency program that sees over 100,000 patients per year. Below he shares with us his approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Malleable, understanding, fun.

What delivery methods do use when teaching on shift?

Post its and fill in the blanks.

What learning theory best describes your approach to teaching?


What is one thing (if nothing else) that you hope to instill in those you teach?

That there is always something you can learn from your patient.

How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?

There is a time to teach and a time to see patients. When we don’t have a specific topic to discuss, we see patients and focus on specific parts of the history and physical one cannot miss for that complaint. It comes at some sacrifice to charting, but that’s the gig.

What is your method for reviewing learners’ notes and how do you provide feedback on documentation?

I do a mix of on-shift and after-shift notes reviews. I focus on finding trends about how learners chart, and give feedback accordingly.

Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?

Yes. But being malleable allows me to again teach with what comes through the door and let each patient we see teach us something.

It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?

This may sound funny, but I count down from 20 in my head. So if I see things going wrong, I count down and then take over. I have found even the learner with the worst struggles can usually course correct in that time.

Do you start a teaching shift with certain objectives or develop them as a shift unfolds?

Develop them as a shift unfolds. Remember, malleable.

Do you typically see patients before or after they are presented to you?

It’s a mix. For my PGY 1’s I want them to see the patient first and ask them to present them as soon as they have so we can focus on their ability to rapidly access and formulate off of their H and P. For my seniors I try to see them first, so when they tell me their plan I can use that time to discuss what they did or didn’t pick up on and how I would change their plan. And everyone else falls somewhere in that spectrum.

How do you boost morale amongst learners on shift?

Focus on the little things they are doing well.

How do you provide learners feedback?

A mix of real-time verbal feedback (towards the end of the shift< post-shift evaluations) and then monthly reviews.

What tips would you give a resident or student to excel on their shift?

Be willing to be wrong. Learning doesn’t happen otherwise.

Are there any resources you use regularly with learners to educate during a shift?


What are your three favorite topics to teach during a shift?

EKGs, procedure tips, and reading plain films.

What techniques do you employ when teaching on shift?

Post it notes, custom made fill in the blanks, and coaching

What is your favorite book or article on teaching?

The Coaching Habit

Who are three other educators you’d like to answer these questions?

George Willis, Jenny Beck Esmay, and Jessie Werner.
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Read other How I Educate posts for more tips on how to approach on-shift teaching.


Andy Little, DO

Andy Little, DO

Associate Program Director, AdventHealth EM Residency
Host/Co-Founder, EM Over Easy Podcast
ALiEM Blog Editor