This week’s How I Educate post features Dr. Christina Shenvi, the Director of the Office of Academic Excellence and former Associate Residency Director at the University of North Carolina, Chapel Hill. Dr. Shevani spends approximately 80% of her shifts with learners, including emergency medicine residents, off-service residents, and medical students. She describes her practice environment as tertiary care academic center. Below she shares with us her approach to teaching learners on shift.
Name 3 words that describe a teaching shift with you.
Interactive, team-based, and collaborative.
What delivery methods do use when teaching on shift?
Verbal discussions usually with both residents and med students, where we take turns coming up with answers to things, and share ideas or resources. For example, if we are discussing the causes of falls in older adults, we go around in a circle coming up with things that contribute to the fall syndrome in older patients until none of us can think of any more. For questions with fewer options or answers, I will start with the med student and then move up to the intern and PGY3 to develop a progressively more nuanced or thorough discussion.
What learning theory best describes your approach to teaching?
Scaffolding; social constructivism.
What is one thing (if nothing else) that you hope to instill in those you teach?
A lifelong curiosity and love of learning.
How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?
I look for times when there is either a natural learning opportunity, a lull in activity, or both. If there is an interesting CT or EKG, that is a good learning moment to gather the group and briefly discuss it. If there is a lull in activity, that is a good time to discuss a given topic related to a patient we have taken care of. It sometimes comes at the expense of documentation, but teaching is a priority.
What is your method for reviewing learners’ notes and how do you provide feedback on documentation?
Usually, I review notes on shift if they are available and provide feedback.
Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?
We do what we can with what we have. There is a joint mission in academic hospitals: to care for patients *and* to teach. If the pendulum swings too far one way or the other, then one of the missions will suffer. The goal is to keep both in mind and find moments for teaching, while making other tasks, such as documentation, as efficient as possible.
It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?
I will usually ask: “Let me know if you need a hand or another set of eyes.” If it is a patient safety issue, then I will step in sooner, otherwise, there is usually time to let them try on their own.
Do you start a teaching shift with certain objectives or develop them as a shift unfolds?
I will usually ask the residents or students what they want to work on that day, or what they would like feedback on. By honing in on their goals, I can pay more attention to the area that they are working on, whether it is ultrasound, EKG interpretation, department flow, communication, etc. That also focuses their attention on the area, so they can work on it.
Do you typically see patients before or after they are presented to you?
After – this allows the learner the chance to gather the information first and present it so that they are the primary caregiver.
How do you boost morale amongst learners on shift?
Staying positive myself is the first goal. Focusing our energy on what we can control vs what is outside of our control is key as well.
How do you provide learners feedback?
Verbal feedback during or at the end of the shift is often the most effective because it can lead to more reflection and discussion. I also provide written feedback online after the shift.
What tips would you give a resident or student to excel on their shift?
Let your attending know what you want to work on and get feedback on. This will help them give you better quality feedback at the end of the shift, rather than “good job” or “read more”. Take ownership of your own learning, making a reading or study schedule for yourself. Pick your favorite resources and podcasts, and make regular time to use them.
Are there any resources you use regularly with learners to educate during a shift?
I often use LITFL and other online resources to show examples of EKGs, procedures, or images.
What are your three favorite topics to teach during a shift?
My fellowship training is in geriatric EM, so I enjoy teaching specifically on geriatric syndromes and falls, ACS in older adults, as well as on EKGs.
What techniques do you employ when teaching on shift?
Discussion, Q&A, elaboration (ie. taking a given case or situation and expanding to other related cases to discuss and expand the learning opportunities).
What is your favorite book or article on teaching?