Picture courtesy of wstera, Flickr Creative Commons

Image credit: wstera

Teaching in the emergency department can be a challenge. Distractions and interruptions are everywhere and there always seem to be more things to do than there are people to do them. These challenges are magnified when our learners are struggling. In The Case of the Exasperated Educator, we will discuss these issues and how we, as educators in emergency medicine, can address them as effectively as possible.

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in pdf format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of the Exasperated Educator

by Drs. Lindsay Melvin (@LMelvinMD) & Teresa Chan (@TChanMD)

The day was turning out okay for Justine. She’d gone to the gym this morning at 8 am, and now refreshed, she strolled into the Emergency Department right on time to start her 10am shift. Double-whip mocha coffee frappe in one hand, stethoscope in the other, she was feeling pretty good. Having just started as a junior faculty member at Best University, Justine felt energized as she walked in the doors of the busy trauma bays of A.W. Esome hospital wondering what exciting new cases would be thrown her way!

Setting down her bag, she looked over and saw her friend (and fellow recent grad) Charlie looking quite a bit exasperated.

“Tell me more about the chest pain, Bobbi,” Charlie grunted. The medical student seemed nervous, shuffling papers and trying desperately to find the answers somewhere in her pile of scrap notes.

“More? Well, I, um, well, it is central… it feels like a knife… um, um, he also had it before, too, but a long time ago…” She pauses. “That’s it.”

Charlie sighed. He abruptly grabbed the chart, and started flipping through her paper work. Justine thought he looked especially tired, and quickly looked over to the staffing schedule. She thought she had seen him last night coming in as she left her busy days shift…. Wait… Ah-ha! That’s right, he HAD worked last night until 2 am! And he was back again already for a 7 am shift? That was an extremely short turn around for him, Justine noted.

Charlie flipped the medical student’s chart to reveal a sparse, very messy, note.

“Is that all you wrote?”

“Yes.” Bobbi replies.

“What about the ECG?”

“Um, It was fine. I think…” There was a pregnant pause. “Actually… I don’t really know where it is.”

“Did you look at it?”

“Well… no. I couldn’t find it… um, it isn’t with the chart.”

If the medical student had been nervous before, now Justine was worried she was going to keel over. Her face had dropped, and she was turning a particularly bright shade of pink.

“Bobbi, this assessment is not complete. Go back and do a better job.”

“Okay… but …”

“No ‘buts’. Go. NOW.”

As the medical student stumbles out of the room, Charlie turned to Justine and shrugs. “Man,” he exclaims, rubbing his eyes. “It’s good to see you! It’s been so busy this morning, and we’ve already had two cardiac arrests, and now the department is totally backed up…”

Justine raised an eyebrow. “Uhhhhh… What’s up with that student?”

“Oh, Bobbi? Yeah, she’s pretty rough still…. All her assessments and notes are always only half done, and she never seems to know what’s going on. This is the third chest pain she’s had now, and this one was no better than the last. I’ve told her twice to be more thorough and not to rush. But she keeps coming back with an incomplete history.”

“Hmmm. Sounds like it’s been a tough day,” remarked Justine. “But you were a bit tough on her, no?”

“She’s really very weak. And it’s my third shift with her. I’ve given her all the time in the world with her patients, and still, she’s just not getting it. Of course, I’m going to be honest with her. She needs to stop making excuses, and get the job done…. Why? What was I supposed to say?”


Key Questions

Imagine you are in Justine’s shoes.  How might you handle the situation?

  1. What advice would you give Charlie colleague about handling this interaction?
  2. Is this a learner in difficulty? How would you make that determination?
  3. What other factors are contributing to this scenario?
  4. What are the barriers to dealing with learners in difficulty in daily interactions and how can these barriers be overcome?

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published on June 5, 2014.

Click HERE for a link to the Expert & Community responses, which include words from:

  • Dr. Allison Kirkham (@AllisonKirkham) is an educational fellow at the University of Alberta. She is currently also undertaking a Masters of Education
  • Dr. James Kimo Takayesu received his M.D. from the University of California San Francisco, after which he headed north to complete his residency with the Harvard Affiliated Emergency Medicine Residency Program (HAEMR) at Brigham and Women’s Hospital and MGH. He now works at MGH as an emergency physician and is also assistant professor of surgery at Harvard Medical School.

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.  Also, as always, we will generate a curated community commentary based on your participation below and on Twitter.  We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

Brent Thoma, MD MA
ALiEM Associate Editor
Emergency Medicine Research Director at the University of Saskatchewan
Editor/Author at CanadiEM.org
Brent Thoma, MD MA