“The worst thing about busy shifts is that I never learn anything.”
– anonymous resident

A junior resident and I were contemplating the many difficulties of residency, especially when working at a busy urban ED where patients are plenty, but teaching during shifts may be harder to come by. We discussed the importance of coming up with at least one learning point or clinical question during each shift, and making a point of following through and reading up on it after.  (That shift we both learned about fat emboli s/p extremity fracture.)

But even with self-initiated learning adventures, I think that it is important that faculty and senior residents take the lead and actively work to ensure that learning occurs for every resident and every medical student during every shift, throughout all years of residency. Some educators actually say that something can be taught on just about every case seen with a resident if approached correctly.


2013 New Year’s Resolution

Create 1 teachable moment, for every resident and every medical student, during every shift!

Don’t get overwhelmed with that resolution.
It is completely do-able!


What is a teachable moment, and how to teach for that moment?

First off, a teachable moment is exactly that, A TEACHABLE MOMENT! Not hour, not lecture, not thesis statement. But, by allowing the thought of the teaching to overwhelm the teacher, we create mountains and mental barriers. How often have we felt that it was too exhausting to explain to the junior the intricacy of the discriminate zone of beta-hcgs regarding work up of ectopic pregnancies, especially with a wait time over 6 hours?

I remember one attending that I worked with who would actually write down a checklist of three items for every patient that I would present to him. This checklist was not a To-Do list, but instead was solely dedicated to three learning points that he wanted me to have for each patient that I presented to him. We all know about the checklist manifesto for getting tasked completed… why not a checklist manifesto for teaching points?

I asked a few experts via Twitter for their thoughts on teachable moments.


Dr. Mallemat (@CriticalCareNow) and Dr. Gharahbaghian (@Sonospot) mentioned that bedside ultrasound is a great opportunity to not only teach about pathology, but also anatomy!  Which means it is perfect for teaching the medical student at the beginner level, and all the way up to senior resident at expert level.

@TheSGEM felt that ALL moments were teachable moments.

@BobStuntz stated that the key is to limit the teaching moment to 1 pearl or point only.  Think back to when you learned about that topic. Was there a learning point or pearl that stuck out for you?  If so, focus on that point during your short discussion.

There is a caveat to all of this… don’t forget that we all are in a constant state of learning, even if we don’t appear to be so. A senior resident once told me  it was particularly difficult to learn anything during shifts because attendings were so willing to defer to her judgment. This is a great amount of responsibility, but always remember that as doctors, there is always room for more.

Lets resolve to bring more learning and teaching on!

Happy New Year!

Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions