The Teaching Course

One of the hottest buzzphrases in Emergency Medicine and Critical Care Education is Stress Inoculation Training (SIT). For this podcast, Swami had the opportunity to sit down and chat with Michael Lauria. Mike is a 1st year medical student at Dartmouth University Medical School but he has extensive experience in SIT from his time as […]

I recently sat down with Salim Rezaie, Swami, and Terry Mulligan during The Teaching Course just last month to record a new episode of iTeachEM…. We discussed the art of saying yes and no in your career. Please leave your comments here on the blog and tweet your thoughts about this very important topic.  

There has been lots of discussion recently about the “flipped classroom” in medical education and how this is changing the face of education. Rob Cooney from iTeachEM and FlippedEM has done some great work with flipped classrooms. Well, this post isn’t really about the flipped classroom at all. It’s about the Global Classroom. More specifically, […]

I just attended the SMACC Gold conference in the Gold Coast, Australia, and I have to tell you it was the best conference I have ever been to. I have been to a lot of medical conferences over the years, some good, some average, and some not so great. SMACC Gold is by far the […]

Teaching medical procedures is one of the most rewarding aspects of medical education. Physicians-in-training place a high value on mastering clinical procedures and often link their confidence to their procedural skills. It is important to provide an opportunity for the student to prepare to learn a new procedure. This phase of learning should occur in a more didactic format, aside from the laboratory or patient bedside where the actual mechanics of the procedure will be performed. The goal of this preparatory time is to ensure that the student understands the large amount of prerequisite information needed to perform the procedure appropriately. This information includes a review of the indications and contraindications for the procedure, the human anatomy involved, the tools used to perform the procedure, and the expected outcome of the procedure.  Students are often able to uncover and retain more information if they consult multiple sources, including colleagues, texts, nurses, and Web-based media. The prospect of learning and performing a new procedure typically serves as adequate motivation for this active learning to occur.  Furthermore, many teaching institutions have developed and evaluated computer-assisted modules that incorporate images, short video clips, and instructional texts for this phase of learning. While students prepare to learn a procedure, the instructor must prepare to teach it. This involves task analysis, a skill in which the instructor breaks down the procedure into small, more digestible components for teaching purposes. For example, when teaching the placement of a central line, one of the microskills that needs to be acquired before attempting the procedure is the ability to draw back on a syringe using a single-handed method. Without accomplishing this smaller component of the motor skill, the physician will never learn to place a central line independently. As this example demonstrates, instructor preparation can be challenging because many of the microskills required to perform procedures are taken for granted once the procedure is mastered. Therefore, instructors must take the time to deconstruct the components of the procedure in preparation for the learning session and create a task analysis. The long-standing tenet “see one, do one, teach one” does not provide an optimal framework for the learner or the instructor to ensure mastery of a procedure. Instead, a multistep process of learning the procedure and then practicing it with a declining level of supervision and guidance is more effective: Steps in the process of learning a procedure Conceptualization—understanding the reasons for performing a procedure, the overall process, the tools involved, and the risks/benefits. Visualization—observing a demonstration of the procedure, performed in a fluid and competent manner by the master teacher Verbalization—reviewing a verbal deconstruction of the procedure while it is performed by the expert, with opportunity for interruptions and clarifications. Guided practice—performing the sequential steps of the procedure under the supervision of an expert physician. When an error is identified, it is best to have the instructor place his or her hand on the trainee’s hand to stop the incorrect action and physically redirect the student to the correct motor action while providing verbal instruction regarding the proper method. It is important that learners be told that this will happen and for them to expect this hand-on-hand contact. One common pitfall is allowing learners to perform procedures with errors and then providing feedback regarding those errors after the procedure has been completed. The idea is to stop the error before it is imprinted in the learner’s motor memory. Practice without guidance can precipitate errors and result in imprinting of inappropriate actions, which is dangerous to patients and a disservice to the learner. Immediate feedback,

As part of a drive to create asynchronous learning resources for the SMACC Education Workshop, Chris Nickson talked to Simon Carley to find out ‘How to make Journal Club work”. It also ties in nicely with the SMACC EBM Workshop that Simon is running. They cover the objectives, structure and setting, the people involved, content and conduct, tech and resources to help with journal club and what the oucomes should be. Check out Simon’s St. Emlyn’s post on Journal Clubs for an introduction. Key Journal Club references BMJ Careers, 2011: Are journal clubs an essential tool for postgraduate education? Yes by Sophie Cook [Free Full text] No by Helen MacDonald [Free Full Text] Deenadayalan Y, Grimmer-Somers K, Prior M, Kumar S. How to run an effective journal club: a systematic review. J Eval Clin Pract. 2008 Oct;14(5):898-911. doi: 10.1111/j.1365-2753.2008.01050.x. Review. PubMed PMID: 19018924. [Free Full Text] Patil P. Establishing an Effective Journal Club: A Postgraduate Educational Tool.Education In Medicine Journal, 2013 5(3). doi:10.5959/eimj.v5i3.134 [Free Full Text] Pitner ND, Fox CA, Riess ML. Implementing a successful journal club in an anesthesiology residency program. F1000Res. 2013 Jan 16;2. doi: 10.12688/f1000research.2-15. PubMed PMID: 24358844; PubMed Central PMCID: PMC3752701. Also, this is the iTeachEM post on NB that was mentioned in the podcast for collaborative document annotation: NB Helps Flip the Classroom Free websites with journal club archives Critical Care Journal Club Critiques EBDM Journal Club Ohio state EM St.Emlyn's Journal Club STH Journal Club The Department of Emergency Medicine at UC Davis The PedsCCM Evidence-Based Journal Club The Washington University Division of Emergency Medicine Journal Club and EMJClub Podcast Twitter Journal Club University of Michigan University of Ottawa Wiki Journal Club Useful critical appraisal resources CEBM critical appraisal BestBETs.org  downloadable checklists and critical appraisal database PedsCCM EBM Resources EBM Toolbox from the University of Alberta How to read a paper (BMJ) or buy the book. JAMAevidence | Users' Guides to the Medical Literature (requires subscription or Athens login) Come meet Simon and the iTeachEM team at smaccGOLD. Vive la FOAM!

In this episode of the iTeachEM podcast Rob discusses what's wrong with education and some thoughts on how we can start to fix the system. From the education of our children to the training of residents and registrars in emergency medicine/critical care, we have lost control of the system and we need to gain control on the most intelligent way to educate. Here are some random thoughts on education and why I think it's so screwed up... 1. We are a textbook and lecture driven education society. This is not how kids and adults learn best! 2. We are very focused (TOO focused on test scores and getting good grades). We train our children at a very young age to focus on the result and not the process of learning. The result: young adults with good test scores, degrees, without the ability to be creative and innovative thinkers. Bad. It drives me absolutely crazy that test scores have become more important than a solid understanding of the subjects and how they all interact in our crazy, chaotic world. A high MCAT or SAT socre may look good on paper, but it is meaningless if it doesn't indicate a deeper understanding of subjects. It's a very tough, sometimes impossible, system to change. 3. We have a very linear way of teaching. This subject then the next then the next. Learning isn't linear in many instances. 4. The current education system isn't really set up to help the slower learners catch up and challenge the faster learners. This is the classic "herd mentality" of education. Move the cattle through at the same pace. 5. We focus too much on math and science and downplay the other subjects like art, music, and dance.  Sure, math and science are really important, but the jobs of the future will only support a workforce that has adaptability and creative and innovative potential. If you need more convincing that we need to take a serious look at the subjects we teach just watch this quick TED talk given by Ken Robinson. Brilliant. This will make you rethink the way the system is designed. httpvh://www.youtube.com/watch?v=iG9CE55wbtY 6. Our current system is filled with the "swiss cheese" model of learning. Salman Khan, creator of the Khan Academy and author of the One World Schoolhouse-Education Reimagined, has noted that many learners develop "holes" in their education, or gaps in knowledge and/or understanding. The main issue is that the system isn't designed to fill in those "holes," and the holes sometimes persist for years and are sometimes permanent. 7. In my opinion,  teachers standing up in front of the class lecturing is a dead model of teaching. We know students, most of them, don't learn like this. Many school systems have changed the way they do this, but most have not.  An iTeachEM challenge and homework assignment... 1. Challenge the system. Consider the way we teach trainees in emergency medicine/critical care. Can we do a better job? Should we lecture as much as we do? Are we motivating and inspiring or just dishing out lecture after lecture. For those of you with children, think outside the box and help them come to grips with the fact that it isn't all about test scores. It's tough to fight the current educational structure, but it has to be done. I don't want to tell you how to parent, but I would strongly recommend instilling in your children a sense that learning, creativity, innovation, and adaptability are more important than a stupid test score. 2. Read The One World School House-by Salman Khan. This book will change the way you think about education. 3. Watch Ken Robinson's videos on the TED website and YouTube. He has three very motivating talks that will get you fired up about teaching and learning. Happy Teaching!

Ladies and Gentlemen, boys and girls, lads and lassies....the new PressorDex app is going to be released in the app store in just a few weeks. You can already purchase the handbook version from EMRA, but very soon you will be able to get the iOS version. Very cool! Take a look at this video advertisement... httpv://www.youtube.com/watch?v=NKhKJNyCDfc Dr. John Greenwood has put together a very nice product for EM/CC folks. Congrats!! You are going to be hearing a lot about this guy....

The 1st International Emergency Medicine Faculty Development and Teaching Course is coming up very soon. I thought this would be a good time to give a little run down on what the course entails and why YOU should attend. The course is the first of its kind, and it is designed for international EPs. Having said that, much if not all of the course content is very relevant and important for emergency physicians practicing in the US as well. So, the course is open to everyone. Here is just a taste of the great topics we will cover during the week... Presenting lectures to large groups Leading small groups Giving feedback Best practices in teaching medical students Using educational technology in medical education The needs of you and your country for developing emergency medicine Developing your special area of interest in emergency medicine Presentation tools for the educator Developing and running a fun and functional journal club What you need to know about adult learners to be a successful educator Developing an educational curriculum Teaching physicians-in-training The use quality assurance (QA) as a teaching tool Morbidity and mortality conference/patient safety as a teaching tool How to teach different types of learners Helping the learner in need Simulation as a teaching tool Leadership skills for the emergency medicine educator A visual tour of emergency department teaching techniques Useful resources for the emergency medicine educator Developing a curriculum vitae and teaching portfolio to promote yourself Unique aspects of the course: Cutting-edge educational material taught by award-winning faculty who are international experts in faculty development and medical education One-on-one mentoring by emergency medicine faculty on a faculty development/teaching project idea that you bring to the course ready to discuss Individualized mentoring on faculty development/medical education ideas that you can institute in your home country Ongoing mentoring in career and faculty development by way of a group e-list A USB thumb drive containing the course content Daily networking lunches, where you can discuss your career and your ideas with experts in faculty development Tours of the adult emergency department at the University of Maryland Medical Center and other medical resources on the medical center campus Social events, where you can meet and converse with course faculty members We have been very busy designing the course, and we truly believe that we have something very special here. So far, people from many different countries will be joining us for this inaugural course on faculty development and medical education. For more information, check out the course website. Don't forget to check out the iTeachEM podcast on iTunes...    

Well, it's about time...the new iTeachEM Podcast is being developed. This podcast, the replacement for EMRAP-Educators Edition, promises to be the premier medical education podcast in emergency medicine. Although much of the content will be focused on the specialty of emergency medicine, the podcast will cover content pertinent to all aspects of medical education and faculty development. Please send us your suggestions for topics. Content is being created at this very moment, and we hope to have the very first episode posted very soon. Stay tuned! Rob Rogers and Chris Nickson The iTeachEM crew