It’s July, again

Maybelle Kou MD, Fellowship Director, The Altieri PEM Fellowship at Inova Children’s Hospital.

For some medical educators June and July can conjure up feelings reminiscent of Bill Murray’s character in the movie “Groundhog Day”. You’ve probably laughed at the scenes where he goes to extremes of self- injurious behavior before waking up the next morning in exactly the same place. No matter what time of year, this can feel like a daily ritual in the Emergency Department. The environment is massively complex with patient and practitioner variability, team interpersonal dynamics, regulatory and local administrative mandates,  all of which contribute to the chaos. Add workforce regulations and it seldom seems as though one works with the same learner more than once or twice during a rotation.

Dr. Mike Greenwald highlighted great models of ED precepting in a recent post, briefly mentioning the One Minute Preceptor1 and SNAPPS2. In addition to his guiding principles (Greenwald’s Guide?) Mike also wrote about coaching in “Find your Coach’s Cap”. To carry along this wavelength I suggest these coaching tips for preceptors to help their teaching be memorable (and enjoyable!) for all the right reasons.

Establish ground rules and your expectations for your learners. Not only does this set up a safe learning environment, it can mean less frustration for you if the learner isn’t presenting or functioning as you expect. Learners don’t read minds any more than experts do.

Practice active listening and debriefing skills. The act of listening is as meaningful to learners as it is to patients. Multi-tasking might be a strength but also a weakness. If you try to document simultaneously as a learner is speaking, you will miss important details.  Be a captive audience (and role model) when learners present and you will have lasting buy in. With advanced learners, posing questions using Advocacy/Inquiry can also be beneficial. A-I is well described in simulation debriefing literature and also has many applications in the clinical setting3.

Define learning moments for your learners. Evaluations often reveal learners “don’t feel as though they are being taught”. While it seems pedantic to have to preface teaching in the clinical setting with “the teaching point here is…” this verbal hack also helps to define a learning objective for a case e.g. “I’ll show you how I discuss fever-phobia” vs “how do you discuss fever-phobia?”

Whether entering our specialty or not, coaching in situ is probably the most valuable teaching strategy to help learners develop mastery in ED communication and patient care skills. By developing more meaningful relationships with your learners, they might even choose EM as a career!

1. Irby DM, Wilkerson L. Teaching when time is limited. BMJ. 2008;336:384–7. doi: 10.1136/bmj.

2. Wolpaw T, Papp KK, Bordage G. Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized comparison group trial. Acad Med. 2009;84:517–24. doi: 10.1097/ACM. 0b013e31819a8cbf.

3. Rudolph, J. W., Simon, R., Raemer, D. B. and Eppich, W. J. (2008), Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education. Academic Emergency Medicine, 15: 1010–1016. doi: 10.1111/j.1553-2712.2008.00248.x 

Maybelle Kou MD FACEP FAAP
Director, The Altieri Pediatric Emergency Medicine Fellowship 
Inova Children’s Hospital 
Inova Fairfax Hospital Emergency Department
3300 Gallows Road, Falls Church, VA 22042


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