Needed: a commitment to basic training in emergency medicine teaching

Commentary

CJEM 2005;7(5):328-329

See also: Original Research

Ask a room full of dedicated emergency physicians why they chose Emergency Medicine (EM) as a career, and many will mention a great EM role model or teacher. As a young, dynamic specialty, EM needs more great educators to inspire future generations. Not only do effective teachers motivate others to choose their specialty; they better stimulate learning in trainees.^1-3 All physicians can benefit from the lessons that emergency physicians teach best, from dealing with emergent and undifferentiated patients to performing diverse procedures -- not to mention professionalism, courtesy, collaboration, caring and grace under pressure.

Effective teaching and successful clinical teachers have been studied for decades⁴ but, recently, investigators have turned their focus toward the unique emergency department setting. Bandiera and colleagues previously identified key characteristics and behaviours of effective EM teachers,⁵ validating concepts reported elsewhere in medical education literature⁶ and informing physicians interested in developing better teaching.

In this issue of CJEM, Bandiera and colleagues describe the educational outcomes of a faculty development workshop designed to impart some of the abilities we should role model on a daily basis.⁷ The workshop design is a model one: systematic, multimodal, with active methods, and tailored precisely to the learners needs.⁸ In follow-up, participants rated the experience and their subsequent application of the learning positively. While this study is limited by small sample size and self-reporting, its methods are appropriate and it should not be dismissed. Randomized trials are rare in education for sound methodologic reasons, and "program evaluation" methods such as these must be used in such investigations.⁹ This Bandiera study reports outcomes at the first level of Kirkpatrick's 4-level model.¹⁰

All emergency physicians should have access to the kind of faculty development programs described here, and now they can. While the vast majority of clinician teachers instruct "by the seat of their pants," they don't have to. Some may be talented; others may role model the best teachers they have met. Unfortunately, research shows that truly effective teachers are rare.³ It is time for a commitment to some basic training for all academic emergency physicians. In 2004, CAEP sponsored the development of a new national, evidence-based EM teaching effectiveness Roadshow, "ED STAT!" (ED STAT!: Strategies for Teaching Any Time; www.caep.ca). This continuing professional development program compiles the science of clinical teaching and imparts it using hands-on teaching methods by those who do it best. Emergency medicine is already one of the most popular specialties in medical schools.¹¹ With greater dedication to the science of teaching, EM can reap the benefits of admiring students, respectful colleagues, competent learners, and greater satisfaction in our work. Bandiera and colleagues remind us that effective EM teaching is both imperative and achievable.

References

1. Griffith CH iii, Georgesen JC, Wilson JF. Six-year documentation of the association between excellent clinical teaching and improved students' examination performances. Acad Med 2000;75(10 suppl):S62-4.
2. Kenny NP, Mann KV, MacLeod H. Role modeling in physicians' professional formation: reconsidering an essential but untapped educational strategy. Acad Med 2003;78:1203-10.
3. Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med 1998;339:1986-93.
4. Norman GR, CPM van der Vleuten, Newble D, editors. International handbook of research in medical education. Boston: Kluwer; 2002.
5. Bandiera G, Lee S, Tiberius R. Creating effective learning in today's emergency departments: how accomplished teachers get it done. Ann Emerg Med 2005;45:253-61.
6. Penciner R. Clinical teaching in a busy emergency department: strategies for success. Can J Emerg Med 2002;4(4):286-8.
7. Bandiera G, Lee S, Foote J. Faculty perceptions and practice impact of a faculty development workshop on emergency medicine teaching. Can J Emerg Med 2005;7(5):321-7.
8. Labrosse J, Moore L. Clinical supervision and feedback. In: Jean P, Des Marchais JE, Delorme P, editors. On becoming an educator in the health professions: a systematic approach. Ottawa: University of Ottawa; 1995. [English edition and adaptation of Apprendre a enseigner les sciences de la sante, Guide de formation pratique. Montreal (QC): Publications Medeva; 1993.]
9. Worthen BR, et al, editors. Program evaluation: alternative approaches and practical guidelines. 2nd ed. New York: Longman; 1997.
10. Kirkpatrick D. Evaluating training programs: the four levels. San Francisco: Berrett-Koehler; 1994. [An illustration of Kirkpatrick's 4-level model can be seen at http://coe.sdsu.edu/eet/Articles/k4levels/index.htm (accessed 2005 Aug 6).]
11. Canadian Resident Matching Service Web site. Available: www.carms.ca.