Next Level Teaching

Authors: Charlotte Davies / Editor: Liz Herrieven, Nino Tarkhnishvili /  Codes: CC15, CC23, SLO9 / Published: 10/08/2021

In EM we love teaching, and we like to think we’re pretty good at it. After talking about teaching with other educators, I think we’re innovative and have lots of good ideas. Here we’ve collated a few of our favourite EM-specific teaching ideas. 

But before we begin, it’s worth having a good think about what a teacher is… and what teaching is. For this, I love to think of the teaching perspectives inventory, as I think it really nicely describes the differences of perception. It talks about teaching as transmission, apprenticeship, development, nurturing or social reform. 

  • Transmission is the easiest perspective of teaching, and is one I think many of our students most consider teaching – they want you, as the teacher to give them the content. A didactic lecture. 
  • Developmental is where we’d all like to be – the teacher teaches from the learner’s point of view, and challenges learners to learn as well as to develop complex reasoning and understanding. I like to think this fits in nicely with Millers pyramid, where developmental teaching really ensures students more than ‘know’ – they do. The question “why” fits in really well into this. 
  • Apprenticeship describes the process of socialising students into the new behavioural norm. The type of teaching we all think medicine is. But is it? We “are” the content, we are doctors, and by watching us and learning from us, learners learn the content. If this is teaching, this is where civility saves and learnt behaviours really come in to their own. 
  • Nurturing as a perspective is underpinned by the belief that effort from the head and heart is needed, and clear standards with appropriate support are provided. With the GMC guidelines suggesting doctors in training need autonomy, belonging and control, this seems like it should be a popular paradigm. 
  • Lastly, social reform is about using teaching to challenge the status quo and existing values and ideologies – something we all do occasionally. The time is now right to use teaching for more social reform, and I challenge you to make sure all of your teaching sessions contain something about health inequalities, public health or differential attainment – three important areas specifically mentioned in the foundation doctor curriculum, and very important to healthcare. 

So now we know what teaching is, the next step is to assess our learner’s needs, and use these to write our aims and objectives. This might be guided by a pre-written curriculum or standards. It might be pre-decided by what the trainee wants and maybe you’ve used an educational checklist to highlight the learning objectives. It might be you’ve noticed poor performance in managing something, like chest pain for example, so you want to teach about it to improve results. Or it might be a selfish need – when you’re independently doing fascia iliaca blocks, I can be in the office more. A structured list like “LOAF and BREAD” can be really useful – visit their website for more details

Educational Checklist: Learning at start of list LOAF, Feedback at end of list BREAD

We then need to consider the teaching environment. We teach in two environments – the classroom and the department. Both have many properties which are out of our control, and make them less than ideal. The key important bit about the environment is not that it is quiet, or well equipped, but that it is psychologically safe for the learners to ask questions, express their concerns, and to learn. Again, this comes back to the GMC guidelines – Autonomy and Belonging. 

Autonomy Belonging Competence

We’ve assessed needs, the environment, aims and objectives. Next up – the teaching and learning activities. 

This framework for teaching is redesigned from the King’s College Hospital “Teaching for Teachers Handbook”. I’ve chosen this model as it fits in well with how I work. 

The aims and objectives will help you decide the associated activities. Whether the session is virtual, face to face or blended, synchronous or asynchronous, will also help you to decide your activities – you can always be creative in solutions.

So let’s start with presentations as the most popular supportive media. Ross Fisher has written some excellent things on this, and you can catch up on a presentation from him here at SMACC

My key suggestions would be:

Classroom Based Teaching 

For classroom based teaching, interactivity adjuncts can be useful if they are properly prepared and appropriate to your learning point. AhaSlides, Mentimeter or Slido can poll opinion. Jeopardy Lab and Kahoot encourage competitive discussion, and open up conversations. Webquest is an inquiry-based activity which gives learners an opportunity to engage in problem-solving tasks. It can be applied to a variety of topics. Thinking about smaller group teaching, the Random Patient Generator is useful on many levels, and really makes it easy for you to talk about health inequalities, as we mentioned earlier.  This concept was designed by Simon McCormack, and he talks more about it on his website here

Gamification is another interactivity adjunct that can be useful if prepared and considered properly. EM3 have some excellent examples that can be freely downloaded and personalised. Many of the games can be adapted to be useful shop floor prompts. 

Shop Floor Teaching

We love teaching when time is tight, and if you haven’t been to the EMEC, you really must! It’s a fantastic education conference for, well, educators like us. It might be a sell out. 

Asking questions regularly is one of the most popular ways of shop floor teaching. It requires little or no preparation, and if done in a psychologically aware manner, is very popular. There are a few structures / styles that are popular: 

* The one minute preceptor covered by ALIEM with a graphical summary on twitter here

* SPITS – Serious, Probable, Interesting, Treatable. Explored further by the RCH here, and printed for shop floor use here.

* SNAPPS – Summarise, Narrow down, Analyse, Probe, Plan 

  • Avoid “pimping” – it doesn’t work for everyone. 

Observation can be useful: 

* “Activated” demonstration – ask the learner to watch with something specific in mind eg. “watch how I ask questions about domestic violence”. 

* Reverse ward rounds work for EM too. I’ve learnt so much by asking my team to do the CDU round as I watch – mostly that, even though they know I’m watching, they don’t introduce themselves or wash their hands!

* A treasure hunt or a targeted mission can be really useful. I enjoy sending my teams on a scavenger hunt – but learnt to ask them to take pictures of the emergency c-section kit, or an empty vomit bowl rather than actually bring them to me! I also enjoy the look on their faces when I ask them to open the crash trolley – there’s a “duh, it’s easy”, and then a slow look of realization as they tug the drawers and nothing opens. 

Teaching Strategies are useful:

Bitesize teaching is also really useful, and it helps highlight how much of what we do has an associated teachable moment. Postitpearls with one patient and one teaching point are great for everyone, and if you share them on twitter or other social media, everyone wins! 

If you’re stuck for what to say, pre-prepared resources on common topics like the EM3 CEMENT can be really useful. A FOAMed prescription can be a nice way of consolidating the learning. The EMEC talk about a 60 second summary, Ninja reflection, and question of the week, and of course, my favourite, #weeCPD or bog learning. For bonus points, add a crossword into your #weeCPD.

Here are some resources suggested by RCEMmembers in their education newsletter:
East Midlands Emergency Medicine Educational Media (EM3) – “Great ED source of knowledge and the Cards Against Paediatrics Orthopaedics is a hoot”
Norwich image interpretation website – “Free to join and good for limb x-ray quizzes”
ABG Ninja Medical Quizzes – “Free quiz on ABGs and other ED things like ECGs. Very easy and quick.”

Bitesized teaching comes with bitesized practicing, and the EM3 Resus Drills nail it on the head. These for me epitomise EM teaching – it’s quick, it’s ready, it’s effective, it’s drilled, it’s emergency medicine! They can be used with simulation, or without simulation, and are generally fantastic. 

I’m sure you’re surprised we’ve got to nearly the end without mentioning simulation. We covered simulation in a blog here, and all forms of simulation are useful – if they’re matched to the learning objectives. Part task trainers and low fidelity simulators can also be great practical resources. You can read our blog about this here

After your teaching, consolidation is always important as it helps to integrate new learning with existing knowledge. Asking learners to reflect, or to create a summary infographic can be useful ways of making sure they’ve understood. It also means you have an infographic to use for your next presentation! If they’re really inspired, maybe they could create a podcast segment, or contribute an RCEMLearning case. 

Happy Learning and Happy Teaching!

For further reading have a look at our trainee teaching notes, and some suggestions on how to teach ABGs.

We haven’t covered supervision in this blog – check out our trainees perspective blog, and our trainers blog.

You can now complete our SBA on this topic. Please log in to access it.

References and Links

  1. Teaching Perspective Inventory TPI
  2. St. Emlyn’s. Educational theories you must know. Miller’s pyramid.
  3. The Educational Checklist. The Educational checklist (LoafnBread): Making every clinical session count for learning.
  4. Developing blended learning approaches. Quick Guide. Jisc. Last updated: 10 July 2020.
  5. Wiley, Tools for Online Asynchronous Learning. Joann Lau. 2017.
  6. SMACC, The Greatest Presentation in the World. Ross Fisher.
  7. A set of posters on how to design for accessibility. Home Office, UK.
  8. Broken Toy. The Random Patient Generator. Simon McCormack. 2017.

Leave a Reply