AEM Education and Training最新文献

Traditionally, bedside teaching in the emergency department (ED) begins with determining the learners’ current skill level and establishing on-shift goals.^1-3 Faculty commonly begin by asking, “What would you like to work on today?”^{3, 4} This method aids in goal setting and initiating conversations with educators but takes a problem-solving approach and promotes identification of weaknesses.⁴ This negatively frames the learning process and requires a high level of self-reflection and vulnerability. Additionally, high-achieving learners without significant deficits may benefit less.

Appreciative inquiry (AI) provides an alternative framework frequently described in business literature. This model focuses on strengths to achieve an individual's or organization's full potential.⁵ AI delineates four phases of inquiry, including discovery (What is the best of what is?); dream (What might be?); design (How can it be?); and destination (What will be? How can we empower and enact?).⁶

Appreciative education (AE) utilizes AI in an educational context to focus on a learner's strengths and potential to accomplish cocreated goals.⁷ Practical tips for applying AE principles to interactions with learners are to identify a clear outcome focus for a situation and to leverage the learner's strengths to achieve the desired outcome.⁷ Use of AE in clinical teaching may enhance targeted feedback, improve learner motivation, and create a more positive learning environment.

A cohort of faculty at our academic 4-year emergency medicine (EM) residency program reviewed an article on AE during a faculty development session and brainstormed how to apply it during subsequent ED shifts with EM trainees and medical students.⁵ Thereafter, the cohort of faculty began each shift by identifying the learners’ outcomes, asking about their current strengths, and the characteristics of their ideal ED shift. Faculty and learners then collaboratively brainstormed concrete ways to achieve those outcomes. Throughout the shift faculty reflect with the learner on progress with their goals and problem solve barriers. The shift concludes with a reflection and debrief. Figure 1 depicts the technique. After a month of implementation, the faculty cohort met to discuss their experiences.

Experience utilizing AE in conjunction with informal feedback from learners has provided insight into the benefits and pitfalls of this teaching strategy. Witnessed benefits include improved learner motivation and self-esteem.⁷ Learners self-reported having a positive reaction to the initial prompt encouraging reflection about strengths and they enjoyed envisioning an ideal shift. AE especially benefited high-achieving learners who felt challenged and motivated by the exercise

The Resident-Student Education Committee (RSEC) is a novel approach to integrate and expand medical student education within an emergency medicine (EM) residency at a large academic center. There is a paucity of literature on such programs and there is no documentation of longitudinal initiatives with residents serving as specialty-specific advisors to students throughout medical school. The goals of creating the RSEC were to expand and improve the student educational experiences in EM, strengthen the connection between students and EM residents, and foster resident career development through sustainable leadership and teaching opportunities. The RSEC was composed of three divisions: the Preclinical Division aimed to increase student exposure to EM through didactics, skill sessions, simulation, and shadowing; the Clinical Division intended to enhance the student experience during clinical EM rotations through simulation and skill sessions and resident-student socials; and the Mentoring Division focused on advising students applying into EM through informational panels and one-on-one resident mentorship. Outcome measures include students applying into EM residency, which saw an increase from 8.9% prior to the RSEC's creation in 2020 to 12.9% in 2023, despite a national decline in EM applicants. Survey data also indicates favorable student preclinical experiences and improved confidence in clinical skills. The RSEC model, with its structured approach, resident leadership, and clear objectives, presents a sustainable and replicable framework for other residency programs seeking to enhance medical student education and promote resident engagement in teaching. Future directions include expanding shadowing opportunities and procedural skills teaching, introducing career mentorship earlier in the medical education timeline, and tracking outcomes data for continuous assessment and improvement.

The authors declare no conflicts of interest.

Supervisors often ask emergency medicine trainees for their learning goals at the start of a clinical shift, though they may do so without considering the reasons for this practice. Recognizing the underlying rationale for voicing on-shift learning goals and proactively considering solutions for some of the associated challenges can help learners and supervisors employ this practice to its full potential. Goal articulation is rooted in educational principles such as self-regulated learning, targeted performance feedback, and collaborative relationships between learner and supervisor. Despite the potential for on-shift learning goals to augment learning, there are numerous barriers that make it challenging for learners and supervisors alike to create or follow up on meaningful goals. Learner-related challenges include uncertainty about how to develop goals within an unpredictable clinical environment and creating goals too narrow or broad in scope. Supervisor-related challenges include difficulties integrating direct observation into the clinical workflow and a desire to avoid negative feedback. The learning environment also presents inherent challenges, such as lack of longitudinal supervisor–learner relationships, time constraints, space limitations, and incentives for learners to conceal their knowledge gaps. The authors discuss these challenges to effective on-shift learning goals and propose solutions that target the learner's approach, the supervisor's approach, and the learning environment itself.