通过赏识教育改善急诊科的教学互动。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES AEM Education and Training Pub Date : 2024-07-07 DOI:10.1002/aet2.11010
Nicole E. Schnabel MD, Donna K. Okoli MD, Carrie A. Bailes MD, Mallory G. Davis MD, MPH, Mary R. C. Haas MD, MHPE
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引用次数: 0

摘要

传统上,急诊科(ED)的床旁教学从确定学习者当前的技能水平和制定当班目标开始。1-3 教员通常会首先询问:"你今天想学什么?"3, 4 这种方法有助于制定目标和启动与教育者的对话,但采取的是一种解决问题的方法,并提倡找出弱点。此外,成绩优秀但没有明显缺陷的学习者可能受益较少。"赏识式探究"(AI)提供了另一种框架,在商业文献中经常被提及。5 赏识式探究划分了四个探究阶段,包括发现(什么是现有事物中最好的?将赏识教育原则应用于与学习者的互动中的实用技巧是,为某一情境确定一个明确的成果重点,并利用学习者的优势来实现预期成果。在临床教学中使用AE可以增强针对性反馈,提高学习者的积极性,并创造一个更积极的学习环境。我们四年制急诊医学(EM)住院医师培训项目的教师团队在一次教师发展会议上回顾了一篇关于AE的文章,并集思广益,讨论了如何在随后的急诊科轮班中与急诊科学员和医学生一起应用AE。然后,教师和学员共同集思广益,找出实现这些成果的具体方法。在整个转变过程中,教师与学习者一起反思他们在实现目标方面的进展,并解决障碍问题。轮班结束时进行反思和汇报。图 1 描述了这一技巧。在实施一个月后,教师团队开会讨论了他们的经验。结合学习者的非正式反馈,使用 AE 的经验让我们深入了解了这种教学策略的益处和缺陷。7 学习者自我报告说,他们对最初鼓励反思优势的提示反应积极,并乐于设想理想的转变。AE 对成绩优秀的学习者尤其有益,他们在练习中感受到了挑战和动力。AE 的缺陷包括:教员有责任让学习者对自己的目标负责。ED 环境的不可预测性可能会使这一技术复杂化,因为我们无法控制使之成为 "理想 "班次的各个方面;然而,尽管存在共同的固有挑战(即登机、频繁中断、顾问互动具有挑战性),但远景规划和关注可修改因素的行为可以使双方感到有能力和有控制感。未来的步骤包括对这一技术进行正式的多机构研究。
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Appreciative education to improve teaching interactions in the emergency department

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. It enhanced the perceived quality of feedback given by faculty.

Pitfalls of AE include that the onus is on the faculty member to keep the learner accountable with their goals. The unpredictable nature of the ED environment can complicate this technique given the lack of control over aspects of the shift that would make it “ideal”; however, the act of visioning and focusing on modifiable factors can allow both parties to feel empowered and have a sense of control despite common inherent challenges (i.e., boarding, frequent interruptions, challenging consultant interactions). Future steps include formal multi-institutional study of this technique.

The authors declare no conflicts of interest.

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来源期刊
AEM Education and Training
AEM Education and Training Nursing-Emergency Nursing
CiteScore
2.60
自引率
22.20%
发文量
89
期刊最新文献
Issue Information Paths to learning: How residents navigate transience in supervisory relationships in the emergency department General emergency physician perceptions of caring for children: A qualitative interview study 5, 4, 3, 2, 1, 0: An evidence-based mnemonic to aid recall and interpretation of heart rate values for pediatric patients presenting for acute care “Ardor and diligence”: Quantifying the faculty effort needed in emergency medicine graduate medical education
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