Impact of a Dedicated Teaching Attending Experience on a Required Emergency Medicine Clerkship

TEAMwork! An Innovative Hospital Medicine Teaching Program to Enhance Learners' Educational Experience

PROBLEM

Workplace-based learning and assessment are dependent on frequent observations, feedback, teaching, and evaluations. Yet high physician workload and multiple learners limit these efforts. A local needs assessment demonstrated insufficient direct observations, small-group teaching, and high-quality evaluations for learners. In response, the authors developed and implemented Teaching Excellence Among Medical providers (TEAM), a teaching program to enhance the educational experience of learners in pediatric hospital medicine (PHM).

APPROACH

The TEAM program, grounded in a self-regulated learning framework, launched in 2019. The University of Colorado Department of Pediatrics provided salary support. TEAM hospitalists completed professional development for teaching and feedback skills. During their TEAM shifts, they observed, provided feedback, completed evaluations, and led teaching sessions for learners on PHM rotations. The program's impact was evaluated by using an electronic work tracking form and surveying learners, attending hospitalists, and TEAM hospitalists, leading to iterative program improvements.

OUTCOMES

Over an 18-month period, TEAM hospitalists completed 1,573 direct observations, 265 teaching sessions attended by 1,921 learners, and more than 497 learner evaluations. Survey results showed that 95% of learners indicated TEAM was "very effective" or "somewhat effective" in helping achieve individualized learning goals, and a similar percentage "strongly agreed" or "agreed" that TEAM hospitalists were effective educators. Eighty-four percent of attending hospitalist survey respondents reported TEAM contributed "very much" or "somewhat" to learner education. Attending hospitalists particularly appreciated TEAM's ability to focus on learners identified as struggling, while TEAM hospitalists rated observation of rounds and small-group teaching sessions as the most valuable TEAM activities.

NEXT STEPS

The TEAM program employed concepts of self-regulated learning to enhance education in PHM through direct observation, feedback, written evaluations, and teaching efforts. This program can mitigate many challenges facing attending physicians and can serve as a model for other institutions. Next steps include evaluation of higher-level learning outcomes.

Self-efficacy beliefs and expectations during an Emergency Medicine Clerkship

Background

Undergraduate emergency medicine (EM) training is important because all medical graduates are expected to have basic emergency knowledge and skills regardless of their future speciality. EM clerkship should provide opportunities to improve not only knowledge and skills but also the self-efficacy of learners. This study aims to evaluate the expectations, opinions, and self-efficacy beliefs of medical students during a 4-week mandatory EM clerkship.

Methods

This study used a prospective longitudinal design with quantitative and qualitative survey methods. It includes final year medical students of the 2015–2016 academic year. Voluntary de-identified pre- and post-clerkship surveys included 25 statements. The post-clerkship survey included two open-ended questions asking participants to identify the best and worst three aspects of EM clerkship. Responses were analysed to determine themes or commonalities in participant comments indicative of the EM clerkship learning experiences and environment.

Results

Sixty-seven out of seventy-nine (85%) students responded to both pre- and post-clerkship surveys. Medical students’ expectations of EM clerkships’ effect on knowledge and skill acquisition were high, and a 4-week mandatory EM clerkship was able to meet their expectations. Medical students had very high expectations of EM clerkships’ educational environment. In most aspects, their experiences significantly exceeded their expectations (p value < 0.001). The only exception was the duration of clerkship, which was deemed insufficient both at the beginning and at the end (p value: 0.92). The students perceived that their self-efficacy improved significantly in the majority of basic EM skills and procedures (p value < 0.001). Emergent qualitative themes in the study also supported these results.

Conclusion

This study showed that a 4-week mandatory EM clerkship increased medical students' perceived self-efficacy in basic emergency management skills. The EM clerkship met students' expectations on knowledge and skill acquisition, and exceeded students’ expectations on educational environment.