1
|
Chan TM, Van Dewark K, Sherbino J, Lineberry M. Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department. AEM Educ Train 2019; 3:145-155. [PMID: 31008426 PMCID: PMC6457384 DOI: 10.1002/aet2.10312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Busy environments, like the emergency department (ED), require teachers to develop instructional strategies for coaching trainees to function within these same environments. Few studies have documented the strategies used by emergency physician (EP)-teachers within these busy, chaotic environments, instead emphasizing teaching in more predictable environments such as the outpatient clinic, hospital wards, or operating room. The authors sought to discover what strategies EP-teachers were using and what trainees recalled experiencing when learning to handle these unpredictable, overcrowded, complex, multipatient environments. METHOD An interpretive description study was conducted at multiple teaching hospitals affiliated with McMaster University from July 2014 to May 2015. Participants (10 EP-teachers and 10 junior residents) were asked to recall teaching strategies related to handling ED patient flow. Participants were asked to describe techniques that they used, observed, or experienced as trainees. Two independent coders read through interview transcripts, analyzing these documents inductively and iteratively. RESULTS Two main types of strategies to teach ED management were discovered: 1) workplace-based methods, including both observation and in situ instruction; and 2) principle-based advice. The most often described techniques were workplace-based methods, which included a variety of in situ techniques ranging from conversations to managerial coaching (e.g., collaborative problem-solving of real-life administrative dilemmas). CONCLUSIONS A mix of strategies are used to teach and coach trainees to handle multipatient environments. Further research is required to determine how to optimize the use of these techniques and innovate new strategies to support the learning of these crucial skills.
Collapse
Affiliation(s)
- Teresa M. Chan
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonON
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonON
| | - Kenneth Van Dewark
- Department of Emergency MedicineUniversity of British ColumbiaVancounverBC
| | - Jonathan Sherbino
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonON
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonON
| | - Matthew Lineberry
- Simulation Research, Assessment, and Outcomes, Zamierowski Institute for Experiential Learning, and Department of Health Policy and ManagementUniversity of Kansas Medical CenterKansas CityKS
| |
Collapse
|
2
|
Chan TM, Mercuri M, Van Dewark K, Sherbino J, Schwartz A, Norman G, Lineberry M. Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments. Acad Med 2018; 93:786-793. [PMID: 29210754 DOI: 10.1097/acm.0000000000002081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Emergency physicians (EPs) regularly manage multiple patients simultaneously, often making time-sensitive decisions around priorities for multiple patients. Few studies have explored physician cognition in multipatient scenarios. The authors sought to develop a conceptual framework to describe how EPs think in busy, multipatient environments. METHOD From July 2014 to May 2015, a qualitative study was conducted at McMaster University, using a think-aloud protocol to examine how 10 attending EPs and 10 junior residents made decisions in multipatient environments. Participants engaged in the think-aloud exercise for five different simulated multipatient scenarios. Transcripts from recorded interviews were analyzed inductively, with an iterative process involving two independent coders, and compared between attendings and residents. RESULTS The attending EPs and junior residents used similar processes to prioritize patients in these multipatient scenarios. The think-aloud processes demonstrated a similar process used by almost all participants. The cognitive task of patient prioritization consisted of three components: a brief overview of the entire cohort of patients to determine a general strategy; an individual chart review, whereby the participant created a functional patient story from information available in a file (i.e., vitals, brief clinical history); and creation of a relative priority list. Compared with residents, the attendings were better able to construct deeper and more complex patient stories. CONCLUSIONS The authors propose a conceptual framework for how EPs prioritize care for multiple patients in complex environments. This study may be useful to teachers who train physicians to function more efficiently in busy clinical environments.
Collapse
Affiliation(s)
- Teresa M Chan
- T.M. Chan is assistant professor, Division of Emergency Medicine, Department of Medicine, Michael G. DeGroote School of Medicine, program director, Clinician Educator Area of Focused Competence program, and adjunct scientist, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada; ORCID: 0000-0001-6104-462X. M. Mercuri is assistant professor, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. K. Van Dewark is clinical instructor, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. J. Sherbino is associate professor, Division of Emergency Medicine, Department of Medicine, Michael G. DeGroote School of Medicine, and assistant dean of education research, and director, McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, Department of Medical Education, and research professor, Department of Pediatrics, College of Medicine, University of Illinois at Chicago; ORCID: 0000-0003-3809-6637. G. Norman is professor emeritus, Department of Clinical Epidemiology Biostatistics, and founding member, Program for Education Research and Development, and scientist, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada. M. Lineberry is director, Simulation Research, Assessment, and Outcomes, Zamierowski Institute for Experiential Learning, and assistant professor, Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas
| | | | | | | | | | | | | |
Collapse
|
3
|
Chan TM, Van Dewark K, Sherbino J, Schwartz A, Norman G, Lineberry M. Failure to flow: An exploration of learning and teaching in busy, multi-patient environments using an interpretive description method. Perspect Med Educ 2017; 6:380-387. [PMID: 29119470 PMCID: PMC5732107 DOI: 10.1007/s40037-017-0384-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION As patient volumes continue to increase, more attention must be paid to skills that foster efficiency without sacrificing patient safety. The emergency department is a fertile ground for examining leadership and management skills, especially those that concern prioritization in multi-patient environments. We sought to understand the needs of emergency physicians (EPs) and emergency medicine junior trainees with regards to teaching and learning about how best to handle busy, multi-patient environments. METHOD A cognitive task analysis was undertaken, using a qualitative approach to elicit knowledge of EPs and residents about handling busy emergency department situations. Ten experienced EPs and 10 junior emergency medicine residents were interviewed about their experiences in busy emergency departments. Transcripts of the interviews were analyzed inductively and iteratively by two independent coders using an interpretive description technique. RESULTS EP teachers and junior residents differed in their perceptions of what makes an emergency department busy. Moreover, they focused on different aspects of patient care that contributed to their busyness: EP teachers tended to focus on volume of patients, junior residents tended to focus on the complexity of certain cases. The most important barrier to effective teaching and learning of managerial skills was thought to be the lack of faculty development in this skill set. CONCLUSIONS This study presents qualitative data that helps us elucidate how patient volumes affect our learning environments, and how clinical teachers and residents operate within these environments.
Collapse
Affiliation(s)
- Teresa M Chan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Kenneth Van Dewark
- Department of Emergency Medicine, University of British Columbia, Vancouver, Ontario, Canada
| | - Jonathan Sherbino
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Schwartz
- Department of Medical Education, University of Illinois, Chicago, USA
| | - Geoff Norman
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Lineberry
- Department of Health Policy & Management, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|