7 minute read
Climate Change: A Guide for Optimizing the Learning Environment
By David Diaz, MD; Ryan, MD; Andrew Kendle, MD; Allison Beaulieu, MD, on behalf of the SAEM Education Committee
Learning climate is broadly defined as the tone, mood, and standards of the teaching environment. Components of the learning climate include both the physical and the emotional environment, as well as the interactions between the instructor, learner, and content. These interactions occur within a specific context such as bedside teaching, on shift lessons, or more formal lectures. It is vital to actively shape this climate both prior to and during learning encounters, as the controlled chaos of the emergency department can present a challenging, but highly valuable, setting to teach and learn. An understanding of the key concepts of the learning climate can be the difference that cements a lifesaving learning point. The four key concepts to be covered in this article are respect, learner involvement, stimulation, and understanding limitations.
Respect
Simple steps can be critical in setting up a respectful learning climate. The first step is to “meet the learner.” Is this a firstyear medical student on his or her first day or an off-service medicine resident interested in critical care? How do your learners refer to themselves, from name to pronouns? What does the learner hope to get out of the session? These questions will help tailor the teaching to the learner’s level and establish a secure environment. Another vital strategy is the creation of a safety statement such as, “we are all here to learn today and there are no silly questions or penalties for not knowing an answer.” Setting this expectation will ensure that learners feel comfortable sharing what they do and do not know. This is especially important in environments with multiple learners who may be reticent to answer for fear of being wrong in front of peers.
It is imperative for educators to understand implicit bias and how to address microaggressions. Implicit bias is defined as the attitudes or stereotypes we hold without having conscious knowledge of them. To assess your own biases, you can take a variety of Implicit Association Tests. A microaggression is defined as a statement, action, or incident resulting in the discrimination against members of a marginalized group. An example would be a Black medical student during a clerkship rotation being asked by staff to show identification. To address microaggressions, you can utilize the A.C.T.I.O.N mnemonic developed by Cheung, Ganote, and Souza: • Ask clarifying questions to help you understand the intentions. • Carefully listen. • Tell others what you observed as a micro aggression in a factual manner. • Impact exploration: Ask for, or state, the potential impact of such a statement or action on others without putting the target of the microaggression on the spot. • Own your own thoughts and feelings around the microaggression’s impact using first-person language. • Next steps – request appropriate action be taken and check in with the target of the microaggression.
Learner Involvement
Learner involvement is how we encourage learners to actively participate in their own education. One way to obtain early buy-in from learners is to elicit their goals, which encourages learners to take an active role in their educational experiences. This also shows that you value their input and helps build a mutual point to work towards that is personally important to the learner. Another point to consider is that there are learners of various stages rotating through the emergency department. Start with the broadest questions for your novice learners and to fill in gaps, probe your senior learners using prior experience and evidence-based medicine. You can also use different questioning techniques to provide some variation to the learning. One example is “what if” questions, which allows you to change a clinical scenario to address various teaching points. Another technique is “round robin,” where each learner answers one question before moving to the next learner. When correcting incorrect answers, be respectful and constructive. Lastly, be an active listener, and encourage learners to participate in the safe environment you have created.
Stimulation
Stimulation is how we design our environment to better engage learners. In the clinical setting, teaching occurs most commonly at the bedside and in the charting area where you can think about varying your presentation style to keep learners interested. A great way to do this is utilizing some of the following techniques to emphasize various points: • White board teaching. The combined visual and verbal format of this technique can be helpful for learners to organize new information. • Post-it notes. A high yield learning point or clinical pearl can be summarized on a Post-it note, helping emphasize the importance of the concept. It can then be posted in another location where the learner will continue to be exposed to it, thus further reinforcing the point. • Note cards. Like Post-it notes, note cards can provide a slightly more incontinued on Page 22
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depth review of a topic, providing an easy format for learners to quickly review a concept. • Practice board/shelf questions. Many question banks have a search function that allows you to find questions relevant to your teaching points. This will not only help your learners work toward a better test score, but also give you an idea of what helpful topics you can focus on.
Lastly, show enthusiasm for whatever topic you’re teaching, explicitly stating why you are interested in the topic and why it is important. An uninterested and unenthusiastic teacher oftentimes results in a similar-minded learner.
Limitations
Address the limitations of the learner, yourself, and those factors intrinsic to the emergency department. New learners may feel uncomfortable in an environment they have never worked in. For example, figuring out the charting system, determining where patient rooms are, and even placing orders can be daunting to novice learners. You can acknowledge these limitations early on with a reassuring statement such as “I know this is your first day in the emergency department and I don’t expect you to have all the answers, but I do expect you to be engaged and learn something new.” This may also be the learner’s first time being exposed to certain medical problems, diagnoses, and management strategies, which can turn presentations into stressful situations. Instead of getting upset at a learner for not knowing something, try to ease his or her fears and normalize the situation. This could be a phrase to set the tone of a conversation such as “when I was an intern, I struggled with this. Let’s take time to discuss it.”
It’s also important to consider your own limitations. To create a safe learning climate, be transparent about your own limitations and admit to your own errors. Ask your learners for feedback to see what you can improve on and how you can make the learning environment even better.
Another limitation to consider in the emergency department is timing. With constant interruptions, it can be difficult to fit in a teaching session. Acknowledge to your learners that “there will be interruptions, but hopefully the next strategies we discuss will give you some new tools to provide the best learning environment while in the emergency department.”
Conclusion
Our goal as educators is to improve patient care through medical education. The emergency department can be a challenging environment for optimal learning due to constant interruptions and its intrinsic unpredictable nature. As teaching often occurs on the fly, consider using the above techniques to focus your efforts on learners at various stages of training. Recognize your own implicit biases and know how to identify and address microaggressions. The safer the learning environment, the more likely learners will feel comfortable asking questions and retaining knowledge. Taking the step to set up a positive learning climate will have a positive impact on your learners.
ABOUT THE AUTHORS
Dr. Diaz is a PGY3 emergency medicine resident at The Ohio State Wexner Medical Center.
Dr. O’Neill is a PGY1 emergency medicine resident at The Ohio State Wexner Medical Center.
Dr. Kendle is a PGY3 emergency medicine resident at The Ohio State Wexner Medical Center.
Dr. Beaulieu is a medical education fellow and interim assistant program director for the combined emergency medicine and internal medicine residency program at The Ohio State Wexner Medical Center.
