Teaching and Learning on the Job: Maximize Your Efficiency Using Learning Theories

By Shaila Quazi, DO

Shifts can get busy and an additional hurdle is blocking time to read and learn outside of work while juggling other responsibilities. One way to gain back some time is to maximize learning while on the job. Here’s a method I use with myself, my residents, and my students. 1. Plan. Give everyone a sheet of paper to write down three things they learned throughout the shift. 2. Discuss. Sometime during the shift, discuss what folks have written down on their papers. Items can include dosages of meds or other pearls learned from utilizing references through self-directed learning or from information learned directly from faculty, staff, or any other emergency department team member. 3. Save. Each learner takes a picture of his or her list and saves it (in a separate album, typically) to review again later.

Applied Theories

Critical reflection. Recognizing and identifying when new knowledge is gained is reflection in action. Later during discussion, reflection-on-action occurs. This allows us to process the information in a way that leads to better understanding and retention. Elaboration. Elaboration is a strategy (under cognitivism) to process information. It involves writing and/or discussion. Elaboration occurs two times in this activity. Learners paraphrase what they learned from websites, phones, online textbooks, etc. when they write down the pearls, thus processing the information the first time. Then, by explaining it in discussion later, elaboration recurs. Spaced repetition. If new information is not reviewed within three days of acquisition, more than 40% is lost. By saving the pearls on our phones, we can review it again later, to minimize learning loss. Social learning. Group learning can be very effective since the positive emotions and feedback from the group will also be tied into the information being processed. We also learn from multiple sources, rather than just a faculty member.

Other applied theories include humanism and constructivism. Sometimes, we turn it into a game and if multiple people have the same pearls, we say “jinx” and it doesn’t count for points. Sometimes we write the pearls on a marker board and draw pictures or come up with mnemonic devices to help remember the information. Use your own creativity to amplify the learning and make it useful in your own setting.

Additional Reading

• Overview of current learning theories for medical educators • Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 • Applying the science of learning to medical education • Applying Cognitive Learning Strategies to Enhance Learning and

Retention in Clinical Teaching Settings • Becoming a Critically Reflective Teacher ABOUT THE AUTHOR

Dr. Quazi is a practicing emergency medicine physician at Tower Health in Reading, PA. As a previous art major, she enjoys the creative aspect of her current job as the director of the simulation program. She also serves as director of faculty development and cochair of the faculty development committee for the seven-hospital health system. She loves teaching and is presently pursuing a Master’s in Education of Health Professions through Johns Hopkins University. Additionally, she is an instructor for a clinical skills course at Drexel University for second year medical students. She will serve as course director for the Reading campus in the upcoming academic year. She is most proud of being a mom to two super kids.

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Transformation of the Digital Health Care Landscape — Older Adults Included

By Mary Mulcare, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

Virtual care has evolved dramatically over the last 18 months. Prior to March 2020, in the academic world, we were slowly trying to roll out different ways in which telemedicine might expedite care for people, particularly those with low acuity concerns. There were a lot of false starts and timid steps in line with regulatory constraints. Telehealth at large was then given — and passed — an unprompted stress test. Content and thought leaders in the virtual care world were given an opportunity to be creative and implement new technology, points of accessibility, and pathways, with end-users ready to trial it. The beauty of the evolution is that almost everyone involved (I’d like was doing it with the same goal in mind: to improve access and outcomes. This was especially true at the start of the pandemic when the fragility of our in-person health care system was unabashedly exposed. We simply needed to get physicians and patients connected to provide care. We had a rapid feedback cycle with the surge of participating patients

“The older adult population stands to benefit significantly from this new digital age of health care.” and providers, which with modified regulatory boundaries, allowed for the iterative process to move much faster than historically happens in health care. Much of this drive was led by academic institutions, especially those that already had built the infrastructure for telehealth programs, providers who were able to quickly adapt, and a trusted brand

which patients sought at a time of much consternation and fear.

Now we are at a place of trying to understand what will stick and how to find that appropriate balance among all the players and interests at hand, while maintaining the common goal of improving health outcomes and containing health care costs that are not sustainable.

The older adult population stands to benefit significantly from this new digital age of health care. Skilled nursing facilities and nursing homes have been adopting telehealth mechanisms for years, trying to keep their patients in the current facility rather than bouncing back to the hospital. However, there are mixed perceptions about how well community dwelling older adults will function with this medium and whether they “like” it. As the digital health care industry grows, community-dwelling older adult populations should not be overlooked based on assumptions as to how this population best receives care.

Those of us practicing telemedicine have seen community-dwelling older adults able to navigate various platforms. Not only that, but the virtual environment has also facilitated care in the following ways: • The ability to do a visit from home that does not require complex transportation, coupled with remote monitoring options, has been a very welcomed change for many. • Providers have been offered a window into people’s homes to do the first (potentially) legitimate medication reconciliation in years, as the patient has been able to display their medication bottles in real time. • Other members of the medical team have been able to expand the scope of home safety evaluations through this virtual medium. • Older adults can turn up the volume on their devices to be able to hear a soft-spoken physician with minimal background noise. • Older adults have benefited from being able to have additional care givers present for medical visits for enhanced communication going forward.

In the fast-paced world of digital health and innovation, we should strive to provide enhanced, convenient, and timely care to our older adults.

ABOUT THE AUTHOR

Dr. Mulcare is fellowship trained in geriatric emergency medicine and is the clinical assistant professor of emergency medicine at Weill Cornell, New York. She has held several educational leadership roles at NYP/Weill Cornell and is currently chief medical officer for Summus Global, Inc, the leading digital platform for specialty care.

About AGEM

The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

10 Years Later: The Effect of Egypt’s Revolution on Emergency Response Systems

By Kirlos N. Haroun, MD; William Weber, MD, MPH; and Gamal Eldin Abbas Khalifa, MB, ChB, MSc EM, EMDM, on behalf of the SAEM Global Emergency Medicine Academy

Dr. Gamal Khalifa served as one of the first emergency physicians in Egypt and helped form the Egyptian Resuscitation Council (EgRC). Ten years after the Egyptian Revolution and Arab Spring, he sat down for an interview to discuss the history and future of emergency medicine in Egypt.

“When the revolution happened, there was a significant amount of distrust between the revolutionaries and the government. Many citizens felt that if they stepped into an ambulance from a site of protest, they would be taken to jail rather than to a hospital,” Dr. Gamal Khalifa remarked, recounting the Egyptian Revolution of 2011.

“The ambulances absolutely were able to do good work by transporting sick and injured patients to local hospitals, but the rumors that spread deeply affected the people. Many people, especially near Tahrir Square, stayed far away from the emergency medical systems support teams, which limited our ability to help our people through the trauma of the revolution.”

What was the state of emergency medicine (EM) prior to the revolution?

“Emergency medicine began as a specialty in Egypt in 1979. A team of health care professionals at Alexandria University, including Professor Abdel Magid, saw an incredible need for primary emergency physicians. The initial training class, known as a Master’s degree, had only two people. The second class had three people, one of whom was me. At that time, no one knew what emergency medicine was. You had a poor salary and no privileges in most hospitals, so people stayed away from the field. However, against my family and friends’ advice, I committed to EM.

“My peers and I formed the Egyptian Resuscitation Council (EgRC) in 2001. Our goal was to create a recognized system that could provide training on resuscitation, trauma, and disaster medicine. With the Egyptian Ministry of Health, we helped to formalize structured EM training programs across the country. To this day we teach the Advanced Life Support European Trauma Course, and the Pediatric Life Support and Neonatal Resuscitation Programs in universities and major hospitals across the country. We also helped develop an emergency medical services infrastructure to better distribute sick patients between the country’s public hospitals; a system that we discovered a decade later had its flaws.”

What was your personal experience of the Egyptian Revolution?

“In 2011, I was employed in Abu Dhabi. By chance, on January 25 — the day the revolution began — I was at Cairo University leading a European Trauma Course to emergency fellows. When the revolution started, I was ecstatic but also afraid for my physician-colleagues. I quickly went to my home city of Alexandria, in all honesty, to take part in the protests. I did not work directly as a medical officer during the revolution, but I was in close communication with physicians throughout.”

How well were Egypt’s hospitals prepared for the stressors of the revolution?

“Much of the response was improvised. Despite our efforts, the public system was not fully trained for disasters. We lacked adequate structural plans and field training. “Much of the response was led by churches and mosques. One church that I remember specifically was a Catholic Church in Cairo whose leader was both a priest and a doctor. They helped many people by creating a field hospital in one of the squares. The hospital depended on volunteers as well as donations for medications and equipment, so you can imagine they were continually strained. “We had limited numbers of welltrained paramedics and emergency medicine technicians as well as upto-date prehospital equipment. EMS staff were overwhelmed and under resourced, but alongside our religious institutions they helped many people. Since then, we have greatly expanded our training of college graduates to

Dr. Gamal Khalifa transition into support careers in EM and have commissioned a new fleet of ambulances.

What do you feel were the biggest challenges and successes that the emergency physicians had to face?

“Emergency physicians, and physicians throughout, sought to maintain trustworthy communication between themselves and the public. The physicians’ presence as respected authorities in our society was one of the most valuable roles they held — maybe even more so than their medical training. We emphasized to the public that hospitals were there to help — a message that was vital amidst the widespread distrust of institutions affiliated with Egypt's government. “Beyond this, an enormous point of organic growth was the improved communication between EMS teams. Emergency physicians quickly became regional leaders across Egypt. The EgRC continues to train regional physician groups specifically around local response systems that have shared approaches to traumatic and medical resuscitations as well as larger-scaled disaster preparedness. “Finally, a success story from the revolution was the great level of teamwork that arose between emergency physicians and other physicians. Splinting broken bones and stitching closed wounds was a task many of us could do together. Physicians also built relationships as they coordinated between major cities to send and receive vital resources and personnel.” continued on Page 30

GLOBAL EM

continued from Page 29

What is the current state of emergency medicine in Egypt?

“Only 20 to 25 hospitals across Egypt have an emergency physician — mostly concentrated in universities. When there is no EM physician present in a department, we consistently see chaos. That being said, common public knowledge of the field of EM is continuing to increase in Egypt, which is leading to more applicants for emergency medicine fellowships after medical school. “Our most pressing problem is brain drain. We train emergency physicians and then they leave. Physicians leave Egypt because of two core issues: lack of income and poor career progression in Egypt. Training for years understandably leads people to seek out good careers. Our graduates often find better opportunities outside of Egypt.”

“Go and teach in one new location — sharing your time and knowledge — and I promise it will only bear the fruit of more and more opportunities.”

Where do you see the future of EM in Egypt going?

“Legislation towards better pay and physician support in Egypt can be slow. The EgRC trains emergency physicians according to rigorous international guidelines and fighting to retain them while also developing a pool of nonphysician providers. Currently, we use the World Health Organization’s (WHO’s) Basic Emergency Care Course to train nonphysician emergency medicine providers. Bringing this course to Egypt will help mitigate effects of the physician gap. “Overall, the EgRC is very well connected, with over 800 members across Egypt and we would be happy to invite others for exchange training programs, research around disaster

preparedness, or clinical rotations. We invite educators and researchers to come teach and learn alongside us. Notably, the EgRC expanded our training around ultrasound and critical care. People in these fields can feel free to reach out to me.”

What are you currently doing within the field of emergency medicine?

“I am currently retired; however, my career has always been centered on training and publishing alongside my international partners. I have always and will continue to teach trauma and nontrauma-based courses to physicians from different specialties and affiliations in Egypt and across the Middle East, Europe, and Asia. “My work with the EgRC has expanded my scope like a chain reaction. An impor-tant lesson I have learned throughout is to work under the umbrella of international organizations. For example, creating collaborative affiliation agreements with the European Resuscitation Council and WHO has helped me develop and implement resuscitation guidelines in Egypt and many other countries. “Beyond training, I participate in writing and publishing extensively on the European resuscitation guidelines, prehospital and hospital disaster planning, as well as simulation in these topics. I am always interested in collaborations if readers share my research interests! One final message I will impart is this: go and teach in one new location — sharing your time and knowledge — and I promise it will only bear the fruit of more and more opportunities.” ABOUT THE AUTHORS

Dr. Haroun is an emergency medicine resident at the University of Chicago. He is interested in medical education and social emergency medicine with a goal of pursuing wellness and health for both learners and community members.

Dr. Weber is an international emergency medicine fellow at the University of Chicago focusing on the health of individuals in carceral settings. He serves on the executive board of SAEM’s Global Emergency Medicine Academy, the Public Health and Injury Prevention Committee of ACEP, and as national medical director for the Medical Justice Alliance.

About GEMA

The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care. Joining GEMA is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”