Specific Teaching Strategies

The Emergency Department, with its fast pace, diverse patient population, and variety of acuity, is a challenging environment in which to effectively and efficiently provide quality medical care while incorporating meaningful educational experiences for learners. Numerous teaching strategies have been developed in order proficiently teach junior learners in the clinical setting.  A few of the more effective and evidence-based strategies are described below.

“One Minute Precepting” – Education using the 5 Microskills

The “one minute preceptor” strategy was first described in the 1990s and recommends five “microskills” for an effective teaching encounter. This method involves identifying needs of a specific learner and providing focused feedback using a five-step approach. The five microskills are listed below.

Five Microskills of the “One Minute Preceptor” 

  • Get a commitment
  • Probe for supporting evidence
  • Teach general rules
  • Reinforce what was done right
  • Correct mistakes/make recommendations for improvement

Here is an example of the One Minute Preceptor model with a handy “NERDS” pneumonic created by Gabe Sudario and posted on ALiEM:

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The SNAPPS Model

The SNAPPS (Summarize, Narrow down, Analyze, Probe, Plan, Select) model is a six-step model for experienced learners to have self-directed learning that allows for insight into the learner’s knowledge base and thought process. The six steps of the SNAPPS Model are listed below:

1. Summarize relevant history and physical findings:The learner should include pertinent history and physical exam findings in a succinct (less than 3 minute) oral presentation.

2. Narrow the differential:The student should create a differential based on the history and physical exam findings. They should include at least 2-3 common and life-threatening diagnoses. Commitment to an initial decision on the part of the student, prior to preceptor input, is a key part of this teaching strategy.

3. Analyze the differential:Based on available data and evidence, the learner should compare and contrast the possible differential diagnoses. They should verbalize their thought process for why they came up with their differentials and what they think the most likely diagnosis is. 

4. Probe the preceptor:The learner is asked to probe the preceptor about the differential diagnosis by asking about uncertainties, difficulties, or other approaches. This allows the preceptor insight into the learner’s thought process and knowledge base and teaches the student to see the preceptor as a knowledge resource.

5. Plan patient management:The student is asked to come up with a brief management plan suggesting specific therapeutic interventions and diagnostic testing, and then the student refines their plan based on preceptor input.

6. Select a case-related learning issue:Finally, the learner is asked to select a case-related issue for self-directed learning and reading, with preceptor input as needed to help focus the question or select learning resources.

Bedside Teaching

The Emergency Department is an ideal setting for clinical bedside teaching. Bedside teaching allows junior learners to discover the subtleties of effectively obtaining the history from an individual patient, see firsthand the clinical manifestations of disease, establish patient rapport, and learn how to competently and compassionately provide patient care.  Bedside teaching also usually allows for immediate feedback.  Great bedside teaching involves improvisation and teaching to each specific learner’s knowledge gap. Medical education can be tailored to the learner, patient, and situation. Bedside teaching is not a passive education model, as teachers must actively seek out learning opportunities and engage the learner to optimize the educational situation.  

Procedural Teaching

Performing a wide array of procedures is an important part of an Emergency Medicine Physician’s scope of practice. Residents and senior medical students frequently supervise and teach junior learners how to successfully perform invasive and potentially dangerous procedures from laceration repair to fracture splinting to intubation.  There are several ways to ensure that procedural teaching is done effectively. However, the most important step is to assess the learner and determine their comfort level and experience with the procedure. The learner’s competency and experience will determine how much autonomy and feedback they will require. If an intern is performing their first central line, then it is likely that the senior resident will need to outline the steps prior to the procedure and walk them through the procedure step by step. However, if the learner has done a dozen central lines, then the supervising resident most likely does not need to provide step by step instruction and can instead observe and provide feedback and advice as needed.  A suggested approach to procedural teaching from the EMRA Resident as Educator guidebook is described below.

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Works Cited

Aldeen, A. Z., & Gisondi, M. A. (2006). Bedside Teaching in the Emergency Department. Academic Emergency Medicine, 13(8), 860-866.

Cayley, W. E. (2011). Effective Clinical Education: Strategies for Teaching Medical Students and Residents in the Office. Wisonsin Medical Journal, 110(4):178-182.

Davenport, C., Hongiman, B., & Druck, J. (2008). The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme. Academic Emergency Medicine, 15:683-687.

Detsky, A. S. (2009). The Art of Pimping. JAMA, 301(13):1379-1381.

Guth, T. A. (2012). EMRA Resident as Educator Handbook.Irving, Texas: Emergency Medicine Residents' Association.

Houghland, J. E. (2009). Effective Clinical Teaching by Residents in Emergency Medicine. Annals of Emergency Medicine, 55(5), 434-439.

Irby, D. M., & Wilkerson, L. (2008, February). Teaching when time is limited. Boston Medical Journal, 336, 384-387.

Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992, July-August). A Five-Step "Microskills" Model of Clinical Teaching. Clinical Teaching, 5(4), 419-424.

Sullivan, G. M. (2015, June). Resources for Clinicians Becoming Clinican Educators. Journal of Graduate Medical Education, 153-155.

Sutkin, G., Wagner, E., Harris, I., & Schiffer, R. (2008). What Makes a Good Clinical Teacher in Medicine? A Review of the Literature. Academic Medicine, 83(5), 452-466.

Wolff, M., Wagner, M. J., & Poznanski, S. (2015). Not Another Boring Lecture: Engaging Learners With Active Learning Techniques. The Journal of Emergency Medicine, 48(1), 85-93.