Background: Time with learners is a finite resource on the teaching wards. As patient care becomes progressively more complex and clinical demands increase, it can be easy for teaching to get deferred to the next day, which is inevitably just as busy as the day before. Limitation in time due to clinical demands is a major factor in shaping the educational experience of learners.
Purpose: Our aim was to develop an ultra-brief teaching session that would encourage learner engagement, be easy for teaching hospitalists to implement, and pose minimal delay to completing clinical work.
Description: We piloted the use of ultra-brief, deliberate teaching sessions at three different teaching hospitals immediately prior to the start of inpatient teaching rounds. The start of rounds is likely to be the time when attention, interest in learning, and caffeine levels of both teachers and learners are highest. These ultra-brief teaching sessions, led by the attending physician, are limited to five minutes or less in an effort to maintain attention and participation, while avoiding any delay in patient care.
Through iterative development and testing, we have found that the content for these ultra-brief sessions must be concise and limited in scope. Examples of topics and methods that we have used successfully include:
1) Discuss the answer to a single clinical question that arose during rounds the previous day
2) Summarize an article that is pertinent to a patient, recently published, or a landmark article
3) Discuss Choosing Wisely recommendations (www.choosingwisely.org) from a relevant field
4) Provide a concise cognitive framework for a common diagnostic or treatment dilemma (e.g., draw a simple algorithm to evaluate causes of
hyponatremia)
5) Review one image or study (e.g., x-ray, EKG)
6) Present one case-based multiple-choice question and discuss the correct answer
Conclusions: The faculty at our institution have found these sessions to be easy to implement without a significant delay to clinical work. Based on spontaneous comments in written faculty evaluations from students and residents, these ultra-brief sessions successfully emphasize the value placed on teaching and learning, even in a busy clinical environment. This feedback has also demonstrated that learners appreciate the brevity and energy of these sessions and value them most when they are relevant to current patients. Additionally, we discovered specific pitfalls to avoid with these sessions, including choosing too large of a topic, sessions lasting longer than 5 minutes (which intrude on clinical work), or having them in a distracting environment.
Having successfully used this at three different hospitals (with different team structures) at our institution, we believe that this format will be easily generalizable to other institutions. Further, we have discovered that senior residents can lead these sessions with attending physician guidance. Ultra-brief teaching sessions prior to the start of clinical work can be a successful strategy to prioritize teaching and engage learners without significantly delaying clinical tasks.