Spent about an hour this morning rereading my feedback from the first year of fellowship. Whoa, there’s a LOT there! After each shift, our attendings are sent a form with two questions: what did the fellow do well? And what could they do better? I filtered out what seemed pertinent to education, but also let myself feel the feelings for my first-year-fellow self.
Teaching in the emergency department is HARD. I remember thinking on a shift: how do I even know what these residents know? How do I figure out what level they are at? How do I know when I can trust them, and when I can’t? It was such a shift from the ward teaching of residency.
(This obviously has informed some of my research interests).
I realized quickly that there was a *lot* of feedback related to teaching (about 700 words worth!), but I figured I could hit the highlights here. I could also see its evolution throughout the year, as I became comfortable with different kinds of learners and various needs, and I (think I) started listening more.
Man, that metabolic talk really comes around. I tailored it to the ED residents early in my first year, and an attending listened to my quick on-shift teaching about it:
“Taught the residents at a knock it out of the park level! Best talk I have ever seen on genetic disorders and what to do and worry about from the EM perspective…she needs to give this brief talk to the ED group…i promise you will be amazed…!!…finally I get IT!!”
This certainly made me smile, as did the many comments about my enthusiasm.
“Helped residents in a way that did not seem like she was doing things for them.” I liked this one too! Kennedy et al called this “backstage oversight” and it certainly feels like a higher level skill.
As some of you may know by now, I really enjoy procedural education, so this comment spoke to my strengths as well: “Excellent job supervising procedures by trainees.” Although, I wasn’t sure which of the many procedures it was referring to and there were some I found easier to supervise than others.
Developing into a better teacher does take some reflection on the constructive feedback as well. In my first month, this was a theme: “Practice open-ended questions and learning how to be comfortable with silence when an open-ended question is asked…. (we could do a kick ass sim on this…)….it is harder than one thinks so practice is required.” Looking back now: 1) yes, we could absolutely do a kick-ass sim on this and 2) oh man, silence is more important than I ever knew. Zoom has made it even more crucial for us educators to sit there in silence, not knowing who will break it or when it will be broken. This is a skill I am continuing to practice, but I think I have come a long way since interrupting presentations my first year as a fellow.
“[Regarding] Anisha’s goal of tailoring her level of supervision to the learner — we had a resident who was on her first (or maybe second?) shift in our ED, and in this case I’d recommend slightly more supervision than he got. At his level, he wasn’t sure what/how much IVF to order, and missed quite a few orders that I caught be reviewing his orders after he put them in. No harm done, but continue to work on this goal.” Oh boy. I’ve definitely gotten better at “backstage oversight” since first year, but there are still times (I am sure) that I trust learners more than maybe I should.
Later in the year, in April, I was told: “I’d encourage Anisha to continue to work on her goal of modifying her teaching/supervision based on the level of learner… Anisha has the ability and skill to teach at all of these levels, and I applaud her for taking on this goal of tailoring her teaching to the learner in front of her.”
I keep reminding myself that slow progress is progress here. Less interrupting, more silence, and the right amount of supervision and teaching come together to make the kind of learner/teacher relationship that a learner wants to be in. This has huge implications for the learner, but also for patient care and safety. I’ve been thinking about that a lot lately: how does one link these things? Resident-sensitive quality measures are one, but I am sure there will be other ways as well.
Anisha Kshetrapal, MD, MSEd 