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Analysis

Learn About Teaching in Your Fast-Paced ICU

By Christopher Cheney  
   October 25, 2018

Strategies for overcoming ICU instruction obstacles include condensing educational interactions and conducting bedside teaching sessions.

The ICU is a unique care environment that includes teaching of a diverse set of caregivers such as nurse practitioners, physician assistants, medical students, residents, and fellows.

Teaching in an ICU involves several obstacles, according to a recent article published in CHEST.

"Teaching in the ICU comes with unique challenges given the medical complexity of the patients, the time pressure, the diverse levels and professions of learners, and the challenges of communication at the end of life," the researchers wrote.

Overcoming these hurdles includes assigning capable instructors, condensing interaction time with students, and teaching at the bedside.

Instructor qualities
 

The researchers surveyed internal medicine resident physicians to find out which qualities an excellent ICU teaching physician should possess.  Enjoyment of teaching was the most coveted quality:

  • Enjoyment of teaching residents
     
  • Demonstrating empathy and compassion to patients and families
     
  • Explaining clinical reasoning and differential diagnosis in the critically ill patient
     
  • Treating non-MD staff members respectfully
     
  • Showing enthusiasm for topics discussed on rounds

"These teaching tactics can be refined and continuously improved, making them ideal for faculty development. Beyond behaviors that educators can learn, they also need to know the targets for board certification to prepare their learners," the researchers wrote.

Time pressure
 

There are ways for ICU instructors to overcome busy schedules, Lekshmi Santhosh, lead author of the CHEST article, told HealthLeaders this week.

"We recognize that the ICU clinical environment is extremely fast-pace and that balancing high clinical workload with teaching is always a challenge. Fortunately, there is robust medical educational literature from the outpatient, ED, and inpatient settings discussing how to approach teaching in a time crunch," she said.

The "1-minute preceptor model" and mini-chalk talks are examples of condensing interactions with trainees.  

Mini-chalk talks can be banked for future use and should be honed in advance of presentation. Simple symbols are effective such as Venn diagrams and flow charts.

Bedside instruction
 

The bedside is a prime location for instructing residents and other trainees in the ICU, Santhosh said.

"Learners crave clinically applicable, relevant teaching points delivered just-in-time to reinforce learning: bedside teaching thus engages learners immediately and they crave good bedside teaching. Moreover, it is patient and family centered as it brings patients and families into the educational process in the role of educators. Lastly, bedside teaching is often efficient for teaching faculty as it combines direct patient care with education."

Bedside instruction must also be constrained to the ICU environment, the researchers wrote.

"ICU bedside teaching has to be deliberately and carefully refined. Educators should thoughtfully consider the limited scope of a bedside teaching session and resist the temptation to over-teach. Instead, giving a brief 5-min to 15-min talk at the bedside that is relevant to current or recently admitted ICU patients may be more helpful," they wrote.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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