Overcome the Challenges of Teaching in Your Fast-Paced ICU

There are unique challenges to teaching knowledge and skills in the ICU setting such as patient urgency.

Part of the challenge of teaching in the ICU setting is the wide array of team members, from a variety of professionals such as pharmacists and nurses to various learner levels such as students and fellows.

In this diverse and multidisciplinary environment, education is fostered with structured bedside teaching techniques, learning end-of-life communication skills, and practicing medical procedures.

There are three strategies to teach diverse ICU teams, according to a research article published recently in CHEST:

1. Bedside teaching should include assigning roles, responsibilities, and expectations for all team members
    
2. Open communication should be encouraged, and educators should create a safe learning environment with critical thinking
    
3. Interprofessional education can take place outside the hospital, including simulations that can train teams

Leadership is an important skill to learn in the ICU, Lekshmi Santhosh, MD, lead author of the CHEST article, told HealthLeaders last week.

"The ICU is particularly important to teach leadership skills, not only in acute situations like Code Blues, but also in the day-to-day rounds situation," she said.

Santhosh said there are several methods to teach leadership skills in an ICU: role modeling, entrustable professional activities that target leadership skills, leadership simulation activities, and small-group workshops and didactics.

End-of-life communication skills
 

End-of-life conversations with families are frequent in the ICU setting and require advanced communication skills.

"Teaching about communication, specifically in the context of family meetings in the ICU, is another invaluable skill for trainees and a teaching opportunity for faculty and fellows," the CHEST researchers wrote.

Earlier research provides several tips on holding difficult conversations with family members in an educational setting:

• Before a family meeting, the learner's baseline communication skills and understanding of the clinical situation should be assessed
   
• The learner's educational needs should be matched with one of the assigned roles in the conversation
   
• Before the meeting, the learner should review the meeting agenda, the instructor should discuss the learner's goals, and pertinent communications skills should be highlighted
   
• Once the meeting starts, the patient and the family should be informed that a trainee will be leading the conversation
   
• The instructor should observe and take notes
   
• After the meeting, the learner should be debriefed with opportunities for reflection, corrective feedback, and planning for future encounters.

"In the meeting itself, the trainee should lead the conversation. The observer should take notes and avoid interruptions—only stepping in if truly needed," Santhosh said.

Procedure training
 

The ICU can be a daunting setting to learn medical procedures, Santhosh said.

"Procedural teaching has added challenges in the ICU environment, in that procedures often have to be done rapidly, with urgency, and with actively decompensating patients," she said.

Procedural basics such as tray preparation, sterilization of the surgical field, and communication cannot be compromised despite the urgency of the situation, Santhosh said. "Maintaining a calm presence under pressure is of utmost importance."

When performing medical procedures, there is a fine line between teaching and treating, she said.

"The balance between autonomy and supervision in the critical care setting is also crucial, since the procedures are high-stakes. Thus, simulation can be extremely helpful—trainees can practice concepts of 'motor memory' and master the various steps, so that they can more readily free up their mental bandwidth when the procedure needs to be done urgently in the ICU."