Friday, June 26, 2015

Clinical Learning in an Urban Emergency Department: An Examination of Learner’s Abilities for Reflective Practice

Matthew Bitner, MD, MEd
Duke University School of Medicine

The Emergency Department (ED) is a fertile ground for learning. The mix of patients, multitasking, and procedural competence creates a unique milieu. However, harnessing this chaotic learning environment to form residents who are reflective practitioners of medicine can prove difficult. One educational intervention to achieve this is structured teaching rounds. This study used structured teaching rounds to determine if it decreased rates of “unrecognized learning” (i.e. increased rates of reflective practice) and improved learner perceptions of teaching, instruction and satisfaction. During the study period, structured teaching rounds were used in an urban, academic ED. Rounds were audio recorded, transcribed, and coded to the ACGME core competencies, and the concept of “unrecognized learning.” Additionally pre- and post-study period surveys were administered regarding learner perception of teaching, instruction and learner satisfaction. There were 266 learned items were captured, which were coded 673 times to the ACGME core competencies. All competencies were represented but off-service rotators and students failed to identify any interpersonal and communications skills or professionalism items. There was a 2.3% rate of decline in “unrecognized learning” over the study (R2=0.67). Overall there was a trend toward increased learner perception of teaching and instruction (a 16.8% increase), as well as improved satisfaction scores, particularly off-service rotators (a 77.8% increase). The use of structured teaching rounds in the ED can increase reflective practice, learner perception of teaching, instruction and instructional satisfaction in the ED.