When I was a resident, I was amazed at the way our faculty routinely took time from the hustle of the department to impart clinical education. A number of my senior faculty seamlessly transitioned from patient care to education in a way that seemed part of the natural flow of the department. Despite being 3 days into a string of 6, 12-hour shifts, a great deal of that clinical education remains fresh in my mind. I vividly remember Bob Hoffman (@bobhoffmd) teaching me the way he approaches acute exacerbations of chronic diseases (AIIIIE – Arrhythmia, Ischemia, Infarction, Infection, Indiscretion, Embolism), what 1% lidocaine actually is and how easy it can be to get to a potentially toxic dose from Lewis Nelson (@LNelsonMD) and learning the “tox handshake” from Dr. Goldfrank in determining the presence of an anticholinergic toxidrome.
It’s not just the discrete learning points that stuck in my head but rather their dedication to making time for teaching during clinical shifts. This was one of the facets of education I wanted to carry into my own style as a resident educator. Unfortunately, the endeavor isn’t nearly as effortless as these giants made it seem. The challenges of providing great clinical care and of keeping the department humming along often limited the amount of clinical education I was able to provide. Additionally, the few times it was slow enough to take time to teach, I found myself exhausted from the clinical work. Even when time and motivation were present, education didn’t always flow naturally. While I don’t think I ever gave up on delivering education during clinical shifts, there were often times I wanted to tap out.
Our goals as physician educators should be to provide excellent/compassionate patient care while teaching the art and science of medicine, despite these barriers. Last year, I decided to try and refocus my efforts on this challenge after seeing another master, Amal Mattu (@amalmattu), post images of his white board teaching to twitter. This post is the first in a series from master educators discussing their hacks to ensure clinical education even during busy shifts.
Swami’s Clinical Education Hack – Post-It Pearls
This is one that many may be familiar with as many educators, including Michelle Lin (@M_Lin), Rob Cooney (@EMEducation), and many others, have posted their notes to twitter (#postitpearls). The Post-It Pearl is a play off of the white board education Amal regularly shares – discrete pearls written down and shared with anyone who happens to be in the department. The idea is to take tiny bits of education, typically generated by a patient presentation or a clinical discussion and generate a sticky note. The stickies accumulate over the shift as pearls pop up. Although I typically lead the creation of the pearls, anyone – nurse, resident, PA, medical student, faculty member – can generate a pearl.
There are a number of benefits to using this system. Instead of trying to find a block of 10 or 15 minutes in which to do education, simply a minute or two will suffice. I find that clinical education can be stifled simply by the thought of the time necessary to dedicate and this provides a workaround to that challenge. There’s little chance of overwhelming the learner since you can only fit so much information on a post-it (I use a sharpie instead of a pen as this further limits volume of content). As notes accumulate, residents, nurses and providers from other areas of the department invariably wander by and will ask about the post-its as well as the pearls prompting more discussion. Often, faculty working other areas will add their opinions to the discussion. It’s amazing how a simple post-it note can prompt a rich and lively educational moment.
There are limitations to this method as well. The strength – a brief nugget of information – is also a weakness: post-its don’t allow for depth on the topic. Thus, discussion around the nugget must be provided as a compliment. The notes typically highlight the knowledge of a single individual instead of the collective knowledge of the group. Again, this weakness can be resolved by encouraging discussion and debate around the single pearl.
So here’s my workflow for using this hack. As soon as I’ve taken sign out, I create a Post-It Pearl based off of something I learned on the way to work (usually from a podcast or blog post). I place the note somewhere that’s a focal point at the team work station which leads team members (nurses, PAs, residents etc) to ask questions about the learning point itself as well as the education tool. Throughout the shift, we add post-its as learning points arise. At the end of the shift, the pearls prompt a discussion with the oncoming team about what we saw and what we learned. Before I leave, I snap a quick photo of the pearls and leave the notes behind hoping this will prompt the new team to add to the list. When I get home, I email the team the photo of the pearls as well as some additional blog posts, podcasts, articles etc about the pearls so that they can dive into the topics later. My hope is that the pearls will act as a jumping point for the learners to delve deeper into the topic.
While I can’t say that I have data to prove a benefit of the system, the residents I’ve worked with appreciate taking small bits of time to do some education even on busy shifts. The next step is to try and spread the method to other faculty and to the residents as well.