Friday 16 January 2015

EM Teacher-Student Matrix of Multi-Tasking in a Transitional Academic Enviornment

From the Desk of
Sagar Galwankar, MD

Earlier in my blog I had discussed what the challenges are as regards education in an Environment in Transition.

Today I want to address what my thoughts are regarding the Teacher-Student Matrix of MULTITASKING in an Transitional Academic Environment.

Emergency Medicine is an unique field where there are defined algorithms and pathways for taking care of a large number of patients with different pathologies. I agree that every patient is different but over and above that there are fixed guidelines and approaches which are advocated. Core Measures, Clinical Pathways, Standard Operating Protocols and Critical Actions are some of the multiple processes which help in operating an efficient and vibrantly progressive Emergency Health System.

Creating Teaching opportunities and sustaining an knowledge imparting environment  in such  a system where the situations change by the second is a great challenge. That is the reason Emergency Medicine Education is different and very important. Its all about Timing and all about the skill to MULTITASK.

Educators who commit to teaching EM are not only educators of subject matter but also experts at Multi Tasking. There can be a time in the ED when you could have 10 beds with ten different patients with 10 different pathologies with different clinical presentations with a Nurse to Bed ratio of 1:3 that means one nurse for three beds with only you covering the 10 beds. That is when the systems and algorithms come into action.

A routine ED shift is 8-12 hours and how you manage your time and try to wrap up your patients with minimum Sign Out to your Next Shift colleague is a part of an art called Multitasking. You still have to not keep patients unseen for a long time in your shift time.

Now this skill has to be nurtured and developed in students and again this has to be displayed and taught LIVE by Teachers.

In an Vibrant Milieu like EM teaching Multi Tasking and learning multitasking is a two way commitment based on the Foundation of Correct and Current Knowledge.

The child Learns what the child is taught, a sibling picks up habits from the other sibling, students learn from their fellow students- these are known fundamentals of learning behavior.

The commitment to teach multi tasking is a daunting task for educators because educators have to be consistent and equivocal to all their students.

Being Efficient in Episodes is not going to impart the skill to the students who know little or nothing and are in transition towards gaining skills and knowledge. 

Example's like Complete Clinical Examination of a Patient in Emergency Department includes examination of the skin. Getting the patient to undress and do a complete clinical examination and see the whole body is a crucial part of the EM Examination because abuse, violence, rashes, ulcers, injuries and reactions are all demonstrated by skin examination and can alter the treatment pathways. WHOLE SKIN EXAMINATION IS CRUCIAL.

In an Academic Environment the educator has to demonstrate that by doing the complete clinical examination all the time and every time so the students learn its importance from the teacher. Theoretical Preaching and Practical Learning have different impacts on a learners skill development. It may be annoying and tiring for the educator to do a complete clinical examination for a small laceration of a stubbed toe but when the educator does that examination what the student is learning is that Complete Clinical Exam includes complete SKIN EXAMINATION and that this fact is important. Imagine if this was not taught to the student , how would be practice of the student when he/ she became a licensed EM Physician. 

In an academic environment in transition where EM is newly developing the responsibilities for the new teachers and the students are exponentially more because both have to develop their skills simultaneously. Being committed to learning with an open mind and teaching and sharing the knowledge are important to both, the teacher and the student.

Having the knowledge, gaining more knowledge and sharing that knowledge consistently is the duty of the teacher. The knowledge has to demonstrated by action and behavior in ACADEMIC THEATER called Emergency Department where Humans Lives are at Stake and seconds count. The student at the same time has to consistently study and improve on his/her skills as to increase the speed and precision in the quest to be efficient thus becoming well trained, safe multitasking Emergency Medicine Expert Care Providers.

If anywhere is this matrix the links of Consistency, Commitment and Current Correct Knowledge are weak then the matrix would break and the outcomes would be bad.

We definitely don't hope bad for our patients that too in a specialty like EM which is newly developing because Bad Outcome in EM is death or damage. I believe a D/D to a EM patient because of a weak matrix demonstrates a system which has to learn to care. In an Academic Environment the teacher and the students are the major stake holders of the system ! 

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