'Just in time' teaching using department internet searches.

Abstract

Emergency departments (ED) are fast paced environments that cater for a wide range of medical conditions. The scope of information needed by emergency medicine (EM) physicians is broad, and decisions are time sensitive. This raises the question of how best to educate EM trainees so that they are comfortable when treating wide ranging conditions in time pressured situations? Curriculum-based teaching has been adopted by the Royal College of Emergency Medicine (RCEM) to facilitate a centralised approach to EM training. Although this model provides explicit and clearly identified learning outcomes, RCEM acknowledges it is deficient in ‘just in time’ and ‘on the job’ training for doctors. RCEM has expressed the need for innovative education strategies to help identify and address EM trainee's knowledge gaps. Our aim was to design education sessions that focused on our trainees needs rather than following a broad curriculum. The internet is the primary means by which EM doctors seek information for clinical questions, while working and emergency physicians average 1.35 internet searches per patient encounter.1 Knowing this, we went about analysing clinically relevant internet searches on our department computers to try and identify our doctor's frequently encountered knowledge gaps. Using this information, we were able to design half hour weekly education sessions. The education sessions involved a ‘rapid revision’ of the most frequently searched clinical topics from the previous week and one high acuity, low occurrence (HALO) topic. The session was delivered by a consultant using a blended approach of didactic lectures and practical demonstrations. To assess participant satisfaction, we adapted a validated questionnaire designed by the Centre for Advanced Learning and Teaching. We successfully facilitated focused revision of 28 topics over a 6-week period. Participant's satisfaction was evident by the fact that we saw global improvements in all of the post intervention questionnaire scores when compared with pre-intervention scores. Participants commented that it was ‘A very novel idea, content very relevant to everyday working practice’, ‘Great recap of topics and cases seen daily. Amazing new addition to the teaching session’ and ‘targeted and concise teaching’. Although this has been a very beneficial teaching practice, we did learn some lessons. The filtering and analysis of the internet search histories is very labour intensive and requires a team of educators to sustain long term. ED computers are used by nursing staff and non-EM medical staff. This meant that some of the searched topics were less relevant to EM doctors. Another issue with data capture is that doctors can use their phones to search clinical topics and therefore we will not pick up all clinical searches. Although we have shown that this form of ‘just in time’ teaching is feasible and enjoyable for participants, we have not been able to assess whether this form of teaching leads to improved knowledge acquisition or retention and we propose this should be next research question in this area.