Purpose, Pleasure, Pace and Contrasting Perspectives: Teaching and Learning in the Emergency Department.

Abstract

Teaching and learning in the clinical setting are vital for the training and development of emergency physicians. Increasing service provision and time pressures in the emergency department (ED) have led to junior trainees' perceptions of a lack of teaching and a lack of support during clinical shifts. We sought to explore the perceptions of learners and supervisors in our ED regarding teaching within this diverse and challenging context. Nine ED physicians and eight ED trainees were interviewed to explore perceptions of teaching in the ED. Clinical teaching was described as "on-the-floor" teaching during work shifts. We used a validated clinical teaching assessment instrument to help pilot and develop some of our interview questions, and data were analyzed using qualitative thematic analysis. We identified three major themes in our study: 1) the strong sense of purpose and the pleasure gained through teaching and learning interactions, despite both groups being unsure of each other's engagement and enthusiasm; 2) contrasting perspectives of teaching with registrars holding a traditional knowledge transmission view, yet shared perspectives of teacher as being ED consultants; and 3) the effect of patient acuity and volume, which both facilitated learning until a critical point of busyness beyond which service provision pressures and staffing limitations were perceived to negatively impact learning. The ED is a complex and fluid working and learning environment. We need to develop a shared understanding of teaching and learning opportunities in the ED, which helps all stakeholders move beyond learning as knowledge acquisition and sees the potential for learning from teachers of a multitude of professional backgrounds.