Sadka Nancy, Lee Victor, Ryan Anna
Emergency Medicine Training Austin Health Heidelberg Victoria Australia.
and the Melbourne Medical School University of Melbourne Melbourne Victoria Australia.
AEM Educ Train. 2020 May 31;5(2):e10468. doi: 10.1002/aet2.10468. eCollection 2021 Apr.
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.
临床环境中的教学与学习对于急诊医生的培训和发展至关重要。急诊科（ED）服务量的增加和时间压力导致初级受训人员感觉在临床轮班期间缺乏教学和支持。我们试图在这个多样化且具有挑战性的背景下，探究我们急诊科的学习者和上级医生对教学的看法。
对9名急诊科医生和8名急诊科受训人员进行了访谈，以探究他们对急诊科教学的看法。临床教学被描述为轮班期间的“现场”教学。我们使用经过验证的临床教学评估工具来帮助设计和完善部分访谈问题，并采用定性主题分析法对数据进行分析。
我们在研究中确定了三个主要主题：1）尽管两组人员都不确定彼此的参与度和热情，但通过教学与学习互动获得了强烈的目标感和乐趣；2）住院医生持有传统知识传授观点，其对教学的看法与其他人形成对比，但大家都认为教师是急诊科顾问；3）患者病情严重程度和数量的影响，这在忙碌达到临界点之前促进了学习，但超过该点后，服务压力和人员配备限制被认为会对学习产生负面影响。
急诊科是一个复杂多变的工作和学习环境。我们需要对急诊科的教学与学习机会形成共同的理解，这有助于所有利益相关者超越将学习视为知识获取的观念，认识到从众多专业背景的教师身上学习的潜力。
