Background: Formal/structured teaching in a busyEmergency Department (ED) can be challenging. ManyEmergency Medicine (EM) residency programs practice sometype of structured on-shift teaching; but to our knowledge theseefforts and their utility are not well described in the literature.Educational Objectives: We implemented a structuredon-shift teaching program with the goals of being practical,efficient, and easily replicable in the academic ED.Curricular Design: We revised a pilot program for onshiftdidactics entitled Quick Hits (QH).” QH consisted of aclinical pearl delivered by on-coming faculty during the signoutprocess at two of the ten available sign-out transitionseach day. This pilot project had an inauspicious trial and asecond iteration was then implemented with several changesto address the challenges identified. The responsibility forgiving QH was changed to the out-going faculty who simplyused a teaching point based on a patient presentation fromthe current shift for the QH (residents had the option to givethe QH, but ultimately it was the faculty’s job to ensurecompliance). The overall presentation was given a strict timelimit of 1-3 minutes; and it was to take place at the beginningof EVERY sign-out (all ten available sign-outs to addressfaculty forgetfulness and resident requests for more teaching).Impact/Effectiveness: Prior to implementing QH wehad no formal on-shift didactic program. The first iterationhad 31.9% overall compliance over a 6 month period. Therevised design has yielded 41.6% overall compliance withina 5-month period and has generated 6.5 times as manyteaching points across all resident shifts. The method oftracking compliance did not change between the two designs.Resident and faculty feedback has favored the new programover the first and there is no evidence that the sign-outprocess has been delayed in any meaningful way. We feel thatthe increased compliance rate and positive feedback was aresult of the more streamlined and pragmatic approach. Keyelements contributing to this success include a truncated timelimit to avoid delays in patient care and post-shift physiciandeparture; content taken real-time from on-shift encounters todecrease preparation time; and placing the QH at the start ofevery shift to better integrate teaching into the culture of oursign-out process.
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