Table 1.
Teaching challenges and strategies for increasing efficiency and effectiveness in critical care education
| ICU Activity | Challenges to teaching | Strategies for improvement |
| Rounding/bedside care | Complexity, unpredictability, rapid pace of clinical care limits time available for teaching | Use of effective, time efficient methods to identify learner needs, teaching to those specific needs, and providing feedback |
| Simultaneously instructing trainees while caring for critically ill patients | Examples: Two-minute observation, one-minute preceptor, activated demonstration and teaching scripts | |
| Lecture/didactics | Wide breadth and depth of knowledge required to care for critically ill patients | Integrate “in-class” experiences with “out-of-class” learning |
| Varying backgrounds and training levels of the learners | Practicing clinical decision-making in the classroom allows trainees to learn from their mistakes in a safe environment | |
| It is not possible expose trainees to all relevant critical care topics | Example: Flipped classroom | |
| The efficacy of traditional lectures is low | ||
| Performing procedures (vascular access, airway management, bronchoscopy, chest tube placement ultrasonography, etc.) | Trainees need to acquire procedural competence with a number of diagnostic and therapeutic tools | Multifaceted learning strategies with performance assessed and mastery demonstrated away from the clinical setting |
| Finding the optimal balance between providing procedural opportunities for trainees and ensuring patient safety | Examples: Computer-based learning, task trainers, and simulation to provide conceptual and technical understanding | |
| Observing and then performing procedures in elective settings, before attempting high risk procedures on critically ill patients | ||
| Just-in-time training immediately prior to actual performance | ||
| Use of adjunct technology (e.g., ultrasound, videolaryngoscopy) | ||
| Patient handover | Handovers are complex communication tasks | Develop learning strategies for ensuring information management and collaboration to generate a shared understanding of patients and reduce clinical uncertainty |
| The process is often error prone and substandard handovers have been linked to adverse events | ||
| Critically ill patients are particularly vulnerable to ineffective handovers | Examples: Discussions of approaches to diagnosis and management of specific conditions promotes learning | |
| Limited evidence for a “best” approach | ||
| Faculty may have limited experience with new handover processes | Providing feedback on clinical actions taken in the preceding shift | |
| Direct supervision of the handover process by experienced clinicians to ensure that communication of critical patient information is occurring and to answer clinical questions | ||
| Supplementing the handover with short educational modules relevant to the patients receiving care | ||
| Using handovers to evaluate trainee performance and provide formative feedback | ||
| Multidisciplinary team practice | High clinical workloads, finding common time to practice, disruption of clinical activities, and cost | Multidisciplinary training incorporated into the activities of daily practice (in situ simulation) can be inexpensive and less disruptive to staffing |
| Training specifically designed to improve team dynamics is new for many critical care clinicians | Example: Regular repetition of commonly occurring scenarios can be used to reinforce learning and teamwork | |
| In situ simulation can be used to interrogate departmental and hospital processes in real practice conditions |
ICU: Intensive care unit.