Table 2.
Managerial Coaching Strategies Described by Participants for Facilitating Learning About ED Management
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Managerial Coaching (Dyadic Interactions Between EP‐Teacher and Resident)
Participatory dyadic interactions between EP‐teachers and residents. Discussions are prompted by real or anticipated scenarios, and the resident is being coached through the decision making of for managing the ED. | ||
| Collaborative problem solving of simulated scenarios | EP‐teachers would pose scenarios to senior trainees and then ask them to work through the case, explaining their problem solving along the way and receiving feedback on their decisions. | So to give them an example. “It's Friday night at 11:00 pm. You have no ambulances on offload, you have 20 patients to be seen, you have 3 learners. Tell me how you are going to deploy them. What are you going to do? What are you going to tell me to do to help you move the department?” And then it's walking them through that process of how would you allocate patients, how would you allocate the resources you have to the patients that have to be seen in order to fulfill all of the available goals that you need to fulfill. (Attending 7) |
| Troubleshooting problems | Senior trainee is expected to be actively engaged in troubleshooting of live problems, with the EP‐teacher mainly guiding the trainee through the problem‐solving process, asking for a commitment about the trainee's plan, but explaining his/her own thinking about the situation. The trainee might not participate in the actual implementation of the discussed plan. Examples might include coaching a senior trainee on ways to get help in a difficult situation or helping them to trigger systems‐level procedures to improve bed‐space issues. | I will sort of walk them through what are the sorts of things you are looking for, who to talk to, who is it important to get information from. The senior residents, a similar sort of thing, … What you hope for though is that as they become more senior, they will come to you at the start of the shift and say: “This is what I have found and this is what I would like to do.” (Attending 7) |
| Collaborative problem solving of real‐life scenarios | While situated in the working environment, a trainee is looped into real‐life situations that the EP‐teachers is facing about bed management or systems‐based problems. The trainee is asked to diagnose the systems issue and then suggest management strategies which they can carry out together with the EP‐teacher. | Two days ago I said, “Okay, here's your tracking board. Tell me what the problem is.” And so we make a diagnosis of the [departmental] problem together … (Attending 8) |
| Think aloud for instruction | Looking at an ED map of patient beds and occupancy and explaining what they are thinking and what they are about to do to manage patient flow. | She asked me to prioritize who I was going to see next and to decide how I was going to see them … And so essentially, I had to try as a very junior resident to take all of these into account and decide who needed to be seen most urgently and who could wait for a little bit longer and why. (Resident 1) |
| “Walk‐around” |
EP‐teacher takes learner around to department in an effort to help them gain situational awareness. Along the way, they ask the following questions:
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So with a junior resident, what I will often do is I will take them with me (walking around the department) and explain what I'm doing. I will tell them that it is a good way to start the shift. I will walk them through what are the sorts of things you are looking for, who to talk to, who is it important to get information from. (Attending 7) |
| Debriefing actions with staff (after actions, discuss and talk about how to change) | Used when situations are especially difficult or challenging, a staff physician may make decisions initially, and then cycle back to his or her decisions later in the shift to explain his or her thinking and rationale. This might include making time to address this when situation is calmer. | But in the case were the trauma patient was sicker than you initially anticipated it is challenging to provide teaching. And so instead of doing teaching online we did a debrief afterwards and talked about management of primarily of flow … (Attending 3) |
| Guide senior learners in deployment of junior learners | The senior trainee is asked by the EP‐teacher to lead the team of trainees, deciding what to do next, and allocating patients to other more junior trainees. | I say, “Okay now look at the board and tell me what patient you're going to see and in what order, and which patient are you going to give to the junior residents.” And so, I ask them to do that. (Attending 8) |