Table 3.

Experiential Learning Strategies Described by Participants for Facilitating Learning About ED Management

Experiential Learning The resident participates in leadership and management of the actual department (in part or in full) with a range of supervisory support, allowing them to explore the work environment and develop strategies for achieving their own goals.
Supervised management of a smaller portfolio of patients	Trainee is asked to manage multiple patients at once with a smaller portfolio of own patients.	Before the shift, we discuss how they are going to manage the department and what part of it they're responsible for. And I try to give them an area that, you know, these eight beds are yours or these 12 beds … or this part of the department. (Attending 1)
Run the board (e.g., review the ED map of patient bed to ensure appropriate patient allocations)	Joint review of ED patients with EP‐teacher to review actual care being provided, with opportunities for more supervisory.	Almost like what you would do running a code but applied to the whole department to kind of resummarize all of that, you know people run the board multiple times and try to figure out where to put the best resources. And also look into how toactivate backup resources if they are available. (Attending 3)
Divide and conquer	Defines limits of resident's responsibility (assigns multiple “sections” to the responsibility of the trainee—e.g., resuscitation; trauma, cardiac). Using geographic zoning results in a larger portfolio of patients.	We might strategize about finding locales to work out of. So, if the senior residents wants … If there is a bunch of stuff to do in critical care and they want to work in the critical care for an hour and I'm gonna work in [the intermediate zone], then I'm gonna work in [the intermediate zone] and he would work in critical care. (Attending 8)
Safety net approach	The trainee begins the day with the goal that they should see all the patients (attempting to “replace” the EP‐teacher). Over the course of the day, the EP‐teacher steps in—seeing more and more patients and assisting in ED flow management, as learner gets more overwhelmed. For instance, when the ED is busy and overwhelming for the resident—then the EP‐teacher would assume 100% control. However, with a fairly experienced senior resident it may require the EP‐teacher to assume a more minimal role.	Then when we get back, we will have a conversation of, “Okay, so when you saw that one sick one, I saw four quick ones, this is how I got through those four quick ones.” (Attending 4) Where the department is really under dramatic stress, usually I run the department but bring the senior along with in the management decisions. But I usually ask them at that point to start seeing the sick patients and doing the clinical medicine. (Attending 2)
Augmented or shared decision making about the trainee's managerial role	The trainee and EP‐teacher discuss the approach for the day and determine the intended strategy for the day. Two variants: ● Learner asks teacher for permission to have this experience ● Learner is pushed by teacher to do it (out of comfort zone)	What I do is I usually try to push them a little bit to go beyond their kind of assigned comfort roles or whatnot. So the juniors soon to be seniors might get pushed a little bit to be senior. (Attending 3)
“Thrown into deep end”	Unknowingly or with little preparation, learner is asked to take the lead on “flowing” department (full experience, little coaching). Two variants of this exist depending on how the trainee interprets this experience “Trial and error”—learner repeatedly given the lead, learns through experience and making mistakes along the way. “Guided reflective practice”—Learner attempts to manage and prioritize multiple patients, reflects on how they did it. This is distinct from the above since in this scenario the learner mindfully and independently initiates a reflective component to improve.	If they are all unwell, but not emergent I might give the resident all of the charts and say all right, you're up. You need to go and see them all and resuscitate them and tell me how you are going to do it. (Attending 7)
“Given the reins”	Performing the actual job of live prioritization with intervention or coaching by EP‐teacher only when requested. This technique is usually reserved for trainees nearing the end of their training.	They stood back and made it very clear, like every once in a while they would look to make sure that you were on the right track, they made it very clear; do what you want to do, and I am not going to say anything unless I have to step in, just stop looking at me and just deal with it, do what you want to do and pretend this is your department tonight. (Resident 4)