Practical strategies for increasing efficiency and effectiveness in critical care education

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.