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Work in progress: How can you balance ED crowding and education?

Michelle Lin, MD |

 I’m working on writing a CORD consensus article on the impact of ED crowding on education and innovations towards maintaining educational excellence. We posited 2 scenarios of ED crowding:

  • Overwhelming numbers of active ED patients
  • Many ED boarders who are awaiting inpatient beds and who are taking up rooms which normally would have been used to see new patients

What approaches do you know of which improve the ED educational experience for learners? We have thus far categorized innovations into 3 areas:

1. Change on the individual educator level

  • Improving faculty and resident development skills (bedside teaching, feedback, frame teaching in reference to competencies)
  • Reinforce to faculty that they are teaching all the time – it’s not all about pathophysiology
  • Resident teaching shifts
  • Attending teaching shifts
  • Incorporating affiliated staff to teach (pharmacist, social worker, nursing)
  • On-hand teaching tools (cards, videos, xrays)
  • Start a teaching file or find an online resource
  • Daily protected time on shift for teaching (AM teaching rounds)
  • More frequent rounds (rapid-fire group learning on patients)
  • Teaching off-shift (feedback on documentation, reflective portfolio)

2. Change on the individual learner level

  • Reset expectations of learner
  • Learner takes more active role in identifying educational focus (eg. Start of shift – What do you want to work on today?)
  • Be obvious as the educator (“This is the teaching point from this case…”)
  • Senior resident role to include management of crowding issues (screening labs, flow management)

3. Change on the systems level

  • Redefining and increasing role of off-service ED resident (Procedures or Sedation resident in ED)
  • Admin resident participation on Crowding QI committee
  • Inpatient staff to care for boarded patients while in ED (frees up ED staff)
  • Improving resident efficiency (role for ED scribes?)


Any other ideas for innovations or approaches to maintain educational excellence in crowded EDs? Crowding isn’t going to be fixed any time soon, and we (as educators) must innovate and adapt.


Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The post Work in progress: How can you balance ED crowding and education? appeared first on ALiEM.

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