“ROPE IN” Your Learners to Wrap Up Your Teaching Shifts

Jessica Noonan is the 2024 winner of the CORD Scientific Assembly’s “FirstUp!” New speaker competition. This article is an adaptation of her talk.

“What a great shift!” you think to yourself, as you exit a successful resuscitation, still daydreaming about that double sequential defibrillation. Reality quickly sinks in, however, as you realize there is only one hour remaining until sign out. You are suddenly flooded with thoughts about the results and dispositions still pending. And what about all the clinical teaching pearls you meant to share with your learners? The last hour of a clinical teaching shift is critical for both patient care and your educational mission. If you make a point to “Rope In” your learners at the top of the last hour, you are dedicating time to discuss both the current management of the patients, as well as to provide education and feedback to your learner in an organized and efficient manner. “Rope In” is a novel clinical teaching model that can be utilized for resident/learner teaching, as well as a feedback tool that can be utilized during any clinical shift.

What does the “Rope In” strategy entail?

Start by asking your learner to run their board. Resist the urge to run the board for them! There is greater educational value in listening as opposed to speaking at this stage. Preface this request by explaining that you are looking for them to touch on 3 key points for each patient: RESULTS, OBSTACLES and PLAN.

Results

Your learner should start by summarizing any pertinent results or updates for each patient. This activity provides a safety check on patient care, making sure no information is missed or misinterpreted. It also provides you the opportunity to evaluate your learner on how they synthesize the data and how well they have followed up on their patients.

Obstacles

Ask your learner to point out any obstacles they have come across for any patients. With one hour to go, you still have plenty of time to help them troubleshoot tough situations. This is one of the most valuable educational moments that can occur in any shift. A learner can easily go home and read about the workup or pathophysiology behind a certain disease, but it is not so easy to google how to navigate the frustrated patient or the patient with competing disease processes: think the bleeding patient who is on anticoagulation for an artificial heart valve. Your greatest value as a teacher is often the years of real-life experience that you can share with your learner in situations that do not “follow the flow chart.

Plan

Make sure your learner tells you their final plan for each patient. Do not make any assumptions. Someone who seems like a slam dunk admission to you may not be so obvious to your learner. This is another great moment to explore their thought process and understanding of each patients’ severity. It also ensures a safe sign out to the next team where everyone agrees on what should happen with the patient after you leave.

When you have finished reviewing all your learners’ patients, they are going to want to run off to accomplish everything that you just talked about. Don’t let them go quite yet! Now it is your turn to lead the meeting touching on: EVALUATION, INSIGHT, and NEXT TIME.

Evaluation

You worked with your learner the whole shift and just finished listening to their medical decision making for their patients. This is the moment to provide a brief verbal evaluation of their performance today. Be sure to point out both their strengths, as well as areas for improvement for the future. Keep it short and to the point. This can be accomplished in less than 60 seconds in most cases. Simple but specific comments are the most helpful. Some examples may include: “Your bedside manner with that anxious patient was excellent.”; “It would have been better to evaluate the patient yourself after the nurse expressed concern instead of just ordering more pain medications.”

Insight

After providing your evaluation, you should always ask your learner to tell you what they thought about the shift. Getting their insight is very important. This opens the door for further dialogue and questions from your learner. If you do not specifically ask this question, your learner may not feel comfortable speaking up.

Next Time

Finally, you should make sure your learner knows that they actually learned something on the shift! Remind them of the take-home learning points that will help them next time. For example, “Today we saw the importance of observing a patient ambulate. Your patient was a great example of how posterior stroke may not cause dysmetria on finger to nose testing.”

You should be able to conduct this meeting in about 10 minutes. It will get easier and more efficient each time you do it. If you think you are too busy to do this, rest assured, you will likely save your learner at least ten minutes of time by your input and guidance. Most importantly, an investment in someone’s education is an investment in the future medical care of thousands of patients over the course of their career. What you do matters, and your learners will appreciate this more than you realize.

So that’s it! Loosen your theoretical “rope” and let them go wrap up their cases before sign out!

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