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What Makes a Good Educator? 5 Characteristics of an Outstanding Ward Attending

Shobha W. Stack, MD, PhD

Disclosures

September 16, 2021

As a former clerkship director, I can say that our team spent a lot of time thinking about what makes a good doctor. Equally important, we also spent a lot of time thinking about what makes a good educator. Over the years, I have found that there are five common characteristics among outstanding ward attendings.

They Take Time to Get to Know Their Learners

When you show your investment in learners, they invest in you. Use the first day to ask them about their learning goals and share your expectations, but also get to know who they are. What brought them to this city? What inspired them to go to med school? What are some of their favorite things? This knowledge builds a connection and can put your teaching into context. For example, your student who is seemingly confused about ST elevations on an ECG may be asking from the vantage point of a highly accomplished physicist. (This really happened!)

Above all, use their names and make sure you are pronouncing them correctly. If you aren't sure, ask again and write it out phonetically to help you remember. Doing so may feel awkward, but you are showing them that you care about getting it right. Our names are our greatest connection to who we are. Over time, we give evolving definitions to our names that describe our evolving personhood. When you use someone's name, you are recognizing that connection and showing them that they are important to you.

They Are Humble Learners

To clarify, humility is not insecurity. Humility means you are confident both in your foundation of knowledge and in the understanding that, especially in medicine, there is always more to learn.

A medical student once noticed an unusual-sounding murmur and asked me what it was. I honestly had no idea and readily admitted so. As we walked through the halls to our next patient, we reasoned out that it wasn't a cardiac murmur at all but the turbulence of an arteriovenous fistula. That simple act of reasoning together was a larger lesson that you won't always know everything in medicine, but you do have the foundation and tools to recognize a question and find the answer.

Their Actions Are Intentional

This is a challenge because with resident work compression comes teaching compression. Within this constraint, it is more important than ever to make your teaching moments count. Some do this by having an intentional plan every day for one or two of our patients. For example, if a patient with cirrhosis was scheduled for a TIPS, I might plan to draw a liver with a portal vein and a hepatic vein on the patient's white board, ask the student what TIPS stands for, the intern to label what vessels are being connected, and the resident what complications the teams should watch out for after the procedure.

A quick drawing, brief framework, or mention of a paper's key takeaway are teaching methods that stick longer when they are immediately applicable to the patient before you. That said, if other teaching points already came up with other patients, the team is running behind, or they are distracted by multiple critically ill patients, swap intentionality for flexibility and save these pearls for another day.

They Recognize That Humiliation Is a Feeble Attempt at Teaching

We are all learners: students, residents, fellows, and frankly everyone on the care team. When something goes wrong, it is a teaching opportunity that can prevent the same or worse consequences in the future. Taking a quality improvement approach to finding the root of the problem can help to separate the fault from the learner's potential to frame it as a systems issue, freeing everyone's emotional response to one that allows for cognition.

Communication errors, work overload, lack of specific knowledge, etc., are all issues that any true educator can effectively remediate without relying on shame. If you find yourself becoming emotionally dysregulated, ask yourself why beyond the error itself. Yelling or insulting others is a sign of being overwhelmed by your work or even burned out. Sadly, we are often the last person to realize this about ourselves. If you find yourself becoming more and more irritable when teaching, step back and take a break or move on to other things. Contrary to the past culture of medical education, bullying is indisputably not an effective teaching tool.

They Keep Growing

Finally, one of the best things about teaching is that it keeps your knowledge fresh. Any misconceptions you pass on to your learners are magnified by the hundreds of patients they will care for in the future. This urgency to get things right is what keeps us growing, giving us extra motivation to read the latest Journal Watch, and think of new ways to revisit old concepts. Moreover, staying up-to-date builds trust for your learners. If they see that you also know the latest guidelines or have a useful framework for thinking about antibiotics, the efficacy of your teaching will be that much stronger.

In the spirit of growth, what would you add to this list? Comment below.

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About Dr Shobha Stack
Shobha W. Stack, MD, PhD, once a mechanical engineer, is a physician in palliative care and hospice medicine and a former hospitalist and assistant professor of medicine at the University of Washington. Outside the hospital, you can find her running with her family, attempting to make her kids laugh, and appreciating the ever dynamic Pacific Northwest sky. Follow her on Twitter: @shobhastack

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