#ICEM2025 Medical Education Track - May 27th
- Shahbaz Syed
- May 27
- 6 min read
Speaker: Elif Cakal
Maximizing Potential: Why Optimizing the Clinical Learning Environment is Vital
What would your department do if a trainee noticed a potentially dangerous medication dose—but hesitated to speak up? Would she stay silent, or would she feel empowered to voice her concern?
Dr. Elif Cakal’s session posed this scenario to emphasize a simple but powerful truth: the clinical learning environment shapes everything—from how trainees learn, to how safe our patients are.
More Than Just a Place to Learn
The educational environment is not just a physical space—it’s a complex, co-created ecosystem of relationships, structures, and culture. It includes:
The physical, virtual, and social spaces where learning occurs
The interactions between staff, trainees, and patients
The values and norms embedded in how we teach, supervise, and support
Dr. Cakal’s preferred definition captures it best:
“A complex psycho-social-physical construct co-created by individuals, social groups, and organizations, shaped by contextual climate and culture.”
Why It Matters
A well-designed learning environment benefits everyone:
👩⚕️ For Trainees:
Improves learning quality, motivation, and feedback seeking
Supports self-regulated learning and professional identity formation
Reduces cognitive overload during high-stakes situations
🧠 For Wellbeing:
Encourages meaningful workplace relationships
Promotes self-care, job satisfaction, and engagement
Reduces burnout, depressive symptoms, and workplace stress
🏥 For Patients:
Increases help-seeking, safety behaviours, and communication
Enhances pain management, treatment explanation, and shared decision-making
Reduces adverse events and improves overall care quality
How Do We Optimize It?
Dr. Cakal outlined three levels of intervention to enhance the learning environment—especially in resource-constrained clinical settings.
1. Organizational Level
Structured, longitudinal teaching
Protected time for learning
Faculty development
Reducing unnecessary competing demands
2. Team Level
Clear shared goals
Culture of grace, accountability, and mutual respect
Strong team dynamics
3. Interpersonal Level
Psychological safety: learners must feel safe to speak up and make mistakes
High-quality, supportive supervision
Encouragement of open dialogue and feedback
Back to Emily
In the story that opened the session, a trainee questioned whether she had the right to challenge an attending’s potentially harmful medication order. In a high-functioning learning environment, she would feel safe and supported in doing so.
Optimizing the learning environment isn’t just about better teaching—it’s about safer care and healthier teams.
Bottom line: A strong clinical learning environment doesn’t just train better doctors. It saves lives.
Speakers: Dr's. Wilson Lam, Jean Chen, Isabelle Gray
Maximizing Potential: Why Optimizing the Clinical Learning Environment is Vital
Teaching in emergency medicine often feels like trying to squeeze learning into the chaos of the department—but with the right tools, even a single minute can be incredibly impactful. In this high-energy lightning talk, Dr. Wilson Lam shared his go-to teaching strategies that every clinician-educator can start using today.
🔑 The One Minute Preceptor: A Bedside Essential
You’ve probably heard of it—but are you using it intentionally?
Dr. Lam recommends explicitly sharing the One Minute Preceptor (OMP) structure with your learners to promote psychological safety. When expectations are clear, feedback feels constructive—not personal.
The OMP framework:
Get a commitment – “What do you think is going on?”
Probe for reasoning – “What led you to that conclusion?”
Reinforce what they did well
Correct or discuss errors
Teach one key takeaway – not ten!
🛠️ Just-In-Time Learning: Teach Right Before Action
Before a procedure like inserting a pigtail catheter, pull up a quick how-to video or walk through the steps—but only the steps for that procedure.
Why it works:
Highly relevant to the immediate task
Focused on a single skill
Immediately applied, which reinforces learning
🔁 Spaced Repetition: Make Learning Stick
Emergency medicine is unpredictable. You may only see certain conditions once during training. That’s why Dr. Lam emphasizes spaced repetition.
His solution?
Write cards—short clinical reflections that he routinely uses with residents every time they work together. This repetition builds familiarity and reinforces clinical thinking over time.
Final Takeaways
Dr. Lam’s quick-hit strategies are ideal for the ED:
Clarify expectations
Prioritize psychological safety
Focus on one impactful pearl
Use “just-in-time” tools
Build habits around spaced learning
“In emergency medicine, you may not get a second chance to teach that case—so make the first one count.”
So then, what do you do when your ED is at capacity, beds are blocked, and there’s “no one left to see”? Instead of letting downtime slip away, Dr. Isabelle Gray lead a discussion on a creative toolkit for micro-teaching—practical, learner-centered strategies that make the most of every minute, even in a gridlocked emergency department.
🎯 Personalize Learning with “What-If” Scenarios
Start by asking your learner about their interests or subspecialty goals, then tailor a case:
🏥 Chest pain case? “What if you were their sports med doc on the sidelines?”
☠️ Toxicology fan? “What if this was a massive ingestion?”
These hypothetical variations make learning relevant, fun, and cognitively rich.
📚 Teach Beyond the Medical Expert Role
Slow moments are a perfect time to explore intrinsic CanMEDS roles:
Scholar: What’s the prevalence of this disease? Are there validated decision rules?
Health Advocate: What are this patient’s barriers to care? Insurance? Housing? Workload?
Communicator: How would you explain this to the family—or teach it to a nurse?
Use these conversations to deepen empathy and system awareness.
👩⚕️ Don’t Skip the Physical Exam
Bedside teaching often falls victim to the pace of ED flow. But when it slows down, watch your learner examine a patient—you’ll be surprised what they haven’t been taught.
Whether it’s properly palpating for hepatomegaly or doing a focused neuro exam, these moments offer teachable pearls that stick.
🧰 Tools, Tricks, and Teaching on the Fly
Here’s a grab-bag of quick-fire ideas you can use when things are slow:
Ultrasound anything: Use non-urgent cases to practice image acquisition and interpretation
Teaching portfolio: Keep ECGs or images to pull from when live cases are scarce
Digital whiteboard: Create a shared Google Doc of pearls and cases—residents take it home!
Role reversal: Let the learner “be the attending” and manage flow—simulate cognitive load
Play with carts: Airway, central line, or halo kits—explore them together hands-on
Flow and systems teaching: Walk them through departmental strategy—who moves where, when, and why
Handover as a case study: Use inherited patients to teach diagnostic reasoning and flow
Teach the teacher: Have the learner give you a focused teaching session
Case reconstruction: Debrief a past case, then rebuild it with an EM lens—what would you do differently?
It’s a classic evening shift scenario: you have two eager learners, but the ED is gridlocked, no beds, and no new patients to assess. Bedside teaching feels nearly impossible. Dr. Jean Chen crowd sources on ideas for how we can still delivery meaningful education:
💡 Turn Tech Into a Teaching Ally
When the clinical environment fails, tech can help pick up the slack. Here’s how:
🧠 1. AI Conversations
Tools like ChatGPT can be used on shift to:
Dissect complex cases
Explore “what-if” scenarios
Run through differential diagnoses
Practice clinical reasoning and explanation
These models don’t replace you—they support you in building structured, just-in-time teaching moments.
🖥️ 2. Virtual Whiteboards & Dossiers
Keep a ready-to-go digital teaching portfolio:
Shareable ECGs, images, or procedural pearls
Google Docs for resident notes and follow-ups
Real-time collaborative teaching logs (digital “whiteboards”)
This gives learners something to take home and review later—even if they saw no new patients.
🔄 3. Reimagine the EMR as a Teaching Tool
Your EMR (like EPIC) isn’t just for documentation:
Use messaging features to model task delegation and flow management
Walk through how to prioritize patients in the waiting room
Teach resource stewardship and triage decisions
When learners see how you navigate chaos, they learn through role modeling even in the absence of direct care.
🎧 4. Blend Podcasts with Active Learning
Encourage learners to use short podcast segments during downtime:
Paired with note-taking apps or Google Keep
Frame them with a “listen + apply” challenge (“How would this approach apply to our boarded COPD patient?”)
Especially useful for just-in-time learning when direct clinical experience is missing
🎯 5. Focus on Interests—Even When the Cases Don’t Match
One resident might be on a trauma shift but is interested in psychiatry. Great! Use trauma cases to teach:
Differential diagnosis of altered LOC
When psych isn’t the answer
The intersection of psych and EM priorities
Learners know when the environment isn’t ideal. They’ll remember that you still showed up to teach.
Final Thoughts: Teaching is Mindset, Not Just Beds
Your learners aren’t expecting perfection—they’re watching to see whether you try.
Whether you’re sharing your thought process in real time, constructing micro-lessons on the fly, or using AI tools to simulate cases, the key is showing your commitment to their growth.
“In a bed-blocked ED, learners won’t remember the lack of patients. They’ll remember the effort you made to teach them anyway.”
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