Teaching critical care

Introduction

As a specialty, critical care medicine has many unique challenges when it comes to teaching trainees. The intensive care unit (ICU) is an environment with high stakes and time-sensitive decision making for acutely ill patients with multiple competing demands for time balanced against learners across multiple levels of training (medical students, residents, fellows) and backgrounds (internal medicine, surgery, anesthesia, emergency medicine, neurology, nurse practitioners, physician assistants, pharmacists, etc.). Given these challenges, it is helpful to know that the skills necessary to be a high-quality, effective teacher are able to be learned with an understanding of the principles of adult learning in addition to developing a toolbox of methods to teach depending on the topic or circumstances. The goal of this chapter is to provide a review of adult learning theory and curriculum development to aid in learners’ ability to acquire knowledge and skill for critical care.

The role of the educator

Teaching success should be measured in terms of student performance, not the activities of the teacher. Delivering a carefully organized PowerPoint presentation, supervising problem-based workshops, or providing bedside clinical tutorials does not mean one has taught. Unless the learner has acquired new cognitive or psychomotor skills, teaching has not occurred. An effective teacher takes responsibility for ensuring that students learn.

Stritter and Bowles described a model focused on the student. In this model, the teacher assumes responsibility for the learner’s success and creates an environment conducive to learning by managing the educational resources. The teacher as a “manager” creates specific educational objectives, motivates students, uses various educational strategies, evaluates learning, and provides effective feedback to ensure the learner achieves all the educational objectives. Using this learner-centric approach, educators can start to think of themselves less as the “sage on the stage” presenting information and more as the “guide on the side” to help learners achieve success assimilating new information.

Adult learning theories

There are multiple theories that describe how individuals learn. In particular, there are several pillars that describe the principles of adult learning. ÔªøMalcolm Knowles’s andragogy demonstrates the principles that drive adult learners: (1) learning is more self-directed; (2) learning is based on the scaffolds of prior experiences; (3) adults are more motivated to learn things directly related to their roles; (4) adult learning is more problem than topic centered; (5) there is a greater emphasis on internal or intrinsic motivation than extrinsic drivers; and (6) adults need to understand why there is a need to learn the material. ^, Kolb describes this model as “experiential learning,” further supporting the need for adult learners to base new knowledge on both prior experiences and the ability to “play” with the novel concepts to help cement into more permanent learning. This is essential to keep in mind when dealing with more mature learners composing a critical care team. Early learners, such as medical students or residents, may be driven more by external factors, such as a rotation evaluation or grade, compared with senior residents, fellows, or junior faculty who have more intrinsic motivation to recognize the need to learn material for their delivery of patient care.

This transitions into the importance of developing an appropriate learning environment. Learners retain more when they feel comfortable and safe as opposed to situations where there may be fear or anxiety. ^, This is derived from the “brain-based learning” principle of “relaxed alertness,” whereby learners are inhibited from processing new information into long-term memory when the predominant emotion is a stress or fear response. Therefore an optimal learning environment should strive to balance presenting learners with level-appropriate challenges in an environment where they feel safe to play, process, and retain the information they are being presented.

Together, these principles should guide educators on ways to optimize their students’ or trainees’ ability to successfully gain new knowledge and skills. The following sections describe different ways to deliver information and develop curricula based upon these learning theories.