The Pre-brief
There are a few procedures in emergency medicine that are both rare and life-saving. For instance, central line placement could be considered a life-saving procedure, but most providers who regularly work in the ED place central venous access regularly enough that they feel comfortable with the procedure. On the other hand, some procedures are rarely performed but not truly life-saving, and thus have less pressure associated with performing the procedure. It can be challenging to teach those procedures that are both rare and life-saving (ED thoracotomy, transvenous pacing, perimortem c-section to name a few), because there are fewer opportunities to actually do the procedure, and when the need arises, it’s critical that the procedure happens as smoothly as possible. As discussed in Part 1 of this series, opening a procedure kit before you need it and emphasizing the prep work are two vital parts of teaching the rare and life-saving procedure. Here, we’ll discuss two more important aspects of procedural education.
Normalize reviewing the procedure
Showing your trainee that you, the educator, are an endless fount of knowledge is one of life’s great pleasures. However, setting pride aside and reviewing a procedure that isn’t frequently done and has the potential (as all procedures do) to go poorly is a sign of an excellent educator. While not always an option, many procedures that are rare and life-saving CAN be reviewed briefly before performing them in the critical setting. Whether it’s grabbing the dusty textbook sitting at the doctor’s station or going to an educational website (may I recommend the CCN Procedures Channel?), showing that the standard of care should include a brief review of the procedure is great for patient care and an excellent teaching technique.
Practice in a simulated setting
Using medical simulation for procedural education isn’t a new idea – most residencies have extensive sim programs that highlight resuscitation, team-building, and leadership, among many other things. While planning and executing an elaborate simulation in a sim center around a single rare procedure may not be something you can fit into your schedule, even a low fidelity simulation with a few learners on shift BEFORE the procedure is needed can increase learner confidence and allow time for questions and corrections in technique. Using simulation in conjunction with the recommended tip of opening a kit before you need it as highlighted in Part 1 of this series is a great way to get learners comfortable with infrequently encountered and high-stress procedures.
The Debrief
Plan ahead when considering how to teach the rare and life-saving procedure. Highlighting the importance of reviewing the procedure prior to performing it and using simulation for procedural education are helpful ways to up your med ed game!
