Ask a case-based question to assess the learner's level of knowledge.
e.g. "What do you know about acute cholecystitis?"
Determine general learning goals at beginning of shift.
e.g. "What are you looking to get out of this shift today?"
Determine general strengths and weaknesses..
e.g. "What rotations have you had so far?"
Determine depth of learner's clinical progress
e.g. "So you saw the guy in 8. He has chest pain?"
Learner's answer can show level of clinicianship.
e.g. "Yeah, it looks pretty serious. He's had a heart attack before and his pain is really bothering him." vs. "He's got a legit CAD history with an old NSTEMI, but his pain is nonexertional, nonradiating, and reproducible on physical exam with no other anginal equivalents. It started when he ran out of his percocet yesterday. His ECG is unchanged so if his troponin is normal his HEART score should be low risk and maybe he can follow up as an outpatient."
e.g. "What do you know about acute cholecystitis?"
e.g. "What are you looking to get out of this shift today?"
e.g. "What rotations have you had so far?"
e.g. "So you saw the guy in 8. He has chest pain?"
Learner's answer can show level of clinicianship.
e.g. "Yeah, it looks pretty serious. He's had a heart attack before and his pain is really bothering him." vs. "He's got a legit CAD history with an old NSTEMI, but his pain is nonexertional, nonradiating, and reproducible on physical exam with no other anginal equivalents. It started when he ran out of his percocet yesterday. His ECG is unchanged so if his troponin is normal his HEART score should be low risk and maybe he can follow up as an outpatient."
e.g. "Yeah, it looks pretty serious. He's had a heart attack before and his pain is really bothering him." vs. "He's got a legit CAD history with an old NSTEMI, but his pain is nonexertional, nonradiating, and reproducible on physical exam with no other anginal equivalents. It started when he ran out of his percocet yesterday. His ECG is unchanged so if his troponin is normal his HEART score should be low risk and maybe he can follow up as an outpatient."
Probe to find limits of the learner's understanding: "constructive pimping".
e.g. "How do you want to use the ultrasound? What probe are you using? What are you looking for? What else are you worried about that you can't see on ultrasound?"
Can be chosen from five general areas:
knowledge (e.g. pathophysiology, diagnosis, treatment of a disease, differential diagnosis)
communication (e.g. patient presentation)
procedural skills (e.g. laceration repair)
attitudes (e.g. coping with an emotional family)
behaviors (e.g. staying on top of ED flow)
knowledge (e.g. pathophysiology, diagnosis, treatment of a disease, differential diagnosis)
communication (e.g. patient presentation)
procedural skills (e.g. laceration repair)
attitudes (e.g. coping with an emotional family)
behaviors (e.g. staying on top of ED flow)
Find an appropriate way to fill in the determined gaps in knowledge.
Didactic: teacher centered, with a speaker and a recipient.
explanation of clinical reasoning
minilectures/videos
Board Rounds
how to use clinical decision tools
Socratic: question and answer, leading learner toward right path. Frequently preferable for adult learners 
start with foundational knowledge such as facts
progress to questions that assess synthesis, application of concepts
allow adequate pauses of several seconds
determine learner's level of comfort based on content and prosody of response, body language 
Demonstrative
dependent on acuity of situation
ideally conceptualized first, then verbalized by learner
simulation is an important field in this
Instructional Level must be based on learner level, type of lesson to be taught, acuity of case.
e.g. high likelihood of cholecystitis→ perform RUQ US together: have learner use probe
e.g. low likelihood of cholecystitis, department is busy→ find Youtube videos of normal RUQ US and of the signs of cholecystitis
e.g. department is empty→ mini-lecture: "Let's go through the differential diagnosis of epigastric pain and nausea/vomiting."
Didactic: teacher centered, with a speaker and a recipient.
explanation of clinical reasoning
minilectures/videos
Board Rounds
how to use clinical decision tools
Socratic: question and answer, leading learner toward right path. Frequently preferable for adult learners 
start with foundational knowledge such as facts
progress to questions that assess synthesis, application of concepts
allow adequate pauses of several seconds
determine learner's level of comfort based on content and prosody of response, body language 
Demonstrative
dependent on acuity of situation
ideally conceptualized first, then verbalized by learner
simulation is an important field in this
explanation of clinical reasoning
minilectures/videos
Board Rounds
how to use clinical decision tools
start with foundational knowledge such as facts
progress to questions that assess synthesis, application of concepts
allow adequate pauses of several seconds
determine learner's level of comfort based on content and prosody of response, body language 
dependent on acuity of situation
ideally conceptualized first, then verbalized by learner
simulation is an important field in this
e.g. high likelihood of cholecystitis→ perform RUQ US together: have learner use probe
e.g. low likelihood of cholecystitis, department is busy→ find Youtube videos of normal RUQ US and of the signs of cholecystitis
e.g. department is empty→ mini-lecture: "Let's go through the differential diagnosis of epigastric pain and nausea/vomiting."
direct questioning (facts)
"So remind me, what are the four major criteria of acute cholecystitis on ultrasound?"
direct application
"Show me the gallbladder in A5. Tell me if you think it's cholecystitis."
hypothetical case (synthesis, application)
"How might our differential change if this patient has jaundice and altered mental status? What about an elevated lipase? What else would we test for? How does treatment and disposition change?"
"So remind me, what are the four major criteria of acute cholecystitis on ultrasound?"
"Show me the gallbladder in A5. Tell me if you think it's cholecystitis."
"How might our differential change if this patient has jaundice and altered mental status? What about an elevated lipase? What else would we test for? How does treatment and disposition change?"
ADDIE system
AVPU scale
SAD PERSONS score
Labs Checklist
Pediatric assessment triangle
NIH Stroke Scale
Anal tags
Hemocue