Welcome to 3 Articles PEM Clinicians Should Read Right Now, a recurring HipPEMcrates series where we ask leaders across pediatric emergency medicine to share three papers they think every clinician should have on their radar today. Each installment features a new guest author highlighting the research shaping their practice – and yours.
Make sure to check out our past posts from Dr. Daniel Tsze and Dr. Peter Dayan.
Here are three articles selected by Dr. Cindy Roskind from Columbia University Irving Medical Center.
- Irby DM, Wilkerson L. Teaching when time is limited. BMJ. 2008;336(7640):384-387. doi:10.1136/bmj.39456.727199.
Effective teaching in the fast-paced, time-constrained Pediatric Emergency Department (PED) that we all call home is both essential and challenging. This widely cited, landmark article offers practical strategies for integrating high-yield teaching into everyday clinical workflow using intentional micro-teaching moments, explicit learning points, time-efficient teaching models, and focused feedback.
This article is a foundational read for emerging clinician-educators and for seasoned faculty seeking to refine their approach. The paper reviews key bedside teaching strategies, including the “One-Minute Preceptor,” “Aunt Minnie,” and “SNAPPS” models. Irby reframes teaching as a clinical skill in its own right.
Beyond its practical guidance, the article also reflects the broader evolution of medical education toward competency-based assessment and workplace-based evaluation, making its insights enduringly relevant across levels and types of learners in the PED setting.
- Bandiera G, Lee S, Tiberius R. Creating effective learning in today’s emergency departments: how accomplished teachers get it done. Ann Emerg Med. 2005;45(3):253-261. doi:10.1016/j.annemergmed.2004.08.007.
This 2005 qualitative study describes how highly regarded emergency department (ED) teachers create effective learning environments. Using grounded theory methodology, the authors aimed to understand what expert ED clinician-educators actually do in practice. They conducted semi-structured interviews with “accomplished” ED teachers from academic departments, selected through peer nomination, reputation, and recognition, and directly observed expert teaching behaviors in real time.
The study identified the following consistent, high-impact behaviors among expert teachers: seamlessly embedding teaching within patient care, rapidly diagnosing learner needs, explicitly modeling clinical reasoning, using strategic questioning, delivering brief targeted feedback, fostering psychological safety, and balancing learner autonomy and appropriate supervision.
This work remains highly relevant for ED educators as it identifies observable, replicable behaviors associated with excellence in clinical teaching. Furthermore, its themes readily translate into teaching evaluation rubrics and faculty development frameworks, offering practical guidance and applications for advancing the quality of our teaching.
- Goldman E, Plack M, Roche C, Smith J. Learning in a Chaotic Environment. Journal of Workplace Learning. 2009. September; 21(7): 555-74.
For this final article, we shift focus to the learner’s perspective. Using semi-structured interviews and direct observation of twelve emergency medicine residents, the authors explored how trainees learn in clinical environments like the emergency department, where unpredictability and chaos are the norm.
The authors concluded that learning in the ED does not occur in scheduled time blocks, but rather in response to real-time clinical problems (see Figure 1 of the paper). Over time, learners develop the ability to recognize patterns, filter extraneous information, and prioritize under pressure, skills that distinguish novices from experts. The most successful learners, the authors note, adjust their decisions mid-course, tolerate ambiguity, and remain flexible despite cognitive discomfort.
The article reframes the inherent “chaos” of the ED as an educational asset, recognizing that the dynamic ED environment cultivates adaptive expertise, accelerates pattern recognition, and supports reflective practice. In doing so, the paper offers a compelling lens on how trainees learn in our setting.
Dr. Cindy Roskind, MD, is a board-certified pediatric emergency medicine physician and a Professor of Pediatrics (in Emergency Medicine) on the Educator Track at the Columbia University Irving Medical Center. She can be reached at cg278@cumc.columbia.edu.
