Mentoring, Teaching and Lifelong Learning: A Critical Connection
Frederick P. Ognibene, MD, FCCM
National Institute of Health
Washington, DC, USA
In this edition of Critical Connections, I have decided to reiterate some of the points made during my presidential address in February at the Society of Critical Care Medicine’s (SCCM) 36th Critical Care Congress in Orlando, Florida, USA. In that address, I highlighted a few of my career milestones and some of the individuals, including my mentors, who were instrumental in helping me to reach them. Throughout our personal and professional lives, we are always learning from conventional and unconventional role models. As I pointed out in my address, one of my goals in 2007 is to focus on the importance of mentoring for all of us. We all have transitioned or will transition from being a protégé to a mentor, and this transition brings new responsibilities. We have to be clinical teachers at the bedside; we must demonstrate and practice effective and compassionate communication with our patients, their families and (very importantly) with each other; and we have to teach the public about critical care professionals – who we are, what we do, and why.
Mentoring students who rotate through our intensive care units (ICUs) is critical. It is important for them to realize the value and the gratification of being an ICU clinician. If the clinicians-in-training who have not yet decided on a career path can understand and realize the wonderful benefits of a career in critical care, then that is one mechanism to help secure the personnel needed to work in our critical care units and to assist with the challenges associated with workforce shortages. However, getting students interested is only the first step. The next steps should focus on the mentoring and teaching aspects I highlighted at Congress. The Gaylord Palms Convention Center was decorated throughout with blue circular medallions displaying the words “teach” and “learn.” It was a very simple, yet graphic, manner to characterize the lifelong principles we must follow.
Learn the Fundamentals
What exactly are these lifelong principles of teaching and learning? First of all, we have to utilize the fundamentals – the most basic of which is to have fundamental critical care knowledge and skills. A variety of didactic tools are available as you begin to develop a curriculum in critical care, and I will mention a few in this column.
We have textbooks to provide, in a comprehensive manner, the pathophysiology, clinical manifestations and therapeutic options for critical illnesses. These textbooks, which may be aimed at all critical care practitioners or specific members of our dedicated team of intensive care professionals, are published with regularity to guarantee that the content is up to date. Our students read these texts, and most are exposed to lectures that explain the principles further. As one progresses from student to practicing critical care clinician, the textbooks and lectures become more sophisticated and contemporary. Mentors must reinforce this content and must master both old and new materials and concepts.
The Society has developed many tools to assist the teacher and the student. Most notable is the annual Critical Care Congress, which is filled with core critical care content as well as contemporary, timely and late-breaking materials. By attending and participating in this meeting, we are all learning new material and refreshing our previous knowledge. We may use this experience to assist our students and trainees. Although it may not be practical to attend every Congress, one has to consider this venue as a valuable source of core and innovative information useful in our professional lives.
In addition to Congress, the Society has a comprehensive annual review course, the ritical Care Academy, where our most knowledgeable members and best teachers participate as lecturers. Although it is geared toward individuals preparing to take examinations leading to certification or maintenance of certification in critical care, the Critical Care Academy provides content that is beneficial to everyone. Details about the Critical Care Academy are available on the back page and at www.sccm.org.
In addition to these traditional education methods, novel ways to engage the lifelong learner exist in forms more acceptable to complicated professional and personal schedules. One mechanism is Web-based learning. Numerous tools are accessible electronically from a variety of sources, providing one with curricular content. Again, I would like to highlight a few offered by our Society. I strongly encourage you to visit the new LearnICU Web site at www.learnicu.org. This site is designed to organize learning opportunities systematically into categories. Knowledge lines established thus far include end of life, infection, neurology, nutrition, and respiratory system – and this list will grow. The Fundamentals section includes information on the Society’s programs, including Fundamental Critical Care Support, Fundamentals of Disaster Management, Hospital Mass-Casualty Disaster Management and the Adult Online ICU Course. In addition, the Society’s guidelines are available on this site, providing a wealth of data-based information.
Educate and Mentor
Once the knowledge in the critical care curriculum has been mastered, the next step in the mentoring and learning paradigm is to educate students and trainees about practical, clinical issues in critical care. Historically, this has been done at a patient’s bedside. While this continues to be the primary site of clinical training, we have entered an era of new educational tools, notably clinical simulation. Simulation as a training tool has grown exponentially in the past five years, and it has become a primary mechanism of education in medical and nursing schools as well as in hospitals.
Simulation of acute medical and surgical events not only provides a direct means of education, but also exemplifies the importance of team interaction. Simulation is
used to gain clinical expertise and manual dexterity with technical issues, such as the establishment of an airway and the placement of venous and arterial catheters, as well as with surgical procedures. Simulation has become a standard in the hands-on education and training related to acute or clinical crises, such as cardiopulmonary arrest or other life-threatening emergencies. Using a mannequin rather than an actual patient allows students and trainees to learn and to gain feedback from mistakes.
Simulation also is being explored as an adjunct to the Fundamental Critical Care Support courses, which would add practical and hands-on components to the didactic lectures that are the mainstay of this program. The scope of simulation programs is expected to grow significantly. I anticipate that many future critical care practitioners will have the benefit of simulation as an important adjunct to traditional learning. However, one cannot ignore the benefits and importance of learning and observing at the bedside of patients. It is through these experiences that one can observe physical findings and witness the pathophysiologic manifestations of an acute illness as well as the changes that occur when a therapy or intervention is initiated. In addition, bedside learning provides an opportunity for students and trainees to absorb the communication skills and compassion required during interactions with patients and their families. These skills can be honed via simulation techniques utilizing trained professionals or actors, but much can be gained by actually watching a skilled clinician obtain informed consent for a procedure, discuss withdrawing care or comfort a grieving family. These skills are as important as the manual skills gained at the bedside or through simulation.
Although I may be stating the obvious to many with this column, I wanted to reinforce some points in the teach-and-learn cycle. We are all part of that ongoing process as teachers and lifelong learners.
