Through the COVID-19 pandemic, the clinical response to it rapidly evolving, it is crucial that we do not forget that to achieve best possible outcomes we need to continue to teach and learn.
‘Never too busy to learn – a pandemic response’ highlights ways that teams can continue to learn and grow together, acknowledging the exceptionally challenging context that we currently face. The tips and guidance below will support your delivery of vital teaching and learning during the COVID-19 pandemic.
COVID-19 has had a far reaching impact and training for clinicians in the NHS has changed considerably to adapt to new demands and to ensure safe and efficient patient care.
More than ever, there is likely to be tension between service delivery and educational development. There will be increasing pressures on clinicians and other healthcare professionals over the coming weeks to meet patient demand. Many who find themselves working in unfamiliar environments or across specialties are needing to rapidly adapt and learn new skills to ensure that the health service can cope and patients receive the care they need.
In response to the COVID-19 pandemic we have adapted our Never too busy to learn resource to provide more specific and focused ways to support learning in this evolving healthcare emergency by learning with (and from) each other and our patients.
Learning in moments
As patient numbers and acuity increase, so do the ever more precious learning opportunities, which can be enhanced by:
- tactical timing – maximise the number of team members who can safely attend and benefit from learning opportunities
- multidisciplinary involvement to ensure relevant knowledge and expertise can be efficiently shared, particularly when new cross-specialty teams are forming
- understanding and addressing the ever-changing learning needs of your wider teams
- considered appropriate use of technology to share new learning in a rapidly changing environment and to ‘virtually’ bring the team together
Board rounds and/or huddles
- Is there still time to relate patient cases to guidance and published evidence? How can pre-existing knowledge and expertise be disseminated most effectively? New information is likely to emerge throughout the course of the healthcare response – how best can we utilise such brief learning moments?
- ‘Invite’ questioning across multidisciplinary team (MDT) members to promote an invitational workplace where all staff are motivated and encouraged to learn and develop.
- As workforce roles evolve to fulfil demands, it might be helpful to encourage teaching that reverses the well-recognised ‘senior to junior’ hierarchy. Eg could junior doctors help to teach their consultants how to use the online patient notes system or improve their e-prescribing skills?
- Quick and informal huddles may not always be patient-specific but can provide an opportunity for focused information sharing around many topics such as patient safety, delegation and new techniques. Eg drug-related huddles led by specific members of the MDT. Adaptions of this method, for example, introduce newcomers to relevant policy or guidelines. Teaching can be targeted to the immediate needs of the workforce, and adapted day to day. Considerations in a crisis may be:
- How many huddles are happening per shift?
- Do all staff need to attend?
- How can these be delivered?
- How are senior managers communicating the daily updates and latest changes?
- Virtual hugs – Serving colleagues’ physical needs is essential for them to feel equipped to learn. Refreshments may not be realistic for every huddle, but (particularly in these challenging circumstances), do not underestimate the power of praise and recognising your colleagues’ efforts.
Technology-enhanced working and learning
Clinicians must be mindful of confidentiality and professionalism in the context of technology-enhanced learning, however, when new information becomes available technology can help the whole team to learn.
- Instant messaging:
- allows teams to share information and learning despite factors such as self-isolation, shift patterns or location
- can create a non-hierarchical communication style
- caution must be taken with patient confidentiality and ensuring a professional tone by setting quick ground rules and maintaining focus on the issue.
- FOAMed (Free Open Access Medical Education):
- Free, open access online learning resources are available, many of which have adapted to provide up-to-date information regarding the current pandemic, eg links on the RCP website to specialty-specific guidance on aspects of clinical care and treatment for COVID-19.
- Caution is always required when accessing information via social media, however, platforms such as Twitter can provide a quick-fire way of networking and learning with colleagues both nationally and internationally.
Learning with patients
The evolving nature of pandemic response requires that all healthcare professionals, inside and outside their specialty, must continue to seek opportunities for learning both from and with their patients.
Observing colleagues with patients
Observing colleagues in COVID-19 treatment environments where infection control is paramount is not always appropriate. However, when working with new colleagues who may be cross-covering in unfamiliar environments, observation provides a helpful way to learn a new skill, or the approach to a particular scenario. Ask the observer to focus on important aspects of the patient encounter and give clear objectives. Who should they observe? What specifically should they look for? What is the purpose of this observation exercise?
In ever-changing and fast-paced environments, all healthcare professionals must consider how they role model best practice to the wider team. This includes the knowledge, skills and attitudes to deliver best patient care, as well as how to act professionally at work. Are you inviting a safe environment of learning and questioning? Are you sharing your decision-making with your team? Are you sharing your decision-making with your patient? How effective and positive is your communication?
In situ simulation
Although some planning and pre-briefing is required, simulation in the clinical environment can help facilitate interprofessional learning and build confidence in managing emergency situations. At a time when teams are more fluid than normal, a simulation scenario can help to improve interaction, and build familiarity and working relationships among team members. It also offers the opportunity to practise both clinical and non-technical skills safely and with feedback, eg donning and doffing personal protective equipment (PPE) in the context of an advanced life support (ALS) scenario.
In situ simulation may be helpful in identifying latent errors in the workplace, particularly where spaces have been rapidly adapted to meet evolving demands.
Learning by debrief
Medical professionals will find themselves facing challenging and unfamiliar situations in the response to the COVID-19 pandemic crisis. Debriefing is a crucial aspect of learning.
- Debriefing together across the team can provide insight into the thought processes of colleagues, and therefore aid learning and highlight alternatives.
- Following in situ simulation or an emergency scenario, structured discussion between team members about difficulties or successes can help with reinforcement and retention of new learning.
Discussing the clinical practicalities of a case can help team members recall learning to later apply in similar situations, but what about discussing the emotional aspects of care? In demanding times, reflecting together on difficult decisions and challenging scenarios is equally beneficial. Do we consider the psychological safety of our teams?
Larger, structured meetings such as Schwartz Rounds are not feasible in the current healthcare climate, but could you take the essence of these and adapt them to new ways of working? Ten to fifteen minutes spent discussing ‘when things go wrong’ or ‘when I felt I made a difference’ for example, helps to share worries, provide support and build stronger professional relationships.
 Royal College of Physicians. Never too busy to learn: How the modern team can learn together in the busy workplace. London: RCP, 2018. www.rcplondon.ac.uk/projects/outputs/never-too-busy-learn-how-modern-team-can-learn-together-busy-workplace [Accessed 30 March 2020].