Faculty-lead Opinions on Workplace-based Methods for Graduated Managerial Teaching (FLOW MGMT): A National Cross-sectional Survey of Canadian Emergency Medicine Lead Educators.

Objectives: Patient volumes are increasing in emergency departments (ED), causing issues with long wait times and overcrowding. One strategy to cope with this phenomenon is to focus on improving patient flow through the ED. Building on earlier work that identified how staff physicians manage flow and what techniques they employ to teach managerial skills to residents, we aimed to determine when it was most appropriate to implement these teaching strategies in a resident's training.

Methods: We employed a Canada-wide cross-sectional survey of experienced emergency medicine (EM) teaching faculty to determine when they felt our previously identified teaching strategies would be appropriate to implement. The survey was piloted with local educational experts.

Results: A total of 21 EM (38% female, 62% male) educators from 11 programs responded to the survey. The respondents provided an average of 42.5 endorsements per participant for specific teaching techniques across the stages of training. The core of discipline (35.9%) and transition to practice (39.7%) were the stages of training that received the most endorsement. The top two teaching techniques included the observational teaching technique "attitudinal role modeling (i.e. a strong work ethic)" and the conversational teaching technique "teacher provides clinical pearls, tips, pointers." The participants showed fairly high agreement, with the advanced in situ techniques showing fairly high reliability as measured by intraclass correlation coefficients ranging from 0.88 to 0.90.

Conclusions: Our results show a trend toward faculty utilizing more didactic and observational teaching techniques early in residency and then progressing toward more experiential techniques in the senior stages of training. This is consistent with a graduated increase in responsibility as residents demonstrate competency and progress through their training. The results of this study will help inform faculty development around teaching managerial skills in the area of competency-based medical education.