Tea trolley teaching: Innovative model for equipping middle-grade doctors with critical care skills in bite-sized sessions
Creators: name: Quek, Karmen
name: Ammara Khan
name: Smith, Emma
name: Potter, Hannah
Publisher: name: F1000 Research Limited
Year: 2024

description: Introduction &amp; Background<br>
Tea-trolley teaching (TTT) is an innovative approach that delivers bite-sized sessions in a positive learning environment, accompanied by tea and chocolates. This model aims to facilitate on-the-job learning, often preferred in busy clinical settings, ensuring minimal disruption to patient care while maintaining staffing levels to provide adaptable one-to-one teaching to learners.<br>
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In the critical care environment, learning tends to be passive during daily reviews, potentially leaving middle-grade doctors underprepared for emergencies. Given the complexity of patients and expertise required for critical care skills, TTT has been introduced in this study to evaluate its benefits and efficacy for middle-grade doctors, as well as the potential for multidisciplinary involvement. Its primary objective is to impart common critical care skills crucial for emergencies, thereby enhancing confidence in managing equipment within a controlled, supportive environment conducive to practice while mitigating risks to patient safety.<br>
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Methods<br>
Utilising the tea-trolley approach, characterised by brief 20 minute sessions with a one-to-one senior-junior clinician structure, pilot sessions covered drugs for rapid sequence intubation and transport ventilator set-up using pre-written learning packs. <br>
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Each session employed a modified version of George and Doto’s model, in which the facilitator starts with an overview of the topic to help learners to understand why the skill is needed. This is followed by a demonstration of the skill and repetition with more details while allowing learners to ask questions or seek clarification of a step or a procedure. Learners are then asked to actively recall the steps of the procedure and finally, perform the skill under observation and to receive feedback from the facilitator. Through this, learners commit the process to memory and given time to practice until they are happy with their own performance. Feedback was collected to assess teaching effectiveness and learner confidence before and after the session.<br>
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Results<br>
Following teaching, all participants reported an increase in knowledge. While most learners illustrated a lack in confidence in the skill before the session, the majority felt comfortable performing it independently afterward.  <br>
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Learners described the tea-trolley teaching approach as a useful learning style which incorporates practicality, interactivity and engagement. Recommendations suggest providing opportunities for practice in real-life clinical settings. Suggestions from participants for program expansion included additional skills such as front-of-neck access, arterial line transducer assembly, non-invasive ventilator setup and ultrasound-guided procedures.<br>
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Discussion<br>
Through the tea-trolley approach, we have created a standardised and sustainable education program for rotational middle-grade doctors in critical care. Doctors are able to upskill quickly and develop confidence when attending critical care emergencies, thus improving the overall efficiency and patient safety. Moving forward, we look to expand its scope to include senior clinicians as learners. This expansion aims to foster a culture of continuous learning and improvement of patient care and safety within the critical care setting. <br>
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As TTT primarily focus on practical skills using a step-by-step demonstration, effective facilitation of theoretical teaching sessions can be difficult. This is due to challenges in developing a learning pack in conceptual topics and possible variations in understanding and delivery of topics among the facilitators.<br>
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Whilst the sessions are developed for one-to-one learning, given variability in facilitators and teaching techniques, some sessions were run with multiple learners at a time, which was reflected in the feedback received. These limitations may diminish the purpose where learners get a personable learning experience and dedicated time to practice skills in a safe and controlled environment. Furthermore, recruiting experienced facilitators to deliver sessions on a regular basis has been proven to be challenging, as they often lack a regular working pattern, posing difficulties in securing their commitment to specific teaching days. <br>
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Considering the limitations discussed, a pragmatic approach is needed to optimise the TTT program. By seeking support from consultants and improvising the program based on feedback collected, TTT can be better tailored to meet the educational needs of middle-grade doctors. <br>
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Conclusion<br>
Tea trolley teaching has been well-received and highly beneficial to learners. This model effectively instills knowledge and confidence in middle-grade doctors regarding critical care skills, ultimately enhancing patient safety at minimal cost.