Barriers and facilitators of teaching practice in the emergency medicine specialty.
Abstract
Background. Emergency medicine residency training takes place in environments characterized by high demand for care, unpredictability, and constant pressure. These conditions create tension between clinical productivity and teaching practice, posing challenges to the quality of the training process. Objective. To explore and understand the barriers and facilitators to teaching practice as perceived by emergency medicine residency faculty at a secondary-level hospital of the Mexican Social Security Institute (IMSS). Methods. A qualitative study with an instrumental case study design was conducted. Participants included faculty members from the emergency department of IMSS Regional General Hospital No. 46. Data were collected through semi-structured interviews and analyzed using thematic analysis following the approach of Braun and Clarke. Results. Four main themes were identified: 1) pedagogical flexibility and the teacher's teaching capital, 2) clinical practice in the emergency department as a situated learning setting, 3) pedagogical inertia associated with workload overload and lack of teacher reflection, and 4) institutional identity gap and precariousness of the teaching role. Intrinsic motivation emerged as a key element for sustaining educational commitment despite structural barriers. Conclusions. Teaching practice in emergency medicine is a situated process, influenced by individual and institutional factors. Strengthening the academic recognition and pedagogical training of clinical teachers is fundamental to sustaining quality medical education in complex healthcare settings.
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References
1. Moffett P, Best A, Lewis N, et al. The effect of hospital boarding on emergency medicine residency productivity. West J Emerg Med. 2025, 26, 1. https://doi.org/10.5811/westjem.31064
2. Olmedo-Canchola VH, Bazán-Miranda G, Sosa-Reyes A, et al. Aspectos relevantes en la formación de especialistas en medicina de urgencias en cursos avalados por la UNAM. Rev Educ Investig Emer. 2024, 6, 1. https://doi.org/10.24875/REIE.23000096
3. Hemphill RR, Heavrin BS, Lesnick J, et al. Those who can, do and they teach too: faculty clinical productivity and teaching. West J Emerg Med. 2011, 12, 2. https://escholarship.org/uc/item/1p7584q6
4. Baugh JJ, Monette DL, Takayesu JK, et al. Documentation displaces teaching in an academic emergency department. West J Emerg Med. 2020, 21, 4. https://doi.org/10.5811/westjem.2020.5.46962
5. Regan L, Jung J, Kelen GD. Educational Value Units: A mission-based approach to assigning and monitoring faculty teaching activities in an academic medical department. Acad Med. 2016, 91, 12. https://doi.org/10.1097/ACM.0000000000001110
6. Carmody KA. An academic relative value unit system: do transparency, consensus, and accountability work?. West J Emerg Med. 2019, 20, 6. https://doi.org/10.5811/westjem.2019.8.43832
7. Zuckerman MD, Lin S, Alsalmi F, et al. Narrative review of clinical productivity and teaching in emergency medicine. Cureus. 2021, 13, 4. https://doi.org/10.7759/cureus.14309
8. Kelly SP, Shapiro N, Woodruff M, et al. The effects of clinical workload on teaching in the emergency department. Acad Emerg Med. 2007, 14, 6. https://doi.org/10.1197/j.aem.2007.01.024
9. Rotoli J, Bodkin R, VanGorder G, et al. Emergency medicine scholarly tracks: a mixed-methods study of faculty and resident experiences. West J Emerg Med. 2025, 26, 4. https://doi.org/10.5811/westjem.19453
10. Wang YF, Lee YH, Lee YK, et al. Implementation of entrustable professional activities in emergency medicine: perspectives from clinical instructors. Int J Med Educ. 2025, 16. https://doi.org/10.5116/ijme.6876.5de2
11. Alghamdi O, Alotaibi S, Alkhulaif A, et al. Key factors impacting morning report learning in emergency residency training: a multicenter qualitative study. BMC Emerg Med. 2025, 25, 1. https://doi.org/10.1186/s12873-025-01358-x
12. Yin R. Case study research: design and methods. Applied social research methods Series. 3 ed. Sage; 2003.
13. Mills J, Harrison H, Franklin R, et al. Case study research: foundations and methodological orientations. Forum Qual Soc Res. 2017, 18, 1. https://doi.org/10.17169/fqs-18.1.2655
14. Rillo AG, Martínez-Carrillo BE, Castillo-Cardiel JA, et al. Constructivism: An interpretation from medical education. IOSR J Res Method Educ. 2020, 10, 3. https://doi.org/10.9790/7388-1003070112
15. Villalpando CG, Estrada-Gutiérrez MA, Álvarez-Quiroz GA. El significado de la práctica docente, en voz de sus protagonistas. Alteridad. 2020, 15, 2. https://doi.org/10.17163/alt.v15n2.2020.07
16. Vergara Fregoso M. La práctica docente. Un estudio desde los significados. Cumbres. 2016, 2, 1. https://revistas.utmachala.edu.ec/revistas/index.php/Cumbres/article/view/39
17. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006, 3, 2. https://doi.org/10.1191/1478088706qp063oa
18. O'Brien BC, Harris IB, Beckman TJ, et al. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014, 89, 9. https://doi.org/10.1097/ACM.0000000000000388
19. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human participants. JAMA. 2025, 333, 1. https://doi.org/10.1001/jama.2024.21972
20. Docherty MA. Sociocultural learning in emergency medicine: a holistic examination of competence. Diagnosis (Berl). 2020, 7, 3. https://doi.org/10.1515/dx-2020-0001
21. de la Rosa Marín M, Solernou Mesa IA, Marrero Hidalgo MM. Aprendizaje significativo y su aplicación en la educación médica. Educ Méd Super. 2023, 37, 3. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21412023000300011&lng=es&tlng=es
22. Latorre Vega AG, Perez C, Lora A, et al. Relevancia actual del aprendizaje significativo en la educación médica. Rev Esp Edu Med. 2023, 5, 1. https://doi.org/10.6018/edumed.590361
23. Zuluaga-Velez JC, Gómez-Gómez MM. Percepción de médicos internos sobre el aprendizaje en un servicio de urgencias. Revista Med. 2025, 33, 1. https://doi.org/10.18359/rmed.7696
24. Loría-Castellanos J. Evolución del proceso aprendizaje-enseñanza dentro de la especialidad de urgencias en Latinoamérica. Rev Educ Investig Emer. 2023, 5, 3. https://doi.org/10.24875/REIE.22000099
25. Chaou CH, Monrouxe LV, Chang LC, et al. Challenges of feedback provision in the workplace: A qualitative study of emergency medicine residents and teachers. Med Teach. 2017, 39, 11. https://doi.org/10.1080/0142159X.2017.1366016
26. Baugh JJ, Monette DL, Takayesu JK, et al. Types and timing of teaching during clinical shifts in an academic emergency department. West J Emerg Med. 2021, 22, 2. https://doi.org/10.5811/westjem.2020.10.47959
27. Repullo D, Miró O, Nogué R, et al. Características, contenidos y profesionales implicados en la enseñanza de la medicina de urgencias y emergencias en las facultades de medicina de las universidades españolas. Emergencias. 2022, 34. https://doi.org/10.55633/s3me/E051.2022
28. Chavarría Islas RA, Colunga Gutiérrez FJ, Loría Castellano J, et al. (2017). Síndrome de burnout en médicos docentes de un hospital de 2.° nivel en México. Educ Med. 2017, 18, 4. https://doi.org/10.1016/j.edumed.2016.09.001
29. Aponte Murcia C, Acero ÁR. Motivación y enganche para la enseñanza clínica en un hospital universitario. Educ Med. 2023, 24. https://doi.org/10.1016/j.edumed.2023.100828
30. Cavaleiro I, de Carvalho Filho MA. Harnessing student feedback to transform teachers: Role of emotions and relationships. Med Educ. 2024, 58, 6. https://doi.org/10.1111/medu.15264
31. Loor Avila KJ, Intriago Rodriguez MM, Gallegos Macias MR, et al. La evaluación del profesorado universitario: tendencias en Iberoamérica. Educ Méd Super. 2017, 32, 1. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21412018000100023
32. Palau P, Domínguez E, Llueca A, et al. Los desafíos del profesorado clínico en la educación médica. Educ Med. 2019, 20. https://doi.org/10.1016/j.edumed.2017.09.001
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