An elevator door opens. The medical team steps inside, silent. No one speaks. For Brad Sharpe, a hospitalist and professor at the University of California, San Francisco, that brief pause between patients represents a missed chance—one he addressed during a medical conference in Nashville.
Sharpe described “teaching on the fly” as a distinct method separate from traditional bedside instruction. It isn’t a formal lecture, feedback session, or care plan discussion. Instead, it involves delivering a short, structured lesson during patient care without interrupting workflow.
He emphasized that this approach isn’t inferior. It requires preparation, not improvisation. “You are not Osler,” he told attendees, referencing the famed physician William Osler. Without planning, even skilled clinicians may default to talking without purpose. Observations from peer reviews confirm this tendency. Learners often don’t recognize such moments as teaching, and evaluations reflect that disconnect. Comments like “talked a lot on rounds” or “didn’t teach anything” appear frequently.
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The obstacles extend beyond intent. Learners contend with time constraints, information overload, and distractions. Even well-delivered lessons fade quickly. Research on memory shows about half of new information is lost within a day, and only a fraction remains after a week—unless steps are taken to reinforce it.
Sharpe outlined a seven-step process: plan, time it, hook, choreograph, teach, repeat, and verify understanding.
Planning occurs during pre-rounding. Clinicians should ask themselves what single lesson they want to convey about a patient that day. A new case of thrombocytopenia, a creatinine spike after medication, or an admission for acute pancreatitis each presents an opportunity to prepare rather than react.
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Timing is essential. Even 30 seconds can work, but if the team is rushed or distracted, the moment slips away. A simple hook—phrases like “one teaching point” or “a mistake I once made”—signals that what follows deserves attention.
Sharpe stressed the importance of choreography. Facing one learner means teaching only that person. He had the audience stand and practice: open your body to the whole group, make deliberate eye contact with each member, and include those on the edges by name. The adjustment is small but changes who feels engaged.
When delivering the lesson, he advised keeping it simple and relevant. Naming the topic first prepares the learner’s mind. Structuring it as a numbered list—”There are three things you need to know”—works better than an open-ended explanation. Varying tone, speeding up for energy or slowing for emphasis, helps maintain focus.
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After delivering the point, repeating it strengthens recall. When time permits, a quick check ensures the message was understood.
The session included a hands-on exercise. Participants practiced the techniques and discussed their experiences. The conclusion was straightforward: this method is harder than it seems. It demands preparation, practice, and flexibility. Yet for those willing to try, even silent moments in an elevator can become valuable learning opportunities.
Teaching on the fly isn’t about filling every second with instruction. It’s about choosing the right moments and making them meaningful without adding unnecessary noise.
