Strategic approaches optimize teaching and learning in the clinic

The landscape of graduate medical education in ophthalmology is evolving with the integration of new teaching technologies, innovative learning methods, and changing learner styles. Although the foundations of educational theory continue to apply for modern learners, faculty mentors and supervisors face new challenges to their time and demands for clinical productivity that can make teaching and mentoring difficult. In addition, rising rates of professional burnout in medicine, including ophthalmology, highlight the pressing need for change and countermeasures to promote staff well-being and improved efficiency.^1-4 Although professional burnout is often driven by mental and emotional exhaustion from work-related stressors and external challenges in scheduling and reimbursement, we believe that one of our best defenses against burnout is finding personal and professional fulfillment in mentorship.

This article describes my methods for improving the efficacy of his teaching time and my strategies for optimizing teaching and learning before (during precharting), during, and after (during postchart rounds and the morning report) the clinic.

During a busy clinic day, physician educators will often face many obstacles that impede effective teaching and learning. Given the limited time dedicated to teaching and learning in the clinical setting during clinic hours, it is important to prepare and start the process well before clinic begins (ie, precharting with purpose). Employing practice management and personal efficiency strategies—such as time blocking—before, during, and after clinic, along with tools such as the Eisenhower Decision Matrix (EDM; Figure) will allow for improvements in teaching opportunities, academic growth, and mentorship.

Our learners prechart every encounter the night before patient visits. This process allows the learner to prechart with purpose (ie, to generate a hypothesis). In addition, learners can read about their cases before seeing patients rather than following the traditional process of reading about the case after the encounter. Learners can also make themselves experts in the precharting phase and be able to answer questions with confidence and sufficient background knowledge to impress the patient and to impress me during the encounter.

A time-saving efficiency measure

The EDM, also known as the Urgent-Important Matrix, is a valuable time management philosophy that helps to prioritize tasks.^5,6 I use the EDM to divide tasks for the day into 4 quadrants based on their urgency and importance: do, delegate, decide, or delete.

For urgent and important items, I force myself to do these tasks right away. They typically require immediate attention and directly impact goals (eg, acute patient care issues or a question that requires an answer). Typically, for these urgent and important decisions, another person is asking for approval or permission to move forward with a task. These urgent and important responses may be as short as one word (eg, “proceed”). Interestingly, for urgent and not important tasks, the same logic applies (ie, the email or message is urgent) but may not be important to me, despite being important to someone, thus the urgency. For these tasks, I delegate and direct the job to the appropriate person. Often, these individuals are simply waiting for the go-ahead from me, but they cannot move forward without my approval, or they are unsure of the next step and are waiting for direction. For example, a resident or medical student preparing for grand rounds that week may simply need a review of their PowerPoint presentation for length, content, and punch line suitability.

I typically delete items in the not important and not urgent box because they are usually tempting distractions and often time-wasting activities. I use this box as a reward for myself (a guilty pleasure), but only after completing the tasks in the other boxes in the EDM.

The most important box in the matrix, however, contains the not urgent but important tasks. I devote 2 hours per day—typically from 4 am to 6 am—to this box during my quiet time, free from distractions and interruptions. Not everyone is a morning person and an early riser, but I cannot accomplish any meaningful work after dinner or following the fatigue of a long clinic day. If I don’t devote 2 hours per day to these not urgent but important tasks, then they will suddenly become urgent and important. In addition, I consider work-life balance, family, friends, date night, and exercise to be in this not urgent but important EDM box.

Time blocking

In addition to the EDM that helps to establish my priorities, I use time blocking to structure my day. I force myself throughout the day to delete, delegate, or do tasks in the EDM (by blocking out time) and defer to my scheduled time block for the not urgent but important tasks in my life. I have found that the combination of time blocking and the EDM forces me (and my learners) to adopt time-blocked preclinic preparation, in-clinic training, and postclinic reflection (the morning report the next day between 7 am and 8:30 am).

Precharting with purpose involves the learner identifying key teaching points before the first patient is seen. We only assign 2 or 3 cases to the learner per day so they can be strategic, deliberate, and intentional about their learning. We use each learner to teach the other learners about the case for which they made themselves an expert, but only at the next day’s morning report. This allows the other learners to read about the patient in the postchart phase of the encounter so that everyone is up to speed. Everybody learns from every case, every day.

Once clinic begins, I only use brief teaching moments to demonstrate a finding, but we save the discussion for the morning report the next day in the postchart phase of the encounter. In this way, we do not disrupt the clinic’s flow. During clinic, learners receive
real-time feedback framed as clinical care and patient teaching (eg, “don’t do that” or “let us look at the algorithm for this clinical presentation”). We are teaching the learner and the patient at the same time in real time because we are talking about the care plan (and not the learner’s performance per se).

I typically discuss the modeling and rationale for clinical reasoning and decision-
making out loud in the dictation. For example, I have found that the live (Dragon) dictation at the conclusion of the encounter with the patient in the exam room is an effective teaching summary for the patient and learner. The dictation explains in plain language the differential diagnosis, the management, and the treatment plan to the patient while emphasizing the reasoning for the learner.

In the postclinic review the next morning (ie, the morning report), we promote ongoing academic and clinical integration for the learner. I have found that learners are just as eager as I am to go home at the end of a long day. For example, our teaching and learning continue to the next day with morning report strategies and case follow-ups as a method of longitudinal teaching. Extending this reflection exercise, each learner is assigned one case from the morning report to present in a more formal didactic format at our Houston Methodist Hospital weekly ophthalmology grand rounds with all the medical students, residents, and fellows. The repetition of the case reinforces key concepts to other learners while offering a structured platform to analyze clinical findings, explore diagnostic challenges, and encourage interdisciplinary discussion. This process also serves as a dry run for the learner, who will then write up a case report or EyeWiki article as a scholarly outcome that promotes the academic growth of learners and opportunities for mentorship.

Long-term and meaningful relationships between mentors and students in medicine have shown to improve student performance in clinics, decrease burnout for both teacher and learner, and create long-term commitments to future mentorship relationships for the former student.

Students can learn these efficient and optimal methods of teaching directly and indirectly from their mentors, creating a lasting and sustainable legacy of teaching for the future. Through observation and direct feedback methods, mentees can actively adopt and be inspired to pass those efficient teaching strategies to future generations. This legacy of teaching will promote motivation in academic medicine for these students and ultimately improve clinical and scholarly outcomes.

Although medicine can—and should—be challenging, it doesn’t have to be overwhelming. A multitude of factors contribute to burnout: increased bureaucratic workload, decreased perceived impact, and a lack of professional fulfillment. Making time for self-care—such as exercising, prioritizing sleep, and maintaining work-life boundaries—can be challenging. However, it is achievable with strategies (eg, using the EDM and time blocking). Thoughtful delegation and the use of high-quality teaching strategies can enhance student learning and reduce your workload.

Balancing the roles of a physician, educator, and mentor should be equally challenging and rewarding. As physician-educators and mentors, we take on a tremendous amount of additional work that demands balance and strategy to sustain. The hope is that these pearls will help you as a mentor to be strategic, intentional, and deliberate with your time and teaching. In doing so, we don’t just support our well-being and patient care, we can also shape the next generation of physicians and the care and mentorship that they will deliver for years to come.

Andrew G. Lee, MD

E: [email protected]

Lee is the Herb and Jean Lyman Centennial Chair in Ophthalmology and chairman of the Blanton Eye Institute, Department of Ophthalmology at Houston Methodist Hospital in Texas and is a professor of ophthalmology, neurology, and neurosurgery at Weill Cornell Medicine. Lee serves as a consultant for the National Aeronautics and Space Administration (NASA) and the National Football League. He is a consultant for Amgen (speakers bureau, advisory board), AstraZeneca, Bristol Myers Squibb, Alexion (speakers bureau), Catalyst, Ethyreal, Stoke, Viridian, and the US Department of Justice. The views expressed here are the authors’ own and do not necessarily represent those of NASA or the US government.

References

1. Hew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018;18(1):38. doi:10.1186/s12909-018-1144-z

2. Kennedy DR, Porter AL. The illusion of urgency. Am J Pharm Educ. 2022;86(7):8914. doi:10.5688/ajpe8914

3. Kilic R, Nasello JA, Melchior V, Triffaux JM. Academic burnout among medical students: respective importance of risk and protective factors. Public Health. 2021;198:187-195. doi:10.1016/j.puhe.2021.07.025

4. Madduri GB, Ryan MS, Collins J, et al. A narrative review of key studies in medical education in 2021: applying current literature to educational practice and scholarship. Acad Pediatr. 2023;23(3):550-561. doi:10.1016/j.acap.2022.12.001

5. Scroggs L. The Eisenhower Matrix. Todoist. Accessed May 19, 2025. https://www.todoist.com/productivity-methods/eisenhower-matrix

6. The Eisenhower Matrix: time and task management made simple. Luxafor. Updated January 31, 2025. Accessed May 19, 2025. https://luxafor.com/the-eisenhower-matrix