Teachers spice up lessons on the fly

Picture your team walking out of a patient’s room. You head down the hallway toward the elevator, the doors open, and for a moment, everyone just stands there. No one says anything. That pause, that small, unremarkable window between one patient and the next, is exactly the teaching opportunity that most clinicians let slip by every single day. Brad Sharpe, MD, a professor of medicine at the University of California, San Francisco, used that moment to frame the hour ahead at SHM Converge 2026 in Nashville: what do you do with it?

Dr. Sharpe was quick to clarify what teaching on the fly is, and just as importantly, what it is not. It is distinct from discussing the plan, asking questions, giving feedback, or delivering a chalk talk. It is the delivery of brief, focused, structured, clinically relevant teaching points embedded in real-time patient care. He was clear that this is not inferior to other teaching, just a distinct skill set.

Before walking the audience through his approach, Dr. Sharpe was candid about why so many well-meaning clinicians fall short. The first obstacle is the mistaken belief that great bedside teaching happens spontaneously. “You are not Osler,” he told the room. Without preparation, even the most knowledgeable attending can end up doing what one colleague was observed doing during a peer observation: just talking. A lot.

The team could see it happening, but did not recognize it as teaching. Nor did it reflect in their evaluations. “Talked a lot on rounds” and “didn’t do any teaching” were real comments that faculty had received. Talking about clinical medicine is not the same as teaching it.

The second obstacle is the reality of what learners face on rounds: time pressure, information overload, competing distractions, and the Ebbinghaus forgetting curve. Even a well-delivered teaching point sees roughly 50% retention by the next day and as little as 10% by one week, unless something is done to make it stick.

A Framework for the Moment

Dr. Sharpe’s evidence-based framework breaks the process into seven steps: plan, time it, hook, choreography, teach, repeat, and check for understanding. Planning is the easiest step to skip, but the one that makes everything else possible. It starts during pre-rounding, when you ask, what is the one teaching point I want to make about this patient today?

Timing it means reading the room, essentially. Even 30 seconds can work, but if the team is 10 minutes from conference or visibly under pressure, this is not the moment. The hook is what serves to separate a teaching point from background noise. Learners are constantly deciding what deserves attention. That signal tells even a distracted learner: stop, listen, this one is worth it.

For residents and students handling the chaos of a hospital ward, these micro-lessons provide stability. Instead of waiting for a formal didactic session that might be delayed by emergencies, they receive immediate, applicable knowledge that changes how they treat the patient in front of them right now. This turns dead time into a high-yield educational moment.

Choreography was one of the session’s most memorable segments. If you face one learner while making a teaching point, you are teaching one person. Dr. Sharpe had the entire audience stand and practice three elements: open your body to the whole team, make deliberate eye contact with each person, and actively bring in anyone on the periphery by name.

Making Lessons Stick

For the actual teaching, Dr. Sharpe offered several techniques. Keep it relevant and simple. Name it before you say it, as telling learners what the teaching point is about opens the mental file folder before the information arrives. Use enumeration: “There are three things you need to know” is more memorable than an open-ended list. He advised keeping it to two or three items at most.

He recommended varying your voice because speeding up creates energy, while slowing down makes learners lean in. Monotone delivery loses a room fast. To explain why some points stick and others fade, Dr. Sharpe dipped into neuroscience. The Von Restorff effect holds that distinctive, unexpected stimuli are far more likely to be remembered. Emotional arousal, whether from humor, surprise, or drama, further enhances memory consolidation.

He illustrated this with clinical examples from his own rounds. For Staphylococcus aureus bacteremia, he escalates the point with repetition: one out of one blood culture is real, one out of two remains real, one out of 12 remains real, and one out of 87 is always real. The drama makes it land differently than a simple statement would.