Making Teaching Visible: A Visual Cue System to Enhance Real-Time Teaching and Feedback Recognition in the Emergency Department

Emergency department (ED) teaching and feedback frequently occur in brief, conversational moments embedded within patient care. Learners often report insufficient teaching or feedback on shift, despite frequent faculty–resident interactions. One contributor may be failure to recognize educational moments when they occur rather than their true absence. We evaluated whether simple visual prompts could improve learner recognition, structure, and perceived quality of real-time teaching and feedback during ED shifts.

We implemented a low-cost visual cue system using two color-coded flags placed at the attending workstation: one indicating active teaching and the other formative feedback. Faculty briefly displayed the corresponding flag during relevant interactions without interrupting clinical workflow. After longitudinal exposure across multiple shifts, residents completed an anonymous survey assessing recognition of teaching and feedback, educational quality, usability, and comparison to traditional unstructured methods using a 5-point Likert scale. The study was deemed exempt by the institutional review board.

Thirty-seven residents (PGY1–3) completed the survey. Mean Likert scores demonstrated strong perceived benefit across domains. Residents reported enhanced recognition of teaching moments (mean 4.2), improved structure and clarity of teaching (4.3), and higher perceived quality of feedback (4.1). The flags were rated as easy to use and non-disruptive to workflow (4.6). Compared with traditional methods, the system was perceived as more effective in highlighting teaching (3.9) and making feedback more meaningful (4.1). Residents also reported increased recognition of routine clinical tasks as valuable learning opportunities (4.1). Consistency of faculty use was identified as the primary barrier to implementation.

A simple visual cue system can make implicit teaching and feedback moments explicit and recognizable during busy ED shifts. This inexpensive, feasible, and scalable intervention addresses learner perception rather than adding educational burden. Visual signaling may represent a novel strategy to enhance educational transparency, improve feedback salience, and reframe routine clinical work as meaningful learning without disrupting patient care.