115 GHS Proc. November 2017; 2 (2): 115-124 Original Research T he primary goal of all emergency medicine (EM) residency programs is to produce competent physicians capable of the inde- pendent practice of EM. Te emergency depart- ment (ED) should expose learners to sufcient opportunities to achieve the cognitive, afective, and psychomotor skills necessary for the indepen- dent practice of EM according to the Model of the Clinical Practice in EM. 1 EM residency programs are also charged with educating learners who include medical students and non-EM residents. Te Accreditation Council for Graduate Medical Education (ACGME) requires that all residency programs, except pathology, include either a formal rotation or at least a clinical experience in EM. 2 Te ACGME also specifes that resident learning should encompass teaching and over- sight of other learners at varied levels (eg, stu- dents, residents, and prehospital personnel). Te ED provides a unique, fertile ground for learning. Te management of undiferentiated Clinical Learning in an Urban Emergency Department: An Examination of Residents’ Abilities for Reflective Practice Matthew Bitner, MD, MEd; Sarah Farris, MD; and Lee Benjamin, MD From the Department of Emergency Medicine, Greenville Health System, Greenville, SC (M.B., S.F.); University of South Carolina School of Medicine Greenville, Greenville, SC (M.B., S.F.); Clemson University School of Health Research (M.B.); and Department of Emergency Medicine, St Joseph Mercy Hospital, Ann Arbor, Mich (L.B.) Abstract Background: The emergency department (ED) provides a fertile ground for learning. However, har- nessing a chaotic learning environment to develop resident physicians into refective medical practi- tioners can prove difcult. This study used structured teaching rounds as an intervention to attempt to increase refective practice by decreasing rates of “unrecognized learning” (new information encountered by potential learners that goes unrecognized) and improving learner perceptions of teaching, instruction, and satisfaction. Methods: During the study period, structured teaching rounds were used in an urban, academic ED. Rounds were audio recorded and transcribed into individual items or concepts (“learned items”). These items were then coded to the Accreditation Council for Graduate Medical Education (AC- GME) core competencies and the concept of “unrecognized learning.” Additionally, pre- and post- study period surveys were administered to students and residents in the ED regarding learner per- ception of teaching, instruction, and satisfaction. Results: A total of 266 learned items were captured, which were coded 673 times to the ACGME core competencies. All competencies were represented, but of-service rotators and students failed to identify any Interpersonal and Communications Skills or any Professionalism items. A 2.3% rate of decline occurred in “unrecognized learning” over the study (R 2 = .67). Overall, learner perception of teaching and instruction increased (16.8% increase), along with improved satisfaction scores, particularly regarding of-service rotators (77.8% increase). Conclusions: Use of structured teaching rounds in the ED can increase refective practice and may in- crease learner perception of teaching and instruction, as well as instructional satisfaction in the ED.