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 of us let slip by every single day. Brad Sharpe, MD, FACP, SFHM, hospitalist and professor of medicine at the University of California, San Francisco in 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.
Why It Takes More Than Good Intentions
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 Structured Approach: Seven Steps
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? A new thrombocytopenia, a creatinine bump after starting a new medication, and an admission with acute pancreatitis: Each is an opportunity to plan for, not stumble upon.
Timing it means reading the room. Even 30 seconds can work, but if the team is 10 minutes from conference or visibly under pressure, this is not the moment, no matter how good the teaching point is.
The hook is what separates 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. Simple phrases work well: “one teaching point,” “a mistake I once made with this,” or “one thing I didn’t know.”
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.
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, but monotone delivery loses a room fast.
Making It Stick
To explain why some points stick and others fade, Dr. Sharpe dipped into neuroscience. The Von Restorff effect, first described by a psychologist in 1933, holds that distinctive, unexpected stimuli are far more likely to be remembered. Emotional arousal, whether from humor, surprise, or drama, further enhances memory consolidation. Creative teaching also generates better retrieval cues, making knowledge easier to access when it is needed in practice.
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. For hypokalemia and hypomagnesemia, he uses the image of fraternal twins, not always together, but often enough that you should check the magnesium when the potassium is low. For enterococcal bacteremia, he invokes Neapolitan ice cream: treatment comes in three flavors, and knowing which one you are dealing with determines your approach. These are not tricks, he said; they are planned, evidence-based strategies. Not every teaching point needs this treatment: “If I want to say gram-negative bacteremia is seven days, I’ll just say it,” but when a point is worth making memorable, these tools give it the best chance of sticking.
After delivering the point, say it again. Repetition harnesses long-term potentiation, strengthening the synaptic connections that make recall possible. Finally, when time allows, a brief check for understanding confirms the message landed.
The session closed with a skill-building exercise in which participants tried these techniques with each other. The debrief made clear that this is genuinely hard to do well and requires planning and practice. Empowered, everyone heading back to a teaching service left with the tools and the framework to fill those silent pauses in the elevator bay with something worth remembering.
Key Takeaways
- Teaching on the fly is the delivery of brief, focused, structured, clinically relevant teaching points embedded in real-time patient care, distinct from other forms of clinical teaching.
- Effective teaching on the fly requires planning. During pre-rounding, identify the one teaching point you want to make for each patient.
- Use a hook to signal that what follows deserves attention: “one teaching point,” “a mistake I once made,” or “one thing I didn’t know.”
- Choreography matters: open your body to the whole team, make eye contact with each person, and bring in distracted learners by name.
- Name the teaching point before making it, keep it relevant and simple, enumerate when possible, and vary your voice for emphasis.
- Dramatic and creative teaching, including analogies, stories, and escalating repetition, improves retention.
- Repeat the teaching point after it is delivered. Even a brief restatement significantly improves retention.
- Check for understanding when time allows.
Dr. Magee
Dr. Kavtaradze
Dr. Choudry
Dr. Magee is an academic hospitalist and division chief of hospital medicine at MedStar Washington Hospital Center and an associate professor of medicine at Georgetown University School of Medicine, both in Washington, D.C. Dr. Kavtaradze is a hospitalist at MedStar Washington Hospital Center and an assistant professor of medicine at Georgetown University School of Medicine, both in Washington, D.C. Dr. Choudry is an academic hospitalist and associate division chief of hospital medicine at MedStar Washington Hospital Center and an assistant professor of medicine at Georgetown University School of Medicine, both in Washington, D.C.