An elevator door opens in a hospital hallway. The medical team steps in, silent. For Brad Sharpe, a hospitalist and professor of medicine at the University of California, San Francisco, that unremarkable pause represents a missed opportunity he observes daily.
At the SHM Converge 2026 conference in Nashville, Sharpe described those moments as central to what he terms “teaching on the fly.” These brief, structured lessons occur in real time without disrupting patient care. He emphasized it is not a replacement for formal instruction but a distinct skill most clinicians find difficult to develop.
Sharpe explained why even experienced physicians often fail at this. The first error involves assuming effective teaching happens naturally. He told the audience, “You are not Osler,” referring to the renowned 19th-century physician. Without preparation, rounds can become monologues—clinically precise yet ineffective for learning.
A peer observation he mentioned highlighted the issue. A faculty member spoke at length during rounds but later received feedback that no teaching had occurred. The disconnect was evident. Learners did not recognize the discussion as instruction, and evaluations reflected that gap.
The environment presents another challenge. Time constraints, information overload, and memory decay—the Ebbinghaus forgetting curve—mean even well-presented lessons lose half their impact within a day. After a week, retention falls to 10%.
The problem extends beyond forgetting. The brain constantly filters information, deciding what to prioritize. Without a clear signal, a teaching point risks being overlooked amid the demands of a busy shift.
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Sharpe’s method divides the process into seven steps: plan, time it, hook, choreography, teach, repeat, and check for understanding.
Planning begins before rounds. Sharpe asks himself a straightforward question for each patient: What single teaching point should be made today? A new case of thrombocytopenia, a creatinine increase after medication, or an admission for acute pancreatitis each become opportunities to prepare rather than improvise.
Timing plays a key role. A 30-second lesson can work if the team is not already overwhelmed. If they are running late or visibly stressed, the moment is lost.
The “hook” determines whether learners engage. Sharpe uses phrases like “one teaching point”, “a mistake I once made with this”, or “one thing I didn’t know” to capture attention. The aim is clarity, not cleverness.
Choreography emerged as one of the session’s most practical elements. Sharpe had the audience stand and practice three actions: open your body to the whole team, make deliberate eye contact with each person, and address distracted learners by name. If you face only one person while teaching, the lesson reaches only that individual.
The actual instruction should remain simple. State the point before explaining it—”This is about hypokalemia”—so learners activate the correct mental framework. Enumeration helps: “There are three things you need to know” works better than an open-ended list. Voice modulation maintains engagement: speeding up creates energy, slowing down commands focus, and monotone delivery loses the audience.
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He illustrated this with clinical examples. For Staphylococcus aureus bacteremia, he escalated the lesson: “One out of one blood culture is real. One out of two is real. One out of 12 is real. One out of 87 is always real.” The repetition ensures retention. For hypokalemia and hypomagnesemia, he used the image of fraternal twins—often together, but not always. For enterococcal bacteremia, it became Neapolitan ice cream: three treatment options, each requiring a different approach.
Not every lesson requires this level of detail. “If I want to say gram-negative bacteremia is seven days, I’ll just say it,” Sharpe noted. But when a point deserves emphasis, these techniques improve its chances of being remembered.
After delivering the lesson, he restates it. A brief summary reinforces memory. When possible, a quick check for understanding—“What’s the one thing you’ll remember?”—confirms the message was received.
The session concluded with a hands-on exercise. Participants practiced the techniques in small groups before discussing their experiences. The realization was clear: this approach is more difficult than it appears. Yet with planning and practice, those silent elevator moments can become valuable learning opportunities.
Sharpe’s method does not aim to turn every interaction into a lecture. It focuses on recognizing small windows where a single, well-delivered lesson can have an impact—and providing the tools to use them effectively. Doctors in leadership roles often face similar challenges in balancing instruction with patient care.
