Teaching in the trenches: adaptive strategies for clinical education in crowded emergency departments

Emergency department crowding has become a pervasive global challenge that strains patient flow and compromises clinical learning environments. Traditional teaching approaches are often impracticable when patient volumes exceed system capacity and clinician bandwidth is limited. This paper, developed on behalf of the CAEP Education Scholars Committee following the ICEM 2025 workshop, explores adaptive strategies for sustaining high-quality teaching in crowded emergency departments. Drawing on relevant literature and the collective experience of approximately 70 international participants, we highlight three practical approaches organized around a Push, Pull, and Delegate framework: microteaching (Push), the One-Minute Preceptor model (Pull), and technology-enhanced just-in-time teaching including emerging applications of artificial intelligence (Delegate). Participants emphasized that effective instruction in high-pressure settings requires intentionality, cognitive flexibility, and adaptive teaching strategies. Rather than viewing crowding solely as a barrier, reframing it as the context within which modern emergency medicine education occurs can support resilient, meaningful, and learner-centered teaching practices.