AM Rounds http://academicmedicineblog.org Beyond the pages of Academic Medicine, journal of the AAMC Thu, 22 Jun 2017 09:40:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.4.10 Author Reading: Humbled http://academicmedicineblog.org/author-reading-humbled/ http://academicmedicineblog.org/author-reading-humbled/#respond Thu, 22 Jun 2017 09:40:49 +0000 http://academicmedicineblog.org/?p=3446 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, J.S. Desai reads his essay, “Humbled,” in which he reflects on what his first patient, his big brother, has taught him about knowing and judging others in his care. His essay was published in the Teaching and Learning Moments column in the June issue of Academic Medicine.

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Editorial Board Q&A: Grace Huang, MD http://academicmedicineblog.org/editorial-board-qa-grace-huang-md/ http://academicmedicineblog.org/editorial-board-qa-grace-huang-md/#respond Mon, 19 Jun 2017 19:45:44 +0000 http://academicmedicineblog.org/?p=3440 Grace Huang Lori Newman 20160411 001

Grace Huang, MD, Editor-in-Chief of MedEdPORTAL, associate professor of medicine at Harvard Medical School, hospitalist at Beth Israel Deaconess, Director of the Rabkin Fellowship in Medical Education, Co-Director of the BIDMC Academy, and Associate Program Director in Internal Medicine

Describe your current activities. 

I have a marvelously multifaceted career, and its common threads are mentorship and scholarship. My faculty development roles allow me to cultivate the careers of faculty members seeking to excel as educators and leaders. For our residency program, I am responsible for resident evaluation and remediation, which is hard, meaningful work. I am the new Editor-in-Chief of MedEdPORTAL, which gives me the privilege of witnessing and shaping the innovative teaching efforts of faculty around the world. As an investigator, I am studying critical thinking, cognitive bias, high value care, and most recently, physician wellness.  Lastly, but not least, my clinical function as a hospitalist reminds me constantly of our ultimate mission as healers.

What gaps do you see in the current academic medicine scholarship?

I’ve always cherished the function of peer review. But my editorial role has given me an intimate window on its beauty…and where it falls short. I entered the position at MedEdPORTAL hoping to better explore the concept of “scholarship on scholarship” and to understand how we can build on a time-honored establishment and take it to the next level.

Name two to three seminal Academic Medicine articles that everyone in your field should read.

What issues will we be reading about in Academic Medicine in five years? 

As the interface between teacher and learner continues to blur, we will be reading more about peer learning and student-as-teacher programs.

We will fully recognize the power of simulation and will use it routinely for high stakes assessment.

Lastly, I pray in 5 years we will be reading about what we learned in conquering physician burnout.

What book(s) are you reading right now? 

I really ought to read more of the kind of books that would inform my work but I tend toward escapist literature instead. I just finished Seveneves by Neal Stephenson. This book spans millennia, beginning with the premise that the fragmentation of the moon into 7 parts will lead eventually to a meteoric shower that destroys the earth. How the world grapples with this inevitability is only the first half of the book…

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How Prepared Are You to Lead? http://academicmedicineblog.org/how-prepared-are-you-to-lead/ http://academicmedicineblog.org/how-prepared-are-you-to-lead/#comments Tue, 13 Jun 2017 13:21:17 +0000 http://academicmedicineblog.org/?p=3402 EKG rhythm with light bulb

By: Peter Pronovost, MD, PhD, and Christopher Myers, PhD, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine

Physicians increasingly are being asked to lead health systems and improvement efforts, so it is important that they have the necessary skills to do so. To see why and how these leadership skills matter, we propose a quick test. Below, we present three scenarios that a health leader might need to navigate. As you read these scenarios, we encourage you to reflect on whether you have a framework you could use to address the issues described, whether you have all of the necessary skills to address these issues, and whether you have a commitment and mechanism to grow and develop these skills.

Case 1: You were just hired as a new attending in a surgical division. A nurse comes to you confidentially to raise concerns about the quality of care provided in the division. The nurse does not want you to discuss the issue with others, because she fears she will suffer retaliation. She states that there is a strong culture of fear and distrust. What do you do?

Case 2: You are leading a project to introduce a new pathway for managing heart failure patients. You bring together the academic and community cardiologists and the primary care physicians. The main academic cardiologist says he wants to make the pathway as he is the world expert. He drafts a pathway and hands it out at the first meeting. The other physicians feel disrespected and do not want to participate. You are under pressure from your hospital leadership to implement the pathway and reduce practice variation. Yet the physicians do not want to join. What could you have done differently and how might you recover?

Case 3: You recently have been made the chief quality officer of a hospital. The boarding time for patients admitted through the emergency department is very high, and your Board and leadership want you to reduce it. You understand that it is a complex problem involving multiple departments. You also know that the interventional cardiologists and surgeons do not want emergency department patients to take their beds–they want to be able to accept transfers from outside hospitals. You call a meeting to work on the problem. How would you motivate the different departments and lead the change effort? The lead medicine physician and surgeon say you do not even need a meeting because the emergency medicine patients are a low priority. How do you approach the problem and get them on board?

All three of these cases illustrate issues of trust, teamwork, power, and change in organizations. These are issues that all leaders face every day, yet they are not the issues that physicians are trained to address. In all three cases, an understanding of leadership and organizational dynamics could provide the frameworks and tools to successfully navigate these challenges.

How did you do on the test? Did you feel prepared to handle the situations? If you need more training, where will you get it?

While we believe these topics need to be incorporated into the medical school curriculum, for physicians who are already in practice, we suggest looking for opportunities at business schools (particularly for those physicians at AMCs affiliated with large universities). Increasingly, business schools are offering specialized courses and opportunities for developing the leadership skills needed in health care. For instance, at Johns Hopkins, we offer a specialized five-day Executive Certificate in Health Care Leadership and Management, which is open to health professionals from any institution and offered for continuing education credit. This program brings together health leaders and management experts to develop the kinds of foundational skills and abilities described in our Academic Medicine article.

In addition to formal training, ongoing skills development through peer or formal coaching is also important. This training can be practical. For example, ask a trusted colleague to provide feedback on your performance in a high stakes meeting. Did you listen to others’ concerns? Did you align around a common interest? Did you reduce resistance? Whatever the source, though, it is never too late to develop these critical leadership competencies, and, by doing so, we can improve the quality of care we provide.

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Author Reading: Nutella http://academicmedicineblog.org/author-reading-nutella/ http://academicmedicineblog.org/author-reading-nutella/#respond Thu, 08 Jun 2017 07:17:14 +0000 http://academicmedicineblog.org/?p=3431 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, Dr. Sarah Bernstein reads her essay, “Nutella,” in which she reflects on a patient who taught her that being a doctor sometimes means sharing a spoonful of Nutella and bearing witness to a patient’s journey rather than ordering tests and medications. Her essay was published in the Teaching and Learning Moments column in the June issue of Academic Medicine.

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Save the Date: Ask-the-Editor Twitter Chat http://academicmedicineblog.org/save-the-date-ask-the-editor-twitter-chat/ http://academicmedicineblog.org/save-the-date-ask-the-editor-twitter-chat/#respond Fri, 02 Jun 2017 15:10:27 +0000 http://academicmedicineblog.org/?p=3415 Final twitter chat graphic

Are you curious about academic medicine scholarship? Why not chat with Academic Medicine’s editor-in-chief? Join our Ask-the-Editor Twitter chat on Tuesday, June 13th, from 2-3PM (ET). Go ahead and ask hard questions—about peer review, about the world of academic medicine, or about conducting and reviewing scholarship.

Our Editor-in-Chief, David P. Sklar, MD, is prepared to answer questions with broad appeal to the academic medicine community, including for example, about his role as editor or about his goals for the journal. Do you want to know about the most common pitfalls Dr. Sklar sees in submitted papers? Just ask! Are you interested in getting involved in scholarly publishing? Academic Medicine’s editor may have career advice.

We want to not only hear your questions but also provide a venue for Academic Medicine’s readers and followers to engage with one another and us. Join us! Just tweet @AcadMedJournal using #AsktheEditor. See you there!

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Reaching the Same Goal Together:The Importance of Medical-Legal Collaboration http://academicmedicineblog.org/reaching-the-same-goal-togetherthe-importance-of-medical-legal-collaboration/ http://academicmedicineblog.org/reaching-the-same-goal-togetherthe-importance-of-medical-legal-collaboration/#respond Mon, 29 May 2017 17:00:46 +0000 http://academicmedicineblog.org/?p=3407 hands in go team formation

Editor’s Note: For more about the interprofessional program described in this blog post, check out this Academic Medicine article.

By: Elizabeth Wedegis, Georgia State University College of Law, 2017 Graduate

Though I first joined the Health Law Partnership (HeLP) Legal Services Clinic to gain practical legal experience, I am leaving the clinic with much more, including a better understanding of how both medical and legal professionals have the same goals and can better accomplish those goals together. Lawyers and doctors do collaborate in some instances: when a lawyer needs a medical expert opinion to prove a case, or when a doctor needs legal advice regarding risk management of patient care. Learning to work together as students, however, will prepare lawyers and doctors to address the social determinants of health together.

Each profession is person-centered. In law school, we are taught how to help each client through diligent research and compassionate client communication. In the HeLP Clinic, we see what medical students are taught by participating in classes at Morehouse School of Medicine, attending patient rounds at Children’s at Hughes Spalding, and sitting in on case deliberation in the resident workroom at Hughes Spalding. Both boil down to a fundamental goal: The client/patient comes first.

During patient rounds, I saw how medical professionals provide for their patients, through both medical technologies and through emotional consideration. I remember one patient, a baby with feeding issues, who had previously visited the hospital due to weight loss. After a couple of days in the hospital, he gained weight and was doing better. The doctors suspected an issue at home and called the Division of Family and Children Services (DFCS). DFCS decided the child should stay with his mother, so he was released to her care. When the child returned to the hospital, the doctors pushed harder for DFCS to find a foster home for him. While recounting the patient’s backstory, the doctor explained “it’s not about [what] the adults [want], it’s about that child in there.” That resonated with me as another reason for collaboration between doctors and lawyers. Both focus on what is best for the individual. In two such person-driven fields, it is important for each to listen to and learn from the views and techniques of the other.

Both professions also strive to balance providing facts and staying compassionate. A doctor once explained to me that, as physicians, “we are scientists, we give the facts,” even when they are not what the patient wants to hear. She and another physician spoke about how some residents are hesitant to include “obesity” as a pregnancy risk because they anticipate a patient’s negative reaction. But, as the doctor explained, it is a risk and, because they must give the facts—it must be added to the chart along with other pregnancy risks that derive from obesity, including heart issues and diabetes.

Similarly, in the HeLP Clinic we have discussed how to handle closing a case when an analysis of the legal requirements for receiving Social Security disability benefits and the medical records show that a child is most likely ineligible. Though providing the facts is an essential part of both professions, compassionately explaining those facts is equally important. I plan to apply what I’ve learned in the HeLP Clinic to my future practice by collaborating with other professionals from the start of each case because, when we have a common goal, working together will always be more rewarding for both the professionals and the client/patient.

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How Medicine Can Be an Instrument of Social Change: A Discussion about Physician Advocacy http://academicmedicineblog.org/how-medicine-can-be-an-instrument-of-social-change-a-discussion-about-physician-advocacy/ Tue, 23 May 2017 19:35:55 +0000 http://academicmedicineblog.org/?p=3398 A new episode of our podcast is now available through iTunes. Listen and download it today.

Discussing social medicine, physician advocacy, and structural competency are editor-in-chief Dr. David Sklar, Dr. Jack Geiger, and medical students Tehreem Rehman and Jennifer Tsai.

This conversation complements articles in the March 2017 issue of the journal. For more on social medicine, check out other AM Rounds content.

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Author Reading: The Stranger in the Room http://academicmedicineblog.org/author-reading-the-stranger-in-the-room/ Thu, 18 May 2017 11:07:40 +0000 http://academicmedicineblog.org/?p=3396 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, Dr. Nancy Angoff reads her essay, “The Stranger in the Room,” in which she compares connecting with patients in the exam room before and after the advent of electronic health records. Her essay was published in the Teaching and Learning Moments column in the May issue of Academic Medicine.

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“My Husband Qualifies for Sainthood”: Balancing Relationships Through Residency Training http://academicmedicineblog.org/my-husband-qualifies-for-sainthood-balancing-relationships-through-residency-training/ Mon, 15 May 2017 11:00:13 +0000 http://academicmedicineblog.org/?p=3391 medical family

By: Brenessa Lindeman, MD, MEHP, fellow, endocrine surgery, Brigham and Women’s Hospital, Boston, Massachusetts.

“My husband qualifies for sainthood.” Anyone that has ever met me and inquired about my life outside of the nearly all-encompassing sphere that is residency training has very likely heard this phrase roll off my tongue. While it is spoken in a lighthearted manner, it belies the seriousness with which I feel this sentiment. My spouse (who is a professional in a field outside of medicine) did not choose this career path and has occasionally struggled to understand why I chose to endure the seemingly never-ending years of sleepless nights, hopelessly inaccurate estimates of when I might leave the hospital, unbreakable tethering to my pager and smartphone, and frequent interruptions throughout dinner and our shared night’s sleep.

Yet, despite my inability to fully explain the magnitude of why it is important to me, he did endure all of these things, and countless more—particularly after we embarked on the journey of parenthood. He did so willingly and graciously, and I truly believe that it is only because he did that I felt so ready and able to weather the up and down storms of a resident physician’s life. His unwavering support allowed me to be free from worry about the laundry, each month’s bills, or what we might eat for our next meal, and instead focus on honing my diagnostic acumen of an acute abdomen, refining technical skills for complex procedures, and struggling to coach and mentor my more junior counterparts.

For all of this, and so much more, there is no individual that merits higher status in my life than him. And that is why I read the article by Law et al with so much interest. They have helped bring light to the inextricable and exceptionally important support networks that all of us rely on—but also how particularly important and precariously strained they can become during the period in which a newly-minted physician is molded and refined. I found myself unconsciously nodding along reading their finding that residents worked to manage others’ expectations about their relationships (only my husband can tell you whether I was successful in this endeavor), as well as how we focus our efforts on the most valued relationships, letting “more distant or less-cherished relationships” wither by the wayside. I am certainly guilty of this.

But as I reflect, I’m not certain that guilt is the emotion that I should be feeling. Having emerged on the other side of residency training, I feel privileged to have been bestowed with the professional identity I worked so hard to develop, and I know that my patients deserve no less than a physician fully dedicated to their care and well-being, which at times requires my full attention and presence long after I had intended to go home. Indeed, the hierarchy of patients’, family members’, and personal needs is a delicate and continually shifting balance, but it is certainly one worthy of navigating. As I look toward the future, I am hopeful that the findings of Law et al, combined with those of the many others they cite, will help inspire structural changes in our training programs to optimize residents’ abilities to navigate this balance.

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Editorial Board Q&A: Anthony R. Artino Jr, PhD http://academicmedicineblog.org/editorial-board-qa-anthony-r-artino-jr-phd/ Tue, 09 May 2017 20:35:10 +0000 http://academicmedicineblog.org/?p=3385 Artino (002) (003)Anthony R. Artino Jr, PhD, professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Describe your current activities. 

I’m a Professor of Medicine and Deputy Director for Graduate Programs in Health Professions Education at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. I am also a Captain in the U.S. Navy with just over 20 years of active-duty service. In my current role, I’m responsible for teaching, research, and administrative leadership. In terms of research, most recently I’ve worked with several colleagues to explore responsible research practices in academic medicine and the use of alternative metrics to help researchers gauge how their work is disseminated outside of traditional publications (e.g., posts on weblogs and tweets on Twitter). Keep your eye out for a couple of upcoming papers on these topics in Academic Medicine!

What gaps do you see in the current academic medicine scholarship?

One of the biggest gaps I see in academic medicine is knowledge translation (or lack thereof). In other words, I think we need more work that explores the role of medical education research in medical education practice. Academic medicine is a growing field, and evidence from our research has provided new insights into how and why certain learning strategies and interventions work, while others do not. Despite this growth of knowledge, many medical educators still don’t consult the research literature when making decisions about curriculum, instruction, and assessment. Some of the research questions I think we need to explore include: Why don’t we have more knowledge translation in the field, and what can we do to promote knowledge uptake and application?

Name two to three seminal Academic Medicine articles that everyone in your field should read.

That’s a tough one, but if I had to pick just a couple, I would probably go with David Cook’s 2005 article entitled “The Research We Still Are Not Doing: An Agenda for the Study of Computer-Based Learning.” In this article, David reiterates a caution that scholars in the field of educational technology have long argued – the idea that it makes no sense to conduct so-called “media-comparison studies,” where researchers compare instruction in one type of media to instruction in another. Such studies are hopelessly confounded, and David does a nice job articulating this argument and calling for more rigorous research.

I also really enjoyed reading the recent article by Elaine Van Melle and her co-authors. The article, entitled “Using Contribution Analysis to Evaluate Competency-Based Medical Education Programs: It’s All about Rigor in Thinking,” is still in the published-ahead-of-print category, and so it’s a little too new to be considered “seminal.” Nonetheless, it’s quite fascinating and, in my opinion, should be required reading for anyone attempting to answer the ubiquitous question: “does my program work?”

What issues will we be reading about in Academic Medicine in five years? 

I hope we’ll be reading more articles that explore translational research efforts in academic medicine. We have to figure out how best to promote knowledge uptake and application. And like everything we do in medical education, the question of knowledge translation should be studied in a systematic way. I’m also hopeful that over the next few years the quality of our measurement tools in medical education will improve, particularly the survey instruments used for research purposes. In some of our most recent work, we’ve found major problems related to the quality of the individual items found in published survey tools.

What book(s) are you reading right now? 

Actually, I don’t do a ton of “reading for fun.” I do, however, listen to lots of audio books. Three of my recent favorites are Greg McKeown’s Essentialism, David Brooks’ The Road to Character, and Angela Duckworth’s Grit. I’m also a big fan of podcasts. Truth be told, I’m slightly obsessed. Some of my favorites are Malcolm Gladwell’s Revisionist History, NPR’s How I Built This, Planet Money, and Invisibilia, and Stephen Dubner and Steven Levitt’s Freakonomics Radio. If you ever need to pass the time on a long trip, these podcasts are just what the doctor ordered.

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