Tips for IM Attendings – Chapter 10 – Repetition
As a resident, I prepared a number of “chalk talks”. They were (at least in my mind) brilliant. I wowed the students and interns. But I never checked to see if they learned the topic.
As attending physicians our goal should involve learners’ learning the material, which differs from “brilliant teaching”. How do we induce learning?
Repetition helps learners absorb the material. As an educator it may seem boring or a waste of time to focus on repetition. But we teach not to look smart, but rather to transfer understanding. A brief anecdote may help.
Several years ago the house staff presented a patient at morning r...
Source: DB's Medical Rants - July 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 9 – Teach the basics
The best attending physicians understand that their learners need to master the basics. Some attending physicians begin their careers believing that they must sparkle with esoteric and arcane knowledge. Our experience suggests that we must stress the basics.
Good clinical care and good diagnostic skill require that we own the basics. We err if we assume that students, interns or even residents know all the basics.
Learning medicine takes time. It takes repetition.
As you start working with your team, ask them basic questions. You will be amazed at what they do not know.
So you should own the basics and make certain that ev...
Source: DB's Medical Rants - July 20, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 9 – Teach the basics
The best attending physicians understand that their learners need to master the basics. Some attending physicians begin their careers believing that they must sparkle with esoteric and arcane knowledge. Our experience suggests that we must stress the basics.
Good clinical care and good diagnostic skill require that we own the basics. We err if we assume that students, interns or even residents know all the basics.
Learning medicine takes time. It takes repetition.
As you start working with your team, ask them basic questions. You will be amazed at what they do not know.
So you should own the basics and make certain that ev...
Source: DB's Medical Rants - July 20, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Part 2 – Tips for IM Attendings – Random Thoughts
The next several chapters come from quick thoughts about rounding. I have no research to support these thoughts.
Please read them and use the thoughts that you like. Excellent ward attending physicians develop their own style and formats. I am sharing mine and hope that some of these thoughts will help you enhance your own rounds.
The thoughts range from details about rounding to general teaching concepts. Please let me know if you like any of these thoughts in particular. (Source: DB's Medical Rants)
Source: DB's Medical Rants - July 20, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Part 2 – Tips for IM Attendings – Random Thoughts
The next several chapters come from quick thoughts about rounding. I have no research to support these thoughts.
Please read them and use the thoughts that you like. Excellent ward attending physicians develop their own style and formats. I am sharing mine and hope that some of these thoughts will help you enhance your own rounds.
The thoughts range from details about rounding to general teaching concepts. Please let me know if you like any of these thoughts in particular. (Source: DB's Medical Rants)
Source: DB's Medical Rants - July 20, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 8 – Teaching Style
As I have mentioned previously, when we started our research we thought that teaching style was very important. Naively we thought that there was a “best practices” for teaching style. Three concepts stood out in this domain.
Ask questions of team about decisions (what and why) (15)
Have part of rounds at bedside, demonstrate key physical findings (22)
Having succinct teaching points (11)
As previously mentioned, teaching style varies greatly among highly rated attending physicians. To reiterate, we have seen three some different trends:
Table rounds prior to bedside rounds
Nursing station (or hallway) discussion...
Source: DB's Medical Rants - July 19, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 8 – Teaching Style
As I have mentioned previously, when we started our research we thought that teaching style was very important. Naively we thought that there was a “best practices” for teaching style. Three concepts stood out in this domain.
Ask questions of team about decisions (what and why) (15)
Have part of rounds at bedside, demonstrate key physical findings (22)
Having succinct teaching points (11)
As previously mentioned, teaching style varies greatly among highly rated attending physicians. To reiterate, we have seen three some different trends:
Table rounds prior to bedside rounds
Nursing station (or hallway) discussion...
Source: DB's Medical Rants - July 19, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 7 – Communicating Expectations
The domain communicating expectations included a few concepts that do not fit as neatly. These two were highly rated.
Stating expectations for residents/students (6)
Allow team some independence in decision-making (7)
The first concept seems obvious at first, but likely appears because it does not occur frequently enough. As attending physicians we have the responsibility to make clear how we want things done. That includes presentation style, daily reporting style and time expectations.
Although not explicitly included, many colleagues will ask the learners to express their expectations of the rounding process.
In...
Source: DB's Medical Rants - July 17, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 7 – Communicating Expectations
The domain communicating expectations included a few concepts that do not fit as neatly. These two were highly rated.
Stating expectations for residents/students (6)
Allow team some independence in decision-making (7)
The first concept seems obvious at first, but likely appears because it does not occur frequently enough. As attending physicians we have the responsibility to make clear how we want things done. That includes presentation style, daily reporting style and time expectations.
Although not explicitly included, many colleagues will ask the learners to express their expectations of the rounding process.
In...
Source: DB's Medical Rants - July 17, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 6 – Clinical Teaching
Clinical Teaching continues to have great importance in successful attending rounds. Clinical teaching has several important components. Here are the top components. Interestingly the lowest rated was teaching evidence based medicine. Why would that not get a higher rating? I suspect that learners can look up the evidence, but they cannot read about these characteristics.
Teaching by example (ie. good bedside manner) (8)
Sharing of attending’s thought processes (4)
Setting aside time to teach (9)
Ensure attendings have a comprehensive knowledge base (19)
Integrate theory with actual patients and findings (18)
...
Source: DB's Medical Rants - July 16, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 6 – Clinical Teaching
Clinical Teaching continues to have great importance in successful attending rounds. Clinical teaching has several important components. Here are the top components. Interestingly the lowest rated was teaching evidence based medicine. Why would that not get a higher rating? I suspect that learners can look up the evidence, but they cannot read about these characteristics.
Teaching by example (ie. good bedside manner) (8)
Sharing of attending’s thought processes (4)
Setting aside time to teach (9)
Ensure attendings have a comprehensive knowledge base (19)
Integrate theory with actual patients and findings (18)
...
Source: DB's Medical Rants - July 16, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 5 – The Learning Atmosphere
As ward team leaders, we have a responsibility to positively influence the team culture. We hold positions of power – we do grade everyone on the team. Students may want us to write letters of recommendation for residency. Residents may want the same for fellowship applications. So we start with a large psychological size. But large psychological size may interfere with learning.
The learning atmosphere domain requires attention to certain interpersonal skills. We have a responsibility to decrease our psychological size.
We all remember unapproachable attending physicians. We remember those who did not learn our name...
Source: DB's Medical Rants - July 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 5 – The Learning Atmosphere
As ward team leaders, we have a responsibility to positively influence the team culture. We hold positions of power – we do grade everyone on the team. Students may want us to write letters of recommendation for residency. Residents may want the same for fellowship applications. So we start with a large psychological size. But large psychological size may interfere with learning.
The learning atmosphere domain requires attention to certain interpersonal skills. We have a responsibility to decrease our psychological size.
We all remember unapproachable attending physicians. We remember those who did not learn our name...
Source: DB's Medical Rants - July 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 4 – The managerial domain
Most newly minted ward attending physicians seem to worry about their knowledge and clinical expertise. They often believe that they have good information to teach. But do they think about the importance of the managerial function?
In our study learners rated these statements most highly as part of the managerial domain:
1. Conduct rounds in an organized, efficient, & timely fashion (17)
2. Having a consistent, coherent plan of care (10)
3. Address appropriate discharge plans for & with each patient (26)
4. Allow time on rounds for residents to meet other responsibilities (21)
For the newly minted ward attending...
Source: DB's Medical Rants - July 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 4 – The managerial domain
Most newly minted ward attending physicians seem to worry about their knowledge and clinical expertise. They often believe that they have good information to teach. But do they think about the importance of the managerial function?
In our study learners rated these statements most highly as part of the managerial domain:
1. Conduct rounds in an organized, efficient, & timely fashion (17)
2. Having a consistent, coherent plan of care (10)
3. Address appropriate discharge plans for & with each patient (26)
4. Allow time on rounds for residents to meet other responsibilities (21)
For the newly minted ward attending...
Source: DB's Medical Rants - July 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
