November 2021 Faculty Development Tip

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Malia E Haddock, APRN-PMHNP

Integrating the Language of Harm Reduction in Clinical Teaching and Care

When reflecting on your clinical and teaching practices as they relate to patients with substance use disorder, it is important to consider the following:

  • The extent to which drug use and people who use drugs are subject to stigma and judgement
  • The extent to which stigmatization impacts how health care providers and trainees talk about and communicate with patients who use drugs
  • The extent to which stigma, judgment and internalized shame produce reluctance among patients who use drugs to communicate openly and honestly with their health care team

If contemplating this feels like uncharted or uncomfortable territory, Harm Reduction provides a framework and language to help bridge gaps between providers/trainees and patients who use drugs.

What is Harm Reduction?

“Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs” (Harm Reduction Coalition [HRC], 2021).

Click on below to watch a short video:

National Harm Reduction Coalition – Harm Reduction Truth

The Harm Reduction Coalition, a leader in Harm Reduction education and advocacy, offers specific guidance on how patients who use drugs can approach their health care providers. As providers and trainees, becoming familiar and comfortable with this kind of approach will support therapeutic encounters with individuals who have histories of negative experiences with the health care system. The HRC training guide includes the following topics, described more fully in attached brochure (HRC, 2021):

  • Talking about drug use is personal
  • Reasons why it may be hard to talk about drug use (and why some people decide not to)
  • Some reasons why it is good to talk about your drug use
  • When talking about your drug use, it’s OK to build trust first
  • If the doctor is focusing too much on your drug use
  • Examples of things you can say to the doctor when you don’t want to talk about drug use

Facilitate Honest and Compassionate Communication through Harm Reduction

  • Harm Reduction provides a framework for providers and trainees to meet patients where they’re at
  • Harm Reduction removes judgement and stigmatization from the narrative
  • Harm Reduction reduces the power differential between those providing and seeking care

Harm Reduction Strategies – Theory into Practice

References:

Harm Reduction Coalition. (2021). Principles of harm reduction. https://harmreduction.org/about-us/principles-of-harm-reduction/

Harm Reduction Coalition. (2021). Quality health care is your right. https://harmreduction.org/wp-content/uploads/2020/08/Resource-SaferDrugUse-QualityHealthcareIsYourRight.pdf

Further reading:

HRC Training Guide

https://harmreduction.org/wp-content/uploads/2020/08/Resource-SaferDrugUse-QualityHealthcareIsYourRight.pdf

Addiction Technology Transfer Center Network, Language Matters Guide

https://attcnetwork.org/sites/default/files/5-Language_Matters_9-18-17.pdf

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July Faculty Development Tip

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MITE Monthly Tip

The Objective Structured Teaching Exercise (OSTE): Tips for Faculty Development

Corinn Martineau, PharmD, BCACP, CDOE

It is clear that faculty development is important to enhance clinical teaching skills, however there are few objective measures of the impact of faculty development on these skills. An Objective Structured Teaching Exercise (OSTE) is both a training modality and an assessment method for the teaching skills of faculty members, preceptors, and residents. Similar to the idea of the well-known OSCE (Objective Structured Clinical Examination), the OSTE offers opportunities to engage in and practice targeted teaching skills with a standardized student (1).

Take a moment to think, “When was the last time I was observed teaching a student or resident in my clinical setting?” Clinical educators are rarely observed teaching in their clinical environment and rarely receive feedback from peers with only minimal feedback from learners. Quality of clinical teaching is generally measured by written evaluations from learners, however these generally tend to comment on a teacher’s communication skills or interest in teaching and not concrete skills.

The OSTE’s simulated teaching scenario and utilization of the standardized learner provides the opportunity for the faculty member or preceptor to develop and practice key teaching skills while being assessed objectively with immediate feedback provided to the teacher. Some of the key benefits of this modality are the ability to adjust scenarios to provide a range of difficulties (support both your junior faculty and senior faculty), provide control over the variable clinical setting, and the chance to practice teaching skills and receive immediate feedback in a safe environment (2). Furthermore, the OSTE may offer interprofessional faculty training opportunities to engage faculty members that are involved in teaching a variety of professional learners, for example, a Clinical Pharmacist Faculty member developing skills in teaching a standardized Family Medicine Resident.

Boillat and colleagues provide wonderful insight and important tips on how to use the OSTE as a faculty and preceptor development tool. Summarized below are key tips and themes gathered from their work (2):

Clarify the Goal

  • What specific teaching skill are you looking to develop or enhance?
  • Is the teacher a seasoned faculty member or a first-year resident completing a Residents as Teachers curriculum?
  • A needs assessment may be helpful prior to this step to clarify the goal prior to the creation of the scenario.
    • If the OSTE is something to be incorporated into a faculty development curriculum, a needs assessment might help identify trends multiple faculty members hope to improve upon.

Determine Context and Target Audience

  • Will the OSTE be one component of a larger faculty development curriculum?
  • Will your target audience be junior preceptors or experienced faculty?
    • This will help to guide the level of difficulty of your scenarios.
  • Consider space restrictions and/or availability of standardized learners.

Identify the Teaching Skill to be Addressed

  • Teaching skills to be addressed should be observable behaviors that can be measured.
  • Will the scenario be focused on the ability to teach a specific procedure or focused on a specific competency such as communication?
  • The sky is the limit here! Refer to the article for many helpful examples.

Prepare the Scenario

  • Consider focusing on a scenario that is based upon real life situations.
    • Perhaps the OSTE illustrates a specific teaching challenge discovered during your needs assessment.
  • Scripts should be detailed leaving minimal room for improvisation
  • Make sure the scenario is relevant to all preceptors or faculty participating.
    • Consider altering scenarios for teachers from different disciplines

Develop the Assessment Tool

  • Assessment is key and may be formative or summative.
  • Consider an objective assessment tool that outlines the observable behaviors of the teaching skill
  • Assessment may include self-assessment, assessment by standardized student(s), and assessment by peer-teachers.

In summary, the OSTE is a unique teacher and faculty development modality that consists of a standardized teaching encounter with a standardized learner and an iterative process of feedback and practice for the teacher. OSTEs are a strong faculty development tool as they offer genuine scenarios, objective, real-time assessment, and direct feedback from peers and learners. Furthermore, OSTEs can offer opportunity for targeted faculty development based upon a needs assessment with opportunity for repeated practice.

References:

  1. Sturpe DA, Schaivone KA. A primer for objective structured teaching exercises. Am J Pharm Educ. 2014;78(5):104.
  2. Boillat M, Bethune C, Ohle E, Razack S, Steinert Y. Twelve tips for using the objective structured teaching exercise for faculty development. Med Teach. 2012;34(4):269-273.
  3. Trowbridge RL, Snydman LK, Skolfield J, Hafler J, Bing-You RG. A systematic review of the use and effectiveness of the objective structured teaching encounter. Med Teach. 2011;33(11):893-903.

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June Faculty Development Tip

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Pronoun Visibility in Health Professions Education

Brandy Brown, LCSW

Program Manager, The Gender Clinic

The Barbara Bush Children’s Hospital

 

Learning Objectives:

  1. Understand the value of creating inclusive norms, by sharing pronouns, in medical education settings.
  2. Identify ways to professionally share pronouns in a medical education setting.

Sharing pronouns in a professional context has become the norm in major academic settings.  This is not surprising; many initiatives to improve education and healthcare come from students.  At Maine Medical Center, we have received feedback from students coming from many institutions, inquiring why our healthcare system and educational programs have not taken steps to normalize sharing pronouns.

In 2018, an MMC workgroup, collaborating with The Gender Clinic, began to look at small ways to effect change and improve support for the LGBTQ+ community in Maine.  Within a year, after consulting with providers and staff throughout the system, community members, patients, and other institutions, a recommendation was made to ask and encourage leaders to share pronoun education with their teams.  Several departments and groups began to champion this education and share it widely as a way to shift their culture.

Why is it important to include your pronouns- in your email signature line, badge, zoom, or introductions?

When we normalize sharing our pronouns, we reduce bias and assumptions among colleagues and clients. We eliminate guessing gender identity from social cues, a process that is particularly harmful to transgender community members. Instead of relying on transgender and gender-nonconforming people to inform and educate others, we can cultivate an environment of learning, respect, and inclusivity.

In 2015, Harvard University students began offering pronoun selections during student registration.  The Kennedy School of Government elevated those recommendations in the classroom, distributing stickers with pronouns on them. Gender Pronouns Can Be Tricky on Campus. Harvard is Making Them Stick.

Theodore Svoronos, 33, a lecturer in public policy, said the stickers took some of the stress out of teaching.

“I see those stickers as a gift,” he said. “It reduces the friction and the cognitive load for us to identify people the way they want to be identified.”

To understand the impact of normalizing pronouns in medical education, read about the experience of a medical student who recently published a personal narrative, Pronouns and Advocacy in Medicine, in the AMA Journal of Ethics, describing the experience of a nonbinary person sharing their experience as a medical student at BUSM and the impact that normalizing pronouns had on their medical education.   Consider also the recently shared experience of a recent Tufts graduate, planning to apply to medical school this year, Embracing Medicine- and One’s True Self.

In recent years, pronoun visibility and sharing has become more common in healthcare settings, as well as education.

“Adding pronouns to our email signatures is another step along the pathway to creating a more equitable, inclusive and accessible work environment and supports our commitment to a more safe and accepting society and healthcare system for all people.” – Fenway Health, VP of Communications

“By committing to using the correct pronouns, we are creating a space of respect and inclusion for all our patients, our staff and students.” – Mayo Clinic, Vice Chair of Administration

How do I edit my email signature?

Open your Outlook and select ‘New Email’ as though you are composing a new message. Select ‘Signature’ (next to attach item). Under the dropdown choices you can update an existing signature or create a new one.

What should I write in my email signature?

Consider what your pronouns are and add them following your name. At MyPronouns.org, they suggest the following format:

Jamaal Johnson Pronouns: he/him

OR

Jamaal Johnson (pronoun: he)

There is no single best way to share pronouns. You might use “she/her/hers” or “she/her” or just “she,” which generally refers to a larger set of pronouns.

You may also want to add a link to a website, with your pronouns like this: “My Pronouns: they/them ~ See www.mypronouns.org to learn more,” if you would like to include a resource that explains why you are making your pronouns visible.

How can I include my pronouns on ZOOM?

Adding your pronouns to your name on ZOOM is another great way to increase pronoun visibility in the workplace.

If you have downloaded the ZOOM app to your computer, login as usual and select the profile icon in the top right corner and then select ‘Settings.’ Select the Profile tab and click ‘Edit my profile.’ This will launch a window in your browser where you can follow the steps listed below.

(If you do not have the ZOOM app, go to ZOOM.us on your browser and login.)

  • In the ‘Profile’ section, click ‘Edit’ far to the right of your name
  • Select ‘Display Name’

References

  1. Gender Pronouns Can Be Tricky on Campus. Harvard Is Making Them Stick. – The New York Times (nytimes.com)
  2. Pronouns and Advocacy in Medicine | Journal of Ethics | American Medical Association (ama-assn.org)
  3. Embracing Medicine—and One’s True Self | Tufts University School of Medicine
  4. Fenway Offers Employees Pronouns In Email Signatures | Fenway Health: Health Care Is A Right, Not A Privilege.
  5. Mayo Clinic employees may now wear buttons displaying their preferred pronouns | Disrn

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October 2020 Faculty Development Tip: How to construct good multiple-choice test questions

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MITE Monthly Tip
October 2020
Eric Brown, MD

How to construct good multiple-choice test questions:
Assessment, or testing, is an important aspect of medical teaching and learning. When done well, testing helps learners meet curricular goals while communicating what the teacher views as important. Multiple choice questions (MCQ) remain a mainstay in testing because they can assess a broad range of knowledge in short period of time, leading to a high degree of testing validity and reliability. When constructed well, MCQs can test higher order learning such as comprehension, application, and analysis. However, as anyone who has ever written a MCQ knows, they can be difficult and time-consuming to construct. Even educators formally trained in the process plan for up to an hour writing each question. For this reason, many poorly written MCQs still abound in medical education and only serve to confuse and frustrate learners. Hopefully these basic concepts and tips will help you demystify the process, avoid pitfalls, and better align learners with your curriculum.

1) Start with your learning objectives:
This probably goes without saying, but a direct relationship between learning objectives and test items must exist. Remember that learning objectives should be written around specific learner behavior and not what the program will “teach”. Following this rule will help avoid simply testing medical trivia.

2) MCQ Terminology:
The Stem
Most MCQs start with the stem, or lead in. The stem should be written as a complete sentence and the item should be answerable without reading all of the answer choices. Instead of a sentence completion (eg Treatment with beta-blockers has been shown to . . . ), the stem should be written as a complete sentence (eg Which of the following is a characteristic of treatment with selective beta-blockers?) Although clinical vignettes are used commonly as the stem, they should not be excessively verbose or contain “red herrings”. Remember that most MCQs should be written so that the learner can read and answer the question in under one minute.

Key point: The stem should be stated so that only one of the options can be substantiated and that option should be indisputably correct. As the question writer, it is wise to document (for later recall) the source of its validity. Above all, avoid negative phrasing.

The Options
These are your test-takers’ answer choices. Between three and five options is ideal. They should follow grammatically from the stem and all be of the same type (all diagnoses, all tests, all therapies). The options should all be similar in length and complexity and should not consistently overlap to avoid ambiguity.

Key point: Avoid options none of the above and all of the above. None of the above is problematic in questions of judgement, and it only informs what the test-taker knows is not correct. All of the above only requires that the test-taker understand two of the options.

The Distractors
These are the answer choices that are not correct. Distractors are essential to write well as they form the basis of an exam’s ability to discriminate (separate those who know from those you do not know).

Key point: The best distractors are statements that are accurate, but do not fully answer the question or incorrect statements that seem right to the test-taker.

3) Types of multiple-choice questions:
True/False question
These questions usually start with a stem and then ask learners to choose all the options that are true (or false). They are usually easy to write but have not been shown to discriminate well between learners that know the content and those that do not.

Key point: True/False type questions should generally be avoided. They are generally either too ambiguous or, when written to remove ambiguity, too easy without good discrimination.

Single best answer questions
This is the most common and best validated MCQ type. In their simplest form they test knowledge, but with some effort, and questions can be written to test comprehension and even higher order learning. This format helps avoid confusion on the part of the learner because they do not have to guess what the writer was “thinking”. Currently, the national board of medical examiners (NBME) uses only this type of question.

Key point: The NBME recommends the following basic rules for crafting an effective single best answer MCQ:
1) Rule 1: Each item should focus on an important concept or testing point.
2) Rule 2: Each item should assess application of knowledge, not recall of an isolated fact.
3) Rule 3: The item lead-in (and stem) should be focused, closed, and clear; the test-taker should be able to answer the item based on the stem and lead-in alone.
4) Rule 4: All options should be homogeneous and plausible, to avoid cueing to the correct option.
5) Rule 5: Always review items to identify and remove technical flaws that add irrelevant difficulty or benefit savvy test-takers.

Additional reading/references:

Mohammed O. Al-Rukban, DPHC, ABFM, SBFM. Guidelines for the construction of multiple choice questions tests. J Family Community Med. 2006 Sep-Dec; 13(3): 125–133.

Burton et. al. Multiple-Choice Test Items: Guidelines for University Faculty. Brigham Young University Testing Services and The Department of Instructional Science, 1991.

Dianne E. Campbell. How to write good multiple-choice questions. Journal of Paediatrics and Child Health 47 (2011) 322–325.

Jannette Collins, MD, Med. Education Techniques for Lifelong Learning: Writing Multiple-Choice Questions for Continuing Medical Education Activities and Self-Assessment Modules. Presented in the RSNA Faculty Development Workshop, October 2005.

Miguel A. Paniagua, MD and Kimberly A. Swygert, PhD. Constructing written test questions for the basic and clinical sciences. The National Board of Medical Examiners, 2016.

April 2020 Faculty Development Tip: Trauma-Informed Approach in Medical Education Settings

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Trauma-Informed Approach in Medical Education Settings

Ruth Frydman, M.D.

Psychological trauma is common. In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 percent of clients in public behavioral health care settings have experienced trauma. 1SAMHSA website: www.integration.samhsa.gov/clinical-practice/trauma    2/13/20

Psychological trauma results from “an event, set of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”2 p.7, SAMHSA.

People who have experienced trauma may feel unsafe in situations that remind them of their trauma. Trauma survivors have been in situations where they did not have a voice or safe choices. They may continue to experience shame or guilt and may tend to isolate to protect themselves.

Trauma is a violation of a person’s sense of self control and personal power.  Trauma survivors are sensitive to power differences in relationships, and these power differences are inherent to  healthcare settings.  Lack of awareness on the part of the provider can lead to a learner or patient getting re-traumatized and breakdown in communication that can result in significant barriers to delivering care.

All of us–faculty, learners, staff, and patients–can benefit from improving the learning climate where we work, train, and receive care.  Attending staff and residents are role models for medical students, so modeling trauma-informed care and relationships can have a ripple effect on learners, staff, and patients.

Learners may have experienced earlier trauma and/or maltreatment during medical education.  This can impact the quality of the treatment provided if their own personal trauma history is impacted by an unhealthy work environment.

Akin to universal precautions, we can minimize trauma and re-traumatization in healthcare settings by using the following principles in our work with trainees, colleagues, and patients:

6 key principles of a trauma-informed approach:

  1. Safety — provide and promote physical and emotional safety in our work and teaching settings e.g. treating students with respect, avoiding giving constructive or negative feedback in ways or places that could result in public humiliation.
  2. Trustworthiness and Transparency — building and maintaining trust, participating in clear communication g. setting clear expectations for learners for rotation goals and accountability, giving learners timely and honest feedback, modeling clear boundaries.
  3. Peer Support — mutual self-help, getting feedback from peers e.g access to resources such as medical student support group, peer-to-peer type programming, time to talk with other learners who may also have struggled or be struggling.
  4. Collaboration and Mutuality — shared decision making, less hierarchical e.g. teacher can model and promote collaboration and mutuality in patient care for learners and can model team based leadership appropriate for learner’s level of training
  5. Empowerment, Voice and Choice — shared decision making, promoting resilience, supporting goals, providing choice and promoting an environment where people can share without fear of negative repercussions e.g. finding out learner’s goals for the rotation; modeling shared decision making with patients;  modeling and respecting advocacy skills in learners, staff, and patients.
  6. Cultural, Historical, and Gender Issues — working on treating others with respect knowing that there are power differences that pervade our culture; understanding some have experienced cultural and historical trauma and that some have experienced trauma based on gender and gender identity; g not making assumptions about learners based on their background, displaying signage or symbols that show support for groups facing discrimination such as rainbow symbols or sharing preferred pronouns to increase sense of safety for LGBTQ people (must be backed up by behavior and attitudes).2

Use of this approach can help engage and empower people, as well as reduce trauma reactive anger and aggression. It can help make our teaching and clinical settings more psychologically safe.

A trauma-informed approach to teaching and clinical work is best supported when the larger organization is committed to using policies to support this.  At Maine Behavioral Healthcare, we are working on becoming a trauma-informed organization.

For more information on the trauma-informed approach and trauma-informed organizations, see SAMHSA’s, Concepts on Trauma and Guidance for a Trauma-Informed Approach listed below.,2

Endnotes:

  1. Substance Abuse and Mental Health Services Administration and Health Resources Services Administration. SAHMSA-HRSA Center for Integrated Health Solutions: Trauma. http://www.integration.samhsa.gov/clinical-practice/trauma. Accessed February 13, 2020.
  2. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. In. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014:7, 10-11.

Questions for discussion:

Why should we have universal precautions regarding psychological trauma?

What are trauma-informed principles?

How might these principles be applied to working with learners?  Please give concrete examples

What are barriers you face in implementing a trauma-informed approach?  How might you address these barriers?

Goals to take away from this months tip:

-understand the high prevalence of trauma

-understand the concept of universal precautions

-develop tools for implementing the 6 principles of trauma-informed approach with respect to teaching and creating a psychologically safe learning environment

February 2020 Faculty Development-Teaching Emotional Resilience in Difficult Clinical Experiences

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MITE Monthly Tip – Teaching Emotional Resilience in Difficult Clinical Experiences 

Thomas Reynolds, DO

Burnout is a common problem amongst medical professionals and trainees.  Medical education experts have been studying this problem and developing curricula to help teach faculty, residents, and students about promoting resilience and preventing burnout after a difficult clinical experience such as what is described in “The AAP Resilience in the Face of Grief and Loss Curriculum.”

Because poor patient outcomes and high acuity clinical experiences are common in medical student and post graduate education, this curriculum highlights certain areas that are representative of opportunities to both promote resilience and teach future medical professionals about how to manage these problems in both themselves and future trainees. These areas include understanding grief and loss, communicating with families about severe and terminal illnesses, managing emotions after difficult clinical experiences, and introducing concepts to combat burnout through personal wellness.

Using these difficult clinical experiences as opportunities to train medical students and residents how to participate in and manage a debriefing session represents an area where all levels of providers can learn to manage emotions in an attempt to promote resilience and prevent burnout.  Additionally, the inclusion of all members of the health care team in a debriefing session can be quite meaningful for all involved.

Medical educators can keep the following basic steps in mind after having a difficult clinical experience that involves trainees or health care providers at any level:

  • Recognize how a provider’s response to grief and loss can either interfere with a patient/family’s experience or may comfort the patient/family and help the provider cope as well
    • For example, try engaging with the patient and family about your own emotional responses to these situations in front of your learners as this can help both the patient/family and the learners to embrace rather than suppress these difficult feelings
  • Integrate one’s response to a difficult experience including acknowledgement of guilt, anger, or sadness into a safe discussion of the event and how to manage these feelings
    • Actively include your conscious recognition of these feelings in the discussion
  • Conduct a debriefing meeting to analyze the experience, identify one’s own emotions, consider perceptions of the various team members, and help team members reach closure
    • Find a place and time to debrief with the team about how you handled the difficult situation with the patient/family, what went well, and what you might adjust in future conversations
  • Practice the above with trainees of all disciplines and at all levels as they work through difficult rotations where acuity and mortality may be elevated
    • Its critical to allow more senior learners to both lead the discussions with patients/families and to run the debriefing sessions as well

Reference:

Serwint JR, Bostwick S, Burke AE, et al. The AAP Resilience in the Face of Grief and Loss Curriculum. Pediatrics. 2016;138(5):e20160791

Tips for Being a Mentee

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Tips for Being a Mentee

Rebecca Hutchinson, MD

Many of us have benefited from excellent mentors who have given their time, expertise and guidance to help us develop to our fullest potential.  Please see earlier MITE tip (link here to July 2018 MITE tip) on characteristics of great mentors, which include enthusiasm for the project and mentee, tailored career guidance, dedicated time, encouraging work-life balance and serving as a role model for mentorship.  In this tip, I’d like to focus on strategies to use as a mentee to maximize your gain from your relationship with your mentor.

  1. Be the driver.1-3 Mentors are busy people who have many competing demands.  You’ll get the biggest bang for your buck if you take ownership and responsibility for determining what to discuss in the mentorship meeting.  Come prepared; identify in advance the ways in which this particular mentor might be able to help you before your meeting.1,3 It’s also important to evaluate your mentor-mentee relationship intermittently to ensure that it is helping you meet your goals; don’t stay in a relationship out of obligation.3  There are tools that can help you evaluate the utility of a particular mentor relationship.4
  2. Let yourself struggle a little – but not too much — before asking for help.3 You’ll learn and develop more if you take risks and try to solve some problems on your own.  On the other hand, you won’t be productive if you spend too much time stymied by a road block.  The balance between reaching out and struggling through is dependent on the particular mentor-mentee relationship; don’t be afraid to ask for feedback in your mentorship meeting about this.
  3. Show gratitude for, and be respectful of your mentors time.2 Your mentor is a busy person.  If you’re hoping to submit an abstract or you need your mentor to write you a recommendation letter, make sure to allow a reasonable amount of time.  One week is the minimum to review an abstract; several weeks are necessary for a letter of recommendation.  If you’re not sure, check-in with your mentor about what a reasonable amount of time might be for the task.
  4. Be enthusiastic and accountable.3 Having a positive attitude and being accountable goes a long way.  Set specific, measurable goals with deadlines, and then meet the deadlines you set!  If you didn’t meet the deadline, be clear about why not.
  5. Have regular meetings and take notes during these meetings. Meeting regularly is a key component of mentorship.3  Take notes during your meetings.  Some experts recommend keeping a “mentoring journal” where you keep all of your notes in one place.3,5
  6. Be open to feedback and remember feedback is bidirectional.2,3 Be open to feedback and try to see it as opportunities for growth and development.  If your mentor edits your writing and there’s more red than black, don’t take the editing personally.   Also, remember that you can give your mentor feedback; UCSF has a template for feedback that is helpful.5
  7. Mutually agree on format of communication.3,5 Your mentor might mostly communicate through email and may not use text messages for professional interactions.  Have a conversation early in your relationship to understand your mentors preferred method of communication.

 

 

 

Straus SE, Chatur F, Taylor M. Issues in the mentor–mentee relationship in academic medicine: A qualitative study. Academic medicine. 2009;84(1):135-139.

Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Academic medicine: journal of the Association of American Medical Colleges. 2013;88(1):82.

Moores LK, Holley AB, Collen JF. Working With a Mentor: Effective Strategies During Fellowship and Early Career. Chest. 2018;153(4):799-804.

Wadhwa V, Nagy P, Chhabra A, Lee CS. How effective are your mentoring relationships? Mentoring quiz for residents. Current problems in diagnostic radiology. 2017;46(1):3-5.

Faculty Mentoring Toolkit. https://academicaffairs.ucsf.edu/ccfl/media/UCSF_Faculty_Mentoring_Program_Toolkit.pdf. Accessed September 26, 2019.

 

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Electronic Communication with Patients

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Electronic Communication with Patients

Annabelle Rae C. Norwood, MD

Electronic communication has now become a routine part of clinical practice. A lot of non-urgent communication with patients and their providers now occur through on-line channels such as secure messaging and e-mails.  In particular, MaineHealth is highly encouraging patients to sign-up for and utilize MyChart, wherein patients can directly send messages to their providers. As such, there may be a need for medical educators and health care institutions to provide more guidance and education about this topic. (1) It has been shown that electronic communication with patients, can actually improve patient care and outcomes such as improved medication adherence (2). However, everyone communicating with patients through these online portals should be cognizant of privacy, confidentiality concerns, and HIPAA rules. Therefore, communication with patients should only occur in secure networks and not through personal e-mails, and definitely not social media. Institutions themselves, however, should also reinforce with patients that online communication should be only about non-urgent matters such as refill requests, that messages should be brief and descriptive and that these messages are going to be a part of the medical record (3).

There are also certain business e-mail etiquette (4) that may be applied to answering patient communication.

  1. Use a professional salutation. “Hi”, “Hello” or a more formal “Dear (name)” are all appropriate salutations. “Hey”, “Hiya” or “Yo” are not.
  2. Try to answer messages in a timely manner. Two business days is usually standard. It may also to just help the patient acknowledge that you have received the message, even if you don’t have an answer right away.
  3. Don’t send angry messages. In that rare instance where a patient were to send offensive or threatening e-mail, in one study analyzing secure messages in two Veterans Administration health care centers, offensive or threatening messages only comprised 0.2% of all messages sent. (5) Formulate an appropriate response when you’re calmer is better.   It would also be good to bring up this situation to your supervisor or team on how best to address this patient’s concern.
  4. Avoid using abbreviations like LOL, writing in all CAPS, using emoticons and using a string of exclamation points!!!!! These are not professional.
  5. Proofread your messages before sending them.

References

  1. A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations. Joy L Lee, Marianne S Matthias, Nir Menachemi, Richard M Frankel, Michael Weiner. 4, 2018, Journal of the American Medical Informatics Association, Vol. 25, pp. 413-418.
  2. Creatine a synergy effect: A cluster randomized controlled trial testing the effect of a tailored multimedia intervention on patient outcomes. Annemiek J Linn, Lisetvan Dijk, Julia C M van Weert, Beniam G Gebeyehu, Ad A van Bedegraven, Edith G Smit. 8, s.l. : Patient Education and Counseling, 2018, Patient Education and Counseling , Vol. 101, pp. 1419-1426.
  3. Expanding the gidelines for electronic communication with patients: Application to a specific tool. Stephanie L Prady, Dierdre Norris, John E Lester, Daniel B Hoch. 4, 2001, Journal of the American Medical Informatics Association, Vol. 8, pp. 344-348.
  4. Whitmore, Jacqueline. The Do’s and Don’ts of Email Etiquette. [Online] 2016. [Cited: May 28, 2019.] https://www.entrepreneur.com/article/272780.
  5. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. Stephanie L Shimada, Beth Ann Petrakis, James A Rothendler, Maryan Zirkle, Shibei Zhao, Hua Feng, Gammae M Fix, Mustafa Ozkaynak, Tracy Martin, Sharon A Johnson, Bengisu Tulu, Howard S Gordon, Steven R Simon, Susan S Woods. 5, 2017, Journal of the American Medical Informatics Association, Vol. 24, pp. 942-949.

Mastering Millennial Mentoring

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MITE Monthly Tip: April 2019-Angela M.  Leclerc, PA-C

Mastering Millennial Mentoring

Generation gaps between teacher and learner are encountered every 10-20 years. Generations are shaped by unique historical circumstances.  Currently, millennials make up approximately 25 % of our workforce and this will increase to 40% and 75% of the workforce in 2020 and 2025 (1).  Adapting to changes in expectations and work habits is imperative to educating learners, preparing future master educators and fostering productive mentoring relationships.

Millennials are frequently labeled to be distracted, impatient, entitled and too engaged in social media and not infrequently found to be on personal device during moments of teaching.  These labels are often misguided.  This generational cohort has been dubbed the “digital natives” with most of their lives accompanied by rapid expansion in technologies, having information and instant communication at their fingertips within seconds.   The millennials have been characterized to appreciate honesty, instant feedback and collaboration. (2)

Here are some tips when mentoring millennials:

Tip What they desire How you deliver
Micromentoring accessibility, frequent short meetings, fast responses Hold brief meetings on narrow topics to discuss progress.  Meetings would be about a single topic with a focused question or set of questions to be addressed.
Reverse mentoring flat leadership structure Find strengths of the mentee, perhaps social media as a means of disseminating research, journal club and networking, harness and promote their unique leadership abilities
Mentorship teams collaboration A team of mentors, interdisciplinary, providing cognitive diversity and the ability to capitalize on the individuals strengths

Adapted from Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176

Finally, the millennial generation has been shaped by the #metoo era.   I agree with the author in JAMA, Mentoring in the Era of #MeToo, with her fears of gender-based neglect.  I most certainly harbor a great amount of empathy for those women who have suffered from sexual harassment and sometimes worse.  However, many of my mentors have been male and have professionally influenced my practice and career path and are close colleagues of mine, likely for life.

The author refers to key behaviors exhibited by her male mentors:

  • Always demonstrate exemplary professional behavior during and outside of the work day (never compromised by alcohol consumption or flirtatious interactions)
  • Behave comfortably, but as if others are watching, demonstrating integrity
  • Refrain from physical touch except in larger social settings where you may give a hug in greeting.
  • Never mention anything about appearance or appearance of others and avoid generalizing comments about gender
  • Text with important or urgent things, and sometimes just very funny things, but never anything that wouldn’t share with either spouses.
  • Most importantly, they have chosen to speak up to support women while other men have chosen to sit quietly or, worse, offend (4)

 

References

  1. Waljee JF1, Chopra V2, Saint S3. Mentoring Millennials. 2018 Apr 17;319(15):1547-1548
  2. Williams VN1, Medina J2, Medina A3, Clifton S4. Bridging the Millennial generation Expectation Gap: Perspectives and Strategies for Physician and Interprofessional Faculty. Am J Med Sci. 2017 Feb;353(2):109-115
  3. Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176
  4. Byerley JS. Mentoring in the Era of #MeToo. JAMA. 2018;319(12):1199-1200

A Compassionate Script

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A Compassionate Script-Kathryn Brouillette, MD

With stressors abounding of record-level hospital census, the opioid epidemic, flu season, the holiday rush and the day-to-day grind of showing up for work while also managing household IADLs, I hope to offer a little salve for burnout.

It is simply compassion, the root meaning of which is to suffer or feel (-passion) with (com-) another person, in this case, our patients and their families. A quick reminder as to what compassion is not[i]:

  • Pity or sympathy
  • Kindness
  • Benevolence
  • Social justice

Compassion is much more specific, regarding a particular person’s feelings about the present situation.   It requires[ii]:

  • Imagination, as we put ourselves in another’s circumstance.
  • Intimacy, as we learn of the hardships of another.
  • Honesty
  • Time

Providers may suffer atrophy in these qualities as their medical education and careers progress.  These are, however, precisely the items touted to be antidotes to burnout[iii], litigation[iv], and medical error[v].  How do we get them back into our lives, our patients’ lives, manage the patient’s care safely, and still make it home on time for dinner?

One possible answer of many: fake it till you make it.  Use a script, perhaps this one:

  • Sit down when you speak with a patient. Lean towards your patient.
  • Ask your patients to tell you about themselves in an open-ended way: “Tell me about your family. Where are you from?  How do you like to spend your free time?”
  • Let them speak, without interruption, for at least 2 minutes.
  • Find something you share in common with them, e.g. “I grew up in a small town as well…”
  • Offer information about yourself, perhaps even revealing some of your own vulnerability. e.g. “I really miss my family around the holidays, too, especially since my parents died.” Gentle humor can sometimes be appreciated
  • After gathering the necessary history/information and performing your exam. Use supportive statements as the history is recounted, e.g. “Oh my, that sounds very scary.” Summarize your thoughts on their case using plain language. If you have uncertainty about the diagnosis, tell them and explain why.
  • As you are leaving, provide supportive statements, e.g. “I am with you”; “I hear you”; “Let’s get you feeling better”; “You’re not alone”; or “I’ll be thinking about your care tonight.”

These added minutes do take time, but the payouts include:

  • A closer rapport with your patient, who will be more likely to divulge important information regarding symptoms.
  • An enriching human interaction for both provider and patient
  • A patient who feels both validated and cared for is more likely to comply with medical therapies.
  • Better medical outcomes for patients and providers.

Whether it is second nature to you, or something that takes practice, compassionate interactions, just like apathy, can be infectious.  Try to share them as much as you can.

 

 

 

[i] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[ii] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[iii] Vallerand et al.  On the Role of Passion for Work in Burnout: A Process Model.  Journal of Personality. 2010, 78(1), 289-312.

[iv] Levinson, Wendy.  Doctor-Patient Communication and Medical Malpractice implications for Pediatricians. Pediatric Annals.  1997, 26(3), 186-193.: I

[v] Shanafelt et al. Burnout and Medical Errors Among American Surgeons.  Annals of Surgery.  2010. 251(6), 995-1000.