September 2020 Faculty Development Tip: Improving Education Skills in Virtual Small Group Learning

MITE Monthly Tip – Improving Education Skills in Virtual Small Group Learning

Thomas Q. Reynolds, DO

Medical education experts have been studying the effects of both virtual learning and small group learning for many years.  Evidence suggests that virtual learning is as effective as traditional learning across multiple different types of studies and analyses.  This has been noted across both a broad field such as health professions[i] as well as in specific disciplines, such as pediatrics.[ii]  Additionally, small group learning in teams has also been studied and reviews of the literature have shown it to be a positive learning experience for students.[iii]

As we have moved into the COVID pandemic-induced age of replacing traditional face to face education with virtual education, questions remain about how to adequately design small group learning in the virtual environment.  Medical educators around the world, and at our institution, have been forced to innovate ways to adopt small group/team based learning into the virtual didactic educational session for trainees at all levels of the medical education hierarchy.

As you continue to work on adjusting your traditional face to face educational sessions for medical students and residents/fellows into the virtual world of the ZOOM platform, consider how to leverage virtual technology such as the breakout room feature to engage students more readily in educational content.  The following 5 tips should be helpful as you plan and deliver small group/team based learning in virtual sessions using breakout rooms.

  • Know your learners; do they all have the same background? Are some learners more advanced than others?  If different backgrounds (residents from different programs and different PGY-level +/- medical students), consider splitting up your groups evenly with different stage learners in each group
  • Consider assigning a specific individual in each group in advance to help facilitate in each small group. No need to ask them to do extra preparatory work, just to be willing to guide the group through whatever small group task you assign during your session.
    1. Alternatively, consider the use of the “Flipped Classroom” technique and ask your learners to read/prepare in advance of the didactic session
  • Be familiar with how to use breakout rooms in zoom (and consider coming to the virtual engagement webinar on this topic being presented on October 2 or reviewing the recording of it afterwards)
    1. Consider assigning students to rooms in advance if you know exactly who your learners are
    2. If you don’t have an accurate list of learners in advance, find one person (a colleague, chief resident, senior resident, etc) to help you with assigning small groups once the zoom didactic begins
  • Prepare your learners for different roles in the small group
    1. Ex: MSIV to read the case and provide summary statement, intern to provide initial differential diagnosis, PGY-2 to provide testing and treatment ideas, PGY-3 to summarize how to educate patient/family

[i] Tudor Car L, Soong A, Kyaw BM, Chua KL, Low-Beer N, Majeed A. Health professions digital education on clinical practice guidelines: a systematic review by Digital Health Education collaborationBMC Med. 2019;17(1):139. Published 2019 Jul 18. doi:10.1186/s12916-019-1370-1

[ii] Brusamento S, Kyaw BM, Whiting P, Li L, Tudor Car L. Digital Health Professions Education in the Field of Pediatrics: Systematic Review and Meta-Analysis by the Digital Health Education CollaborationJ Med Internet Res. 2019;21(9):e14231. Published 2019 Sep 25. doi:10.2196/14231

[iii] Burgess AW, McGregor DM, Mellis CM. Applying established guidelines to team-based learning programs in medical schools: a systematic review. Acad Med. 2014;89(4):678-688. doi:10.1097/ACM.0000000000000162

 

 

 

June 2020 Faculty Development Tip: The Benefits of Utilizing Twitter During a Global Pandemic and Beyond

The Benefits of Utilizing Twitter During a Global Pandemic and Beyond

Jillian Gregory, DO

Information regarding the novel Coronavirus Disease 2019 (COVID-19) has saturated all media platforms in recent months, providing an overwhelming and often anecdotal account of personal experiences. It can be difficult to sort through the abundance of information. Medical professionals need real time data during a global pandemic to treat patients when standards of care have not been established for a new disease. Social media platforms like Twitter enable health care providers from all disciplines across the world to communicate and share information instantaneously. By utilizing specific hashtags, physicians can acquire guidance and advice from leaders in their field, obtain knowledge from case series, learn about new physical exam findings or sequelae of disease processes, and access relevant evidence-based medicine at no cost during a global pandemic. Users also have the ability to network with healthcare professionals in various sub-specialties across the globe.

In a recently published article in the Pediatric Critical Care Medicine Journal entitled, “Using Social Media for Rapid Information Dissemination in a Pandemic: #PedsICU and Coronavirus Disease 2019”, the authors collected data on all tweets over a four-month period with the hashtag “PedsICU” and “COVID19” (1).

The following results were found:

  • All of the most highly shared tweets and links were from individual pediatric critical care stakeholders or established medical organizations and made available as open-access resources.
  • As #PedsICU influencers shared studies with their followers, a virtual library was created that updates automatically and is accessible to all.

The authors note that highly tweeted articles are 11 times more likely to be cited (2). In a study of articles randomized to Twitter, their promotion received almost three times as many page visits as controls. Twitter has proven to be a real time way of obtaining and disseminating data amongst healthcare leaders in a specific discipline.

For those not familiar with the platform and how to use it successfully, the faculty development website at Johns Hopkins University has published a “Best Practice and Tips for Physicians” (3). Highlights of this guide include:

  • Building and optimizing your profile for search
  • Building and monitoring your community
  • Engaging with your community and the proper way to use hashtags
  • Best practices for formatting a tweet
  • FAQs regarding engagement with patients on social media

Evidence-based medicine during a global pandemic can be found on the social media platform Twitter. By following specific hashtags for diseases as well as hashtags associated with popular medical journals, healthcare workers can stay up to date on the myriad of information published on a daily basis. This information can be shared easily amongst followers and provides a global network of opportunity amongst healthcare providers’ when treating patients during a global pandemic. Creating a profile and engaging in this community is easily accessible.

References:

  1. Kudchadkar SR, Carroll CL. Using Social Media for Rapid Information Dissemination in a Pandemic: #PedsICU and Coronavirus Disease 2019 [published online ahead of print, 2020 May 27]. Pediatr Crit Care Med. 2020;10.1097/PCC.0000000000002474. doi:10.1097/PCC.0000000000002474
  2. Eysenbach G. Can tweets predict citations? Metrics of social impact based on Twitter and correlation with traditional metrics of scientific impact [published correction appears in doi:10.2196/jmir.2041]. J Med Internet Res. 2011;13(4):e123. Published 2011 Dec 19. doi:10.2196/jmir.2012
  3. Twitter best practices: https://www.hopkinsmedicine.org/fac_development/course_offerings/twitter%20best%20practices.pdf

For further reading:

Barnes SS, Kaul V, Kudchadkar SR. Social Media Engagement and the Critical Care Medicine Community. J Intensive Care Med. 2019;34(3):175‐182. doi:10.1177/0885066618769599

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

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

March 2020 Faculty Development: Tips for using learning theory to craft an effective PowerPoint presentation

Tips for using learning theory to craft an effective PowerPoint presentation

Eric Brown MD

March 2020

We have all endured slide-based lectures that left us yawning or scratching our heads in confusion. Presentations with too many slides, too busy slides, or hard to see fonts and diagrams are common in medical education and can sabotage even the most dynamic speaker or an otherwise fascinating topic. Here are some tips for crafting slide-based visual aids that will better support your learning objectives and keep learners engaged

  • Remember that slides do not have to be the default option
    • For every presentation you give, ask yourself whether slide-based visuals are the ideal means to deliver your message.
      • For example, a lecture that introduces and then uses a lot of new terms may be better served with a handout with definitions that learners can reference throughout the talk.
  • Use a logical, time-tested story structure
    • The three-act storytelling structure has been around for thousands of years and is firmly imbedded in most learners’ long-term memory.
    • By visually accessing this structure in your learners’ long-term memory, you are able to create a clear pathway for learning new information in their limited-capacity working memory.[1]
      • Act 1: Introduces the setting, main character (or subject), and an unresolved state of affairs.
        • Slide titles in this phase of your talk should reference emotions or situations already familiar to the learner.
      • Act 2: Drives the story forward by picking up on the unresolved state of affairs.
        • Use a story-board approach for organizing concepts and sub-concepts.
        • Limit major concepts to 4-5.
        • Use a slide hierarchy with color coding or other visual cues to anchor the learner.
          • In this graphic, major concepts are all on slides with orange backgrounds while supporting concepts are yellow and sub-concepts are white. Visual adapted from Beyond Bullet Points 
        • Act 3: Frames a climax and resolution around your topic
          • Recycling visual cues from the first “act” can help solidify conclusions
  • Apply Mayer’s principles for designing instructional multimedia presentations
    • Four evidence-based principles for reducing learners’ extraneous processing[2]:
      • Coherence: Exclude extraneous words, pictures, and sounds
      • Signaling: Highlight essential material with yellow boxes or high contrast
      • Redundancy: Do not add on-screen text to narrated animations or videos
      • Spatial Contiguity: Place printed words next to corresponding graphics

 

  • Watch David JP Phillips “How to avoid death by PowerPoint” and then apply his “6 rules”[3] https://www.youtube.com/watch?v=Iwpi1Lm6dFo
    • One “message” per slide.
    • No text sentences (instead use written words/phrases as talking points)
      • When audience members read a sentence while you are speaking it, they hear nothing!
    • Size: The most important part of your slide should be the biggest.
      • For example, the title or heading on the slide should be smaller than the points you are trying to make.
    • Use contrast to your advantage.
      • Dark background with light text
      • Use high contrast to draw attention to important areas of busy slides
    • Six or less ‘objects’ per slide

Hopefully these tips help keep your audiences more engaged during you slide-based talks. When in doubt, try this mnemonic:

ONE message per slide

FEW matching colors

VERY FEW fonts

PHOTOS, not clipart

[1] Atkinson, Cliff (2011). Beyond Bullet Points: Using Microsoft PowerPoint to Create Presentations that Inform, Motivate, and Inspire. Microsoft Press, USA.

[2] Mayer, R. E. (2008). Applying the science of learning: Evidence-based principles for the design of multimedia instruction. American Psychologist, 63(8), 760–769.

[3] Phillips, David JP (2011). How to Avoid Death by PowerPoint. Presentation Skills Ltd. Ted Talk Video available on YouTube and davidjpphillips.com

 

 

 

 

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

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

January 2020 Faculty Development: How do Advanced Practice Providers fit into IPE at academic medical centers?

How do Advanced Practice Providers fit into IPE at academic medical centers?

Angela Leclerc, PA-C

Does your service have one or more Advanced Practice Providers (APPs)?  Chances are you do, or you will!  Originally conceived in the 1960s to assist with the primary care shortage, APPs can be found in almost every specialty and subspecialty of medicine and surgery.  In addition, APPs now support a large part of the workforce at academic centers due to resident work hour restrictions, as well as the stable clinical competence a well-trained APP maintains.

APPs complete rigorous graduate programs prior to entering practice.  To be successful, the new APP requires additional postgraduate training as they are transitioning to practice.  A small percentage of APPs may complete a postgraduate residency/fellowship program in areas such as Emergency Medicine (EM), Critical Care Medicine, Cardiothoracic Surgery, Trauma Surgery or Hospital Medicine, just to name a few.  However, these postgraduate programs are not mandatory and 80% of applicants are new graduates (Maine Medical Center).  How do we leverage the current academic opportunities in your institution to incorporate and educate APPs, either through formal or informal postgraduate training, leading to improved safety, lower cost and improved retention through professional development?

Investing in the training of APPs leads to a high level of consistent competency (Figure 1) (1).

Figure 1

Clin Med 12(3):200-206 (2012)

The well-trained APP provides a consistent level of competence and beyond.  Here the graph on the left represents the PGY1-PGY3 resident while the graph on the right represents the fellow. The solid line labeled ”Physician Assistants” is the well-trained APP that has been practicing for at least 2 years on service.

Chekijian et al. aimed to describe best practices and considerations regarding the integration of APPs at four separate academic institutions in Emergency Medicine.  Yale has a postgraduate APP residency in EM that is 18 months in duration and directly parallels the medical residency for MDs with complete integration from the start date of the internship year through the 18 month program.  Expectations of review of board material also parallel the MD residency program.    At Brown, Physician Extender Development Program (PEDP) was developed for new graduate APPs for a 1 year period.  This includes 5 hours of lecture time each week with the EM residency program.  This program is overseen by the chief education APP as well as two other educational assistant APPs.  UMMS-Baystate program accepts up to two PAs a year into a 12 month residency program who are partially integrated into the physician residency program (2).

You may be curious of the impact of additional learners integrated with the residents and fellows.  Kahn et al. sent a survey to 1178 surgical residents to which 354 (30%) responded.  A large majority of the respondents were part of residencies where the APPs had been integrated into the ICU for 5 or more years (3).

Figure 2

J Surg Res 2015; 199:7-12

If you do not have a formal postgraduate training program to train your APPs, not to worry. Here are some quick tips you can incorporate now:

·         Incorporate your APP(s) into bedside teaching rounds
·         Invite new APPs to resident and medical school didactics
·         Train new APPs simultaneously with residents and medical students in simulation
·         Provide access to shared educations sites or drives for APPs (i.e. asynchronous learning)
·         Provide time for your APPs to attend Grand Rounds
·         Provide formal feedback and support for APP education in your department
·         Provide highly functioning APPs the opportunity to educate other learners on the healthcare team as well as participate ongoing professional development activities in the department
·         Put APPs in charge of the education of onboarding new APPs, have them collaborate with the department chief for incorporation of the new APPs with the medical student and resident learning activities

References:

  1. Ross N1, Parle J, Begg P, Kuhns D.  The case for the physician assistant. Clin Med (Lond). 2012 Jun;12(3):200-6.
  2. Chekijian SA1, Elia TR2, Monti JE3, Temin ES4. Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations. AEM Educ Train. 2018 Nov 27;2(Suppl Suppl 1):S48-S55.
  3. Kahn SA, Davis SA, Banes CT, et al: Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents’ critical care experience. J Surg Res 2015; 199:7-12.

December 2019 Faculty Development: “I heard it in a podcast” How to navigate learners’ use of non-traditional learning platforms

“I heard it in a podcast”

How to navigate learners’ use of non-traditional learning platforms

 

It is no secret that non-traditional learning platforms such as blogs and podcasts are becoming more popular among learners. This article will help guide you with a 3-step approach to the trainee who brings up such material.

 

Rather than leaf through a textbook, many current trainees will open their favorite RSS feed or podcast app to find study material. In fact, Mallin et al. found that listening to podcasts outranked textbook reading as the preferred form of study among emergency medicine residents (35% vs 33.6%).1 Regardless of your stance on blogs/podcasts, it is important to recognize that they are here and a part of our learners’ knowledge acquisition.

A trainee’s use of non-traditional learning platforms often comes to light while in our clinical work, with phrases such as “I heard X in a podcast” or “I read about Y in a blog and I would like to try it.” These statements can be off-putting, and our reflexive response is sometimes dismissive or condemning. This reaction often stems from one of the following:

  • Lack of familiarity with the podcast/blog
  • Lack of understanding in the topic matter
  • Lack of comfort implementing practice change based on non-traditional resources

When we go with our knee-jerk reaction of dismissal, we invalidate the learner and their efforts, and miss an opportunity to teach them about the use of these non-traditional materials. We must recognize what is before us: a motivated student, doing independent learning, is asking us about practical application of new medical knowledge. Our response, ideally, is structured and supportive. With this 3-step approach, it can be.

Step 1: Validation

First, it is important to recognize the independent learning of the trainee and commend them for their application of this clinically.

Example: “That is so awesome you are finding time outside of your busy medical student/resident life to study independently! Even more kudos for trying to apply that to patient care. Awesome work!”

Step 2: Structured critique

Similar to how journal club teaches trainees how to critique an article, we should be offering the same skill set on how to assess a blog or podcast. Structured approaches exist, and I recommend that published by Academic Life in Emergency Medicine. This assessment is a 5-element approach to assessing a blog/podcast’s quality (ALIEM Scoring Instrument).

Example: “I’m not familiar with that specific blog/podcast. Just like the articles we review in journal club, it’s important to have a structured approach to critiquing these pieces. Luckily, someone has created an assessment tool to help us. Why don’t you send me the material and I’ll send to assessment tool. We can then look at the material, appraise it with the tool, and reconvene on how to apply it to our clinical practice.”

Step 3: Wrapping It Up

After you and the student have done some independent learning, it is important to close the loop. This, too, can be done asynchronously if time is an issue. In this conversation topics to address include:

  • Issues with the use of the assessment tool
  • Questions regarding the individual blog/podcast’s quality
  • Content review
  • Clinical application

Example: “Thanks for bringing that podcast on stress testing to my attention. I thought it did well in 4 of the five areas in the assessment tool. The one area I had reservations was that it seemed to have a lot of expert opinion and less literature citation. We always have to be cautious there. How do you think this will affect your clinical practice?”

 

With some premeditation and structure, these challenging interactions can be turned very rewarding for both learner and teacher. For more information on learners’ views on blogs and podcasts, look at Independent and Interwoven.3

 

References:

  1. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med. 2014 Apr;89(4):598-601.
  2. https://www.aliem.com/aliem-air-pro/
  3. Riddell J, Robins L, Brown A, Sherbino J, Lin M, Ilgen JS. Independent and Interwoven: A Qualitative Exploration of Residents’ Experiences with Educational Podcasts. Acad Med. 2019 Sep 10.

November 2019 Faculty Development: Case in Point: How to Write an Effective Case Report or Series

Case in Point: How to Write an Effective Case Report or Series

William J. Sauer, M.D.

Case reports continue to play a critical role in the advancement of medicine, particularly with regard to new disease entities (e.g. AIDS and Kaposi Sarcoma), adverse reactions (e.g. thalidomide associated birth defects), as well as other novel observations (see Table1).  As an example, there is currently a lot of attention from the CDC and NEJM correspondence regarding vaping-associated lung injury, yet a well written case report was published over two years ago.

 

 

 

Although often labelled as low quality of evidence, the objective of these publications are entirely different from a randomized controlled trial.  Instead of directly impacting medical decision making, case reports should inspire creativity, promote engagement, and further investigations.  They function to alert clinicians of new or rare phenomena that cannot be described in RCTs.  Several specialties, including surgery, infectious disease, and pharmacology, rely on case reports to support their foundation of knowledge.

In an era of information overload, the delivery of these “clinical stories” is particularly important as the audience can quickly become un-engaged.  Several resources, including the CARE (CAse REport) guidelines and checklist, should be used to ensure accurate and intriguing presentation of the intended message.

Tips from the CARE Guidelines include2:

  • Clearly identify the message. The title should succinctly describe the primary interest the author hopes to describe.
  • Create a timeline. The patient(s) chief complaints, clinical course, and outcome should be articulated in a chronological and engaging manner.
  • Complete the remainder using specialty-specific information with references. Highlight key words as well as references (if available) to summarize findings.
  • De-Identify patient information. Informed consent needs to be obtained.
  • Follow journal-specific submission requirements/ guidelines. Unfortunately, a smaller number of journals are publishing case reports/ series.

 

1) Vandenbroucke JP.  In Defense of Case Reports and Case Series.  Ann Intern Med. 2001; 134(4):330-4 (see attached PDF for article)

2) CARE case reports guidelines.  www.care-statement.org. (see attached PDF for article)

3) Gagnier JJ, et al.  The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development.  Glob Adv Health Med. 2013; 2(5): 38-43.

4) Riley DS, et al.  CARE guidelines for case reports: explanation and elaboration document.  Journal of Clinical Epidemiology. 2017; 89:218-235

 

Tips for Being a Mentee

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

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.