Academia

The Return of #JHMChat and Choosing Wisely

by Charlie M. Wray DO, MS
By: Charlie M. Wray DO, MS I’ll be honest – I can’t remember who won the 2012 Super Bowl, World Series or any other pop culture phenomenon*, but I do recall stumbling across something called Choosing Wisely® one afternoon while sitting in my clinic. With a burgeoning awareness that much of the care I was providing seemed superfluous and wasteful, the discovery that there was a group of physicians who shared this same sentiment was exciting! Five years in, the Choosing Wisely® campaign has published more than 500 specialty recommendations – with the Society of Hospital Medicine working on the upcoming version 2.0 (all are welcome to contribute!). Just as Choosing Wisely is gearing up for round 2, the Journal of Hospital Medicine’s (JHM) online journal club, #JHMChat, is rebooting as well! After a brief summer hiatus, we’re happy to announce that #JHMChat will be returning to discuss “Against Medical…
Charlie M. Wray DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.

A New Face For Online Modules

It is hard for me to get excited by online modules. Perhaps my reflex repulsion stems from my experience – ok, experiences – completing online traffic school courses. Those timers forcing you to stay on a page for a specific amount of time. The quizzes that might not actually teach you anything. Maybe you are a more cautious driver than I am, but if so, just think of the last time you had to complete a mandatory online module for your hospital. I doubt it gripped your attention. The future of education may increasingly be online, but I am unconvinced that mandatory online modules are a format that will change the world. This is why I have spent so much time working with innovative teams to develop interactive learning modules that do not feel like online modules. Vinny Arora and I recently described on this blog our Costs of Care…

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

Should Resource Overutilization Be Considered an Adverse Event?

We have all seen the Choosing Wisely lists and the new “Things We Do for No Reason” section in the Journal of Hospital Medicine. We have heard a lot about common areas of overuse in hospitals. Sure, there have been some success stories of hospitalists leading projects to decrease an area of overuse, but when you get down to it, have we really done much to not just recognize overuse but to actually decrease it? Think about the patient safety movement over the last two decades. Telling horrifying stories of wrong-limb surgeries may have caught headlines, but that did not do much to stop the problem from still happening. The medical world had to shift our thinking from one of individual blame to recognizing the role of systems and environments in creating these problems. We had to put structures in place, such as safety review committees and mandated processes for…
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