MedEd

Rounds: Are We Spinning our Wheels?

As a Johns Hopkins undergraduate, I used to run the Welch lecture series in medical history. Through this role, I learned about an interesting tidbit – the origin of the word “rounds.” Johns Hopkins Hospital had a circular ward where the infamous and quotable Dr. Osler made his “rounds” to see patients. While medicine has come a long way since Osler’s days, have rounds? This is the crux of a paper in the Journal of Hospital Medicine by led one of our former Pritzker students Olliver Hulland along with mentors and hospitalists Dr. Jeanne Farnan and Dr. Barrett Fromme. In a 3-site study with UCSF and Georgetown, they conducted focus groups with attendings and medical students to ask the quintessential question, “What is the purpose of rounds?” Interestingly, the answers were markedly similar and revealed the multi-faceted nature of rounds: Communication, which included coordination of patient care team, patient/family communication,…

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…

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…

Pulling the Welcome Mat Out from Under Our Colleagues

We sat in the living room at a colleague’s home, drinking beer, wine or sparkling water, eating desserts, and talking. Talk started with residents comparing notes about clinical sites or rotations, worries about being prepared for boards, congratulations on fellowship matches, and discussions about trying to decide what to do post-residency. “How are you doing?” my colleague and assistant residency program director asked the group. Silence followed. One person spoke up. “I’m worried about what will happen with my fellowship. I’m still talking with my lawyer.” This was not a question of where he would match, how his clinical skills would be stretched, or adapting to a new location. This was about his immigration status. We met two weeks after the president’s executive order on immigration, and he was worried if he would be able to continue to work under his current visa, being from one of the seven countries…

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…
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