While the saying goes, “you can’t teach an old dog new tricks”, I think we all assume you can teach a new dog new tricks… or at least all of us in medical education believe this! However, new research in the Journal of Hospital Medicine highlights that maybe the old dog is the key to the puzzle after all.
In the case of routine labs, a practice that has already been called into question by the Society of Hospital Medicine’s Choosing Wisely list, the majority of medicine and surgery residents at University of Pennsylvania admitted that they engaged in unnecessary ordering of inpatient labs, with over a third of them occurring on a daily basis! Why is this so hard to change? Not surprisingly, one of the key culprits was it was hard-to-break habit.
However, several of the top reasons were also related to the “old dog”, also known as the attending. This included both the fear attending would ask for the labs and the the resident would be empty-handed or the that the attending simply does not role model this behavior. In fact, one of the top suggestions written in by the residents, in addition to making lab costs transparent, was “role modeling restrain”, or in other words, “training the old dogs!” This is certainly not the first time celebrating restraint by faculty has been suggested, but of course, the more difficult question is how to accomplish that. Perhaps you have an idea to share? This is just one of the many questions we will tackle on next week’s #JHMChat.
So, on the night before our 2016 presidential election, come debate the best ways to root out the routine lab on the Journal of Hospital Medicine’s 5th #JHMChat on Monday, November 7, 9-10 pm EST. You can join the chat from virtually anywhere – your living room couch, your office in the hospital or even on the go riding the train. During this Twitter-based ‘journal club’, we will also be joined by author Mina Sedrak, who can provide insights beyond what’s in the paper.
In addition to being a great way to connect with other hospital medicine leaders and medical educators, #JHMChat is certified for CME! Participants can claim up to one AMA PRA Category 1 Credit™ following the chat by taking an evaluation through the SHM Learning Portal. (The amount of credit earned will be directly associated with the amount of time spent on the chat).
Get ready for the chat in a few easy steps:
- Sign up for Twitter (if you haven’t already).
- Follow JHM (@JHospMedicine), in addition to me (@FutureDocs, your moderator) and @MinaSedrakMD, our guest author.
- Download the paper “Residents’ self-report on why they order perceived unnecessary inpatient laboratory tests”
- Preregister for the event on SHM’s Learning Portal https://www.shmlearningportal.org/Activity/4559594/Detail.aspx#lnk3518579
- Attend the chat Monday, November 7, 9-10 p.m. EST.
- Take the post-chat evaluation to claim your CME (link released on Twitter right after the chat).
Vineet Arora MD, MPP is Director of GME Clinical Learning Environment and Assistant Dean for Scholarship and Discovery at the University of Chicago Pritzker School of Medicine. Dr. Arora’s scholarly work has focused on resident duty hours, patient handoffs, sleep, and quality and safety of hospital care. She is the recipient of the SHM Excellence in Hospital Medicine Research Award in 2007. Her work has appeared in numerous journals, including JAMA and the Annals of Internal Medicine, and has received coverage from the New York Times, CNN, and US News & World Report. She was selected as ACP Hospitalist Magazine’s Top Hospitalist in 2009 and by HealthLeaders Magazine as one of 20 who make healthcare better in 2011. She has testified to the Institute of Medicine on resident duty hours and to Congress about increasing medical student debt and the primary care crisis. As an academic hospitalist, she supervises medical residents and students caring for hospitalized patients.
Dr. Arora is an avid social media user, and serves as Deputy Social Media Editor to the Jounral of Hospital Medicine, helping to maintain its Twitter feed and Facebook presence. She blogs about her experiences at http://www.FutureDocsblog.com and actively tweets at @futuredocs.