1/ Time for #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends!
This week is our 3rd “Fitting it All In” on how we structure teaching into our inpatient attending time!
2/ As a reminder, we are discussing the foundational skills for inpatient teaching.
Last week, @JenniferSpicer4 provided her take as a consult service attending: https://t.co/12hjMWAnfW
3/ Rounding & teaching on the inpatient service often needs to be adjusted to fit differences in resident schedules & program cultures. Since I’ve been at 2 different institutions recently, I’ll provide a unique perspective on how I’ve changed rounding based on those factors.
4/ Let’s start!
One practice that has remained consistent for me: before I even start on service, I try to avoid overcommitting myself. I:
[x] Schedule meetings & other commitments to when I’m not on service
[x] Set automated “on service” email reply
5/ In terms of rounds, some of you know that I prefer bedside rounds, which I use to advance pt care, communicate w/ pts & staff, educate learners & pts.
Bedside rounding allows me to informally assess clinical & communication skills w/ more opportunities for direct observation.
6/ For more tips on how to structure bedside teaching, please see my Bedside Teaching #MedEdMethodsMonday Moment: twitter.com/i/events/14376…
The rest of the tweets here will review how I schedule my day.
7/ I started attending @ a program where residents had similar schedules daily on wards.
Team: 1 attending: resident: intern & 10pt cap.
Program culture: round w/ team on all pts, admits b4 5PM typically staffed same day.
Afternoon rounds: for pts who require additional TLC.
8/ Last year, I moved to an institution with:
- 4-day call cycle, q4 28hr call
- variable presence of learners daily
- very medically complex pts
- still 1 attending: resident: intern; 10pt cap
Me trying to figure out how best to teach in this structure when I first started:
9/ So here is how I adjusted my rounding & teaching time based upon the call cycle & which learners are present each day.
*I use chart-stimulated recall to review H&Ps, progress notes, d/c summaries. Stay tuned to future #MedEdTwagTeam tweetorial on this topic!
10/ Bedside rounds aren’t the norm here. Initially, I was hesitant to have teams adopt this practice. But after my 1st year w/ redundant conversations & hx gathering that could’ve been done 1x in the room, I recommitted.
Hopefully I’ve converted some residents @uw_chiefs :)
11/ I also adjust rounds based on the independence of the PGY3.
Towards the end of the year, many PGY3s want more autonomy. I often schedule 1 day where the team rounds w/out me. The PGY3 then card flips w/ me after, where we also debrief & review teaching/rounding challenges
12/ Have others adjusted their rounding/teaching strategies over time? Or after changing jobs?
Next wk, stay tuned for #TweetorialTuesday by @JenniferSpicer4 w/ tips on Preparing for Teaching.
In the meantime, follow @GStetsonMD & @JenniferSpicer4 @MedEdTwagTeam!
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