1/ On Chalk Talks - #UncleBob opines for #5goodminutes
I consider the development of chalk talks a very useful (perhaps even essential) activity for successful clinician-educators.
@Sharminzi @AnnKumfer @IgG4thewin @CPSolvers @DxRxEdu @rabihmgeha @tony_breu #MedEd
I consider the development of chalk talks a very useful (perhaps even essential) activity for successful clinician-educators.
@Sharminzi @AnnKumfer @IgG4thewin @CPSolvers @DxRxEdu @rabihmgeha @tony_breu #MedEd
2/ Chalk talks evolve over time, and can be used in shortened or full form. I will use 1 of my favorite chalk talks to illustrate their development and use: Anion Gap Metabolic Acidosis (I do love the practical use of renal physiology.)
3/ Many years ago, I was determined to have a good way to teach Anion Gap Metabolic Acidosis. My learners quickly note that I love developing categories as that is how I best use my memory. So I developed KILU (Ketoacidosis, Ingestions, Lactic Acidosis and Uremia.)
4/ I never liked MUDPILES because it was just a list without categories (and no one has used paraldehyde on patients since the 70s). The chalk talk started out simple and short. Because this was a favorite chalk talk, I had to go read and learn the fine points.
5/ Fortunately, I had a CPC with a patient who had a chronic lactic acidosis. My research for that patient helped me develop my overall categorization, and particularly the various causes of lactic acidosis. But that changed over time.
6/ I did a morning report in which the patient had d-lactic acidosis after a Roux-en-Y procedure - so I read about that phenomenon and added it to the talk. I read the ED literature that taught me that lactate goes up before the anion gap increases - an important teaching point!
7/ Later I saw cases of lactic acidosis secondary to propylene glycol (used to dissolve lorazepam for IV administration). This was very important for a period of time - now critical docs avoid IV lorazepam when they can because of this phenomenon.
8/ I then found this article Diagnostic Importance of an Increased Serum Anion Gap | NEJM nejm.org/doi/full/10.10… that helped me teach when to worry and when to just repeat.
9/ I read much about ketoacidosis - but the big change came when SGLT2 inhibitors had reports of euglycemic DKA - so my teaching had to change. And there is much more. I have a list of drugs that can cause a lactic acidosis.
10/ The entire talk might take 20-30 minutes, but I can address any small part of the talk when time matters. For most chalk talks I continue revisions. Sometimes the learners teach me something to add or change. Sometimes my reading alters the content.
11/ The goal is always to give a structure for the learners to use the material in patient care (and perhaps even help them on tests). I'll pull part of a talk out on a busy day, when that part is relevant to our patient.
12/ Finally, at the beginning of most rotations I provide the learners a list of potential talks - and allow them to choose which ones we should prioritize. Here is my active list of favorite topics:
13/ Anion Gap Acidosis, Normal Gap Acidosis, Severe hypokalemia, CKD for non-nephrolotists, HFrEF management (a historical perspective), Cirrhosis - deducing complications from the med list, CAD - understanding cardiology recommendations, Hypophosphatemia, Hypercalcemia
14/ I am happy to expand on these thoughts if it might help more junior educators. Please ask questions and I will try to answer them. Use the reply feature so that I do not miss your questions.
