1/12 The jump from classroom teaching to clinical rotations is made tougher by the fact that physicians have illness-specific frameworks for presentations and documentation. Let's explore a bunch of them (feedback is most welcome)!
2/12 Let's start with anemia. It is ideal if you report the baseline Hgb and an interpretation of the MCV. #HemeTwitter
3/12 For VTEs, it is helpful to tell the listener/reader if you think it is provoked vs. unprovoked. A hypercoagulable work-up should not be sent routinely.
4/12 Next is heart failure. Reporting the medications with mortality benefit (for HFrEF) can be valuable in identifying if another medication needs to be started. #CardioTwitter, thoughts on best practices?
5/12 The anatomy of lesions in CAD, which arteries have been stented, and anti-platelet agents can be helpful.
6/12 Next we have A-fib/flutter - the main highlights are anti-coagulation and rate/rhythm control
7/12 Next is sepsis! Here are some helpful qualifiers to stay organized (along with definitions of severe sepsis and septic shock)
8/12 There is a nice list of things to review in patients with cirrhosis #GITwitter#LiverTwitter
10/12 It is helpful to delineate pathologic from non-pathologic fractures as this helps delineate treatment options #OrthoTwitter
11/12 COPD is up next! Remember that the goal O2 sat in patients with COPD is 88-92% to prevent uncoupling of compensatory hypoxic vasoconstriction #PulmTwitter
2/ Brandon asked the group three questions:
1⃣ What is your approach to the pain?
2⃣ How does that inform your next steps for history and physical?
3⃣ How does that inform your next diagnostic steps?
3/ Group answers:
1⃣ We discussed an approach that is nicely captured by this slide
1/10 We often talk about evaluation of AKI in the context of ⬆️ creatinine, but let’s take a step back and think about eGFRs. Here is an approach to interpreting ⬇️ in eGFR! #NephTwitter#MedTwitter#FOAMed#MedEd
2/ This differential focuses on the estimated GFR (eGFR), which is calculated using serum creatinine +/- serum cystatin C levels (we will take a look at the equations in a bit). Biomarkers that actually measure GFR (such as inulin) are not clinically practical to obtain.
3/ Thanks to @ZacNephron for explaining GFR vs eGFR, referring me to Chapter 2 of @BookBurton, and sharing this thread to deepen my understanding of the utility of GFR:
1/10 As someone who struggles with test-taking, I made a framework for tackling some common test-taking hurdles. I had the opportunity to go over this with all our @uclaimchiefs housestaff and decided to make it into a 🧵 #MedTwitter#MedStudentTwitter#FOAMed
2/ Test scores are important because they are what you need to become board-certified. Scores are often conflated with competency - that is quite a fallacy as so many other factors go into competency.
3/ Here is a non-comprehensive set of examples of test-taking hurdles. Let’s go through each of them systematically in a way that resonates with internists - problem listing! FYI, all of these end of overlapping a lot
1/12 The cognitive load on rounds can be high, so I like using daily e-mails as an adjunct to teaching on rounds. Here is a 🧵 on my approach! #MedTwitter#MedEd#FOAMEd
2/ I am of the opinion that you can form an outline of a lesson plan BEFORE you even start on service! My group attends for 14 days at a time, so this tells me how much “time” I have allotted to teach (more on this later).
3/ Make sure to include every learner who will rotate with you while you are on (I use amion to figure out which trainees are on with me). They might appreciate getting learning when they are off service and if there is an ongoing thread of teaching, they won’t miss out!
1/8 Medical education has evolved tremendously, and I am a HUGE fan of having a peripheral brain. An common question trainees ask me is “how do you cultivate references?” A 🧵 on my methodology for organizing information #MedTwitter#MedEd
2/8 Before we start, it is important to categorize the purpose of the info you are gathering:
1⃣ To teach others
2⃣To teach myself
I don’t organize my references this way, but I start here to remind myself that everyone learns best with different modalities!
3/8 Now that we’ve acknowledged that, you must create a list of modalities that you can consistently categorize information into. Here is my organizational system.
The primary focus of this thread is going to be on the history (a heads up - the flowchart at the end will go a little bit out of order)!
3/18 When taking a chest pain history, we ask lots of questions about associated symptoms and alleviating/aggravating factors, mostly because we were taught to obtain and report this history. But is there a more focused way to approach this?