Yihan Yang, MD MHS-MedEd Profile picture
Sep 14, 2021 12 tweets 7 min read Read on X
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! Image
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 Image
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. Image
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 Image
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. Image
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. Image
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. Image
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! Image
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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More from @YihanYangMD

Jul 26, 2022
1/ “When you have time, can we look over one of my notes?”

Do you have an approach to teaching when learners ask for feedback on documentation? Check out the following thread for some high-yield tips!

#MedEd #MedEdTwagTeam #TweetorialTuesday #MedTwitter Image
2/ As a reminder, we are still in our series on inpatient teaching. I typically will teach about notes after rounds. Image
3/ First… in your opinion, how valuable is it for learners to receive feedback from notes?
#MedEd #MedTwitter #MedStudentTwitter
Read 14 tweets
Jul 19, 2022
1/ You’re prepping a 15min post-rounds talk on anticoagulation. To excite the crowd, you say, “This is going to be interactive!”

How do you avoid learners reflexively cringing,waiting to be “socratically” questioned?

#MedEd #MedTwitter #MedEdTwagTeam #TweetorialTuesday
2/ We are still covering teaching in the inpatient setting. Interactive teaching can be done in most settings, but I’ll focus on opportunities before/after rounds. We covered interactive teaching during rounds & @ bedside earlier this series
3/ When people say, “This session is going to be interactive,” a talk where learners are asked a series of ?s akin to the socratic method often comes to mind.

For this thread, I'd like to frame “interactive teaching” as below:
Read 14 tweets
Jul 5, 2022
1/ Last week, @ChrisDJackson dropped some serious 🔥tips on putting together the content of chalk talks. Check it out if you missed it ⬇️

Part 2 this wk will cover high yield delivery tips!

#MedEd #MedTwitter #MedEdTwagTeam #TweetorialTuesday Image
2/ As a reminder, we are still covering teaching in the inpatient setting. Again, chalk talks are fair game both during or after rounds, depending on how much time you have available Image
3/ We will cover the following tips for chalk talk delivery in this week’s🧵: Image
Read 16 tweets
Jun 14, 2022
1/ A new dx of cirrhosis…
Recurrence of cancer…
A Monday procedure is canceled & your pt waited since Friday…

We’re frequently the bearer of bad news in the hospital.

Today #MedEdTwagTeam shares tips on incorporating teaching when giving difficult news.

#MedTwitter #MedEd Image
2/ As a reminder, we are continuing our discussion inpatient teaching.

Last wk, we covered tips on teaching around family meetings:

This wk, we focus on teaching when delivering difficult news, which can also be done during rounds & routine patient care Image
3/ But 1st… what counts as “difficult news?” We often think of cancer or terminal illnesses.

But with the definition ⬇️ I think we can agree there are plenty of times when we may be delivering difficult news to patients without even identifying it as such. Image
Read 11 tweets
Jun 7, 2022
1/ Your intern on rounds: “I’m worried about Ms. H & think we need a family meeting.”

You mentally check your schedule to decide where to fit a 30-60 min family meeting AND make it a good learning experience.

#MedEdTwagTeam is back w tips on the latter!

#MedTwitter #MedEd Image
2/ As a reminder, we are continuing our discussion about opportunities for inpatient teaching after rounds. We return to the bedside this week to discuss teaching around family meetings Image
3/ What are your objectives for using the family meeting as a method of teaching?

Common areas for intentional skill-building with family meetings are highlighted 👇🏼 Image
Read 11 tweets
Apr 12, 2022
1/ A room full of rising chief residents discussing report facilitation - wonderful to teach in person again @AAIMOnline #AIMW22!

If you missed our workshop, please check out the following links for my report facilitation tweetorials! #MedEd #MedTwitter
2/ In our #AIMW22 workshop we shared 8 tips for facilitating resident report

Tip 1 - Starting on Time in the link below!

Tips 2-8 in the following 🧵
Read 7 tweets

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