1/ As the team starts discussing patient #16 on the list during rounds, you look around & notice:

Learner 1: *👀 at their phone*
Learner 2: *🥱, almost 🛌*
Learner 3: *🥺 pleading for rounds to end*

How can you keep everyone engaged?!

If this feels familiar, check out this 🧵! Image
2/ This week, we are continuing our discussion about opportunities for inpatient teaching during rounds with a focus on how to keep learners engaged.

Although these tips are primarily for rounds that do NOT occur at the bedside, many of the same principles apply. Image
3/ For tips on how to engage all learners at the bedside, check out this recent thread from @YihanYangMD on engaging all learners at the bedside with physical exam teaching:

4/ As I mentioned previously, I often start with teaching BEFORE rounds.



Then, once rounds begin, everyone is already turned away from their computers, involved in the discussion, and primed to learn.
5/ Now that I have the team's attention, it's important for me to maintain it during rounds by involving EVERYONE in the discussion of ALL patients, not just their own.

At the beginning of the month, I set this expectation. Because sometimes other team members have great ideas!
6/ So let's talk about opportunities to involve other team members during patient presentations.

None of this is ground-breaking. You probably ask these questions already!

BUT...I want us to think about how we can use these questions to engage other members of the team. Image
7/ So after a team member finishes presenting portions of the history, I ask other team members to weigh in:

What else do they want to know?
What do they think is going on?

This promotes other team members' active listening! Image
8/ I may ask other team members to REQUEST portions of the exam or PREDICT what they would see based on their current hypotheses.

This teaches the team to use the exam as a diagnostic tool (and could be done at the bedside too!). Image
9/ Instead of the presenter list all of the labs, I ask other team members what tests they want & why. THEN the presenter shares in any other unexpected labs.

Or sometimes I have other team members read the patient's EKG/imaging/PFTs, then the presenter share the official read. Image
10/ @gradydoctor once told me her trick of having a different team member summarize the relevant data into the problem representation. (sgim.org/web-only/clini…)

Again, brilliant! This requires everyone to listen and helps teach clinical reasoning skills during the case. Image
11/ I always allow the presenter to provide their ddx; however, when we have a true diagnostic mystery, I ask everyone to add additional thoughts.

This works great on our HIV service when I'm trying to teach residents a structured approach to HIV syndromes. Image
12/ Then I do the same thing for the plan.

The presenter gets the first run at the plan, but other team members have the opportunity to add their thoughts on the diagnostic plan. Image
13/ And finally, when discussing treatment, I love to have team members debate treatment options, ESPECIALLY when selecting antibiotics.

Often, there's not ONE correct answer, so everyone has different thoughts!

Even better: have them write it on a notecard, then share & debate Image
14/ The key to making this effective is to ensure that the presenter knows that THEY ARE IN CHARGE of the decision-making.

You don't want team members one-upping each other; rather, create a spirit of team discussion while allowing the presenter to make the final decision.
15/ And if you're looking for tips on engaging multi-level learners, then review this tweetorial.



When asking the group questions, use either:
1⃣ open-ended questions with potential multiple answers
2⃣questions targeted to a specific learner level Image
16/ So, in summary, consider how you can ask the TEAM to engage during each presentation.
Don't just ask these questions to the presenter.

Asking other members of the team engages them as active listeners and makes patient care a true team experience. Image
17/ Join us next week for #TweetorialTuesday when @GStetsonMD will discuss how to drop teaching pearls on rounds.

And don't forget to follow @YihanYangMD, @ChrisDJacksonMD, & the @MedEdTwagTeam so that you don't miss a thread. Image

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More from @JenniferSpicer4

Mar 22
1/ Are you struggling to get buy-in from learners/administrators who prioritize learning "real medicine" (i.e. medical knowledge) > "soft skills" (e.g. patient-physician communication)?

Then this 🧵 is for you!

This week I highlight the importance of the so-called "soft skills"
2/ This week, we are continuing our discussion about opportunities for inpatient teaching during rounds with a focus on communication.

This will be a 3-week series on patient-physician communication, and this week we will highlight WHY it’s important to teach.
3/ As poignantly stated by Robin Williams in the movie Patch Adams...

"You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.”

Read 12 tweets
Mar 1
1/ I’m at the bedside.
I want to teach.
This patient has a great lung exam.

🔴But is it high-yield to teach? We already have the CT...
🔴And do I do my exam "correctly"?
🔴And what's the best way to teach it?

If you have these ❓ too, then the 🧵 these next 3 weeks are for you!
2/ This week, we are continuing our discussion about opportunities for inpatient teaching during rounds with a focus on the physical exam.

This will be a 3-week series, beginning with an introduction today.
3/ So first, we'd like to know:

When you're in the inpatient or outpatient setting, how often do you teach physical exam skills?
Read 13 tweets
Nov 2, 2021
1/ You're on the inpatient service,
and you want to teach...

but HOW are you supposed to FIND TIME ⏲️while also
✅ caring for patients
✅ writing notes
✅ completing other administrative work

Not to mention managing your personal life!

This week: tips on teaching BEFORE rounds Image
2/ This week, I will share practical tips on how to integrate teaching into your daily routine BEFORE rounds.

It's another #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends! Image
When do you typically teach?
Read 14 tweets
Oct 12, 2021
1/ You are standing in front of your team, getting ready to teach about diabetic foot infections.

HOW will you get them interested in this topic?

And how are you going to teach so that EVERYONE learns, from student all the way up to the fellow?!

#MedEd #MedTwitter: HELP!
2/ This week, I will share tips on teaching to multiple learner levels AND interests to help you effectively engage your entire team during inpatient teaching sessions.

It's another #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends.
3/ You have a team of learners and a patient to discuss.

How will you make the teaching both INTERESTING & RELEVANT for your learners?

I mean, you're teaching about diabetic foot infection. Everyone's going to 😴💤 as soon as you start teaching. How can you keep them engaged?!
Read 15 tweets
Sep 21, 2021
1/ Have you ever...

...promised yourself that THIS time you'll prioritize teaching while on the inpatient service but then get TOO BUSY?

...or WANT to teach something on rounds but realize that you have FORGOTTEN the details of that clinical pearl.

Then this week is for you!
2/ This week, I will share tips to help you prepare to teach effectively on rounds as one of our “foundational skills” for inpatient teaching.

It's another #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends.
3/ Before we get started, I want you to reflect on something:

When you travel, do you tend to plan an itinerary for your trip or "wing it"?

Now, what if you only had a single day in that city but wanted to see all the famous sites?

Would your answer change?
Read 16 tweets
Sep 7, 2021
1/ It's another #TweetorialTuesday from the @MedEdTwagTeam for our #MedTwitter & #MedEd friends.

This week, I will give you a glimpse into how I structure my day on the inpatient service to balance teaching & completing my own tasks as an attending!
2/ As a reminder, we are discussing the foundational skills for inpatient teaching - i.e., how to "fit it in"

@GStetsonMD provided his perspective last week.

This week, I will compare/contrast how I approach this when I'm on a primary vs consulting team.
3/ I've used the literature to consider how I want to teach and conduct rounds.

Therefore, I consider:
1⃣ how my actions impact the learning climate
2⃣ what content my learners need to know for their future practice
3⃣how to incorporate focused, relevant teaching into rounds
Read 15 tweets

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