Christopher D. Jackson, MD Profile picture
Apr 26, 2022 13 tweets 6 min read Read on X
1/ Happy Tweetorial Tuesday from @ChrisDJacksonMD!

Clinical pearls? Evidence based medicine? Are we trying to mix oil and water?

Don't worry, your #MedEdTwagTeam crew is here to help with this week's thread!
2/ The clinical pearl bridges our learner's clinical observations and their developing evidence-based practice.

Our learners are often navigating so much clinical data that a well-timed and well-crafted pearl can help them navigate challenging dx & mgmt scenarios
3/ Clinical pearls have 3 important qualities.

They convey a key easily understood clinical point. This information could inform dx, mgmt, or both. Most important, they should build the knowledge of the receiver, pointing out what is not already known.
4/ The teaching of clinical pearls is not perfect

Presenting teaching points with qualifiers of ALWAYS or NEVER can misrepresent the reality of clinical practice. Some pearls don't withstand scientific rigor. Lastly, pearls with no clear point can confuse learners.
5/ How do we reclaim the pithiness of the clinical pearl while keeping it scientifically sound and effective in teaching future generations of clinicians?
6/ Listed below are some of the clinical pearls repeated multiple times throughout my training. Over the next few slides, I'll share a framework and illustrate how to be more thoughtful in how we discuss pearls on rounds.
7/ Here is my framework for teaching clinical pearls to my learners.
8/ Prime your learners to use pearls with caution. Pearls should be used in specific contexts and they do not replace your clinical judgment. Much like a stethoscope, a clinical pearl is only as useful as the clinician applying it to a patient scenario.
9/ Context is everything. For each of the pearls above, they do have merit in specific clinical situations. Providing learners the appropriate context for the pearl allows them to incorporate these observations in their developing illness and management scripts for diagnoses.
10/ After giving the pearl, it's important to have the learner operationalize its meaning. Most pearls have both a dx and tx implication. More important than the pearl is the learner's understanding of how it impacts the patient scenario in question.
11/ Pearls are not eternal. I encourage and model confirming pearls in real-time. This confirmation can be searching MKSAP, UpToDate, or ACP Journal Club based on the nature of the pearl. I have the learner do it with me, or I ask them to search and report back the next day.
12/ Your clinical pearls need to serve a purpose to have the most impact. As I listen to a learner present a case, I try to think of the 3 questions below when I formulate a pearl. Grounding the pearl in one of these questions is the hook to engage your learner about a point.
13/ Please join us next week as @JenniferSpicer4 introduces teaching clinical reasoning.

You can find our previous threads by following @MedEdTwagTeam

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More from @ChrisDJacksonMD

Aug 2, 2022
1/ “I had so much more I wanted to teach or discuss about our patient with hyponatremia, but I couldn’t fit it on rounds. What should I do?”

Check out the following thread for some high-yield tips on teaching after hours!
2/ As a reminder, we are still in our series on inpatient teaching.
3/ First, how often do you use strategies to teach after hours?
Read 13 tweets
Jun 28, 2022
1/ Happy Tweetorial Tuesday!

You just start on a busy clinical service, and on the first day, your students and residents mention they would like more chalk talks on common things they see on the wards.

This week we'll talk about giving effective chalk talks Image
2/ Chalk talks can be given during or after rounds, although the latter is often more feasible.

Compared to didactic talks, their focus is narrower and their relevance to patient care is more readily apparent. Image
3/ The most effective chalk talks strike the "rite" balance.

- Relevance to patient care is clear.
- Interactivity maximizes engagement &knowledge retention
- Timing chalk talks to < = 20 minutes balance completeness with learner attn
- Evolve talks based on feedback Image
Read 15 tweets
Feb 22, 2022
1/ Happy #TweetorialTuesday from @ChrisDJacksonMD!

Hypothesis-driven history? Bedside rounds? How do we put it all together?

Don't worry, your #MedEdTwagTeam crew is here to help with this week's thread! Image
2/ Last week, we emphasized the why of teaching and using hypothesis-driven history. Image
3/ Outlined in this figure are the 5 steps in a hypothesis-driven-history encounter

Depending upon the patient scenario, you may use some or all of these steps.

More important, though, is engaging the learner at each point towards obtaining the diagnosis for the patient Image
Read 18 tweets
Feb 15, 2022
1/ Happy #TweetorialTuesday from @ChrisDJacksonMD!

Welcome back to the #MedEdTwagTeam threads on all things teaching, feedback, and so much more.
We have exciting stuff to help you level up your bedside history and physical examination teaching skills in the coming weeks. Image
2/ We are still covering the foundations of inpatient teaching. This week, we will be focusing on strategies to improve hypothesis-driven history taking at the bedside during rounds. Image
3/ Obtaining the HPI is a core skill for patient care.

We're taught to take this history with attention to comprehensiveness

The goal of hypothesis-driven history is to carefully consider what questions impact our diagnostic thinking to make our history taking more effective Image
Read 11 tweets
Jan 5, 2020
Hey #medtwitter! I am giving a go at my first #MedEd #Tweetorial! I want to review my top 10 trials of 2019 inspired by my talk @UTHSC_Medicine on 2019 GIM updates. Thanks to @cjchiu for the inspiration and encouragement to do this!
1) POC CRP to Guide Antibiotic Treatment for COPD trial:
- RCT of 636 patients with GOLD stage II COPD seen at 86 clinics for AECOPD
- 20.4% absolute difference in self-reported abx use with no difference in COPD-related health at 4 weeks
- Maybe a CRP a day keeps the abx away
POC CRP to Guide Antibiotic Treatment Limitations:
- May not be generalizable to patients with more advanced COPD
- Bias reporting by patients
- Not all places have POC CRP available
- Read more here: nejm.org/doi/full/10.10…
Read 24 tweets

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