Yihan Yang, MD MHS-MedEd Profile picture
Jun 14, 2022 11 tweets 7 min read Read on X
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
4/ At the end of last wks 🧵 on family meetings, I shared a schematic on steps before, during, and after family meetings. These same steps could be altered for delivery of difficult news.

I’d like to highlight a few updated points to this approach for delivering difficult news Image
5/ For your pre-brief: there are several frameworks available to structure the delivery of difficult news that you can review with a learner prior to news delivery.

SPIKES is one commonly-used framework developed by Braile, Buckman, et al

pubmed.ncbi.nlm.nih.gov/10964998/ Image
6/ I also wanted to highlight an excellent tip brought up by @harryhan08 last week to include in your pre-brief: identify a “signal” that your learner can use to indicate that they want you to jump in and help out:

7/ In addition to clear communication, delivering difficult news is the perfect time to teach / reenforce strategies that help learners develop empathic connections with patients. This is a crucial skill that can be used in any – if not ALL -- patient encounters.
8/ The @ACHonline has an excellent resource on the NURS framework for engaging empathically w/ pts. See the pocket card ⬇️ for the framework & sample phrases.

This framework is what I find myself role modeling the most during difficult news delivery. Image
9/ Delivering difficult news can be tough not just for the pts, but for us as clinicians as well.

It’s important to acknowledge & normalize this, esp when your learners are delivering the news.

Make sure to NURS your team’s emotions around delivery of the news during debrief Image
10/ #MedTwitter, what additional tips or strategies do you have when you are teaching learners about delivering difficult news? Image
11/ Stay tuned for next week’s #TweetorialTuesday by @JenniferSpicer4 on Patient Education

Make sure to follow our other @MedEdTwagTeam members @GStetsonMD @ChrisDJacksonMD so you don’t miss anything! Image

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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 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
Mar 15, 2022
1/ Your student is trying to characterize the pt’s aortic stenosis murmur. The pt looks concerned. The rest of your team looks bored, waiting to examine the pt.

How to make PE teaching fruitful & engaging for EVERYONE?

#TweetorialTuesday #MedTwitter #MedEdTwagTeam #MedEd Image
2/ As a reminder, we are continuing our discussion about opportunities for inpatient teaching during rounds.

Today is the final installment on the physical exam. Image
3/ You’ve decided to teach exam skills. You’ve prepped WHAT you’d like to teach.

But with so many different levels of learners on a team, keeping all your learners & the pt engaged can be a challenge during exam teaching.
Read 16 tweets

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