Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

@gradydoctorImage
Do you want a 4-step process for questions to ask when you get a page next year when you’re alone on nightfloat or ICU call?

Check out this framework! Image
And now, do you wanna remember who the heck to order DEXA scans for in clinic?

Thankfully Miko De Bruyn comes to the rescue. Image
And what are those risk factors for fracture?

Here they are! Image
And when should you repeat screening?

Thankfully you know due to this BST Mode talk by Miko De Bruyn, coached by @TracyVettese! Image
Next up, Sanjay Chandrasekhar to teach us how to remember RTAs.

Because, let’s be honest, this just never sticks. Image
So here’s your ddx for a non-anion gap acidosis.

Don’t forget about that RTA! Image
Here’s your summary slide to help you diagnose that RTA! Image
And for our last talk - how to remember that pesky shoulder exam when you need it in clinic by Alex Galloway. Image
Here are our objectives Image
So how do we broach shoulder pain? Image
Remember all those exams you learned in medical school?

The truth is you only need 3 to help determine if it’s rotator cuff issues that require surgery or MRI Image
First, figure out if they have rotator cuff pathology.

If the painful arc is positive, then they have rotator cuff pathology. Image
Then, do the internal and external lag. If they can’t hold it, then they have a full thickness tear! Image
So then what do you do?

If it’s a full thickness tear, then refer to surgery.

Otherwise, conservative management rules! Image
Thanks for joining, and happy #MatchDay2023!!! Image

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Keep Current with Jennifer Spicer, MD, MPH

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More from @JenniferSpicer4

Mar 7
1/ You're seeing a new consult with your team, and you want to teach the primary team too.

But WHEN is the best time to teach them?

On the phone?
At the bedside?
In their team room?

And in the morning?
Or maybe the afternoon?

This week: Image
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.



But when should we teach them?

Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.

With one caveat.

Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.

But let's explore some general principles to consider.
Read 15 tweets
Feb 21
1/ You're finishing your last consult of the day.

It's late.
And it's been a long day.

You intended to find the primary team to teach them, but you have a million other things on your "to do" list.

Here are 8 reasons why you should still find time to teach the primary team. Image
2/ Reason #1: They want to learn

The primary team called with a question.
They are invested in the answer.

It's all about finding out what they want to know and targeting your teaching accordingly.
3/ Reason #2: It empowers them

Often the primary team has an idea of what to do but wants reinforcement that their plan is correct.

Teach them general rules that they can re-use. Image
Read 12 tweets
Jan 31
1/ Your team just saw a patient with syphilis, and you're ready to teach, but:

Resident #1: on week 2 of their rotation
👉 Has already seen 2 patients w/ syphilis

Resident #2: started today
👉 Hasn't seen a single patient with syphilis

What should you do now? Image
2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons. Image
3/ As @VarunPhadke2 previously pointed out, all learners on the team are usually not present all day, every day for the entire time we are on clinical services.

Image
Read 16 tweets
Jan 24
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.

Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow

How can you possibly provide valuable teaching to all of them?

This week: Multi-level teaching Image
2/ Teaching multi-level learners is hard.

Their range in baseline knowledge means a single teaching point is often not effective for everyone.

So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.

This is one 🗝️ for effective multi-level teaching.

Know what materials is RELEVANT and INTERESTING for each learner level.

Read 14 tweets
Jan 10
1/ *Re-consult 📞*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🤦 I feel you... We'll see the patient again. Image
2/ You wonder...

💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?
3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

Read 15 tweets
Dec 13, 2022
1/ *Consult team room*

A brand-new learner joins your consult team.

You share details about a new consult & schedule ⏱️ to meet in the afternoon to staff.

⌛️

5 minutes into their presentation you realize, "Oh no. I'm going to have to redo this consult, aren't I?"
2/ Learners on consult teams must tackle unfamiliar and complex questions, often with less time to evaluate a patient and develop a plan than on primary services.
3/ This @AcadMedJournal paper by @s_brond describes factors that contribute to cognitive load on consults.
 
pubmed.ncbi.nlm.nih.gov/34348389/
 
Although this article focuses on the experiences of fellows, other learners likely struggle with some of these areas as well.
Read 16 tweets

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