Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

⁦@gradydoctor⁩ 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!

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

https://twitter.com/VarunPhadke2/status/1630620614179405845

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.

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. 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.

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? 2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons.

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 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?

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. 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?

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.

1/ On a subspecialty team, we often have students & residents NOT going into our specialty...

...and then fellows who are trying to become experts.

How can we balance our teaching for everyone?

This week: Setting Learning Goals on Consult Teams 2/ First, I strongly believe in shared goal-setting, as described in this prior thread by @YihanYangMD

https://twitter.com/YihanYangMD/status/1445412708006850571

This process is especially important for learners who have CHOSEN the rotation as an elective. They likely have a particular learning need/interest!

1/ Have you ever started your day with a great teaching plan...

...then by 12 pm, you've received consult 📟 #10:

"This patient has been hospitalized for 65 days & developed a 🌡️ 2 weeks ago..."
😱

This week: balancing consults & teaching
(w/ principles for primary teams too!) 2/ Last week when we asked about your biggest challenge to teaching as a consultant, you answered:

#1: Time constraints
#2: Unpredictable workload

I feel this. This is what makes the day difficult to plan.

https://twitter.com/VarunPhadke2/status/1587502112073814018

1/ Do you want to know tips & tricks for incorporating technology into teaching?

Here are the take home points from my presentation today at #iMed2022. 2/ First, remember that technology can *augment* teaching but can't replace good instructional design.

Just like a good stethoscope is helpful to hear a murmur but can't replace the skills and knowledge necessary to diagnose valvular dysfunction.

1/ Are you a new resident, fellow, or attending trying to improve your inpatient teaching skills?

Then 👀 no further!

This week, the @MedEdTwagTeam ends a 3-week summary of our inpatient teaching 🧵 from the past year. 2/ This week we will summarize our content on how to do effective inpatient teaching after rounds – whether it’s a chalk talk or an afternoon discussion at the bedside.

1/ Are you a new resident, fellow, or attending trying to improve your inpatient teaching skills?

Then 👀 no further!

This week, the @MedEdTwagTeam continues a 3-week summary of our inpatient teaching 🧵 from the past year. 2/ This week we will summarize our content on how to do effective teaching while on rounds, including at the bedside!

1/ Are you a new resident, fellow, or attending trying to improve your inpatient teaching skills?

Then 👀 no further!

This week, the @MedEdTwagTeam starts a 3-week summary of our inpatient teaching 🧵 from the past year. 2/ This week, we will summarize the content on:

✅ organizing your day
✅ preparing for teaching
✅ using learning objectives to focus teaching
✅ teaching multiple learner levels
✅ teaching before rounds

1/ While on the teaching service, have you:

✅ noticed bias impacting decision-making?
✅ made a diagnostic or management error?
✅ had an emotionally charged interaction w/ patients or staff?

If so, then let's discuss how to use reflection to turn it into a teachable moment. 2/ Reflection is a meta-cognitive process, which means that it's best done when you have time - i.e., AFTER rounds.

1/ A patient on your team was admitted for a COPD exacerbation, and you're concerned that they may not know how to use their inhalers correctly.

How can you use patient education as an opportunity to teach your learners AND the patient?

This week: teaching w/ patient education 2/ Patient education can be done either during or after rounds.

This is my favorite thing to teach on the day of discharge (or when "signing off" for those who are consultants!)

Let's talk about how to use patient education as an opportunity to teach your team too.

1/ "Do you have a second to chat?"

(i.e., The phrase that results in almost a reflex cringe 😳...)

We all want feedback,
but we dread it at the same time.

How can we deliver better feedback?

Check out this week's thread for some tips! 2/ This week we will discuss giving feedback in the inpatient setting with a focus on integrating it into daily clinical care.

For more detailed threads on feedback, check out our prior 11-week series on the topic:
twitter.com/i/events/13632…

1/ *Case presentation of MSSA osteomyelitis*
...
Expert 1: Clearly we should treat w/ IV ceftriaxone
Expert 2: WHAT?! I would never use ceftriaxone to treat this
...
💭Trainee in the audience: What the heck should I be doing?

This week: teaching management reasoning effectively 2/ This week we will discuss how to teach management reasoning, also sometimes referred to as "therapeutic reasoning."

1/During case conference (& on rounds), we often see master clinicians come up w/ brilliant diagnoses before the HPI is even finished.

But how did they get there?
And how can you teach yourself & others those skills?

This week: how to teach diagnostic reasoning more explicitly 2/ This week, we will discuss how to teach clinical reasoning.

Clinical reasoning can be divided into 2 distinct domains.

1⃣Diagnostic reasoning
2⃣Management reasoning

This week we will focus on diagnostic reasoning, and we will cover management reasoning next week.

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 🧵! 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.

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.

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.