Showing posts with label Medical Education. Show all posts
Showing posts with label Medical Education. Show all posts

Monday, October 5, 2015

Humanism Is Alive And Well

      This Monthly Feature in our journal this month  is from the Council on Medical School Education in Pediatrics (COMSEP), and Dr, Plant et al. (doi: 10.1542/peds.2015-3042) invite us to think together about humanism. The topic and piece are timed to celebrate and promote humanism, since the month of October has been designated in honor of two revered physicians, Drs. Steve Miller and Richard Sarkin, (pcitured) who served as Travelling Fellows for the Arnold P. Gold Foundation and died tragically in a plane crash in 2004.
      I find great inspiration in this article. First, by defining humanism, the authors bring focus to their discussion, and clarity to our practice of medicine. Humanism “…encompasses a spirit of sincere concern for the centrality of human values in every aspect of professional activity…” If I slow down for a moment and think about that definition, it is almost like meditation.  Every time I care for a patient, I can practice humanism, and by acknowledging this “centrality,” I am able to feel good about being a doctor, which is not always easy given the intrusion of so many non-medical issues on my daily practice.
      Second, I love thinking about what educators can do to continue to practice and teach humanism. It’s certainly easy to achieve “burn out” given the many tasks we must perform that are not in the service of humanism (can any of us tolerate one more required presentation on ICD-10 coding and billing?), and yet it feels remarkably hopeful to learn about behaviors that will help keep us on track, such as self-reflection, seeking a connection with our patients, focusing on our own wellness, and teaching the humanistic approach we practice. I can do those things. It helps me immensely to know that relatively simple behaviors that I can control, which are not dependent on an administrator or a computer or even a colleague, will make a difference.
       Third, the practical aspects of teaching humanism might seem daunting, but Dr. Plant and colleagues give us crystal clear examples, in table format no less, of how daily patient interactions are actually teaching opportunities. They call these “embedded strategies,” which emphasize that every aspect of seeing a patient includes multiple windows for learners to deepen their understanding of what it really means to be a physician. This highly pragmatic approach grounds this “teach the teacher” article, and is a consistent and outstanding feature of the COMSEP group’s superb contributions. 
       And all of this in under 1200 words!  Enjoy.
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Friday, August 7, 2015

Oh the Places We Will Go…

By: Lewis First, MD, MS; Editor-in-Chief       

          One of the most fascinating trends to watch nowadays is who is choosing to go into pediatrics and what do pediatricians do once they make that choice and complete their residency?  Is pediatrics viewed more and more as a part-time or full-time specialty?  Are more of our trainees heading for specialty training and away from primary care or vice-versa?   
     It is becoming more and more timely to get a handle on the decisions being made professionally by the next generation of pediatricians by tracking their trajectory post-residency to determine present and future workforce needs. To help with that, the American Academy of Pediatrics has launched its PLACES study where PLACES stands for Pediatrician Life and Career Experience Study which kicked off in 2012.  This week Frinter et al. (doi: 10.1542/peds.2014-3972) who are overseeing this study share with us the design of this study involving 2 cohorts of US pediatricians , one who graduated residency in 2002-2004 and the other who recently graduated (2009-2022) with a total of over 1800 pediatricians enrolled.   
     This study sets the table for what will be twice yearly surveys of both cohorts with the hope of learning more about career, life choices, and the transitions experienced early in post-graduate training.  If you want a window into the recent world of our work force, then find a place for this special article and in turn the subsequent findings that will determine what will influence the career trajectory of the next generation of pediatricians.

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Monday, August 3, 2015

Sources for Infant Care Advice: What Are They and How Well Is That Advice Received?

By: Lewis First, MD, MS; Editor-in-Chief       

          A key component of every health maintenance visit is the advice we provide to parents who bring their infants and children to us.  In fact as pediatricians, we pride ourselves on making sure that advice is evidence-based and individualized for each patient and family under our care.  That being said, parents seek advice not just from pediatricians, but from birth hospital nurses, family and the media—at least according to a new study by Eisenberg et al. (2015-0551) being released this week. 
     The authors surveyed more than 1000 mothers from across the country regarding five key advice topics—immunization, breastfeeding, sleep position, sleep location and pacifier use. While the good news is that pediatricians are the most prevalent source of advice, mothers self-reported that they got no advice on sleep location or pacifier use, and about 1/5 of the sample stated they got no advice on breastfeeding or sleep position.  To find out how the other sources of advice performed, read the study yourself—although be ready to learn just how popular or unpopular family members and the media can be in also offering advice to your patients.   
     So do you agree with the findings in this study and are you surprised how often key areas of advice are not being received by families from pediatricians?  Does this mean the advice is not given, or it just doesn’t register given everything else a family wanted to learn during a visit?  To provide some further input on this study and what it means to all who practice, Drs. Scott Krugman and Carolyn Fowler provide their interesting opinion in an accompanying commentary (doi: 10.1542/peds.2015-1826).   
      Take my advice—and read this study and commentary and share the findings with families of infants as you provide your anticipatory guidance that will help insure they stay healthy in that important first year of life.

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Tuesday, June 9, 2015

Should the Manikin Die in a Mock Code?

By: Lewis First, MD, MS; Editor-in-Chief 

          It has been more than 25 years since I helped to run the mock code program in the emergency department at Boston Children’s Hospital, and yet I cannot forget the one day I decided to let the manikin die despite the valiant efforts of our trainees—and as a result—I ended up doing bereavement counseling with almost everyone who was involved in that experience given how seriously they took the exercise and how upset they were that the manikin died during this powerful learning experience.   
     As a result of the emotional wear and tear of making the manikin die, I opted not to repeat this experience in future mock codes and instead focused on making each week’s resuscitation result in a happier ending.  Yet was this the right thing for me to do from a trainee’s standpoint? 
     This question had never been studied until Lizotte et al. (doi: 10.1542/peds.2014-3910) undertook a study to see what trainees thought about having the manikin die during a mock code scenario. Just what trainees thought about their manikin having a fatal outcome, while stressful, was also acceptable in preparing them for the future.  There is a richness to the information shared in this study that may or may not prompt you to try an unsuccessful mock code in your institution with staff or trainees.  
      If you have participated or directed mock codes, have you “killed” the manikin and if so, what was the impact of doing so?  We welcome your comments on this issue via a response to this blog, an e-letter, or a posting on our Facebook or Twitter sites.

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Monday, May 18, 2015

Meaningful Use and The Exchange of Electronic Health Records

By: Joann Schulte  DO, MPH; Editorial Board Member

     Doctors and hospitals know a lot about paper pushing. Your office staff can  spend hours arranging referrals for children who each need to see a sub-specialist.   After the appointment, the same staff must feel like they’re on a treasure hunt  as they search for  the consultant’s recommendations or that delayed  lab result in the  medical record.   
     Or maybe you’re the hospitalist who needs to report a case of meningitis to the state health department. You spend fifteen minutes finding the form you need to report the case and you may spend another thirty minutes filling out the paper form if it is not online and faxing it.  Those kinds of frustrations were some of the reasons that electronic health records (EHR) were developed.  The EHR systems are supposed to end some of the paper pushing.   Information is supposed to get where it needs to go, lab results appear, and diseases are reported. That’s the concept of meaningful use (MU) of EHRs.
     At the end of last year, about 3/4 of US hospitals had adopted a basic electronic medical record that included clinician notes.  MU is another matter. The federal Centers for Medicare and Medicaid offer incentive payments to encourage implementation of EHR and meaningful use(MU) of those records.  The first phase of MU includes medication reconciliation and the exchange of health information between facilities.
      A new report by Teufel et al. (doi: 10.1542/peds.2014-2720)  published in this months' Pediatrics explores the progress of EHR adoption in children's hospitals and what barriers are reported by those institutions.  Early reports suggest that implementing pediatric EHR use was difficult because programs didn't include basics, such as weight-based dosing for medications, and pediatric normal values  for vital signs and diagnostic testing.
     The researchers surveyed the 224 members of the Children’s' Hospital Association to assess EHR adoption challenges the hospitals faced and how many got MU payments. The study period covered September 2011 to May 2012. The survey results were linked to records from the American Hospital Association to characterize the hospitals and federal records to identify the payment of MU incentives.
     Survey responses came from 133 children's hospitals (59.4%) and 35% of those hospitals (47) received some MU incentive payment.  The hospitals reported their most frequently anticipated challenges included the exchange of information with other hospitals (49%) and the generation of numerator and denominator information from the EHR to report quality information (41%).   Among the 47 hospitals that received MU payments, 58% reported that  the greatest challenge to achieving MU was the lack of meaningful criteria to pediatric care. The hospitals getting MU incentive payments reported their most challenging issues remained exchanging information with other providers (17, 44%) and generating numerator and denominator data (18, 46%).
     This report assessed only the first phase of MU; others will be implemented through 2018.  It seems that pediatric hospitals have a long EHR road ahead.

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