CPR, High Value Care, and MedPeds

What a whirlwind of a day today.  Lots of productive meetings, and some incredible learning along the way.  I have two “A-HA” learning moments from today.

The first was our Pediatrics Grand Rounds at Riley Hospital for Children.  Our PICU physicians set up a truly innovative Grand Rounds to have a discussion about the topic of “Do Everything?” regarding pediatric patients in the ICU.  It was co-hosted by a nurse researcher at our Ethics Center who has studied "Moral Distress", and a PICU nurse who provided an amazing perspective to the discussion.  It featured two role playing scenarios in how health care professionals speak with families of terminally ill children about CPR.  It was a great way to engage the audience to think about how families understand outcomes from CPR.  A critical learning point of this topic, common to many regarding patient-physician communication, is to avoid overly complex medical terminology, or jargon, when speaking with families.  In addition to talking about using language that matters, we discussed this paper from 1996, in which the authors evaluated the rate of successful CPR on television shows and compared it to the actual rate of survival in real patients.

This blog here is a recent update to that piece with a great infographic comparing the rates on specific shows.  The other great part was that this grand rounds was totally packed: not an open seat in the room!  For a CME person like myself, it is nice to see that so many participants were able to benefit from this presentation.  My tweets from today (1/15/14) convey much of the content of this educational session, for those with further interest on this topic.

Secondly, I am proud to announce that we piloted our first “High Value Care” curriculum to our MedPeds residents today.  The ABIM Foundation has been leading the charge on this, with the creation of the Choosing Wisely campaign.  Luckily, we did not have to reinvent the wheel, and were able to utilize this amazing high value care teaching resource from the ACP which was recently rolled out.  The residents were as engaged in this discussion as they have ever been.  I think this phrase captures their sentiments: “We want to be part of the solution to the costs of health care crisis and not just order tests indiscriminately”.  I couldn’t have been more proud!

For those interested in finding and using ready-made resources to teach cost-conscious care to residents or students, I can say that we were able to easily complete one of the five current modules with 8 formal multiple choice questions in less than one hour, with ample opportunity for robust in-depth discussion of some of the points.  We elaborated on clinical decision making in the context of cost conscious care.  Kudos to Dr. Daisy Smith of the ACP for creating these online modules that educators can use “off the shelf” right away in their training programs.  One does not even need to be an ACP member to gain access to these modules!

Looking back on these two topics noted above, I now see that they are a perfect example of the variety of training in MedPeds: both a Pediatric topic and an Internal Medicine topic in the same day!  Hooray for MedPeds!  I only hope that other days can be as “educationally productive and rewarding” as today was for me.

#AAMC13: Saturday November 2, 2013 Reflections

It is currently the first night of my time in Philadelphia at the 2013 AAMC meeting.  I’ve only been here a little over 24 hours, but today has just been phenomenal for thinking about the future of medicine and medical education.  This blog is a few reflections from the day.  There were many other sessions that I attended, but these are some key elements from a few of the sessions that had a great impact on me.  The credit truly goes to the speakers whom I heard discuss these topics.

CME (Attribution: David Price)

The old way of thinking about CME is this: a “credit” required to justify “widgets” of learning.  This is shifting to a new CME/CPD model: aligning education with the gaps/needs of our communities.  In this new model, we can study why things work or don’t work.  For example: Does it work?  Can it work in real life?  How/why does it work?  Does it work better/cheaper?   What I think the challenge will be is finding the linkage to determine how the education is created, disseminated and implemented across health care systems.

Teaching Costs of Care/Value in Health Care (Attribution: Chris Moriates, Vineet Arora, Neel Shah)

The ABIM Foundation created a wonderful program as part of the Choosing Wisely Campaign which was a competition for programs/schools to present educational innovations to teach this important topic.  The criteria for this necessitated that the innovations be FINER: Feasible, Interesting, Novel, Ethical and Relevant.  Ultimately, interventions needed to address “COST”: Culture, Oversight, Systems Change, and Training.  3 speakers from different institutions highlighted their innovations, which demonstrated a variety of techniques to tackle this critical component of health care. My take home is that the health care providers have an obligation to our patients and society to tackle the issues of health care costs stemming from the unsustainable strain that these costs are putting on society.  This program showcases the fact that medicine as a field, under the leadership of the ABIM Foundation, is not pointing fingers at others (insurance companies politicians, or lawyers, for example), but rather is looking introspectively at how can we make a difference in addressing the cost issue.  The issue is real, but we are no longer burying our heads in the sand.

The Future of Medicine and the Need for More Residency Training Positions

I had the fortune of having dinner with our Associate Dean for Medical Student Affairs and 3 medical students from the IU School of Medicine.  We all reflected on the day, and what we all can take from the conference so far.  One big theme from that discussion is that advocacy is alive and well in the current generation that is going through school and training now.  Advocacy can take many forms, such as helping the disenfranchised, educating patients and families about the importance of vaccines, and/or even lobbying Congress to secure more positions for residency training.  The future of health care needs more physicians: medical schools have responded by increasing enrollment (and adding new schools), but the “bottleneck” is truly at the GME level.  In order to alleviate this, the number of residency positions need to increase.  This is not just a way to help students secure a residency position, but is the ultimate path towards addressing societal need for more health care providers.

Thank you, AAMC, for a wonderful first day of learning, camaraderie, discussion and interaction.  I look forward to the next few days as well!