Reflections on #AIMW13 and the APDIM Fall Meeting

I just finished a wonderful two days at the Academic Internal Medicine Week meeting in New Orleans.  This is a meeting bringing together organizations involved in internal medicine education and leadership, including, among others, the Clerkship Directors in Internal Medicine, and the Association of Program Directors in Internal Medicine.  It is this latter group to which I belong, and, as usual, this meeting did not disappoint.  I was not able to attend the entire meeting, but was present for the last two days.  Here are my brief thoughts on this meeting from those sessions I attended.

Direct observation has definitely come front and center as an important component of training.  Not just an an assessment tool OF learning, but rather as assessment FOR learning.  It needs to be the culture that we regularly observe trainees in their direct interaction with patients (akin to playing the piano: my teacher was there right next to me the entire time, giving constant feedback when I was doing something wrong or had held my fingers in the incorrect position!).

I attended a session on a writer’s club to improve scholarly output.  This session really was riveting for those who attended.  Probably the best discussion was on the fact that scholarly output does NOT have to be ONLY the peer-reviewed publication (although that certainly is excellent!).  Rather, we should consider other products which still demonstrate a scholarly approach.  Those products might include writing a policy, disseminating a curriculum, or creating a tool that others can use for evaluation purposes.  A phenomenal example of how to consider this (focusing on the scholarship of education) is this toolbox from the AAMC MedEdPortal on evaluating educators.

I also attended a great session by colleagues from the U of Cincinnati and Nebraska on considering tools that we ALREADY use to report the Next Accreditation System Milestones.  This session created my “A-HA” moment for how educators might look at Milestones and Entrustable Professional Activities.

The next day, I was on the docket with others focusing on innovation in resident ambulatory experiences.  I had the privilege of discussing our residency experience with teaching quality improvement to trainees.  Other leaders discussed “X+Y scheduling”, to help improve resident interest in doing primary care, ways to teach Evidence-Based Medicine in the ambulatory arena, and experiences in residents having a second continuity clinic with primary care physicians (known in their program as “Second Site”).

In the final plenary, on one of my favorite topics, utilizing emerging technology in medical education, four different programs discussed their experiences with what they were able to accomplish.  One was a current fellow who himself created a smartphone app focusing on evidence-based management of patients admitted/observed for chest pain.  The app link is found here (only available on iOS devices).  Another speaker taught us basics of using Podcasting for medical education, and two others demonstrated the use of iPads in medical education and how others might consider using tablets for that purpose.

For anyone interested, the presentations mentioned above, as well as all of the presentations that were loaded up, can be found here.

All in all, it was a phenomenal conference for me to attend.  Lots of great tweeting was done, as the conference encouraged the Twitter hashtag #AIMW13 for connections via this microblogging social network.  If you are interested, please see my tweets from 10/5/13 and 10/6/13, which were mostly dedicated to the content of this conference.

As a last note, I want to thank the incredibly professional staff of AAIM for hosting a phenomenal meeting, and especially the security staff of the Hilton Riverside in New Orleans Hotel for finding my misplaced keys!

Promotion and Tenure: Peer Review

In the world of academic medicine, Promotion and Tenure (P&T) refers to the process where someone “applies” to rise up the ranks from Lecturer, to Assistant, to Associate, and ultimately, to “Full” Professor.  There are set criteria for this process set forth by academic institutions.  I am impressed at how the P&T process at my institution is disseminated out to faculty: complete transparency in what the expectations are.

I recently attended a session for faculty to teach us about this process.  I have been to these before, but I learn something new every time I attend these.  It allows me to understand what I need to be doing within a timeline, what data I need to collect, and how I should go about crafting my “personal statement” (akin to the same personal statement one writes for residency applications).

While hearing about the criteria at a faculty development session on P&T, I learned about different ways to apply scholarship.  I am pleased that my institution uses the word “scholarship” instead of “research”, because scholarship is more broadly defined and does not restrict it to only publishing papers in traditional medical or scientific journals (although those are still the “holy grail” of scholarship).

Given my interest in social media, and blogging, I asked a simple question: “Would describing my blog and my foray into social media through Twitter be considered scholarship?”  After all, my blog is really about Medical Education in general (it is even in the title!).  It was a simple question, as at the time, other examples of scholarship besides publications in mainstream journals were being described.  The answer came in the form of a question: “Is your blog peer reviewed?”

Apparently, having something be “peer reviewed” is a critical step to making it “count” as scholarship (in the eyes of P&T, at least).  Another step is “retrievable”.  Whew!  That one is easily attainable—but the peer reviewed part—I’m not so sure.

It got me thinking.  How can we “peer review” content disseminated via social media, with respect to medicine or medical education?  A great blog here (from earlier today!) describes a future direction of medical education, called “FOAM”.  In it, the author describes the lack of peer review, but also calls into question the “traditional peer review process”.  What I love is a reference to an article titled “Peer review: a flawed process at the heart of science and journals”, which, undoubtedly and ironically, required peer review, to get into the journal in the first place.  Another article describing a survey to chairs related to E-learning as educational scholarship concludes that chairs feel that e-learning is valuable as scholarship. 

So here is the question to ponder: how can those who blog or use other social media tools within medicine or medical education achieve the “peer review” criterion for P&T?  Or should we call into question that criterion, as demonstrated in the article?  Given the explosion of social media (including blogging) in today’s society, should we push to abandon or adapt the “it needs to be peer reviewed” component necessary for scholarship within academic P&T committees?

At this time, I am still crafting my own opinion on this, but figured “Why not crowd source the question and see what others think?”  In reality, that is a version of a “peer review process” in and of itself.  Please feel free to weigh in on this topic; I would love to know your opinion.