Residency, Success, Team Sports and Being a Member of a Team

In a recent medical education twitter chat, other medical educators and I were discussing success being tied to previous experience playing a team sport.  It stemmed from this article, which suggested that success in residency (otolaryngology) may be more likely if one played a team sport earlier.  This is a fascinating observation, and one that I hadn’t thought of when interviewing applicants.  Others commented that there may be bias since in early schooling, boys are more likely to be members of team sports than girls.

It is interesting that residency program directors really struggle with trying to find the magic bullet that will determine success.  What does “success” really mean?  For program directors, I suppose it could mean having a resident who performed very well clinically, who was not a rabble rouser and thus “caused no trouble”, and who received excellent evaluations throughout training.  It could mean impeccable surgical outcomes for procedurally-related fields (although there are other factors besides a resident involvement in surgery that might affect surgical outcomes).  It could also mean getting a job and starting a practice after residency, or securing a fellowship after residency training.  I really don’t think there is ONE thing that defines this success. 

There may be success on a test (such as passing a board examination): that has been studied.  The old adage: “past performance predicts future performance” is true with regards to tests, in my opinion.  How this translates for programs directors is that those students who performed well on USMLE Step 1 and/or Step 2 are more likely to pass the board examinations after residency.  While this is only one aspect of “being a doctor” (using competency language, it would be the competency of medical knowledge), residency programs are indeed being evaluated on this measure of board pass rate.

There may be success regarding professionalism. Some might take the reverse approach.  When one is unprofessional, what factors predict that unprofessional behavior? This has been studied by Dr. M Papadakis, and basically, past “unprofessional” behavior in medical school predicts future disciplinary action by state medical boards. 

There may be success in securing a match position.  Many educators have published on this, such as this from plastic surgery. 

There may be success in other domains as well.  Here is a description that uses a surgical aptitude test.  Here is another study looking at the utility of letters of recommendation to predict success. 

I have heard many references over the years that medicine is a “team sport”.  No one takes care of a patient by only herself/himself.  We really need a team to help patients optimize their health.  I believe that the field of geriatrics models this very well, and has described training on working in multidisciplinary teams.  The importance of teams in medicine has also been outlined for patient-centered medical homes, such that teamwork competencies need to be defined.

One of my mentors (a female) has mentioned “I love seeing applicants who were Eagle Scouts”.  I have heard others who get excited seeing certain extracurricular activities, such as volunteerism, on a written application.  Like others, I certainly enjoy reading some things on an application more than others, but I really haven’t found any one thing that predicts success. 

To me, it is not just the application that is important. The application gets you in the door [for the job interview], but the interview gets you the job.  As for defining success: well, we in medical education have a long way to go before we are able to pinpoint that one down.

Advocacy and Education in Social Media for Medical Students

I had a great discussion today as part of a social media faculty learning community (FLC) at my institution and thought it should be shared.  

As a group, we decided that what we would create is an elective for 4^th year medical students on using social media in medicine and medical education.  We are still finalizing the learning objectives, content and other components of what we want the students to learn.  We are aware that students are very savvy when it comes to social media, but know that there is more for them (and others, including us) to learn.  Including a section on professionalism is an obvious must.  In addition, we plan to have a reflection component where students must contribute their reflections in writing.

We had a phenomenal discussion today about including a section on advocacy.  We came to the conclusion that medical students should learn advocacy within the realm of social media.  An absolutely phenomenal example is what Dr.Bryan Vartabadian has accomplished with his blog and Twitter feed, which ultimately made its way to a post on the Forbes website.  This clearly demonstrates the impact that implementing one’s voice through social media channels can have.

What are your thoughts on medical education focusing on advocacy within social media?  In addition, we would love your opinions on what else we should include in this elective for students.  I look forward to any ideas.  Crowdsourcing at its best!

Mobile Tablets in Clinical Medicine

I read this piece on perception of professionalism around use of mobile tablets in medicine this morning, and it struck a chord with me.  I am the first to admit that I have had both formal and informal discussions with medical students and residents about looking on smart phones or tablet in the middle of rounds.  I have discussed it in a variety of terms likely related to “this is not professional, and it appears to me as if you are disinterested.”  The traditional thinking is that the learner is bored and/or distracted, and either surfing the internet, checking email, playing a video game or doing some other activity besides listening intently on rounds.

However, this survey article on the use of mobile computing by trainees is quite intriguing.  40% of academic physicians and trainees said they owned a mobile tablet, and 50% of those, or 20% total, use them for clinical medicine at the point of care.  That is a lot, and I bet the number is growing daily.  Many residency programs have begun purchasing mobile tablets for their trainees specifically for the use in the clinical arena, either for the purposes of medical education, or direct patient care activities.  The University of Chicago Department of Medicine residency program even published outcomes on the impact of providing trainees with tablets.

So what should we do about the professionalism issue?  One thing I would suggest is calling out the “elephant in the room”.  Trainees could actually state up front to their faculty instructors that they use their tablets to look up information.  Second, faculty could embrace it, and have, for example, “tablet breaks”, where in the middle of rounds, for 5-10 minutes, everyone could stop, take a break, and look at their tablets for whatever they wanted (be it looking up information, checking email, or whatever they feel is important for themselves personally). [credit for this idea goes to my Executive Associate Dean for Education, Dr. Maryellen Gusic, who suggested it to me].  Third, faculty can lead by example.  Specifically, they could show trainees how to use tablets and collect and disseminate information from the use of mobile tablets at the point of care, without appearing completely engrossed in the tablet itself (provided they know how to do so themselves).  Literally, this would be done as a teaching point just like any other golden nugget of teaching.  We highlighted this example as a workshop at the APDIM Spring conference in April of 2012.

One example from my own personal learning is what I do every week.  When in attendance, I tweet Pediatrics Grand Rounds every Wednesday at 8 am EST, at the hashtag #IUPedsGrRounds.  I wonder what I look like to others in the room as I am typing furiously on the tablet keyboard to keep up with the speaker.  I can honestly say that I am totally listening to the speaker, trying to learn as much as possible, and also trying to get the information out there onto Twitter.  I could probably argue that I am more engaged in learning from the one-hour session than others in the room—but I see how it could appear to others that I am distracted, and doing something less than "scholarly-appearing".

Have you seen instances where trainees appear to have their faces buried in their tablets or smartphones, and how have you handled it?  What can we say to trainees to help them avoid the appearance of being unprofessional, especially when they may be doing the exact opposite: helping the team find information to optimize patient care?

As a way of highlighting the importance of this and other ways to integrate mobile tablets into the medical education arena, we are excited to host the inaugural Mobile Computing in Medical Education conference on Friday May 31, 2013, on the campus of the Indiana University School of Medicine.  Topics like this would be definitely welcome.  The call for proposals is still open—please submit if you are interested in attending, and disseminating your work to others!