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!

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!

Learning from Technology in Education

Yesterday, I had the privilege of attending a conference hosted by my children’s school corporation on the use of tablet computers/iPads in education.  As a medical educator, this absolutely piqued my interest.  In addition, as a parent, I have a big voice in how my children are educated, and want to know how I can help.  As it is now, my children are pretty tablet computer-savvy, and are always asking “Can I borrow your red iPad?” 

This conference was nothing short of incredible!  I learned so much, from how to get organized, to how to use video conferencing, to what apps are helpful for children in 3^rd grade.  The keynote speaker was truly inspirational, with a wonderful message that “technology is always changing, but teachers will never be replaced.”  This was so great to hear, as an educator myself.  I also loved seeing teachers from all over Indiana come together to learn for themselves and ultimately for their students.

It is my opinion that the medical education world can learn from what the Center Grove Community School Corporation put on yesterday.  The focus was how to embrace technology in order to connect, create and collaborate.  I saw my kids’ teachers there as well, which was invigorating to see that other educators take an interest in their own personal professional development.

As a take home, I am now jazzed up to learn more about how to use tablet in education, for my own personal learning network (I love the phrase “personal learning network”, which is similar to medicine’s “individualized learning plan”).

To the organizers of the iPossibilities Conference at Center Grove, thank you so much, from one education arena to another.  I have taken away so many great ideas from your conference, both for helping my own children learn, and also for my day-to-day work as a medical educator.  I hope to be able to put on a similar conference within medical education, to demonstrate what is possible.  Our learners deserve nothing less!

[To learn more about the iPossibilities conference hosted by the Center Grove Community School Corporation, which was funded through a grant from the Department of Education, and to see handouts, please click here.]