Medical Education Transitions

I have been noticeably absent from the online space over the past few months.  However, I think I have a valid reason for this.  I am excited to announce a major professional transition.  I have been given an incredible opportunity, and am excited to begin a new chapter in my career.

Beginning January 4, 2016, I will begin as the Education Editor for the NEJM Group within the Massachusetts Medical Society, which oversees the New England Journal of Medicine and other educational offerings such as Knowledge+.  This position will allow me to learn from and work with an amazing group of folks in medical publishing, and provide exposure to new opportunities for learning in healthcare.  I will work with the adaptive personalized learning product, Knowledge+, and will learn from the other journal deputy editors associated with the Review Articles within the Journal.  NEJM Group already is well established with the Journal itself, Journal Watch, Knowledge+, CareerCenter, and a new product launched in December 2015 called NEJM Catalyst that focuses on healthcare delivery.  Clinically, I will care for patients and continue to teach residents through the Med-Peds Residency at Brigham & Women’s/Children’s Hospital of Boston affiliated with Harvard Medical School, after getting settled.

This means leaving my academic home, the Indiana University School of Medicine, to begin this full-time position with NEJM Group.  I have learned so much from the incredible people there; I will miss my mentors, colleagues and friends who have taught me so much.  I will miss the CME team, who has helped me better understand how physicians and other health care providers learn.  Of course, the residency program with which I have been associated since 2002, and prior to that as a resident trainee, will always be a part of what I do.  As much as I will miss it, I leave knowing that the program is in good hands and thriving, with amazing residents and faculty!

I am excited to begin this new journey; the folks at NEJM Group have been so welcoming to me.  I will pick up my Twitter and blogging presence, and look forward to sharing my experiences with my medical education friends, colleagues, learners and mentors!

#ITeachMedicine

I have mentioned for several years now how social media has been able to impact how I teach, and how others learn in medicine.  It has been an incredible journey to see, as I have met many folks virtually whom I would otherwise never meet.

It is also amazing how quickly information can be spread via social media.  Sometimes, this can be bad, but other times, it can be very good.  A great example of advocacy within medicine began earlier this month, with a tweet from a surgeon-in-training, Dr. Heather Logghe (@LoggheMD).  A blog which began this campaign describes early successes.  This campaign continues to grow, and has amassed an incredible number of tweets and impressions.  It is so refreshing to see stereotypes broken down, and to see the human side behind these incredible physicians.  I've never met Heather, but as a residency program director, I am impressed!

I got to thinking: the #meded hashtag (for medical education) has really taken off over the past few years due to my colleague, Dr. Ryan Madanick from the University of North Carolina, and includes a weekly tweetchat and many other tweets at any time.  #meded has even been described in the peer-reviewed literature (here and here).  How about highlighting some of the amazing medical educators out there who enjoy teaching medicine (at any level)?

So here goes: #ITeachMedicine is starting today with this blog.  Please distribute to all of those dedicated teachers who make medicine and the teaching of and within it a wonderful profession! I am a #meded ‘er, and #ITeachMedicine !!

Medical Education: What Matters

So I've been in Chicago for the past few days at the inaugural Association of American Medical Colleges (AAMC) Medical Education meeting and the Society for Academic CME (SACME) meeting.  What a showcase of incredible learning opportunities!  Here are just a few of my take home thoughts and reflections from the past few days.

1. Healthcare in the U.S. has real problems, and medical education can really contribute to fixing this. We need to start calling ourselves healthcare learning systems. Medical education matters!

2. Getting one's message out to others (whether in the form of an abstract for a future presentation, or in a manuscript for a peer-reviewed publication) means that one has to be mindful of words.  Words matter!

3. Technology can be used to improve communication and healthcare, but we must be careful that technology in and of itself is not a solution.  People matter!

4. Seeing old friends and meeting new people create a wonderful community of learners, and together we can tackle problems better as a group than as individuals. Connections matter!

I still have another day of learning here, and lots more people to meet!  Thank you to the organizers for a wonderful meeting!

[for the record, I wrote and posted this piece while on the "L" headed to the meeting]

Tweeting the (Medical) Meeting

I am currently in the airport on the last leg of a brief trip to present to the Institute of Medicine about using emerging technology in medical education. I am very pleased that the IOM has agreed to use a second screen to showcase a live Twitter feed during the meeting.  I have used this “second screen” option for several presentations over the past few years; it is done as an attempt to demonstrate live the content that is being highlighted: an opportunity for communication and discussion within medical education in a unique format.

I have written about this in the past.  However, this piece from a few days ago cautioned folks who do tweet the meetings.  Dr. Bryan Vartabedian wrote this phenomenal piece on “tweeting the meeting” earlier today.  I concur 100% with his eloquent, succinct statements that really get into “what it is all about” at such meetings.

I hope the demonstration tomorrow goes well.  If interested, please follow the hashtag highlighting this meeting: #IOMgenomics.  My part is “Innovative Models of Education: Using Technology Appropriately in Medical Education” and starts around 9:45 am EST on 8/18/14.  As always, feel free to follow the #meded chat as well.

Scholarship, Emerging Technology and Medical Education

Those who know me know my interest in emerging technology in medicine and medical education continues to flourish.  I am always looking for ways that technology can help drive medical education.  Specifically, social media has the capability of disseminating information to a much greater number of learners than in the past via traditional formats.  One such example is this great video by the AAMC on using wearable technologies in medical education, featuring Dr. Warren Wiechmann.

In discussing this within my academic environment, conversations almost always come back to scholarship, specifically, publishing in peer-reviewed journals.  Articles on the use of social media in medicine are sparse, but are beginning to crop up in mainstream medical journals.  Leaders such as Dr. Terry Kind are really demonstrating the impact via a scholarly approach.

It is with excitement that I read some recent articles (this and this) by some innovators in emergency medicine that can get physicians started using online resources and thinking about peer review with respect to blogs.  Simply put, these articles are phenomenal!  It is exciting to see that journal editors are beginning to see the impact of technology and social media for their readers.  

With this blog, I am excited to announce a new opportunity for me: as social media editor for the Journal of Continuing Education in the Health Professions (@JCEHP).  I thank JCEHP's senior editor, Curt Olson, for his vision to allow me to become involved in growing the journal's reach by utilizing social media, specifically twitter.  In the coming year, we will work on creating and disseminating information via a blog for readers to provide comments on articles of interest, and will push content out to those interested via online social networks.

There are great ways of using social media for the betterment of medicine and medical education.  One such way we have been utilizing at the Indiana University School of Medicine is to tweet our Pediatrics Grand Rounds (follow on Wednesday mornings, 8 am EST, at #iupedsgrrounds), which we've been doing for several years now.  But how do we show (in a peer-reviewed journal) the impact of this activity?  Many specialties have written about tweeting national conferences (including Oncology, Surgery, Nephrology and Urology, to name a few).  

So how can we demonstrate this impact in the JCEHP journal?  By including a presence within social media, we hope to start a conversation on how social media can provide an impact within medical education.  It's a start, but we have to start somewhere.  I'm excited to be a small part of this journey, both at my institution and at JCEHP.

Blogging

This last week, our institution hosted the 2^nd annual Mobile Computing in Medical Education conference.  Our keynote speaker, Dr. Bryan Vartabedian from Baylor, spoke eloquently about the “public physician”, and what literacies the physician of the future may need in order to succeed.  Audience members asked about how emergency medicine providers such as Dr. Zubin Damania (AKA ZDoggMD) seem to be ahead of the curve on social media and blogging.  Bryan himself later blogged about it here. 

In addition, Dr. Aaron Carroll, one of my IUSM pediatric faculty colleagues, blogs often on a variety of health care topics in today’s society.  Here is one of his recent blogs. 

Reading these helped me reflect about my own blogging and how I could do better. So what is the “secret sauce of success” related to blogging in health care?  From the examples above, it seems so simple.

Tip #1: You have to have something to write about.

Tip #1.5: If you can include a reference or a link, it adds some credibility.

Tip #2: You have to keep it short and sweet.

So here’s my attempt to take my own advice.

From #1, today’s blog is about blogging. 

From #1.5, see this reference.

From #2, I need to end this blog very soon.

If you have something to say, say it; the fewer words, the better.  Thanks for reading.

Technology in Medical Education

I was given the privilege of presenting the keynote talk at a faculty development session for the Indiana University School of Medicine Department of Emergency Medicine earlier this week.  The theme of the entire day was using technology in education.  The opening speaker, Dr. Bart Besinger, gave a phenomenal talk on “How to give a lecture with or without technology”.  It was one of the most engaging talks I have ever heard, and included practical information and tips for making one’s didactics top notch!  Later in the day, the topic I spoke about was the use of social media to communicate and teach in medicine.  It was a wonderful opportunity to network with colleagues from outside of my own departments, and I found the faculty completely engaged and willing to try something new.

We discussed some of the literature on the use of social media in medicine and medical education, and how educators can leverage social media as a tool to disseminate medical information.  The highlight came at the end, when we taught the faculty how to use Twitter.  The goal was to have 5 new faculty join Twitter.  Many more joined, and the discussion was nothing short of fabulous.  It was clear that the faculty were wholly accepting of taking the plunge to use Twitter in medical education (the hashtag used was #IUEMFacDev).

Today, the learning that took place just two days ago was put into action.  The faculty used a hashtag (#IUEMTalks) for their own lecture series.  Kudos to Dr. Dan Rusyniak, for putting on this great workshop.  I appreciate so much the invitation to share and learn from emergency medicine faculty colleagues, as well as the  willingness of so many to put into practice this new learning tool. 

Here is a link to the workshop handouts.

In an upcoming venue, our institution is privileged to host the 1^st inaugural Mobile Computing in Medical Education conference on May 31, 2013, in Indianapolis.  In this conference, we will showcase several different ways in which medical students, residents, fellows and faculty utilize mobile tablets in medical education.  We look forward to sharing the learning opportunities in this one-of-a-kind conference.

So how are you using emerging technology to further medical education?

Reflections on ACEHP13 - Halfway Through

The Alliance for Continuing Education in the Health Professions annual conference is going on right now in San Francisco.  It is about halfway done now, and this post is a series of my thoughts so far based on discussions I have had, or comments people have made in workshops or plenary presentations, that have impacted me as a part of my personal learning network.

1.       The far-reaching, ultimate goal of continuing education is really about improving and optimizing patient care, specifically at a population/community health level.

2.       Quality improvement and patient safety are not fads; they are an integral part of the practice of health education, and linking education to these areas is crucial to achieving #1 above.

3.       Research about education practices is critical to advance the field.

4.       There is a broad scope of activities beyond “live activities” for education of health professionals [I especially like Performance Improvement CME and Point of Care Learning CME as examples, and we need to be doing more of these].

5.       Emerging technology is becoming more relevant every day in continuing education, and we need to embrace it rather than shy away from it.

6.       We need a new paradigm for health care education that needs to be learner-centric, ultimately to achieve #1 above, and communication skills will be a critical component of that education.

7.       Engaging all members of the health care team (from physicians to pharmacists, from nurses to social workers, just to name a few) is critical to the success of optimal patient care and #1 above.  This includes interprofessional education, and also interprofessional practice.

So what do you think?  What are some other take-home points from the conference so far?  Please let me know by coming to the breakout session I am privileged to host with Dr. Jennifer Gunter on February 1, 2013, at 3:15 pm, on “Perspectives in Learning Through Social Media”.

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!

Thoughts on Incoming Intern Orientation

This particular week is the week that the new intern physicians arrived, and become oriented to clinical care. Ours start on June 24 with managing real patients. They are brimming with excitement, but also have a lot to do during the week.

It is interesting to hear from the "old guard" about how it used to be. "My

orientation was 'here is the ER, and here are the bathrooms: now go and see some patients.'" While I certainly would not think that such an orientation is acceptable nowadays, I have to reflect on what exactly we now make the new interns go through.  HIPAA training, ACLS, PALS, NRP, FIT testing, composites, meal cards, explanation of the numerous (not an exaggeration here) computer systems and log-in codes that are necessary are literally just a small part of orientation--and that doesn't even include Handoff training (my personal area of interest).  I mean no disrespect to our hospital administrative personnel by these comments, but am constantly reflecting on what we could do better for our incoming learners.

So what do they actually remember? While as educators we certainly do feel that it is important to have them learn why HIPAA training is critical, or that they have to foster professionalism within the context of social media, I do think that what currently exists truly is an overwhelming mass of "do this, don't do that, you must sign this, you must complete that." So how much do they really retain, when we KNOW that many learners lose interest after a very short time (adult learning theory tells us this)?

Does making interns sign a "I heard this info"-form really help? Does "don't forget to do this" really mean translation of knowledge? Will taking multiple modules online actually help when they won't be back to that particular hospital for 5 months? I'm not so sure.

If anyone has better ways of completing this training in an environment that

promotes retention of information, believe me, I am all ears. I suppose that a similar situation exists in starting other new jobs, and new hires are frustrated. What is so telling is that so many come back later saying "if only I had known that information during orientation, then I wouldn't have done X".

So how long are your orientations, and what do you do to make it educational and fun? Do you feel that the interns complete orientation ready for direct patient care within your system?  Personally, I am looking forward to the "10 things you ought to know about internship"-talk that one of the CURRENT residents is giving later in the week. I would be willing to bet that that is the most useful "orientation" information that the incoming interns will actually get for the entire week, despite months of planning and trying to fit so many “required” things into the week.

I am curious as to any ideas that others have. Believe me, everyone is learning here, and this is after knowing for 10 years exactly what previous trainees have told us about orientation.  I’m sure other educators out there have similar thoughts.  Please let me know your ideas.

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.]

Medical Administrators – Should They Still Care For Patients?

I have been relatively absent from social media for the past week or so.  I have been doing inpatient duties on a general medicine service, and really enjoy working with medical students, interns, residents, pharmacists, and inpatient floor nurses.  It has been a wonderful opportunity to experience the day-to-day activities involved in hospital medicine, and of course, to see and care for patients.

The time on the inpatient service is demanding, both physically and emotionally.  Managing ill patients, long hours caring for complex patients and updating their families leave little time for my other duties in overseeing a CME office and a residency program.  I am trying my best to juggle all of these duties, but for now, the patient care priorities do come first.

As I was arriving one day this week, I saw the chair of another department coming in, and mentioned that I was on service doing inpatient work.  He remarked: “So good to hear that you are continuing this great work, and that you are still actively involved in patient care.  Keep it up!”  That made my day.

So I have been pondering this: should physicians who have major administrative duties and oversee programs, and thus have major time devoted to such activities, still care for patients?  Should they still remain clinically active in order to have “street credibility” with their mostly clinical colleagues? 

I think the answer to this is “yes”.  As busy as it is, I still believe that it keeps me fresh.  It allows me the opportunity to reflect on why I went into medicine in the first place.  It allows me to still remember what it is like to talk with a worried family member about a loved one, to see the gradual changes when a patient improves from hospital admission to discharge.  It allows me to also see the trainees doing what we want them to do: learn to care for patients.

The more I become involved in overseeing administrative programs, the less time I can devote to direct patient care.  But I still really enjoy doing the day-to-day patient care, and working with trainees as they learn the art and science of medicine.  I still haven’t forgotten the old adage by Francis Peabody: “The secret in the care of the patient is in caring for the patient.”

A Medical Educator Joins Social Media: One Year Later

I just realized that yesterday was my one-year “anniversary” for joining Twitter.  Wow, what a ride it has been.  I have learned so much in this short year.  Here are a few take-home points:

1.      If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are.

2.      Despite #1, there are late adopters who feel that social media is a “waste of time” for physicians.  That is ok.  Forcing them to “do social networking” will not be fruitful.

3.      Social media is a fantastic way to meet other like-minded individuals who have similar interests.  I never would have met a great group of people (some in real life) had I not joined social media.

4.      Patients crave information about their health.  If they want it via social networking routes, we should offer it to them.

5.      There is a lot of mis-information floating around on the internet.  It is a duty of physicians to combat this and provide correct information.  I fail to understand why physicians don’t embrace this more: it is advocacy in the truest sense!

6.      If you decide to join social media, start slow, but start.  It will take a while, like riding a bike is not learned in 15 minutes.

7.      Do not let social media take over your life.  The important things (family, friends, etc.) are still the important things, so don’t lose the priorities.

8.      Push the envelope.  It is time for curricula in social media within medical education to be formally written, and also to be disseminated.  Policies or guidelines are one thing, but curricula are another.

9.      There are many “tools” to make it easier to integrate social media into “what you do”.  Pick one or two, and use them.  It will make the process less overwhelming.

10.   Have fun!  There is some great learning, and in addition there are some fun people out there, and I am a better person for having met them virtually.