#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!

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!

Mentoring

Today was a very good day for education at the Indiana University School of Medicine, Department of Pediatrics.  Our institution hosts an annual Pediatric Chief Resident Conference.  I was privileged to be a part of this, giving a discussion on quality improvement.  The chief residents were engaging, had fascinating ideas, and demonstrated wonderful participation, in addition to harboring motivation to make change.  

We were proud to host Dr. Nancy Spector, known in the education world for her impressive work on mentoring within medical education.  She gave a phenomenal Grand Rounds presentation on the topic of “Mentee-Centered Mentoring”, and provided some wonderful pearls on the topic that participants could immediately take back to their home institutions.  She discussed different models for mentoring, including a riveting discussion of “Speed Mentoring” (akin to “speed dating”).  She provided us with 5 steps to successful facilitated mentoring, which I will summarize here:

Step 1: Determine an important project.

Step 2: Find the right leader to facilitate.

Step 3: Communicate effectively (planning regular communication), which may include getting work done during meetings.

Step 4: Manage projects skillfully.

Step 5: Assure benefits to participants.

Some of her final pearls for successful mentoring programs included the importance of cultivating mentoring relationships, consider having a portfolio of mentors, and also that mentees should drive the process.  Her talk provided the audience with a framework for how to create a successful mentoring program.  It provided us with outstanding reflection on how we can improve ourselves and each other!  I highly encourage you to follow our tweets from the Grand Rounds presentation, which can be found at #IUPedsGrRounds.

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!

Medical School Graduation: The "Calling"

Today was graduation for the Indiana University School of Medicine (IUSM).  It was a privilege being a part of this special day for the graduates; I was honored to be a recipient of a Trustee Teaching Award, and so I was able to sit on the stage for the ceremony and watch all of the graduates receive the hood, as well as congratulations from the Deans.  What an awesome spectacle!  Over 300 IUSM medical students became physicians, and their names now all end with “MD”.  Very cool!

I wonder what others think about graduation ceremonies.  It is a long day for all; the room is packed with people (there were over 3000 at the Sagamore Ballroom at the Convention Center in downtown Indianapolis). Parents, grandparents, spouses, significant others, friends, children and others were able to witness this special day for the graduates.  I saw the pride in so many faces.  Eight of them will be joining me as part of the IUSM Med-Peds Residency Program (sorry, my pics didn’t turn out so great; you all walk too fast!).

One student who would have graduated today passed away earlier this year.  His wife spoke to those in attendance after an honorary posthumous degree was granted.  There was not a dry eye in the room, including my own.

This year our amazing Dean, Dr. D. Craig Brater, is retiring after over 25 years of service to the IUSM. He will certainly be missed, and has been the face of IUSM, leading us with honesty, integrity, and humility for 13 years.

In addition, graduation today included a keynote speaker, Dr. Tom Nasca, the CEO of the Accreditation Council for Graduate Medical Education, which is responsible for graduate medical education in the United States.  It was an honor to meet him before the ceremony.  Dr. Nasca is probably one of the busiest physicians in the United States now, overseeing the accreditation of all of the training programs of residents and fellows.  He is an internationally known medical educator.  We were blessed to have him be part of the ceremony.

In his address today, he showed no slides about duty hours.  He did not mention Milestones or competencies.  Rather, he focused on the “why” of going into medicine, as a “calling”.  He told a story about a dialysis patient who had an incredible impact on him when he was in nephrology training.  He reiterated why many of us choose medicine as a profession: to care for others, and delved into the impact that a patient can have that teaches us as physicians or physicians-in-training.  This was inspiring, and helped me to reflect and understand why I do what I do: to help patients, to train the doctors of the future, and to help educate students, residents and faculty in some small way. 

To all the medical students graduating and becoming physicians over the next few weeks: kudos to you for all of your hard work.  The journey is not yet over, and the learning is really just beginning!  Be proud of your amazing accomplishments, but more importantly, embrace what lies ahead.  The opportunities to do good in the world, and care for others, are now coming to fruition.  Congratulations to the class of 2013!

P.S. If you were wondering, yes I did tweet parts of the graduation.  Check out the hashtag #IUSMGraduation for tweets and pics.

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?