Monday, September 27, 2010

An Academic Hospitalist

Well.  A lot of things have happened since my last post. I'm not precisely very happy with my scant productivity in this blog, and as frequent as I have ideas that I want to share, it is the same frequency I have other things to do.

I was busy in May, attending the ACP Leadership Day, advocating for Internal Medicine, attempting to minimize the Medicare cuts based on the obsolete Sustainable Growth Rate (SGR) formula; as well tried hard in advocating to ensure the perpetuation of a constant supply of Primary Care providers to ensure the future medical coverage of americans. It was exciting as well as intense and inspiring.

Then in June, I had a fantastic trip to the Far East, especifically, South Korea, where in addition to climbing the Halla-San in Jeju, we enjoyed the temples and cold water of the Sea of China in Busan, the jovial nature of the University in Gwanju, and the energetic life of Seoul. We appreciated the Korean food and hospitality, attempted to understand the Hangool symbols, and to learn some of their salutations and greetings ..."ani-aseei-yoh!, kansamnida!, etc...."as well as got inspired by their incredible and fast evolution within half a century. Understood a lot of their sentiments toward the japanese, whom essentially attempted to destroy their culture and heritage in a savage and brutal way. I'm impressed on the power of forgiveness and the intelligence of dialogue that both countries have nowadays; an example to follow in the rest of the world.

Then in July, the excitement of the new academic year brought winds of energy and passion; I attended in the Pediatric wards the first week of the month, and was happy with the new interns' performance.
Subsequently, got a sequential series of academic and curricular updates - got an accepted workshop at the 2011 Society of Hospital Medicine meeting, about Perioperative Management of the Pediatric Patient; got promoted to Full Staff; started my activity as a core faculty at the Internal Medicine residency; started a 4 weeks slam in the Internal Medicine teaching service (briefly interrupted by a family emergency that required switching my role from a physician to become a patient's relative).

Looking at the vertiginous last month, I realized how passionate I am about academic medicine, most importantly, Hospital Medicine. My accepted SHM workshop is in Pediatric Hospital Medicine and I'm giving tomorrow the Children's Hospital Grand Rounds on Pediatric Perioperative Medicine which will be a nice catalizer to find out which topics will be the best ones to present at the national meeting.

I was very fortunate, given my interest in academics, that there is an fantastic available course for thriving academic hospitalists, called the Academic Hospitalist Academy. It is sponsored by 2 of my favorite institutions, the Society of Hospital Medicine and the Society of General Internal Medicine. We flew last September 21 to Atlanta, GA. Then took a cab to the hotel in Peachtree, GA, 45 min away from downtown Atlanta, located in a picturesque town where people trasnport themselves in.....golf carts! (they have more than 9000 golf carts in this town).

This course was given over three days, covering the most important aspects that will enhance any academic physician's career. I appreciated the innovative approach to teaching medicine, such as the Clinical Coaching, where rather than filling the students and residents with a bunch of facts, we teach them how to do clinical reasoning and think in a structured way. We had a fantastic approach to the Bayesian method for problem solving, and the use of a Socratic non-threatiening questionning technique for bedside teaching, as well as classroom teaching. In this very tenure, time management is a very important element, and the way to better administrate the time was taught in a masterful way.

We rediscovered the magic of the white board and color markers, with the idea of making didactic points clear and outstanding. We gave all mini-lectures, 6 minutes each in break groups, providing afterwards a feedback based upon the content and outline, as well as delivery of the talk. We used specific feedback with the idea of strongly improving  flaws such as "talking to the board", talking pace, shyness, etc. We discussed as well ways to give feedback to our students and residents, both on the fly and in a formal separate setting, with the notion that feedback is non-judgementa, targeting areas for improvement.

We discovered a new way of setting goals and expectations in a SMART way - Goals should be specific (but also systematic, synergistic and significant); measurable (and also meaningful and motivating); achievable; relevant (but also realistic, reasonable, rewarding, responsible, reliable, and remarkable); timely, tangible and thoughtful.

Fantastic lectures and workshops on career building and paths for Promotion with specific 1- and 5-Year Planning were held, and this apparently threatening activity showed how important it is to efficiently organize the academic activities; some activities can occur simultaneously; some will occur at different stages; but the most important thing is not to lose track of  at what level of progress is each activity standing. The long term goal is the continuous career development and academic advancement. For instance, one of my goals is to be promoted to Associate Professor within the next 3 to 5 years.

The peer networking was fantastic, and I loved to meet so many young people from all the US, especially from the most important academic medical centers, all motivated with a single interest - become better academicians to improve medical education and patient care.

Other important skills were the Applied Principles of Quality Improvement (QI) and Change Management, as well as Patient safety and error analysis - hospitalists have a niche in QI. Most of the subspecialists will be busy enough to even attempt to stare at this. The hospitalists have become stewards of QI and patient safety, mainly through the use of IT, improved communication skills and efficient transitions of care. The systematic and critical analysis of errors, along with the proposal of corrective strategies to overcome these errors, are paramount in the establishement of QI initiatives to promote patient safety. We felt good about the importance hospitalists can achieve for their healthcare system.

Other fun activites included the teaching on how to develop a great Clinical Vignette - we had one on one teaching on pre-written Clinical Vignettes, and in a very rapid way were able to find significant flaws in the initial vignettes and correct them immediately. It was nice to see the before and after.

The creation and mainteinance of a teaching portfolio was one of the most important skills practiced, which will help find success in the academic career advancement. It was very clarifying to see the organization of the CV's according to each academic institution, which although seemed like a very though task, once accomplished, is a great stress reliever, as it is the tool required to apply for academic positions, awards, grants, etc.

Finally, the discussion of what the relationship among a mentor and a mentee should be was clarifying. I have changed my CV to my institution's characteristics and am now in search for an experienced but motivating and empowering mentor.

I found a lot of substance in this course - actually, I found that there is a lot of substance in our academic practice; a lot of raw energy and talent that appears as a brute diamond that needs to be polished. The energy needs to carefully be  focused and shifted toward constructive and highly achieving goals and profiles. I think the elements we obtained from this fantastic resource will be rewarding in the near future.

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You can access the the presentations I have given at the Department of Hospital Medicine as well as the Children's Hospital at the Cleveland Clinic, as well as lectures given to the medical students at the Cleveland Clinic Lerner College of Medicine. http://www.scribd.com/medpedshospitalist

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