Tuesday, August 5, 2014

Rescuing my blog from the oblivion. Musings on the transformation of our millennial trainees into patient-centered professionals.

It is interesting to see the excitement with which lots of people (including yours truly) starts blogging, using Twitter, etc. and how the energy and effort into it appears to slowly getting diluted within the incredibly intense day to day activites, responsibilities, anxiety, etc.

In my case, I started blogging for a variety of reasons - it is my own forum to express ideas and thoughts that happens in my everyday busy clinical life. We as hospitalists (in my case, Med-Peds), get exposed to an incredibly wide array of different clinical situations from childbirth until caring for a century age patient; these situations can vary from very complex disease presentations with highly complex comorbid conditions, to witnessing very difficult social situations that impedes treatment compliance.

On top of the daily clinical experience, there is the exposure to academic activity, where we are role models and teachers for medical students and residents to train them to become specialists. It is our role to teach them to become patient-centered, rather than self-centered. With this, I mean to change the importance trainees give to their own "presentation" or the feedback/evaluation they receive into focusing in the aspect that they are part of a team privileged in taking care of patients. We have the compromise to provide optimal and evidence-based patient centered medical care - emphasizing in excellent communication and patient experience.

Nowadays, I try to ensure that my residents appreciate teaching through rounds - not necessarily classic Socratic teaching - but the teaching that emanates from actively discussing medical decision making; the dissertation of the different outcomes that can occur, etc. We may complement with additional reading material, and perhaps some protected time for board teaching. Yet, the most important thing to me, is to ignite in them the spark that will trigger their behavior as adult learners to pursue self study and close their own knowledge gaps.

We are training a new generation of medical students and residents - the millennials - self-driven, hi-tech adults. We need to adjust to a different perspective of doing things and approach knowledge. It is cool to have an app for everything you want to teach - but most importantly, this generation does not learn dogmatic concepts by default. I love when they challenge the concepts and try to reason about the rationale for specific outcomes or medical decisions.

However, even if they are self learners, we need to strive in helping them find their own knowledge gaps - and use toward our own advantage their self-learning behavior to go and close it on their own. In my case, I ask them to give a small 3-5 minutes presentation to the team on a specific concept that they have just read upon and learned.

We must create academic momentum within a strongly humanistic, empathetic and compassionate care. I want to appreciate the enthusiasm, interest, motivation, energy, desire to learn and excel, and overall, the most incredible passion for patient care. They are learning to become good doctors and to broaden their knowledge - but most importantly, because they want to provide safe medical care to our patients. I cannot divorce compassionate medical care from excellent medical decision making. What distinguishes the good physician from a mere human being technical expert is the blend of outstanding medical knowledge with genuine compassion and empathy.

When the medical student or resident is compassionate, and feels the compelling need and desire to excel, and master the knowledge as much as possible, it is because wants to provide the best care for their patients - they know the patient well; they have read about their medications; explored in depth the details discussed during rounds - and all this effort is targeted toward providing outstanding medical care.  Then the rounds are about presenting to the team the most relevant aspects of the patient medical status, current state of the diagnostic and treatment phase, provide focused teaching to the team, etc. But rounds are not anymore about "my presentation". They are now genuinly engaging in the care delivery as very valuable team members and their work is centered around the patient.

This is the transformation we desire. They can accompany it by all the issues of the New England Journal, most recent Up To Date articles, McGee's physical diagnosis evidence based information, etc. But this knowledge is parallel to their genuine desire to help the patient thrive through his/her experience in the hospital and receive the most compassionate and empathetic care as possible.

For the trainees, the situation becomes a very different one - the patient experience has becomes a paramount composite not only of the medical care, but is even embedded in the CMS payment models. No matter how technically beautiful a brain aneurysm surgery went - if the patient experience in the hospital is bad, then the technical aspects become secondary. And the trainees as a part of a medical team have a shared responsibility in ensuring the best experience for the patients.

Being a doctor is a tremendous privilege - we get the confidence and trust of our patients. We became doctors to provide healing, relief, and alleviate suffering. I hope that most people who became doctors did it for this sake, and not just to pursue a necessary pathway to become a specialist in refractive surgery, or joint replacement surgery, or cosmetic surgery, etc.

When a trainee is under our supervision, we can't really change what motivated them to become a medical student or now as a doctor, to pursue a residency training, but we can certainly demonstrate a role model for humanistic and compassionate medical care, and teach how to conduct their bedside manners in the most respectful and excellent way as possible. And then, blend this behavior with their own acknowledgment of necessity of self boost of their medical education in order to safely take care of patients. If this combination is successful (learners acknowledgment of their own knowledge gaps with subsequent gap closure, blended with a genuine compassionate behavior and understanding that all we do is patient-centered), then we can take pride on our modest yet valuable contribution to medical education.

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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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