Monday, March 18, 2013

Goodfellows.

Last Thursday
Rock steady, baby
That's what I feel now
 Let's call the song exactly what it is
Step'n'move your hips with a feeling from side to side
Sit yourself down in your car and take a ride
While you're moving, rock steady
Rock steady, baby

~ Aretha Franklin
_______________________________________________

Sigh. 

So much excitement this past week. As if match day weren't enough, last week also included one of my favorite events of the year -- The Fellows Teaching Competition!



What's that, you ask? Okay. Let me explain from the beginning. . . .

First, since a lot of non-medical people read this blog, let's just digress with a recap of who all of our usual suspects are in teaching hospitals, shall we? Yes, we shall. Okay. So you already know that I have finished my training and I supervise medical students and residents as an ATTENDING physician, right? I also know that most of you recognize that those who are still working toward earning medical degrees are our MEDICAL STUDENTS. We number them by year--M1 through M4--first year through fourth year, respectively. You with me? I figured you were and that you're yawning right about now. But stay with me because this is the part where I think people who aren't in medicine get confused.

And a few people in medicine, too. Uhh. . .yeah.

Okay, so check it. Our academic calendar runs from July through June. Most medical students graduate in May and then start their post-graduate training in late June. Sometime during your third and fourth year of medical school, you declare your chosen career path and that's what you then interview for as a senior student. Match day is the day where you find out, through some crazy computerized game of card shuffling, where you will be spending the next several years shaping yourself into a sho' nuff and bona fide member of whatever specialty you want to do.



Whew.

So that FIRST year when you first start in late June fresh out of med school commencement, you are an INTERN. That lasts for the academic year until the following July when the next crop of bright-eyed bushy-tailed neophytes arrives. After that, you become a RESIDENT. This pretty much lasts until you finish your training. And just in case you weren't confused, let me quickly rectify that by telling you that we collectively refer to all of those people, interns and residents, as "residents." I think it's because the official verbiage from the graduate medical education governing body uses the word "resident" to describe specialty trainees. And guess what? We also refer to them all as "house staff," too. That dates back to the times when residents lived in the hospital which, hallelujah, I never personally experienced. (At least not in an official capacity.)

Yeah, but there's more so stay with me. In most specialties, a program selects a few standout residents to serve an additional year as a CHIEF RESIDENT. This is usually an honor given to a select few who stay on beyond the final year of training to serve in a year of administration and teaching. The caveat is that in some surgical fields and training programs, the Chief Resident is any person in their final year. (But hell, getting to your final year of a surgical residency is often an honor given to a select few all the same.)

Alright. We still cool? Good. Okay. So let's just say you have chosen to train in the best specialty ever--Internal Medicine. You've done your first year (internship) and also your last two years as an upper level resident. At that point, you are eligible to take your specialty boards, hang your shingle and start to practice. But you also have another option, which many people take. You can go and get some ADDITIONAL training in a subspecialty so that you can narrow your expertise to one area.

Such as:

  • Cardiology
  • Infectious Diseases
  • Hematology and Oncology
  • Endocrinology
  • Pulmonary and Critical Care
  • Rheumatology
  • Geriatrics
  • Hospital Medicine
  • Nephrology
  • Gastroenterology

Or something else if you happened to train in a specialty that isn't the best specialty in the world.

Mmm hmmm.

So IN ADDITION to our teaching hospitals being filled to the brim with house staff and medical students, we also have a whole cohort of wonderful trainees who have finished their residencies but are now getting an additional three + years training as specialists. We call these folks FELLOWS.

Whew. I know that was an awful lot to put you through just to set up what I'm about to tell you. But you know? I think all of your medical folks need to bookmark this post for your loved ones so that you won't have to keep fielding these kinds of questions:

"So, are you still in medical school?"

"No, ma'am. I'm doing a fellowship in Rheumatology."

"In who?"

"Rheumatology. We see people with things like lupus and bad arthritis."

"So are you a full-fledged doctor that can write a prescription?"

"Yes, ma'am."

"So when do you graduate?"

"Next year."

"Damn, ain't you over thirty?"

"Beg Pardon?"

"Medical school sure do seem like it last a long time these days."


 And I know that somebody somewhere is nodding their head HARD to this because they just had this very discussion with someone last week.

Mmm hmmm.



So what was my point of all this? Oh. The fellows. Yes! The fellows. Okay. So our fellows are such a huge part of patient care in the hospital. But not only that--they do a TON of the clinical teaching. That said, fellows don't often get much . . . how can I say it. . . shine. . . for all they do. Those guys work very, very hard and provide so much to us yet there aren't many opportunities to shine a light on them. Last year, with the help of a great committee, we set out to change that.

Enter the "Demonstration of Teaching Excellence" aka "The Fellows Teaching Competition."

So, a few years ago, I was asked to serve as a judge for a similar event held by the Department of Pediatrics at Emory. They'd been holding their fellows teaching competition for quite a few years and when I participated as a judge that year, I fell in love with the idea. Later that academic year, I pitched a similar event to our Department of Medicine leadership and they gave the green light. Because the Internal Medicine Department has a lot more people and trainees, we set out to build on their wonderful ideas to make it a HUGE signature event.

And the best part? Our unsung heroes--our FELLOWS--would be at the center of the attention. Yes!

Last year was our first year doing it and man! It was a smashing success. People had no idea what it would be but our fellows made it into something special. So special that it became a "don't miss" event just one year later. So yeah, this was our second year and all I can say is . . .wow. It was unbelievably awesome. Recognize that I'm a medicine nerd, so these kinds of things excite me in ways that aren't really normal.

Yeah. So the official name of ours is "The J.Willis Hurst Demonstration of Teaching Excellence: A Teaching Competition Between Fellows." Nine of our subspecialty divisions get to nominate one of their fellows to represent them in the competition. We make it very clear that it is a distinct honor to even be asked to participate and, truthfully, everyone sees it this way. Kind of like being asked to be chief resident. Kind of.

Anywho. The fellows are allowed only eight minutes to present a topic of their choice. The focus is on delivery, intonation, enthusiasm, use of learning materials and all of the things that set good teachers apart from exceptional ones. Because the focus is teaching methods, there is no question and answer period--just applause. Now how sweet is that?





We select a panel of esteemed judges from across our Department of Medicine and also one from another Department. (This year it was my buddy Jaffar K. from Neurology.) That group also includes one medical student and one of our Chief Residents--because these learners are important judges, too.




After a MAJOR PR blast to the whole of Emory (sorry, y'all--I just get excited), last Thursday our nine fellows showed up and BROUGHT it to a full house. Really. A full house! Here's my favorite of our email blasts featuring Cardiology fellow and former Chief Resident, Akram I., who was a super good sport.


I was so excited, y'all. When we pitched this to our leadership, the exact vision was an event that would celebrate teaching in a packed room buzzing with excitement. That's precisely what it was. There were division chiefs, program directors, fellows, house staff and students of all levels. And all of them were buzzing with enthusiasm about excellent teaching--and all focused on our fellows.







Yay!

It's so cool to see something come together. Our fellows were amazing--both last year and this year. Oh, and I almost forgot--the part that I'm most proud of is that the judges name one winner who gets a substantial cash prize. I love that our Department of Medicine put our money where our mouth was. Last year our winner was Eddie S. from Infectious Diseases and this year it was Randy H. from Pulmonary and Critical Care. But the real winners were all of us who came to the event because we learned SO much.

And to all you medicine nerds out there reading this, let me just go ahead and read your minds: YES, it was EXACTLY as awesome as it sounds and YES, you would have TOTALLY enjoyed it had you been there. And YES, you should TOTALLY try to do something like this at your institution and YES, we are TOTALLY going to write it up for publication so that more institutions will.

Eddie S., 2012 winner
Randy H., 2013 winner
What can I say? The flyer worked so nice, we used it twice. Ahem. (Don't judge, people. I was on wards.)

Anyways. Another neat thing was to see the innovative tools the fellows used for their presentations. Last year's winner, Eddie S., was the lone person to use a presenting tool called Prezi, and it was fun to see how many more people used that interface this year. Also lot of them used videos and sound and all sorts of cool things. And they did all of that in just EIGHT MINUTES.

EIGHT. MINUTES.

And would you believe that NOT ONE of them went over time? Not a one. Man. Imagine if all lectures could be limited to eight minutes? Hmmmm.



So at the end, our committee members snuck off to a secret location, tallied up the scores and named the winner on the spot. People were cheering and the energy was awesome. And all of the fellows who were in it and even there felt that spotlight and some love, too. Yup.


So shout out to our fellows. And also a HUGE shout out to our awesome planning committee that included what is quite possibly the most easygoing bunch of busy clinician-educators in our entire institution. Yay for drama-free and non-"extra" people to work with! And double-yay for people coming through and doing what they say they will which is what a great planning committee is all about.

You know? The whole thing was social, too, which was also a bonus. It was fun to see students talking to full professors and residents hob-nobbing with division chiefs. So much to talk about and discuss (especially since we wouldn't allow any questions. . .ha!) But seriously. . .all of it was full of the very best spirit and the climate for learning was like the clearest, most perfect spring day you could ever imagine.

Yeah.

The thing is this: "Not enough time" is never an excuse to ignore learners and not teach. Whether you're in a teaching hospital like me or just talking to a patient in the clinic. Once you make up your mind to do it, it can happen a lot faster than we realize. I've even started giving my ward teams fifteen minute chalk talks instead of 45 minute or 1 hour sessions. I learned from organizing that event that lots of rich teaching can happen in a more condensed period with some preparation.





Yup.

So that's the other super cool thing that happened last week. And yes, all of this went down while I had a ward team, kid responsibilities and butterflies in my stomach about the match. But more than that, it was also another one of those things that makes me love my job so much. I'm surrounded by lots of really cool, smart people who love sharing ideas and realizing visions. And that's a really cool place to be in.

A rock steady one, even.

Man. I know I've said it a million times before . . . but me? I'm just glad to be here.

***
Happy Monday.

Now playing on my mental iPod. . . ."Rock Steady" by Aretha Franklin -- the theme song for our intro video for the 2nd Annual Fellows Teaching Competition. These are our awesome fellows who demonstrated their teaching excellence. Enjoy!

Fellows Teaching 2013 - Rock Steady from Emory Medicine on Vimeo.

8 comments:

  1. wow..what a week you have had! Have you read Brain on fire by Susannah Cahalan?...I finished it last night and thought of you...thinking Dr. M. would have figured this out ..ha!..It was very interesting and a fast read...you might like it.

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    1. I will totally check that out. Thanks!

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  2. What a great competition. Wish I could have been there. The explanation was excellent as well. Explain this...the medical and surgical oncology doctors at my cancer center are fellows, but the Radiation Oncology docs are residents. They do a fellowship in disease specific areas later. Confusing. Our fellows are the best, and it is fun to see them grow over the 3 years they are with us. Love the video too.

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    1. Awww, thanks Mary Alice. It was amazing. And yes, it does get very, very confusing keeping track of who's who and at what level, right? Our fellows are the best, too. :)

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  3. You can tell that you make people happy and comfortable. I love to see the pictures you take for the blog, people always look happy and glad to be in your presence, that's a gift and I'm sure your patients admire that too!

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    Replies
    1. That's a real compliment. I appreciate your kind words and will look at pictures a little differently because of it. Thank you.

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  4. Many of the entries in your blog show what an amazing doctor you are. This is yet another example of that. I was thinking of you the other day when I visited my good friend in the hospital. She had a relapse in her ovarian cancer and after the surgery for that she got two blood clots including a pulmonary embolism. Just as she was preparing to leave rehab, she got a high fever and a terrible infection that involved liquid in her abdomen and a bile leak from a possible nick to a bile duct during her surgery. What made me think of you was a resident gastroenterologist that came to tell her she needed another procedure done was very cold and clinical with my friend. My friend kept saying she'd been through so much and she didn't feel she could go through another thing. This resident, though nice, was not empathetic and did not take the time with my friend to try and understand all she'd been through and that a hospitalization that was to be 4 days max is continuing into its 4rd week. I was thinking that if you were her doctor how you likely would have handled this differently and showed your compassion and caring as was needed in this instance. I wish they could clone you but that you are teaching your students your way is what you do to make more doctors tend to their patients as real human beings. I respect what you do. Sweet Jo

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    1. Hey, Sweet Jo. I'm so sorry about what your friend has gone through. And honestly, I know a number of wonderful physicians who would have dutifully stood by her and held her hand. It sucks that one of them wasn't there that day.

      Illness is hard. People go through a lot and they need more than just sterile conditions. Far more. Your friend did have you, though. Thank goodness she did, too. I will think of her today. I will and please tell her so.

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