Posts in Residency
Where Did All the LPs Go?

Physicians must be competent to perform the skills of their respective specialties before completing residency training. Educators struggle to understand just how many procedures are required of a trainee to become competent. Is there a minimum number? Does it differ by procedure for each trainee? How many is ‘enough’? And what should educators do if there are too few procedures to go around???

Our accreditation systems are designed to ensure patient safety, as a societal responsibility. Residency program directors attest to their trainees’ competence before graduation — as a safeguard. I was a program director and I lost sleep worrying about this expectation of my role. Were my residents ready? What if my mistakes assessing them led to their mistakes with vulnerable patients?

The worry – how many procedures is enough? – was a tough one for me. Every trainee is different and they each require a unique set of training experiences to become competent. The BIG however: there are a limited number of cases for trainees to learn from in teaching hospitals.

There, I said it. There are only so many chest tubes, crics, and LPs to go around.

As medicine advances, there is a slow decrease in the number of necessary bedside and surgical procedures required to diagnosis and treat a variety of acute illnesses.

Thanks vaccines and CTAs, but where did all the LPs go?

The math is as follows: if X is the number of procedures required to train a class of residents per year, and Y is the total number of procedures available, your program is fine if Y > X.

But if X > Y… you need to think outside the box.

Medical education has fundamentally changed in the last several decades. There are more trainees. There *may* be more patients. And there are certainly more training programs and teaching hospitals, sponsored by health systems that were previously and decidedly non-teaching. This represents both a challenge and an opportunity for educators who need to be creative in their search for ‘enough’ procedures for their trainees.

My research collaborators and I have some potential solutions for teaching hospitals and program directors to consider, in our article, “More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside” in Academic Medicine.

Co-Authors: Linda Regan, MD – Johns Hopkins University, Jeremy Branzetti, MD – New York University, Laura Hopson, MD – University of Michigan

May 26, 2019

Ethical Dilemmas, Simulated

My most-cited publication to date describes a research project that I conducted during my Faculty Development Fellowship at Stanford University in 2003, “Assessment of Resident Professionalism Using High-fidelity Simulation of Ethical Dilemmas”. Medical simulation centers are wonderful venues for teaching high-risk tasks in low-stakes environments: the perfect settings for teaching medical ethics.

In 2003, medical simulation was still a relatively new teaching tool and the options for training seemed endless. I was particularly interested in medical ethics at the time and thought to marry that interest with my medical education training.

The design of the study was simple enough: emergency medicine residents who were managing a simulated clinical case would encounter an unexpected ethical dilemma – not all that dissimilar from day-to-day clinical practice. We designed a “Professionalism Performance Assessment Tool” as a checklist of dichotomous options for management of the case. Trainees either followed ethical and professional standards during their management of the simulated case or they did not, yes or no. A critical action was included in each case.

The ethical dilemmas selected in this 2003 research study are still important topics for trainees to learn about today. Five cases were used to test concepts in key domains: Patient Confidentiality, Informed Consent, Withdrawal of Life-sustaining Treatment, Practicing Procedures on the Recently Dead (Hint: Don’t do this!), and Do-Not-Resuscitate Orders.

I’ll always reflect fondly on this project because it was the first medical education research study that I designed and executed as the principal investigator. Thanks once more to my project mentors at the time, Drs. Rebecca Smith-Coggins and Phillip Harter. (Dr. Harter still co-directs Stanford’s Medical Education Scholarship Fellowship today!)

Read more about the study design, case development, and study outcomes in our article in Academic Emergency Medicine.

Co-Authors: Rebecca Smith-Coggins, MD – Stanford University, Phillip Harter, MD – Stanford University, Robert C. Soltysik, MS – Veterans Affairs - Chicago Health Care System, Paul R. Yarnold, PhD - Northwestern University

May 15, 2019

Brand Your Residency

Residency programs are products. These products can be experienced in a variety of ways by consumers that include current residents, program alumni, prospective students, faculty members, patients, and many others. How can program directors use branding principles to improve communication with such different cohorts of consumers?

I just returned from the 2019 Academic Assembly of the Council of Residency Directors in Emergency Medicine, where I gave presentations on a range of topics… Mastermind GroupsInterdependence… Presentation Skills… Digital Scholarship… but my favorite lecture topic by far was: Branding.

Jeremy Branzetti and I have been lecturing on the topic of branding for residency programs and hospitals for many years. We argue that an understanding of basic branding principles can prove highly valuable to program directors or administrators who struggle to reach their target consumers of students, alumni, faculty members, and others.

In his 2008 book, Jean-Noël Kapferer describes a brand as a “set of signs certifying the origin of a product or service and differentiating it from the competition”. Program directors know the origin stories of their programs and they can best describe the curricular features that set their programs apart from others in the educational marketplace. But how can program directors be sure that the right students are hearing these messages?  

The first step is to understand some key branding concepts:

·         Brand Identity: What are the mission, vision, and values that guide your program?

·         Brand Image: What do your consumers think about your program?

·         Brand Experience: How do your consumers experience your program?

·         Brand Alignment: Alignment reflects your efforts to equate brand identity and brand image.

·         Brand Audit: The process of examining and refining each of the elements of your brand.

Read more about branding principles and how they relate to residency recruitment in our article, “Branding and Recruitment: A Primer for Residency Program Leadership” in the Journal of Graduate Medical Education.

Co-Authors: Eric Shappell, MD, MHPE – Harvard University, Nahzinine Shakeri, MD – Northwestern University, Abra Fant, MD, MS – Northwestern University, Jeremy Branzetti, MD - New York University, Christine Babcock, MD, MSc – University of Chicago, James Ahn, MD, MHPE – University of Chicago

April 7, 2019