See One, Do One…#TPSER8

There’s an old adage in medical education “see one, do one, teach one.” I don’t particularly subscribe to it in a literal sense because I think training requires a more intensive learning process than that.  But sometimes it does apply quite nicely.  A perfect example of this was on Wednesday when I helped run a session about shared decision making and informed consent at our new house staff orientation.  The session consisted of a viewing of the video of Michael Skolnik’s story followed by a moderated discussion with the house staff.  The idea came out of a casual conversation with my hospital’s Associate Vice President for Academic Affairs.  I thought it would be a helpful to new residents to think about these important issues before they really start on the wards and she let me run with it.   Just two weeks out of TPSER8, I just felt the itch to continue sharing what I’ve learned.  I had never led anything like this, but after seeing how David Mayer and Tim McDonald guided our discussion in Telluride I was inspired to try it myself.  I had some great help from a fellow Telluride alum, Hilary Kunizaki as well as several other CIR staff who came for the session.  Here are a few comments from the new house staff:

  • I asked, “What do you do when patients don’t understand a treatment or procedure?” and had some great responses: “draw a picture”, “have someone else ask” and “figure out if there is a language barrier”
  • In regards to the stereotype that general practitioners know less than specialists, the interns suggested that specialists should work with PMDs in a team-like manner, concentrate on common goals and the interests of patients, and verify information by referring back to the literature.
  • There was some hesitance among  house staff who might be doing a procedure for the first time about admitting their inexperience to patients so I pushed them to consider an appropriate response.  Interns said they would tell patients that “they were under supervision and working with attending X who has x number of years of experience.”
  • Important strategies to verify consent included the “teach-back” method, assessing capacity to make a decision, and involvement of family members.
  • One intern said that “no one patient is an island” and echoed the consensus that involving family members is important even if the patient is over the age of being legally able to sign an informed consent document.
  • Some difficulties that residents mentioned when performing informed consent include language barriers, time, and dealing with patients who are uncooperative.

Overall, the new house staff seemed to really enjoy having the opportunity to be engaged in a discussion rather than just hear a lecture about the importance of informed consent.  I think this further proved the importance of narratives in medicine.  I’m looking forward to holding more conversations like this in the future.


Bringing It All Back Home

Admittedly, I was not so good about posting to the blog during my week in Telluride.  I did do quite a bit of tweeting, which I found to be a lot more fun than I expected.  But I have spent a lot of time over the past week pondering much of what I learned.  June has been a month of intense transition for me as I am completing my Internal Medicine training while beginning my Chief Residency.  In my program, the new Chief Residents begin at the very end of May so that we can get our feed wet before the new interns start.  I have said to many people, both in Telluride and now back at home, that after spending the past couple of months making schedules for next year and performing various other administrative tasks it was so refreshing to think about patients and how to deliver them high quality safe health care.  These two are not mutually exclusive.  It is near impossible to deliver the best patient care if your origination lacks proper administration.  Conversely, I think that even if you run a tight ship with maximal efficiency, if your organization lacks passion and clear purpose you still may miss your patient care goals.  Over the next few weeks and months, I think my biggest challenge will be learning to strike this balance.   I will continue to post as I learn how to achieve this balance so stay tuned.

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