Rounds are the central component to medical education from the the third year of medical school through residency. Dr Centor gives his perspective on the best way to conduct rounds, but no one solution fits all specialities and training levels.
Personally, I think we need to ask a more fundamental question—are teaching rounds truly the best way to provide clinical education? What other formats might be more efficient?
I too noticed the plethora of premeds freaking out on Tumblr and considered doing a post myself but thanks to these guys all I need to do is refer. Great post! Just read it.
So I’ve noticed on my blog and most of the other medblrs I follow that there have been a metric crapton (units= kg/crapⁿ, n=number of craps) of asks from concerned pre-meds about their grades. It’s the end of the year. You’re getting your grades. Activate freakout mode.
David Foster Wallace | This Is Water - video by The Glossary
This is an excerpt from the commencement address to the 2005 graduating class of Kenyon College given by author David Foster Wallace. It should absolutely be watched by every medical student, resident, and doctor. The practice of medicine can become repetitive, mundane, and often annoying.
The banality of the day-to-day practice of medicine coupled with a medical culture that puts doctors at the center of the health care team makes physicians prone to what Wallace describes as us “operating on the automatic, unconscious belief that [we] are the center of the world and that [our] immediate needs are what should determine the world’s priorities.” This plays out in hospitals and clinics as us viewing patient’s as annoyances (especially uncomplicated cases) rather than people under our care, deserving of every ounce of our attention. We must constantly remind ourselves that we typically know very little about our patients and that they very often have “much more difficult and tedious lives” than our own.
“The real value of a real education has almost nothing to do with knowledge and everything to do with simple awareness.” Good medical educators know this and teach true patient care (which is very much about awareness) rather than focusing on ever-changing book knowledge.
Medical schools should go beyond MCAT scores and GPAs to select candidates. However, real change would be to set minimum standards, then not let MCAT scores or GPAs to influence the admissions process at all. The program in place at the Icahn School of Medicine at Mount Sinai is a great step in this direction.
TED | Thomas Insel: Toward a new understanding of mental illness
This is a graph from an incredible TEDxCaltech talk by the Director of the National Institute of Mental Health, Thomas Insel, about the importance of reframing our conceptualization of mental/behavioral disorders as “brain disorder”. Behavior is the last thing to change in brain disorders, yet this is what we currently rely on for diagnosis and, as with any medical condition, early detection and treatment will lead to better outcomes.
Another great discussion with Jason Newland MD MEd this week.
In this week’s brief episode, Josh and Jason tackle antibiotic use in agriculture, TEDMED and the smartphone physical, and touch on physical diagnosis.
Paul Sax (who works at Brigham and Women’s in Boston) answers this query from a colleague:
We are being consulted by surgeons who are finding within blast victims tissues from other humans. We have been offering post-exposure prophylaxis. Have you folks developed any policies re PEP for explosion victims?
“TEDMED isn’t science. TEDMED is show: really, really beautiful, articulate, polished, high-definition-brought-from-a thousand-angles-of-view, show. We are wowed…But real scientific inquiry and discovery takes cynics, doubting Thomases, and critics, not just ideas and stage shows. Medicine isn’t practiced in corporate suites or in front of a computer (despite what others think), it’s practiced at the bedside. It is practiced face-to-face.”
Westby G. Fisher MD discussing the “magic” of TEDMED
I attended TEDMED last year and it truly is a spectacle to behold. It is wonderfully imaginative and entertaining, but very much needs a critical eye and that is the most salient missing element of TEDMED*. Organizers and speakers are more concerned with wrapping up stories into nice tidy packages than the often messy discourse needed for true scientific inquiry.
*I wrote about the lack of critical discussion after I attended last year’s event and suggested a possible solution.
I was going to write about this, but I think the comment from WayfaringMD says it all.
Two years after the 16-hour mandate was established for doctors in training, studies on the outcomes are being published, and the results reveal one thing: Maybe we should have thought a little harder about the arithmetic.
No one is joking when they say that being a 21st century doctor is hard. The new rules on hour restrictions and the poor way it has been addressed with ‘floater’ schedules and the like has been discouraging. I haven’t started my clerkship yet, but this is definitely something on my mind.
I can definitely vouch for the fact that interns don’t get more sleep or feel happier with 16 hour shifts. I did the 30 hour call system q4days in med school, and I felt like I got more time (usable time that is) off on that schedule than I do now with 16 hours. And I’m definitely not happier now.
This morning was the perfect example of work Hour rules gone wrong. I was on call yesterday and got off at 8:15pm. The Rules say I have to have a 10 hour break between shifts, which means I can’t legally come to work until 6:15. However, I had 10 patients to see this morning and have notes on them my 8:30. Plus one of the 3 interns on my team was off today and we had to cross cover her patients as well. So as a result, I came in “illegally” at 5:40, finished my last note at 8:32, an didn’t get to see the cross cover patient before rounds. The third intern on my team didn’t get to her cross cover people either, partially because the “off” intern hadn’t told us she was off and we hadn’t prepared to come in even earlier to see her people.
So what was the final result? Bad check outs led to an ICU pneumonia patient going without antibiotics for >24 hours.
So yeah, the rules suck.
Important and interesting study headed up by Atul Gawande MD about how hospitals profit from surgical complications. Here is the NY Times commentary on the study (but you should really read the original).