| rotation: 12* |
PGY-1 |
PGY-2 |
PGY-3 |
Faculty/CMRs |
| Mon 27 Apr |
2005 |
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1.Medical
Knowledge
--of basic scien.
--socio-behav.
--epidemiology
["Double
Helix"]
&Clin.Judgmnt
[D.Bordley-2005] |
Review OnLineCurric
Faculty should remind residents to review Curriculum at beginning of each rotation.
Journal of the Clev.Clin.
One of several reasonable, free, online medical journals. May wish to assign an article for a PGY-1 to present.
Clev.Clin. Pharmacology
We don't have a separate pharmacology course for residents, but pharmacology is what we all use to treat our patients. My favorite source for unbiased information is The Medical Letter, but there is a reasonable series in Cleveland Clinic. A review of Viagra might go well with the recent Cleveland Clinic article on evaluation and Rx of impotence (which should always include an OGTT....)
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Cleve.Clin. -ID
ID guidelines from the Cleveland Clinic. Just for "fyi". |
Clev.Clin. Conf.
As we continue our focus on Cleveland, another "fyi" for senior residents, about to graduate, for a source of good CME.
eMed-Lib of Lib
Lots of good reference material organized by eMedicine.
AdvPCS-iScribe
More "fyi" - what your patients are reading.
CME-ACP-Alguire
The strategies we use to Dx and Rx will continue to rapidly change. This article by Dr. Alguire points out how CME & recertification will address that.
CME-SGIM
For graduating residents interested in primary care, lots of good references for CME. |
Consult.Live-Sympos
Univ. of Ariz-conf
CC-One Min Cons.
CME-ACP-Alguire
CME-SGIM |
2.Commun w/
patient
family
nurses
social work
attending
consultants
PCP
team member
collaborator
team leader |
Why some MDs get sued
Ask the PGY-1s to summarize.
DV-HITS
Do we screen for domestic violence? Should we? I like simple approaches, and this fits the bill.
CC: Opposites Distract
The terms "low blood" and "high blood" are fairly common in our patient population. Do you know what they mean?
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Unexplained Sx-2
We frequently are asked to evaluate patient symptoms for which we can not find a cause. Whether we can find an organic cause or not, the symptoms are real. How do we communicate about that?
Somat.Pain-Epst&Quill
A common cause of unexplained symtoms is the somatisizing patient. This is one of many articles by Quill (& Epstein) in our curriculum. Ask PGY-2 to present a few points from this article.
EOL-Cassem-anx(sp)
Ned Cassem is part of the psych-liason team of the MGH. This is a good review of difficult topic. Ask PGY-2 to present a few points from this article.
CC: One Question
Cultural Competency: What is "shared understanding"? What one question must physicians ask to be culturally aware? This is one of several articles you have been asked to review on the Cornell approach of Drs. Carillo, Betancourt and Green.
PCP-the 'Hub'
Most of our discussions have been on patient-physician communication. This article discusses the role of the PCP in physician-physician communication. Have PGY-2 summarize.
Sorry (WMA)
When should physicians apologize to patients? Use Windows Media Audio player to listen to this radio NPR discussion. What do you think?
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Demanding Pt
We face lots of challenges. The demanding patient is one of them. What is meant by "patient-centered"?
Somat.Pain-Epst&Q
Epstein&Quill-let
Follow up letters regarding Quill and Epstein's article on somatization.
EOL-Good-bye
End-of-life communication can be uncomfortable and difficult. These authors offer some suggestions.
Mea culpa
You make a mistake. You lose the blood specimen you drew & need to draw a new one. You cause a pneumothorax. You give the patient the wrong medicine, or the wrong dose....
After listening to the NPR discussion (see PGY-2) & reading the above article, discuss if and when you should inform patient and apologize.
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Quill&Cassel-neutral
Two of our favorite authors discuss a complicated topic.
See Cassel article in Professionalism section also.
Epstein-tools avail
***Important article for faculty. The Kalamazoo 2 Consensus Conference is THE synthesis of where medical communication is at today. Although the original conference materials have been presented in previous months, this is a concise summary with checklists. One of the authors of this article, Forrest Lang, may stop by in a few months for faculty development....
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3.Pat.Care
Hx:gather data
PE
Procedures &
test interp
Clin. reason
Clin. judgment
Counsel pts.
Dis.prevent.
Health.promo |
What patients want-Stern
Incorporating patients into rounds. Summarize briefly
EOL-Palliative1(sp)
Good palliative care review. May be password protected.
EOL-Palliative2(sp)
Making patient comfortable at end-of-life
May be password protected.
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PE: Acute Dyspnea
DDx of dyspnea. Have PGY-2 briefly discuss approach to this very common symptom.
Patient-centered care
"Patient-centered care" is a term being used more and more since it was emphasized in one of the IOM reports on quality. What do people mean when they mention "patient-centered" care? Is it necessary? Sufficient?
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Alfie
Why we are not pathologists. (No offense to pathologists, you just get the answers a day late.) |
Teaching (in Clinic)
More faculty development -or- teaching teachers to teach. We all teach in the continuity clinics. This is an interesting approach. |
4.Profess
cultural comp.
empathy-c-r-i
inform.consent
conflict of int.
commun. serv.
&altruism
acknow. limits
reliable&
accountable to:
ans pages
arrive on time
complete.tasks approp.signout
prov. continuity
at discharge
knows ethics
stress reduction
recog. fatigue
balance |
Res.Self-eval p1
Res.Self-eval p2
By mid-rotation, faculty should remind residents to complete the above reflective self-evaluation, and go over this with the teaching attending as a confidential mid-rotation formative feedback.
At the beginning of the rotation, teaching attending should make certain residents are familiar with the "chain of command", what resources are available for undue stress/fatigue, and how to reach the teaching attending.
CasselOnEthics(sp)
(sp) means you might need a password to read this. Guess what (sp) stands for?
These articles were all emailed to the residents already, in preparation for the Ethics Grand Rounds.
ACP-Ethics Manual ***
mp3: Quill on Schiavo
EOL-Quill on Schiavo |
Pharma Altruism
The pharmaceutical companies provide a lot of good to society. They also provide a lot of free or low price medications to patients who can't afford it. And they provide educational activities (& food!) for physicians. So despite their multinational unrestrained clawing capitalism and sophisticated mind-bending advertising, they are always good for a discussion of where to draw the line.
Humanities Curric
From Georgetown, a creative humanities approach to patient care.
Look around, see if anything catches your interest.
ACP-Ethics Manual ***
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NYS-Profile
I guess this site would not exist if it did not fulfill a need.
Weisel-WWII
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NYS-Profile |
5.PBLI
"The Mirror"
EBM & IT:
ask focus.quest
analy. article
design study
research
quality improv.
by analyze
own practice
for:
pract. guidelines
core measures
personal errors
teach & life-
long learning |
How are we doing?
Quality at SBH- ask the PGY-1s to look us up. How are we doing? |
Public Reporting
What are the unintended consequences of publishing data on hospital outcomes? Ask the PGY-2 to explain what Dr. Asch has written.
AAIM-FMEA
Five organizations interested in tracking medical quality. Just be prepared to list them.
Who's knees are these?
This physician helped to write most (?all) of the IOM reports on quality, safety and he runs his own quality improvement organization. Who is he? I wouldn't even want to start an IV on him. Can you imagine operating on him?
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ACP-Net
The ACP explains its view of Practice-based improvement for:
Diabetes Mellitus
Warfarin Treatment
Cholesterol Screening
Asthma
Congestive Heart Failure
Safety List
Safety and electronic prescribing
Probably where we are heading..
AAFP-error reduct
Tracking test results (did they get done, did we receive them, did we review them). Missing results can be bad for both patient and physicians.
Reason for office err
Personal errors are part of PBLI. System errors are part of SBP. (We love to split hairs.) Here are some suggestions for graduating PGY-3s to decrease their chances of medical errors. |
ACP-Net
How Am I Doing? |
6.SBP
"The Village"
SHx,<>resources
disch. planning
man.& othercare
pt.safety(6th VS)
& system errors
pt.advoc->satisf. |
Dartmouth Atlas: **
Dartmouth has been a leader in the study of healthcare "systems". What is the Dartmouth Atlas?
Windows on Healthcare
Have some time? Watch these four streaming videos from Dartmouth Atlas.
QualityChasm-redux
Hopefully you read this IOM report earlier in the year. Since it is one of the most quoted references, it is repeated here with some annotation. In addition to care that is "patient-centered", what are its other suggestions. Don't skip this one! (One of the authors is going for knee surgery - do you know which one?)
To Err-redux
This is the other key IOM report. (We actually have shown part of it at Orientation, since it was first published.)
Have the PGY-1s summarize a few of its key points. Don't skip!
Culture of Safety
What is meant by a "culture of safety". Have PGY-1 present a few key points.
EOL-Legal Syst.-Schiavo
Discuss some of the key cases the came before Schiavo. |
ACP-Jobs
This and the NEJM links are a good starting point when thinking about jobs.
NEJM-Jobs
NEJM-Jobs2
Dartmouth Atlas:
Windows on Healthcare
QualityChasm-redux
To Err-redux
Reason&SwissCheese
Dr. Reason's diagram of Swiss cheese is a classic in discussions of how serious errors occur. Residents should be prepared to describe on rounds.
Headrick-Reasonably
Safe MDs
Dr. Headrick is now a key officer in the ACGME. She also uses the Swiss cheese model to describe how we might avoid graduating physicians who are not yet competent. Helps to explain why we do some of the things we do.
A micro-system
There are "macro" systems (like Medicare) and "micro" systems (like a residency. This article discusses causes of error in the resident micro-system when patients are signed out from resident to resident. Well worth discussing.
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ABMS
New systems graduates will deal with.
NYSED
ACP-Jobs
NEJM-Jobs
MeMag-OffWeGo
Last minute advice.
MeMag-3
QualityChasm-redux
To Err-redux
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ABMS
ABIM
Recert
NYSED
Cornell-business
Leach: In summary...
The head of the ACGME, Dr. Leach, explains his philosophy of medical education.
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