Friday, May 24, 2013

Technology in medical education

I was given the privilege of presenting the keynote talk at a faculty development session for the Indiana University School of Medicine Department of Emergency Medicine earlier this week. The theme of the entire day was using technology in education. The opening speaker, Bart Besinger, MD, gave a phenomenal talk on "How to give a lecture with or without technology." It was one of the most engaging talks I have ever heard, and included practical information and tips for making one's didactics top notch! Later in the day, the topic I spoke about was the use of social media to communicate and teach in medicine. It was a wonderful opportunity to network with colleagues from outside of my own departments, and I found the faculty completely engaged and willing to try something new.

We discussed some of the literature on the use of social media in medicine and medical education, and how educators can leverage social media as a tool to disseminate medical information. The highlight came at the end, when we taught the faculty how to use Twitter. The goal was to have five new faculty join Twitter. Many more joined, and the discussion was nothing short of fabulous. It was clear that the faculty were wholly accepting of taking the plunge to use Twitter in medical education (the hashtag used was #IUEMFacDev).

Today, the learning that took place just two days ago was put into action. The faculty used a hashtag (#IUEMTalks) for their own lecture series. Kudos to Dan Rusyniak, MD, for putting on this great workshop. I appreciate so much the invitation to share and learn from emergency medicine faculty colleagues, as well as the willingness of so many to put into practice this new learning tool.

Here is a link to the workshop handouts.

In an upcoming venue, our institution is privileged to host (to have hosted, for some readers) the first inaugural Mobile Computing in Medical Education conference on May 31, 2013, in Indianapolis. In this conference, we will showcase several different ways in which medical students, residents, fellows and faculty utilize mobile tablets in medical education. We look forward to sharing the learning opportunities in this one-of-a-kind conference.

So how are you using emerging technology to further medical education?

Alexander M. Djuricich, MD, FACP, is Associate Dean for Continuing Medical Education and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis. This post originally appeared at Mired in MedEd, where he blogs about medical education.

Labels: Alex Djuricich, guest post, medical education, Mired in MedEd, new technology, social media

QD: News Every Day--CDC urges smokers to seek physician help when quitting

Because a doctor's advice and assistance more than doubles the odds that a smoker will quit successfully, the Centers for Disease Control and Prevention is partnering with ACP and four other physician groups on a "Talk With Your Doctor" campaign.

Get ready for the influx in your waiting room? Almost 70% of all smokers want to quit, according to the CDC cited in its National Health Interview Survey.

The drive will be part of the "Tips From Former Smokers'' national television and online ad campaign through the end of this month, the agency said in a press release. Ads in the campaign end with the voice-over narration, "You can quit. Talk with your doctor for help."

"We hope doctors will offer evidence based counseling and medications to all patients who can benefit from them," the CDC director said.

Through partnerships, doctors will be offered training on tobacco interventions, and will receive information about the campaign through academic journals, newsletters, and digital communications. Besides ACP, participating medical societies include the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists.

Labels: CDC, patient communication, public health, QD, smoking cessation

Time to redesign residencies

Once upon a time (actually when I did my residency), we worked long hours, were taught well and learned from our patients. Residency training had minimal rules. When we looked for a residency we took work load into consideration. Some residencies were more challenging than others. I choose a busy residency because I thought (back then) that I needed to see sufficient numbers of patients to become a good internist.

Our progress over the subsequent 35 years (since I finished my residency) is dubious. Pauline Chen, MD's wonderful article in the New York Times today, "The Impossible Workload for Doctors in Training," tells part of the story--no adjustment of work load as work hours have changed.

What does not make this article is the never ending paper work that program directors must document. What does not make this article is a reluctance to reconsider call schedules.

When the rules change, then the system must change. We have to adjust call schedules for the benefit of continuity. We need call schedules that value "ownership" and patient responsibility. We have to help our residents function as a team, with different members of the team working different shifts.

We who work in residency programs can do a better job at designing the residencies.

This will not solve the ACGME problems and will not solve the major problem of not enough funding to expand residency training slots. CMS has fixed the number of residency positions. Private insurers up to now have not made contributions to training--yet they benefit from well-trained physicians.

Residency is hard. It has always been hard. It is necessary if we want well trained physicians. But it does cost money. We do not have enough residency slots and that is a major societal problem. And no one is really addressing that problem.

For those who want to blame the AMA, the AAMC is responsible for medical student numbers, and they continue to increase quickly. They have increased so much that many U.S. graduates did not find an internship that past year (I have heard numbers ranging from 500-800). This does not count DO graduates, off shore graduates or IMGs. Can you find a new doctor? If you cannot, do not blame the AMA or the AAMC. Blame those who fund residency positions.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.

Labels: db's Medical Rants, guest post, IMGs, medical education, residency, Robert M. Centor, work hour restrictions, work-life balance

QD: News Every Day--Dextrose injections for knee osteoarthritis aids pain, function

Prolotherapy injections of dextrose for knee osteoarthritis resulted in clinically meaningful sustained improvement of pain, function and stiffness scores compared with blinded saline injections and at-home exercises, a study found.

Researchers randomly assigned 90 adults with at least 3 months of painful knee osteoarthritis to blinded injection with dextrose prolotherapy or saline, or to at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed treatments at weeks 13 and 17.

Outcome measures included knee pain, post-procedure opioid use for injection-related pain, and patient satisfaction. Results appeared in the May/June issue of Annals of Family Medicine.

No baseline differences existed between groups. All groups reported improved for a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points) scores compared with baseline status (P less than <.01) at 52 weeks. WOMAC scores for patients receiving dextrose prolotherapy improved more (P less than .05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 +/- 3.5 vs. 7.6 +/- 3.4, and 8.2 +/- 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference.

Individual knee pain scores also improved more in the prolotherapy group (P=.05).

Postprocedure opioid medication addressed injection-related pain, satisfaction with the procedure was high and there were no adverse events, researchers noted.

Researchers wrote, "Its use in clinical practice is relatively uncomplicated; prolotherapy is performed in the outpatient setting without ultrasound guidance using inexpensive solutions. The knee protocol is easy to learn and requires less than 15 minutes to perform; continuing medical education is provided in major university and national physician organizations settings."

Labels: alternative medicine, osteoarthritis, pain management, QD

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Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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