Compiled by Jennifer J. Salopek
Welcome to the September edition of Chart Review. As fall rushes toward us at full speed and we attempt to regain momentum at school and work, varied blog posts from the world of academic medicine provide inspiration. As the start of a new school year, September can be a time of reflection and renewed energy. Enjoy these August posts as you summon your resources and plan your goals for the upcoming months.
Costs of Care
We open with a submission from Brian Powers, a student at Harvard Medical School who has also worked at the Institute of Medicine’s Roundtable on Value & Science-Driven Health Care. In his August 5 post, “High-Value Medical Decision Making Starts in the Classroom,” Powers notes that “discussing cost and value is still not a routine part of the clinical decision-making process” for many docs. He suggests that, given the curriculum and scheduling tension that exists in medical schools, cost and value education should be integrated into existing curriculum modules rather than attempting to create stand-alone courses or modules.
The Doctor’s Tablet
If you haven’t yet read “On Retirement: Thoughts of an Academic Physician,” you should. In this post, Robert Marion, MD, chief of genetics and developmental medicine in the department of pediatrics at the Albert Einstein College of Medicine, reveals the life changes necessitated by a heart attack he suffered last winter. In announcing that he would step down as director of Einstein’s Children’s Evaluation and Rehabilitation Center, Marion offers pointed questions to other academic physicians who may be considering retirement. He notes, “There are almost no role models for the academic physician who would like to make a graceful exit.” Marion himself surely will be one—someday.
Training Family Doctors
In “Overheard in Kansas City,” Allen Perkins, MD, chair of the department of family medicine at the University of South Alabama, relates an experience from the National Conference of Family Medicine Students and Residents. Having overheard student attendees discussing the number of procedures they would have to learn during residency, Perkins uses the comment as a springboard to discuss the fact that Americans still use procedures as a way to evaluate the “quality” of health care they receive.
Duke Community and Family Medicine
This new blog features posts from family medicine residents at Duke University Medical Center. Two joined forces to author “Beyond 15 Minutes: Shifting from Office Visit to Experience.” Aaron George, DO, and Jonathan Bonnet, MD, write about trying to create an office experience in their clinic. They’ve held town hall meetings to find out what patients want and are taking a holistic approach to health. One innovation: partnering with a community organization to offer fresh produce to patients at a reduced rate.
Giving to Medicine & Health
On this blog published by the University of Minnesota, the writer describes the genesis of the Urban Community and Ambulatory Medicine program, which was launched 20 years ago. The program allows 12 students per year to spend three months at an urban family medicine clinic in the Twin Cities. Programs like UCAM and the university’s renowned Rural Physician Associate Program can attract more students to primary care and work with underserved populations. These programs are real success stories that other institutions can emulate.
Karan Chhabra offers his take in “The Fix for the Doctor Shortage is Right Under Our Noses.” He notes that the issue is largely one of geography (many newly minted doctors gravitate to urban areas) and proposes that foreign-trained immigrant physicians could help to fill the coverage gaps. But the major obstacle they face is one that domestically-trained physicians do too: the shortage of residency slots.
A Thousand Points of Transformation
In “Family Dinnertime: The Meaningless Nine and Magical Tenth,” Jim McDeavitt, MD, notes that eating dinner together was an important ritual for his family. Even though nothing revelatory might be revealed during nine meals out of ten, it was that “magical tenth” that reassured McDeavitt that the tradition was worth continuing. Similarly, he writes, leaders in academic medicine need to spend time with the people they lead: “The development of empathy and trust is… a time-dependent activity.” McDeavitt is chief academic officer for Carolinas Health System.
Dean Katz’s Blog
Guest poster Annette Reboli, MD, vice dean of the medical school at Cooper Rowan University, relates the visit she and Paul Katz made to the Macy Foundation’s “New and Developing Medical Schools” meeting in May. In “Moving Beyond LCME Accreditation,” Reboli notes the need for a push for innovation as charged by the president of the foundation, George E. Thibault, MD. Thibault outlined six areas of necessary emphasis that include a competency-based approach to medical education and new models of clinical education.
A recent study in Academic Medicine examined inpatient attending physicians’ workloads before and after the 2003 resident duty hour regulations and found that less than half of the 738 physicians surveyed reported that they had enough time for teaching. In a post from two of the study Docs Lisa Roshetsky, MD, MS, assistant professor of clinical internal medicine at Medstar Georgetown University Hospital, and Vineet Arora, MD, MAPP, assistant dean for scholarship & discovery at the University of Chicago Pritzker School of Medicine discuss the study contextually. The authors borrowed from methods developed at NASA to examine astronauts’ workload, and used them to attendings’ perceptions of workload and the relationship of those perceptions to reporting enough time for teaching. In doing so, we found a steep relationship between attendings’ greater perceived workload and time for teaching.
Chart Review is a monthly feature in which the editors at Wing of Zock highlight our favorite blog posts from the previous month. We focus on blogs about academic medicine, whether from the perspective of student, resident, faculty member, dean, or administrator. Medical schools and teaching hospitals provide fertile ground for innovative responses to health care challenges. We are pleased to highlight some of the best here, and hope you will send us your favorites as well. As always, we encourage cross posting.