The Other Side of the Bounce Back

In this narrative medicine essay, an internist becomes sensitized to the harshness of inside medical language when the expression bounce back is applied to her father’s return to the hospital shortly after his discharge.

An innovative approach to career development and promotion of diverse faculty

Women and persons from racial and ethnic populations underrepresented in medicine (URiM) comprise a substantially lower proportion of academic internal medicine faculty, particularly at senior ranks (associate professors and professors). Numerous factors lead to this inequity which has broad implications for medical education and healthcare. The Emory University Division of General Internal Medicine Grady Section (GIMG) formed the Faculty Review Committee (FRC) in 2013 to address low promotion rates to senior ranks as part of a strategy to foster a more inclusive, equitable environment. The FRC systematically and proactively reviews all GIMG faculty years prior to possible promotion to provide tailored recommendations to bolster professional development and with a goal to expedite successful advancement to senior ranks. Deidentified GIMG academic rank data was compared with aggregate data from Emory University School of Medicine and the American Association of Medical Colleges. In 2020, GIMG had significantly more senior faculty compared with pre-FRC intervention (odds ratio [OR]: 3.94, 95% confidence interval [CI]: 1.65-9.42). Subgroup analyses of non-URiM women GIMG senior faculty compared with preintervention (OR: 11.6, 95% CI: 2.52-53.7), showed a significant increase. A trend toward increased URiM women faculty was also seen. Descriptive analysis suggests that the GIMG group had a higher promotion to senior ranks among women and URiM compared with national and institutional comparators. The FRC is associated with significant increases in the promotion of all faculty and non-URiM women faculty, and an increasing trend of URiM women faculty, effects which help contribute to an equitable academic medicine environment, fostering a more diverse workforce and improved patient outcomes.

The micro revolution: effect of Bite-Sized Teaching (BST) on learner engagement and learning in postgraduate medical education

CONTEXT

Bite-sized learning is an instructional method that utilizes brief, focused learning units. This approach may be beneficial in medical education given demands on learner time and cognitive load. This study aims to assess the impact of this approach on knowledge acquisition and learner attitudes in postgraduate medical education.

METHODS

An instructional method, termed Bite-Sized Teaching (BST), was implemented within the curriculum at a US Internal Medicine postgraduate training program. In BST, content is distilled into manageable units focused on relevant schemas and delivered via brief peer teaching. A two-fold assessment of BST was performed that included cross sectional survey to assess learner attitudes and experiences and a controlled study to assess knowledge acquisition with BST and case-based teaching control.

RESULTS

One hundred and six of 171 residents (62% response rate) completed the survey. Most residents (79.8%) reported BST was among the best conference types in the curriculum. Important components of BST cited by residents include the distilled content, multiple short talk format and peer teaching. Residents report incorporating what they learned via BST into their teaching (76.1%) and clinical practice (74.1%). Resident who had participated as speaker were significantly more likely to report incorporating learning from BST into their teaching (87.2% vs 63.0%, p < 0.01, Cramer's V effect size = 0.37) and clinical practice (89.7% vs 65.3%, p = 0.02, Cramer's V effect size 0.28). Fifty-one residents participated in the knowledge assessment. Residents taught via BST scored significantly higher on immediate post-test compared to case-based teaching (score [SE] 62.5% [1.9] vs 55.2% [2.4], p = 0.03, Hedges g effect size 0.66). While both groups improved over pretest, there was no significant difference in scores between BST and case-based teaching at two (score [SE] 57.1 [2.1] vs 54.8 [2.5], p = 0.54) and six weeks (score [SD] 55.9 [2.1] vs 53.0 [2.9], p = 0.43).

CONCLUSIONS

Teaching via brief, focused learning units delivered by peers is well received by learners and appears to have a significantly greater impact on immediate knowledge recall than case-based teaching. Further study on long term knowledge retention and behaviors is needed. Bite-Sized Teaching may be a promising instructional approach in medical education.

Encouraging Student Interest in Teaching Through a Medical Student Teaching Competition

PROBLEM

Clinician educators have realized the value not only of assigning teaching roles to medical students but also of offering explicit training in how to teach effectively. Despite this interest in the development of medical students' teaching skills, formal teaching instruction and opportunities for practice are lacking.

APPROACH

To encourage medical student interest in teaching, the authors developed and implemented a medical student teaching competition (MSTC) at Emory University School of Medicine during the summers of 2014, 2015, and 2016. Each year, eight student finalists were each paired with a physician "teaching coach" and given one month to prepare for the MSTC. During the competition, each finalist delivered an eight-minute presentation to a panel of seven physician and resident judges. The authors describe the development, implementation, and assessment of the MSTC.

OUTCOMES

Approximately 150 medical students and faculty members attended the MSTC each year. The students in attendance felt that the MSTC made them more likely to seek out opportunities to learn how to teach effectively and to practice teaching. Additionally, some students are now more interested in learning about a career in academic medicine than they were before the MSTC.

NEXT STEPS

Given the need for more formal initiatives dedicated to improving the teaching skills of doctors-in-training, including medical students, innovative solutions such as the MSTC may enhance a medical school's existing curriculum and encourage student interest in teaching. The MSTC model may be generalizable to other medical schools.

On-site Night Float by Attending Physicians: A Model to Improve Resident Education and Patient Care

BACKGROUND

In 2003, the Accreditation Council for Graduate Medical Education instituted common duty hour limits, and in 2008 the Institute of Medicine recommended additional limits on continuous duty hours. Using a night-float system is an accepted approach for adhering to duty hour mandates.

OBJECTIVE

To determine the effect of an on-site night-float attending physician on resident education and patient care.

METHODS

Night-float residents and daytime ward residents were surveyed at the end of their rotation about the impact of an on-site night-float attending physician on education and quality of patient care. Responses were provided on a 5-point Likert scale ranging from 1, strongly agree, to 5, strongly disagree.

RESULTS

Overall, 92 of the 140 distributed surveys were completed (66% response rate). Night-float residents found the night-float attending physician to be helpful with cross-cover issues (mean  =  2.00), initial history and physical examination (mean  =  1.56), choosing appropriate diagnostic tests (mean  =  1.79), developing a treatment plan (mean  =  1.74), and improving overall patient care (mean  =  1.91). Daytime ward residents were very satisfied with the quality of the admission workups (mean  =  1.78), tests and diagnostic procedures (mean  =  1.76), and initial treatment plan (mean  =  1.62) provided by the night-float service.

CONCLUSION

A night-float system that includes on-site attending physician supervision can provide a valuable opportunity for resident education and may help improve the quality of patient care.