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Tag ecsearchesearchssearchosearch thsearch Interestratefixedmortgage ew csearchrrcsearchl Lower m Interestratefixedmortgage ssearche searchas Interestratefixedmortgage l Interestratefixedmortgage o Tag besearcht Lower searchet a raise to update her wardrobe!). She quickly became a hit among all the medical students and residents who were truly “charmed”. Then one day, at the stroke of midnight, Cinderella’s protected time ran out…and all of her work went up in smoke as she was forced back to her life of hardship seeing patients and doing research. The students and residents were distraught at the thought of losing their most prized teacher and searched the academic complex for her –they were so moved they wanted to award her the precious “Glass Slipper” teaching award, which not only is bestowed with honor, but also a promotion to become a tenured educator in the academic kingdom. And she lived happily ever after…
While you may think that this is the stuff of fairy tales (especially happily ever after), we all have Cinderellas at our institutions. And those Cinderellas want to teach, but they struggle not only with funding, but also the realities of today’s inpatient environment. So, what are these Cinderellas to do? Well, there are few of the ways to ensure that clinical teaching is rewarded – and possible resolutions for the New Year for medical educators.
- Focus on a gap that needs to be filled: Protected time is most likely be awarded to someone who is filling a need – think new curriculum that is mandated by LCME/ACGME or other alphabet soup organizational body. What is the specific need that you can fill with teaching? Often this may require thinking about a topic that may not exactly match your initial interest, but it is more likely to lead to funding for your teaching.
- Learn new teaching methods: Teaching methods for today’s wards are not well developed in the land of an organized chaos. By incorporating a new platform for teaching (think case blogs, video reflection, standardized patients, or a host of other ideas), you can breathe new life into an old topic. For example, using simulation to teach end of life discussion, or using blogs to teach about professionalism, can result in a novel curricular program that not only engage next generation learners, but also gains attention of leaders in medical education.
- Document the effectiveness of the teaching – it is only through methodological evaluation that one can document that teaching translates into practice. By showing that teaching can be linked to improvements in knowledge, attitudes, or practice, it is more likely that someone (maybe a fairy) will finance this teaching as critical to the mission of the hospital. Think about procedural training that shows reduction in central lines.
- Work with a mentor – Just like ‘big research’, mentorship is still important although not always emphasized. To be honest, mentors can serve to mobilize resources or promote your work with senior leaders.
However, regardless of these strategies, funding for teaching requires institutional leadership to recognize that the academic mission of teaching hospitals is still ‘to teach’. Of course, this mission is sometimes lost in the chaos of teaching hospitals surviving budget crisis in an increasingly competitive environment. So during this holiday season as everyone is reminded of the time of giving, now is a great time to remind the fiscally minded Mr. Scrooge in your C-suite that the greatest gift they can give is enabling a teacher to teach the future doctors of our nation.
–Vineet Arora MD
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Tags: advocacy, attending, hospital, medical student, payment, technology, writing
Categories : doctor
28
11
2011
This past Thanksgiving, I was able to reflect on the always jam-packed and inspiring Association of American Medical Colleges 2011 Meeting that took place earlier this month in Denver. The theme of the meeting was transformation. It was certainly an interesting theme with the undertones of economic recession and the GME funding crisis- and that was before the failure of the Supercommittee to reach a resolution. So, how does medical education need to transform? In more ways than one, it turns out. So here are just 4 that were the recurring themes of the meeting and being a fan of alliteration, they all begin with “T”.
- Trust – it was clear that we need to restore the Americans people trust in physicians and in the medical education process. While students enter medicine to make a difference, something that they see in their journey to becoming a physician makes them jaded and they sometimes lose sight of their initial intention. Is it debt, burnout, role models…Or likely some combination of the 3? It does not matter, because we have to restore their faith in teaching– yes teaching. Teaching is the heart and soul of our medical education and it is sometimes the easiest to lose in an academic health center focused on NIH dollars or US news world report rankings. In addition to teaching our students, it is time to teach another constituency, our patients and Congress about the critical need for medical education. And in fact, advocacy is something we need to be teaching our own trainees so they can engage in the dialogue regarding the future of healthcare.
- Time- perhaps the most radical proposal advanced was by Victor Fuchs who suggested that we radically redesign medical school to have medical students specialize 2 years after medical school and enter specific pathways like they do in many other countries and in other fields. I’m all for shortening dwell time for our medical trainees, but I am not so sure that young people are ready to make a serious commitment about what they want to do at such an early age. There has to be a middle ground since at the same time, one of the most well attended sessions was “who cares about the 4th year of medical school?” which included many insightful comments about the need for reflection and consolidation of core skills. So, clearly not all time is easily tossed to the waste side.
- Teams- given the projected shortage of over 90,000 physicians by 2020, it is important to reorganize care into teams. While there is a lot of controversy about what to call nurses who have PhDs, that was not the focus of the meeting. It was about how can you encourage everyone to practice to their highest level of certification. Team based competences have actually been developed by several groups and have been advanced by many schools with inter professional learning. One difficulty we face at home is that we don’t have allied health professions, but we are brainstorming how to involve actual nurses and pharmacists in training medical students.
- Technology -there was a lot of discussion about technology to boost medical education. There was even a technology in medical education abstract session moderated by @motherinmedicine and including podcasts, iPads, and social media in medicine. Perhaps the most interesting speaker was Chuck Friedman at the University of Michigan who is the former technology czar of the US and eloquently highlighted the need for moving medical education from wrote memorization to a distributed knowledge where the most important information future physicians will need to know is not what the information is off the top of their head BUT how to access information. He went so far to say testing would move to “unassisted testing” followed by “cloud-supported testing” which would then merge into a pass or fail based on performance on both. I know all of us who certified or recertified recently would welcome assistance from the cloud- it is after all the closest approximation to real medicine. However, my hands down favorite moment of this session was when someone astutely asked what about these physicians when the power goes out or when the computer system fries. His response was simple and so spot on… “Dont get me started on the state of IT in our teaching hospitals”.
So, while we just celebrated a holiday and accompanying ritual to give thanks, it is now time for medical educators to transcend the traditional status quo and instead test novel techniques to transform medical training — not only to restore public trust but so we can also train the trainees who will treat us in the future.
–Vineet Arora MD