Saturday, August 31, 2013

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Sunday, August 25, 2013

Article Review: Professionalism of physicians on Twitter


In a Research Letter in JAMA, Dr. Chretien et al describe the profile of physicians in the Twitter universe, specifically focusing on professionalism.

Inclusion criteria:
  • Self identified physician
  • At least 500 followers during May 1-31, 2010 (Whew, I only have 309 followers.)
  • English tweets
  • Posted a tweet within last 6 months
A total of 260 physicians were studied.
  • 6.2% were from Emergency Medicine.
  • 15% (most) were from Surgery and its subspecialties.
  • 76% were from the United States.

Three physicians independently coded the 20 most recent tweets from each account (total n= 5,156) for unprofessional content. There were 144 (3%) unprofessional tweets from 27 users:
  • 55 (1%) - possible conflict of interest, advocating for non-standard therapies
  • 38 (0.7%) - potentially violation of patient privacy
  • 33 (0.6%) - profanity
  • 14 (0.3%) - sexually explicit material
  • 4 (0.1%) - discriminatory statement
  • 25 of 27 (92%) of users were identifiable 
The authors conclude that, although rare, there should be more physician accountability and guidelines in the age of social media. This is even more true, since I just discovered that all tweets are archived by the Library of Congress!

Take a look at your most recent tweets. How would they have performed if you were included in this study?

Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA: The journal of the American Medical Association. 2011. 305(6), 566-8. PMID: 21304081

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Wednesday, August 21, 2013

Article review: Faculty skills impact their rating of residents


One of the frustrating things about reviewing evaluation cards of medical students and residents is the degree of variability in how faculty rate them. There are some faculty who can be generalized as "hawks" and "doves"-- really tough or really benign graders, respectively.

Why do faculty rate the same learner differently? This has been a topic of much debate over the years. In this study in Academic Medicine, Dr. Kogan et al make an interesting hypothesis:
  • Faculty with better clinical skills and experience would be more stringent raters.
  • These relationships would be stronger in competency-specific domains ("i.e., faculty with more complete history-taking approaches would rate history-taking more stringently").
  • 48 faculty volunteered to participate in this study (paid)
  • Each faculty member completed eight 15-minute standardized patient (SP) encounters on common outpatient scenarios.
  • The standardized patients scored each faculty member using checklists on history, physical exam, counseling, interpersonal, and professionalism skills.
  • Subsequently, each faculty member reviewed 4 videos of residents participating in SP encounters.
  • Each residents was graded using a mini-Clinical Evaluation Exercise (CEX) tool, which assessed 7 competencies on a 9-point scale (interviewing, physical exam, humanistic/professional qualities, clinical judgment, counseling skills, organization/efficiency, overall competence)
Before I present the results, let's review "linear correlation coefficient", usually designated as "r". This measures the strength and direction of a linear relationship between two variables. Generally a r greater than 0.8 or less than -0.8 suggests a strong correlation.
  • There was a significant negative correlation between faculty's history-taking scores and their ratings of residents in interviewing skills (r= - 0.55) and organizational skills (r= - 0.35). This means faculty who were better history-takers were more stringent raters in the areas of interviewing and organizational skills.
  • Faculty with better process performance scores (eg. not interrupting patients in the chief complaint, using open-ended questions, avoiding jargon) were more stringent raters in the areas of interviewing, physical exam, and organization (r= - 0.41, - 0.42, - 0.36, respectively).

Bottom Line:
This study shows that variability in learner assessment is dependent on the faculty's clinical skills. Should we only have our most skilled faculty evaluate our learners then? This study highlights the importance of faculty competencies in residency competency assessment.

Thinking about myself, I know that I usually give learners relatively high scores unless they are blatantly poor performers. I'm more of a "dove" than a "hawk". So, what does that say about me? Can I extrapolate that I'm not as clinically skilled as my peers? Wait, I'm offended by the implication...

Kogan JR, Hess BJ, Conforti LN, Holmboe ES. What drives faculty ratings of residents' clinical skills? The impact of faculty's own clinical skills. Academic Medicine. 2010, 85:S25-S28. PMID: 20881697

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Friday, August 16, 2013

What exactly is "scholarship" in Emergency Medicine?


The SAEM website houses a Faculty Development Handbook, which is a key document to read if you are an EM resident interested in academics or an EM faculty member. It reviews key points and issues in academic EM, including research, mentorship, promotions, and career longevity. I encourage you to take a look at this at: SAEM faculty development handbook.

In this electronic handbook, it specifically helps define what "scholarship" is. To be successful in academics, one needs to successfully build a portfolio of scholarly work. But what exactly IS "scholarship"?

Here is a snippet from the handbook on this topic in the Preface by Dr. Marcus Martin and Dr. E. John Gallagher:

The development of a successful career in any branch of academic medicine is predicated upon the systematic accumulation of a body of scholarly work. The Faculty Development Committee therefore began by seeking a working definition of the term scholarship to serve as the organizing principle for this Handbook. Ultimately, we settled upon a classification originally proposed a decade ago by Ernest Boyer of The Carnegie Foundation, and subsequently adopted by the Council of Academic Societies (CAS) of the Association of American Medical Colleges (AAMC).

This taxonomy divides scholarship into four major categories, as defined below:
  • The scholarship of discovery is that of original research. This is the predominant form of scholarship that has traditionally found the greatest favor with medical institutions during the latter half of the 20th century.
  • The scholarship of integration is that of trans-disciplinary merger of information from disparate branches of science and medicine, with the goal of formulating creative and novel insights. This is often the most difficult form of scholarship to characterize because it typically operates at the periphery of several disciplines, and may consequently be relatively far-removed from the mainstream of any single area of knowledge.
  • Closely allied to the scholarship of integration is the scholarship of application, which bridges the gap between theory and practice by bringing new information to bear on practical problem-solving, e.g., bench to bedside translocation of knowledge.
  • Finally, there is the scholarship of teaching, which requires intelligible communication of valid and reliable information supported by thoughtful, coherent reasoning from a knowledgeable source to students, younger physicians, and other colleagues.
The last type, the scholarship of teaching, is the most common form of scholarship in academic departments. This is where clinician-educators, such as myself, focus our time, effort, and passion. In the setting of increased clinical demands, though, it has been more and more difficult to maintain such active scholarship in academic departments. There was a hot article published in Academic EM focusing on this exact issue, which I'll review in the upcoming weeks.

(Schrader et al. Scholarship in emergency medicine in an environment of increasing clinical demand: proceedings from the 2007 Association of American Medical Colleges annual meeting. Acad Emerg Med. 2008; 15 (6): 567-72.)

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Tuesday, August 13, 2013

It's WAY too crowded in the Emergency Dept


It is a sad commentary on ED's across the country when extremely crowded clinical conditions are being seen as the norm. It's been shown that crowding negatively impacts patient satisfaction, delays the administration of pain medicines, and increases patient mortality.

I'm working on a study that I conducted with my research associate Sandi, assessing whether a crowded clinical environment impacts teaching. This came up after writing a paper with Dr. Philip Shayne (Emory) on the sad state of literature looking at this question. We have many students, interns, and residents at the General, and anecdotally faculty find that there is less teaching when there are just too many clinical "fires" to put out simultaneously.

In our study, Sandi furtively recorded the clinical activities of 19 attendings over the past few months. I've seen her creatively listen from behind curtains, hide around corners but still within earshot, and generally look busy with other duties. I think she was a spy in a former life... I just sent the data to the statisticians. We'll see.

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Monday, August 12, 2013

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Monday, August 5, 2013

Grab the Perfect Online Different Automotive Wallpapers


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