MedEd

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

Pulling the Welcome Mat Out from Under Our Colleagues

We sat in the living room at a colleague’s home, drinking beer, wine or sparkling water, eating desserts, and talking. Talk started with residents comparing notes about clinical sites or rotations, worries about being prepared for boards, congratulations on fellowship matches, and discussions about trying to decide what to do post-residency. “How are you doing?” my colleague and assistant residency program director asked the group. Silence followed. One person spoke up. “I’m worried about what will happen with my fellowship. I’m still talking with my lawyer.” This was not a question of where he would match, how his clinical skills would be stretched, or adapting to a new location. This was about his immigration status. We met two weeks after the president’s executive order on immigration, and he was worried if he would be able to continue to work under his current visa, being from one of the seven countries…

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…

How I Realized QI Could Be a Dirty Word

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?” Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and then spent the first 4 years of my post-residency career at UCSF, where quality improvement (QI) was well established and celebrated. Sure, I suppose there were some eye rolls from a few surgeons, or…

Legacy from the Dying to the Living

by Jamie Yao
By: Jamie Yao Jamie is a fourth year medical student at the University of California, San Francisco entering into the field of internal medicine. She shares how her recent experience on a palliative care rotation at Moffitt Hospital in San Francisco, CA inspired her to express her feelings through poetry. Many of the moments on my palliative care rotation, such as the ones described in the poem, were inspiring. One that particularly resonates is when I had the opportunity to facilitate and witness the video chat exchange between one of our patients and his family, including his young children. It was simultaneously joyful and heartbreaking to see the love shared between him, his fiancee, and children. It was one of the many examples I encountered of the interactions between patients and their loved ones, who were often the crux of what patients derived meaning from in their lives. "Legacy from…
Jamie Yao is a fourth year UCSF medical student entering the field of internal medicine. Prior to medical school, she majored in Microbiology, Immunology, and Molecular Genetics at UCLA and completed a year of AmeriCorps with Hudson River HealthCare in Peekskill, New York. During her time on a palliative care elective at Moffitt Cancer Center, she had the privilege of working with and learning from an interprofessional team that showed her the varied ways that providers can care for patients. After being incredibly impacted by the patients she met and the vulnerability, resilience and love that they shared with her and their loved ones, she wrote her reflections in the poem, "Legacy from the Dying to the Living."
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