CDEM VOICE – Committee Update

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– An opportunity for involvement and a call for nominations – 


Greetings and Happy New Year from the CDEM Awards Committee. The committee has both the honor and pleasure of recognizing medical student faculty educators from across the country for their dedication, innovation and achievement in undergraduate medical education. It is a great opportunity to get involved (we are looking for new members to join us) and to reward our colleagues for the work they do. The committee solicits nominations for four awards at the beginning of each calendar year to be presented at the annual CDEM business meeting each spring –

  • CDEM Clerkship Director of the Year Award
  • CDEM Young Educator of the Year Award
  • CDEM Distinguished Educator Award
  • CDEM Award for Innovation in Medical Education

For a description of each award, please go to CDEM Awards.


Please nominate yourself or someone you know!

Each nomination packet must include:

  1. Letter of Support from the nominator specifying which award the candidate is being nominated for, how the nominee fulfills the award criteria, the relationship of the letter writer to the nominee (self-nominations are welcome).
  2. Curriculum Vitae and/or Teaching Portfolio of the nominee.
  3. Nominations may also include other supporting documentation, such as a detailed description of curricular innovations, teaching evaluations, letters of support from colleagues, supervisor or students, funded grant or project applications, and publications.

All applications and questions should be sent to CDEM@saem.org

Importantly the DEADLINE for submission is    march-17

David Cheng MD & Sarkis Kouyoumijian MD

CDEM Awards Committee Co-Chairs

CDEM Voice – Topic 360

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I remember vividly my first patient as an academic Attending, it was many years ago now but it is still sharp in my memory and an interaction that I still reflect on. The patient was a 20’s year old male, post cardiac arrest, and presenting in sinus rhythm thanks to the great work of our prehospital providers. But he now was in need of a more definitive airway. I prepped the new intern on patient positioning, technique, medications, backup plans, confirmatory devices/methods, post-intubation management, and after all of that we proceeded. The new EM-1 approached the patient with great outward confidence and promptly and expertly converted the endotracheal tube into a nasogastric tube. The one phrase that sticks out in my mind was when I asked, “Are you in?” (Keep in mind this was before the days of video laryngoscopy) the not so confident response was “I think so…?” The patient did very well despite our initial attempt, no complications, no desaturation and I have reflected back on this interaction many times over the years. You see, I spent all my time in preparation and amazing instruction (if I do say so myself) but had I prepared my new resident for failure? Why wasn’t that a part of my plan/instruction? Was I afraid of even mentioning failure? I think it’s safe to assume that my intern reflected on that interaction as much as I did in the days to weeks that followed.

For some of our residents, the post-graduate training period may represent the first time in their life (professional or personal) that they experience a significant setback, mistake, or failure with negative consequences. This may take the form of a clinical decision (or indecision), interaction(s) with colleagues or patients, or just the stress of the training. The students and residents that we are lucky enough to mentor and teach are (for the most part) extraordinarily gifted and driven individuals, many of whom have never failed.

In her book Mindset: The New Psychology of Success Dr. Carol Dweck discusses how the mindset of the individual can be a great determinant of their success. She makes the distinction between was is referred to as a ‘Fixed’ vs a ‘Growth’ mindset. I can tell you that this book has helped me on numerous occasions to have more meaningful interactions with my students and residents (and Faculty), and has helped me to understand how help our trainees work through a setback in a much more beneficial way. In the book Dr. Dweck discusses that praising learners for their talent instead of hard work does not build mental toughness or confidence or help to develop resiliency, and can actually be counterproductive.

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I suspect that many of us in medical education might recognize some examples of a Fixed mindset. That defensive pushback you encounter with a resident or student discussing a “miss” or the frustration/anger voiced after critical feedback on an evaluation or during a Faculty interaction. If a learner seems to give up with this type of feedback of feels that they are “no good” this should be an indication to us of the mindset (at that time) of the learner. Developing a growth mindset will take time and my hope is that we view it as a wonderful opportunity to build trust with our learners and demonstrate to them that their intelligence and talent do not determine their worth. The “Growth” mindset is one that welcomes challenges and opportunities and the “Fixed” places more value on praise and accolades.

After reading existing work on this concept in other fields I have tried to incorporate this into our resident and student curriculum. I stopped trying to ” win” the crucial conversations that I was having with my residents and students and have instead began to listen in order to understand their mindset. I guess you would have to talk to them but I feel that our interactions are much more meaningful and understanding.

Bo Burns, DO FACEP
George Kaiser Foundation Chair in Emergency Medicine
Associate Professor & Program Director
Department of Emergency Medicine
University of Oklahoma School of Community Medicine

 

 

 

 

 

 

 

 

CDEM VOICE – Research Column

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Systematic Review and Meta-analysis as a Means to Publish in Medical Education

As 2016 came to a close, JAMA released its list of the top 10 most talked about articles of the year. One of these papers, “Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systemic Review and Meta-Analysis” by Rotenstein et al1, falls within the realm of medical education. This paper certainly serves as yet another reminder of the high prevalence of suicide in our medical student population and emphasizes the importance of prevention and wellness during training. However, it is also an example of a research modality that can be used to publish in the area of medical education.

Systematic review and meta-analyses refer to two distinct but related processes that are typically presented together in a single article. A systemic review is the deliberate, pre-determined process of performing a thorough and comprehensive search of the literature on a topic of interest. The findings are then statistically analyzed by meta-analysis, a statistical method, by which data from individual studies are analyzed together to give a single, quantitative description or estimate of the topic of interest. Effect sizes are calculated using one of several statistical models in order to draw conclusions based on an inclusive body of literature. A heterogeneity coefficient, which is used to describe similarity among individual studies, is typically calculated as well. A nonsignificant heterogeneity value signifies that the studies are similar enough for comparison and is more robust.

When publishing a systematic review and meta-analysis, there are several important factors to consider. It is crucial to perform a review that encompasses multiple databases and to have pre-determined inclusion criteria based on subject population and study methodology. A research librarian can be particularly helpful in formulating a search strategy that is most inclusive. Having at least two study investigators independently review each search result and assess for eligibility in the meta-analysis, while noting reasons for exclusion of those that are not eligible, can reduce heterogeneity. It is also important to extract meaningful data, including demographics, in an organized fashion. Invoking the assistance of a statistician for choosing the appropriate effects model is of utmost importance for those without an extensive statistical background. Finally, as with any type of research study, it is important that the conclusions you draw are justified by the analysis performed and not an over generalization.

Successful meta-analyses have been performed on medical education topics including wellness issues, simulation, teaching techniques, assessment modalities.

If there is a medical education topic of interest to you for which there is a growing body of evidence, consider performing a meta-analysis as your next research endeavor and add to our literature!

 

Nicole Dubosh, MD
Instructor, Harvard Medical School
Associate Clerkship Director
Department of Emergency Medicine
Beth Israel Deaconess Medical Center

Referenced –

Rotenstein LS, Ramos MA, Torre M et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systemic review and meta-analysis. JAMA 2016 Dec 6;316(21):2214-2236

CDEM Voice – Member Highlight

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 Jennifer Avegno, MD MA

Clinical Associate Professor, LSU Emergency Medicine

Community Health Relations and Engagement

Director of Student Rotations


 

Brief Bio:

Jennifer Avegno currently serves as Associate Program Director and Director of Undergraduate Education for the LSU – New Orleans Section of Emergency Medicine, where she is a Clinical Associate Professor.  A proud New Orleans native, she is a graduate of the University of Notre Dame (go Irish), and has a master’s degree from Tulane University and MD from LSU – New Orleans.  She completed her residency in EM at the famed Charity Hospital in New Orleans in 2005, just months before Katrina unceremoniously destroyed it.  Since then, she has been involved with student and resident education and community health engagement in areas of violence intervention, sexual assault, homelessness and Hotspotting.  Since assuming EM Clerkship Director
duties for both Tulane and LSU Schools of Medicine, she has developed and directs 3 separate rotations in the ED at University Medical Center that serve nearly 400 learners per year. She is active on several local boards and community organizations, 400and though fairly nerdy still gets to ride in the largest all-female Mardi Gras parade during Carnival.  Jennifer and her husband enjoy the adventure that is parenting four children, and she is grateful for the relative calm of her inner-city, urban teaching hospital ED compared to a typical night at home.

What is your most memorable moment of teaching?

I developed a mandatory course for senior students designed to ensure that no matter what their specialty, they had exposure to acutely ill, undifferentiated patients (in the ED), and thus would hopefully not fear the “sick” patients they encountered in residency and beyond.  An intern who had previously completed the course stopped me on the street one day on a visit home and said, “I never would have taken a course that forced me to see really sick patients … but because I did, I was able to know what to do on a crashing patient in the ICU.”  The confidence in her eyes was an honor to see and know our efforts had made a difference.

Who or what is your biggest influence? 

My mother – the most intelligent person I know – was a longtime educator at a local high school.  Every day, she prepared to teach 16-year old girls as if she was about to defend a dissertation or debate a seasoned scholar.  She never made more than the average intern or received much academic praise or advancement; yet she did it with passion and not a month goes by that someone doesn’t tell me “your mother made such an impact on me.”  Education is a job where the rewards are often unseen by the educator, but substantial to the learner.mom

Any advice for other clerkship directors?

Don’t be afraid to tell it like it is, particularly to those students you are advising on a career in EM.  It took me several years to learn that delivering direct, honest advice or feedback – however painful –  is far better than sparing feelings or always presenting the “best case” scenario.  And – having a supportive residency director makes life easy and the job much more doable.  If anyone knows the headache of scheduling didactics, setting curriculum, and arranging clinical duties while making sure everyone shows up on time, it’s the PD.

What is your favorite part about being and educator/director?

I love exposing students going into non-EM specialties to what we do.  Before they rotate, they often have jaded or inaccurate ideas about how the ED operates … once they’ve worked a few nights in the trenches, there’s a whole new appreciation that hopefully they’ll bring to their own fields.  Plus, everyone’s best stories as a student come from their EM experience.

Any interesting factoids you would like to share?

I think being a Clerkship Director is the most fun you can have in a residency program.  From the sublime (that visiting student who is so fabulous the nurses beg you to hire them
on the spot) to the ridiculous (the kid who is so disengaged on a night shift that they start reading Harry Potter and instantly incur the collective wrath of your entirharry-pottere residency) – students always keep it interesting.

CDEM Voice – FOAMonthly

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Resuscitate your slides!

http://www.garrreynolds.com/preso-tips/design/

No more death by PowerPoint. We have all sat through PowerPoint presentations overrun by animations and littered with barely readable text and clip-art. Well, no more. Whether you are guilty of poor slide design yourself or interested in coaching faculty, residents or students on designing powerful slide presentations, the Top 10 Slide Tips from Garr Reynolds is a great place to start. Garr Reynolds is the author of Presentation Zen (an excellent read on slide design) and hosts a blog on professional presentation design. In his easily digestible and immediately applicable Top 10 Tips Garr Reynolds reminds us of the purpose of slides and provides easy-to-follow recommendations on how to make your slides more visually appealing and impactful. Those that resonated most strongly with me were that the audience is there to hear you speak, not read your slides. Your slides should be essentially meaningless without you. To put it another way, if you properly design the slides for the talk, the slides should not be usable as a handout. More is not better so choose your graphics carefully and with purpose. Photographs of people are great to evoke emotion. Fonts and colors impact your message. Use sans serif fonts and whatever font you use, stick with it throughout the entire presentation. Use these tips and share liberally with your faculty, residents, and students to help prevent needless death by PowerPoint and to bring new life to educational talks.

Kendra Parekh, MD

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CDEM VOICE – Member Highlight

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Melissa C. Janse, MD

Director of Undergraduate Medical Education
Clerkship Director
Department of Emergency Medicine, Greenville Health System
Clinical Assistant Professor
University of South Carolina School of Medicine Greenville
Clemson University School of Health Research

 

What is your most memorable moment of teaching?

I think that it was walking into our brand new medical school ready to meet my small group students for the first time.  I wanted that teaching position more than anything and was extremely nervous. I had been up late the night before, reviewing the chapter multiple times, taking notes, memorizing my students’ names and faces on the roster, and even stressing about what to wear.  I wasn’t sure if I was up to the task, but as I began to relax, and the students excitedly asked questions (and I actually knew the answers), I realized that I could do this.

Who or what is your biggest influence?

It isn’t any one person/event, but more a composite of what I learned from my emergency medicine residency training. I remember the attending that brought in a dead copperhead that had been run over by a car, just to show us the differences between venomous and non-venomous snakes.  I remember the attending that calmly intubated and saved the life of a patient that had de-saturated to the 50s and was becoming bradycardic after an intern and I (the second year resident) failed to secure the airway.  I remember my mistakes, my “saves,” and how I felt afterwards as well as the mentorship I received from my attendings.  I try to channel this when I teach now so that students know they are not alone.  I figure that they can learn from my past mistakes and successes as well as their own.

Any advice for other clerkship directors?helpsupport

I truthfully had very little idea of what a clerkship director actually did when I jumped on the opportunity. I learned on the job, sought mentors, and reached out to CDEM for advice.  Emergency Medicine is a small, close community.  Take advantage of CDEM and the collective wisdom of your peers.  They want you to succeed.

What is your favorite part about being and educator/director?

I am excited about my job all over again. After the initial fervor from medical school and residency waned, I grew complacent if not jaded as an attending.  But now I see my job from the perspective of new learners.  Their enthusiasm rejuvenates me.  I find my students’ eagerness to learn a personal challenge, as I am always trying to stay a few steps ahead of them and keep up to date.  Teaching has definitely made me a better, not to mention much happier, Emergency Medicine physician.

Any interesting factoids you would like to share?

I went straight from residency to a private, independent group contracted by a hospital (Greenville Health System) to staff their multiple emergency departments. The compensation was lucrative, but I was working strictly for a paycheck and did not find my job fulfilling. I dropped to half time, working just enough hours to maintain benefits as I tried to balance my role of wife and mother of three with that of a physician. Fifteen years later, as part of its commitment to being an academic health center, Greenville Health System created an independent department of Emergency Medicine making its EM physician employees, started a new medical school (University of South Carolina School of Medicine Greenville), and pledged resources to begin an Emergency Medicine residency program. I got the opportunity to teach at the medical school and be the EM clerkship director, increased my hours, and have never been happier with my career. USCSOMG graduated its first class this past spring, our department just finished hosting our very first visiting student rotations, and our accredited GHS EM residency program will begin next summer.

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CDEM VOICE – Research Column

 

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Feeding and weighing rats, changing cages, petri dishes, hours and hours looking through a microscope – these were all concepts I associated with research prior to going to medical school, and honestly even during the beginning of medical school. They were my equivalent of scratching my fingers down a chalkboard; they invoked memories mostly of smells I had hoped to forget. Having done a study during my undergraduate time looking at the sense of taste and its effects of weight gain in albino rats, you may understand why upon getting accepted into medical school I saw research as something I would never again take part in. Then medical school came and went. During this time I was immersed in the study of the form and function of the human body. I was enamored by people, by patients. It was then my thought of research – rats, petri dishes, etc. – was changed. I realized that I really enjoyed asking a relevant question about the patient and finding an answer; ergo I began to enjoy research. I believe many clinicians have similar feelings towards research  and my hope is that we all can change those feelings by following along with this blog.

Now as a practicing Emergency Medicine physician I have found myself with more questions than answers, and I am less and less satisfied with the proverbial “this is how we have always done it.” Which novel approach to a medical query works best? Why does it work in that setting versus this one? How do we as medical educators teach better, give better feedback, or mentor more effectively? I know I am not the only one who has these questions, and I also know not everyone has the tools to go about answering them. Each of you has a question that is worth researching in whatever form you choose.

So why do research? Research is a way to validate our current practices – whether you work at a level 1 academic center or a small critical access hospital; whether you teach students, residents, fellows, or the patient tech helping you with that reduction. It helps the practice and knowledge base of EM grow. It makes ALL of us better at what we love to do. It will empower you to be a better clinician educator and will start you down a road you will not regret. Over the next few months we will be writing other primers on research. We are excited to have you along for the ride, and please, if rat-987c78e8f6d5124306d52a0a978ad8853a9d8988-s300-c85there is a specific topic you want covered let us know in the comments below!

Andy Little, DO

Research Director, Emergency Medicine Residency

Doctors Hospital/Ohio Health