#PHMFellowJC Transcript
Healthcare social media transcript of the #PHMFellowJC hashtag.
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See #PHMFellowJC Influencers/Analytics.
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 | #PHMFellowJC @PHMFellowJC Hello #PHMFellowJC followers and #medtwitter! Thanks for joining us to discuss an article that was a top 10 #PedsHM article at the 2018 @PHMConf. Take a moment to introduce yourself in the comments with your role and institution. Remember to use #PHMFellowJC in all your tweets. https://t.co/iuzQzV8Ae5 |
 | John @jmomdphd John here! Second-year fellow @AllChildrens @JHACHPHM #PHMFellowJC Excited for tonight’s discussion! |
| #PHMFellowJC @PHMFellowJC We are so thankful for @herchd for moderating this #PHMFellowJC chat, creating objectives and questions. Dan is a 1st yr #PedsHM fellow (@PHMFellowships) @ CHOP and will be obtaining a Masters of Education (#meded). As a former @CincyPedsRes chief, he did a lot of work on safety. |
| John @jmomdphd Welcome @herchd ! Looking forward to the journal club tonight! #PHMFellowJC |
 | Dan Herchline @herchd Hey all! Dan Herchline here in Philly. Huge shout-out to the PHM JC club for letting me moderate tonight! #phmfellowjc |
 | Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC This was the 10th article discussed during Top 10 & @anusubram & Jimmy Beck discussed it the longest. #PHMFellowJC |
 | Kate Kyler, MD @kedkyler @PHMFellowJC @PHMConf Hi everyone! I'm Kate, a 3rd year #pedsHM fellow at @ChildrensMercy in Kansas City. Pumped for tonight's chat, thanks for moderating @herchd! #PHMFellowJC |
 | Med Peds Hospitalist @medpedshosp RT @PHMFellowJC: T-30 minutes until #PHMFellowJC with moderator @herchd. Get ready for a fun and educational discussion about direct supervision on rounds and its impact on #patientsafety and #meded #PatientSafetyAwarenessWeek https://t.co/9YJ75bju1L |
| #PHMFellowJC @PHMFellowJC Didn't get a chance to read the @JAMAInternalMed article by Finn et al (including @landriganc, @AmulyaNagarurMD )? No problem! We've highlighted the key points and tables for you below. #PHMFellowJC Article: 10.1001/jamainternmed.2018.1244 https://t.co/KUCa0zJvBL |
| John @jmomdphd Join us now for #PHMFellowJC even if you haven’t had a chance to read the article! |
 | Wade Harrison @WadeNHarrison Hi everyone, I'm Wade a 3rd year resident in Utah and future chief and peds hospitalist. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc Also this is Anika Kumar, #PedsHM doc in Cleveland. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp RT @PHMFellowJC: Didn't get a chance to read the @JAMAInternalMed article by Finn et al (including @landriganc, @AmulyaNagarurMD )? No problem! We've highlighted the key points and tables for you below. #PHMFellowJC Article: 10.1001/jamainternmed.2018.1244 https://t.co/KUCa0zJvBL |
| #PHMFellowJC @PHMFellowJC @herchd We're so excited that you were willing to do this! Thanks for the great discussion questions. #PHMFellowJC |
 | Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC starting now! |
| #PHMFellowJC @PHMFellowJC Let's make sure we're all on the same page in terms of definitions for this #PHMFellowJC chat. Below is how the ACGME defines direct vs. indirect supervision. Today we are specifically discussing supervision during rounds, when the team makes plans for patients in the morning. https://t.co/G9CFf15qo7 |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC @PHMConf Jen from San Diego here! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc @anusubram Generated a lot of discussion @Phmconf, so we're excited to discuss more! #PHMFellowJC Welcome Anika! |
| John @jmomdphd Important to remember @acgme definitions of supervision before we start #PHMFellowJC |
 | Alex Hogan, MD, MS @AlexHoganMD Alex Hogan, #PedsHM attending in Hartford @ctchildrens; former fellow @MontefioreNYC #PHMFellowJC |
| Dan Herchline @herchd RT @PHMFellowJC: Let's make sure we're all on the same page in terms of definitions for this #PHMFellowJC chat. Below is how the ACGME defines direct vs. indirect supervision. Today we are specifically discussing supervision during rounds, when the team makes plans for patients in the morning. https://t.co/G9CFf15qo7 |
| Med Peds Hospitalist @medpedshosp Moises Auron, Med-Peds hospitalist at Cleveland Clinic. Will join briefly. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Let's get started with the #PHMFellowJC chat! Remember to use #PHMFellowJC and T1 in all your tweets and retweets! T1: How do you try to balance trainee autonomy/education and patient safety on rounds? https://t.co/140iVCFNpS |
| #PHMFellowJC @PHMFellowJC @AlexHoganMD @ctchildrens @MontefioreNYC Welcome Alex! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @medpedshosp Thanks for spending some time with us tonight at #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp RT @PHMFellowJC: Let's get started with the #PHMFellowJC chat! Remember to use #PHMFellowJC and T1 in all your tweets and retweets! T1: How do you try to balance trainee autonomy/education and patient safety on rounds? https://t.co/140iVCFNpS |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T1: I do LOVE to teach on rounds (in rooms or between) and could/should probably give the seniors more chance to teach, but I love telling them about all the stuff I learn on #PHMFellowJC ;) Last time I was on service, I mentioned #PHMFellowJC 3x in one day. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T1: I tell my team that goal should be for me not to talk in pt rooms. If they address everything, I just stand back/examine the patient. My purpose is not to repeat but ensure key issues are addressed (d/c planning for complex patients). |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T1: If I think they are missing something or going off tangent, I try to redirect by asking a question. "Have you considered?" And if the senior resident is near me, I try to whisper in his/her ear so that he/she can make the suggestion. |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @PHMFellowJC I feel like this too Alex! #PHMFellowJC |
| Kate Kyler, MD @kedkyler T1: At our institution, the attending is always on rounds, even with a fellow on service. We (attending and fellow as supervisors) do our best to allow the senior resident to run the team, but I often find the burden of education falls on the fellow/attnding #PHMFellowJC |
| Dan Herchline @herchd T1: It's always somewhat of a week to week decision for me. A lot depends on the residents and the patient acuity/complexity but I definitely don't feel comfortable being away from rounds yet! #phmfellowjc |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC T1 - Asking socratic questions and allowing the resident to decide next steps. I aim to agree as a team. It also allows to pursue metacognition. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @WadeNHarrison Welcome Wade! WE're excited to hear the resident voice in this! #PHMFellowJC |
| Dan Herchline @herchd @STangGirdwood Love the ninja mentality! #ninjamentality #phmfellowjc |
| Kate Kyler, MD @kedkyler @STangGirdwood Same over here. I always try to set expectations that the team belongs to the senior, but I often find myself talking more than I want to for purposes of education #PHMFellowJC |
| John @jmomdphd #PHMFellowJC T1: I usually lean towards having a greater presence on rounds for a variety of reasons. Patient safety is one of them-it’s easier for me to identify any issues that arise when I’m there at the bedside. Easier may not be synonymous with me catching more per se |
| #PHMFellowJC @PHMFellowJC @herchd @STangGirdwood For those who aren't familiar with #NINJA, can you explain a little more about what that entails? #PHMFellowJC |
| John @jmomdphd @kedkyler @STangGirdwood T1: I’ve gotten relatively comfortable not saying anything medical. I do, however like to at least let the family know I’m there with questions such as “What can we do to improve your stay with us?” #PHMFellowJC #CustomerService |
| Anika Kumar, MD (she/her) @freckledpedidoc T1. When rounding with a Fellow I provide indirect supervision but when rounding without a fellow I provide direct supervision. It’s a culture. I’ve provided indirect supervision to residents in the past but that isn’t the culture at my current hospital #PHMFellowJC |
 | Jamee Walters, MD @jamee_walters @PHMFellowJC A1: I don’t have any fellows but I do have residents. I always set up an expectation that the senior will run rounds. I admit, staying quiet on my part is hard s #PHMFellowJC |
| Dan Herchline @herchd @kedkyler @STangGirdwood How much do you expect seniors to take initiative for teaching during the course of the week? #phmfellowjc |
| #PHMFellowJC @PHMFellowJC Anyone else choose to be physically on rounds for safety reasons? #PHMFellowJC #PatientSafetyAwarenessWeek #Patientsafety |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC T1: I specifically tell the presenters to look toward the senior/family in rooms during #FCR. I try to push intern to discuss plan/answer family Qs first, then up the chain to senior, then me. We often discuss teaching points between rooms to keep moving #MedEd |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc Can you tell us a little more about some of the differences you saw between indirec and direct supervision of residents on #PedsHM rounds? #PHMFellowJC? |
| John @jmomdphd #PHMFellowJC T1: Some of my success depends on the size of the team. How many learners are on your team? We usually have 2 medical students, 3 interns, a Resident As Educator, and a senior resident. |
| Kate Kyler, MD @kedkyler @herchd @STangGirdwood I do my best to set expectations for seniors, especially 3rd years, that they should pick a topic to talk about every day on rounds. It can/should be super simple, keeping it basic for the med studs and solidifying concepts for the interns #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @kedkyler @STangGirdwood Do you ever feel like this detracts from the residents being seen as the main decision maker? #phmfellowjc |
| Alex Hogan, MD, MS @AlexHoganMD @DrJenChen4kids My division has hotly debated who to direct the presentation to. options: 1. parent 2. senior 3. attending after introducing concept to family many settled on intern presenting to senior...to my chagrin. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @freckledpedidoc Same at my institution. it would take a major culture change to move toward indirect supervision of rounds as a rule. Right now, it's a major exception! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @herchd @kedkyler When I set expectations on the first day, I ask them to bring up one teaching point a week and offer to meet with them each day to find a teaching point. But some residents prioritize teaching last especially in high census. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc T1. On a resident only team I set expectations on Day 1 of rounding that the senior resident is “in charge” and I’m present for “clinical pearls” and eye candy (the eye candy gets chuckles/groans) #PHMFellowJC |
| Dan Herchline @herchd @freckledpedidoc Was it difficult making that transition between institutions and culture? #phmfellowjc |
| Med Peds Hospitalist @medpedshosp @freckledpedidoc Unfortunately, it all depends on the place. In Internal Medicine, I can do indirect supervision- I foster autonomy. @abbyCCim #PHMFellowJC |
| Alex Hogan, MD, MS @AlexHoganMD @PHMFellowJC More efficiency than safety #PHMFellowJC |
| John @jmomdphd @herchd @kedkyler @STangGirdwood When residents are unsure of the answer and I need to chime in, yes. With me there residents don’t get the opportunity to practice the, “I”m not sure but I’ll look this up routine.” But otherwise I support decisions that they throw out there even if it’s stylistic #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @AlexHoganMD I try to nudge the senior to stand near the family so the presenter is looking at both of them simultaneously, but it can be tricky esp when using interpreter phones or in small rooms #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @AlexHoganMD @DrJenChen4kids What would you prefer? #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @jmomdphd Presence on rounds is very important, but we can still foster the residents to take decisions and we back them up. #PHMFellowJC |
| Alex Hogan, MD, MS @AlexHoganMD @kedkyler @freckledpedidoc for my institution it would probably be ok 1 day a week, but not routinely. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Setting expectations with your team about rounds on Day 1 is essential! #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC Well it was often census dependent and complexity dependent. I often would provide direct supervision for our complicated IMC level patients but I think it allowed the senior residents to make more decisions & ask questions #PHMFellowJC |
| Wade Harrison @WadeNHarrison @medpedshosp @freckledpedidoc @abbyCCim This is an interesting point and a big question I had about the article of how this model would translate to pediatrics from adults. Talking to colleagues in med-peds, the differences in culture and expectations is profound #PHMFellowJC |
 | Blake Cirks, MD @BlakeCirks @PHMFellowJC @PHMConf Hi #PHMFellowJC I'm Blake a PGY2 peds resident!! |
| Kate Kyler, MD @kedkyler @AlexHoganMD @PHMFellowJC I thought it was interesting to note that in the article, the indirect supervision was only for established patients, not the new ones. Maybe if that were the case in a #PedsHM setting, it wouldn't affect efficiency as much? #PHMFellowJC |
| John @jmomdphd @WadeNHarrison @medpedshosp @freckledpedidoc @abbyCCim Great point @WadeNHarrison. I would love to see this study reported in pediatrics #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @herchd @freckledpedidoc Not really. But when I come to Peds I bring some of the Medicine flavor - we discuss the cases and let the residents plan the care and I back them up. #PHMFellowJC |
 | MedEdBot @MedEdBot RT @PHMFellowJC: We are so thankful for @herchd for moderating this #PHMFellowJC chat, creating objectives and questions. Dan is a 1st yr #PedsHM fellow (@PHMFellowships) @ CHOP and will be obtaining a Masters of Education (#meded). As a former @CincyPedsRes chief, he did a lot of work on safety. |
| Wade Harrison @WadeNHarrison @PHMFellowJC And then staying consistent with those expectations! #PHMFellowJC |
| MedEdBot @MedEdBot RT @DrJenChen4kids: #PHMFellowJC T1: #PHMFellowJC T1: I specifically tell the presenters to look toward the senior/family in rooms during #FCR. I try to push intern to discuss plan/answer family Qs first, then up the chain to senior, then me. We often discuss teaching points between rooms to keep moving #MedEd |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd @herchd @kedkyler Residents have told me that they just like my being in the background nodding because they feel more empowered and assured knowing that they are making sound medical decisions. #PHMFellowJC |
| Alex Hogan, MD, MS @AlexHoganMD @PHMFellowJC @DrJenChen4kids I was taught to present to the family (#FCR!) It prevents you from using medical jargon. No trainee has ever simplified their language enough for me to not understand what they were trying to say. the idea that we MUST use medical lang to communicate is a dogma. #PHMFellowJC |
| Dan Herchline @herchd Always disappointing when education seems to fall by the wayside! I feel like trying to find even the 1-2 minute gaps for a quick teaching point can really spice up rounds and break the monotony. #phmfellowjc |
| Kate Kyler, MD @kedkyler @AlexHoganMD @freckledpedidoc I think it would depend on the resident team and amount of patient turn over and complexity. If I know and have great confidence in a team, I would be more comfortable with it on a routine basis. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @herchd No, I trained at an institution with direct supervision during rounds (but that direct supervision was sometimes for a handful of pts, not the entire team). With indirect supervision, the key for me was gauging feedback from families bc I still had to round/bill #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @DrJenChen4kids @AlexHoganMD Yes, adding a live/phone interpreter certainly makes it more tricky! #PHMFellowJC |
| John @jmomdphd @medpedshosp @herchd @freckledpedidoc @medpedshosp Can you clarify what you mean by backing them up? I’ll support my residents’ decisions but at the same time I will challenge them if I disagree with the management plan #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Great start to the discussion! On to topic 2: T2: How might our ability to coach and provide accurate assessments of our learners be impacted by decreasing direct supervision on rounds? Use #PHMFellowJC and T2 in all your tweets! https://t.co/0mCw5e3fXS |
| Dan Herchline @herchd 10 minutes before rounds is all it takes! #phmfellowjc |
| John @jmomdphd Me too. Autonomy is only part of the equation. When on rounds I have the attention of the learners. Once we break after rounds it’s difficult to get everyone’s attention. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @jmomdphd @WadeNHarrison @medpedshosp @freckledpedidoc @abbyCCim In the study, the "standard" practice was indirect supervision on established patients, and the intervention was having the attending present for the entirety of rounds. Very different from the #PedsHM world, I'd bet. #PHMFellowJC |
| Wade Harrison @WadeNHarrison @jmomdphd @medpedshosp @freckledpedidoc @abbyCCim Definitely. Would have to look at patient / family experience in addition to safety as well #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @WadeNHarrison @medpedshosp @freckledpedidoc @abbyCCim Yes, and we will be discussing that with topic 4! #PHMFellowJC |
| John @jmomdphd RT @PHMFellowJC: Great start to the discussion! On to topic 2: T2: How might our ability to coach and provide accurate assessments of our learners be impacted by decreasing direct supervision on rounds? Use #PHMFellowJC and T2 in all your tweets! https://t.co/0mCw5e3fXS |
| #PHMFellowJC @PHMFellowJC @BlakeCirks @PHMConf Thanks Blake for joining us! Love hearing the resident voice in #PHMFellowJC! |
| Anika Kumar, MD (she/her) @freckledpedidoc @kedkyler @AlexHoganMD #PHMFellowJC https://t.co/Z8kaWcO76A |
| Med Peds Hospitalist @medpedshosp @jmomdphd @herchd @freckledpedidoc Indeed. If I agree w the plan, I support it. Otherwise, give a rationale for a different plan and aim to have it be done as a consensus - make everybody learn and work as a team. Avoid imposition. #PHMFellowJC |
| Dan Herchline @herchd @kedkyler @AlexHoganMD @PHMFellowJC I feel like the authors assume that established patients already have a set trajectory and that's why they feel more comfortable with indirect supervision. But this definitely isn't always the case! #phmfellowjc |
| Alex Hogan, MD, MS @AlexHoganMD @PHMFellowJC @DrJenChen4kids The big hangup here (and may places) is the 🐮/💻. Senior often lags getting into the room so can't position herself appropriately next to the family. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @WadeNHarrison IT's important to get feedback from your residents if you are sticking to the expectations. #PHMfellowJC |
| John @jmomdphd T2: In it’s simplest form: I can’t provide feedback and/or evaluation on something I don’t witness. However, the number of encounters I need to provide good feedback varies from resident to resident #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @kedkyler @jmomdphd @WadeNHarrison @freckledpedidoc @abbyCCim In our institution, the attending is present on the entire round; but is family/patient centered and the residents are the ones who lead it. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @WadeNHarrison @abbyCCim Where I practiced indirect supervision, 50% of my group was Med-Peds. When I started at my current hospital, @medpedshosp was the only Med-Peds trained physician. #PHMFellowJC |
| Wade Harrison @WadeNHarrison @herchd @kedkyler @AlexHoganMD @PHMFellowJC For sure. It's more of an acuity, social situation, or other complexity that is more meaningful than new/established in my mind. #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMfellowJC T2: This is hard- started service today asking all my team for their specific goals. MS3s/interns said presentations, talking to families, and physical exam skills. Senior said leading rounds. Obviously I can’t do much of that w/out direct observation on #FCR! |
| Kate Kyler, MD @kedkyler T2: I think one of the biggest drawbacks from my point of view of indirect supervision of rounds is the lack of time I'd get to properly evaluate the medical students and residents. I provide the majority of feedback immediately on rounds (unless it's very negative) #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T2: I struggle to see how I can assess rapport building with patients if I don't actually see the residents interact with patients and parents. Watching residents formulate plans on rounds when there are new exam findings or lab results helps my assessment |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T2: Most important, I use rounds as a time to give timely feedback-on-the-fly esp for med students, and feel I would give less feedback if not on rounds. Much of what I write in my recommendation letters for medical students are about what I observed on rounds. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T2: @#PHMFellowJC, T2: @DrStevenTChen, how did you provide accurate assessments of your learners when you weren't on rounds and provide timely feedback and teaching when you were in the study? |
| Med Peds Hospitalist @medpedshosp @kedkyler @freckledpedidoc Indirect supervision can happen after the rounds #PHMFellowJC |
| John @jmomdphd RT @kedkyler: T2: T2: I think one of the biggest drawbacks from my point of view of indirect supervision of rounds is the lack of time I'd get to properly evaluate the medical students and residents. I provide the majority of feedback immediately on rounds (unless it's very negative) #PHMFellowJC |
| John @jmomdphd RT @STangGirdwood: #PHMFellowJC, T2: #PHMFellowJC, T2: Most important, I use rounds as a time to give timely feedback-on-the-fly esp for med students, and feel I would give less feedback if not on rounds. Much of what I write in my recommendation letters for medical students are about what I observed on rounds. |
| Kate Kyler, MD @kedkyler @AlexHoganMD @PHMFellowJC @DrJenChen4kids UGH, so true!! On days when we only have 1 senior present (usually have 2), it can be tough to peel them away from the computer in a timely fashion to supervise the interns #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @kedkyler @jmomdphd @WadeNHarrison @medpedshosp @freckledpedidoc @abbyCCim Yes! And even more so for institutions like mine that practice family centered rounds I'd imagine #PHMFellowJC |
| Alex Hogan, MD, MS @AlexHoganMD @herchd @kedkyler @PHMFellowJC Length of stay is also an issue. I dont know what the #LOS is for adult HM, but with our LOS of 2 days, and >50% leaving in 24 hrs of admit, the bang for the buck of indirect supervision for established patients is potentially low. #PHMFellowJC |
| Dan Herchline @herchd T2: When I really think about it, rounds is the biggest chunk of time I spend directly observing residents. Without that time, I don't know exactly what I would have to gauge performance other than documentation and new patient presentations. #phmfellowjc |
| #PHMFellowJC @PHMFellowJC @herchd @kedkyler @AlexHoganMD Yes, especially with diagnostic dilemmas, patients with multiple consults, complex care patients. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @jmomdphd @herchd @kedkyler @STangGirdwood And allowing a non-intimidating culture enhances learning and promotes motivation. #PHMFellowJC |
| Dan Herchline @herchd Where else do you pull your data for assessments from? #phmfellowjc |
| John @jmomdphd @AlexHoganMD @herchd @kedkyler @PHMFellowJC Great point @AlexHoganMD. Would be curious to see if routine indirect supervision prolonged LOS. Particularly important during busy seasons where patient flow and bed availability is vital #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @AlexHoganMD @PHMFellowJC @DrJenChen4kids At our institution, the senior doesn't have the COW/WOW. We often have the presenting intern go in first, then senior. Then rest of team, then the attending. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @STangGirdwood I honestly don't know how I could evaluate the medical students without my observing them on rounds. The feedback to them would be so limited, it would be nearly useless 🙁 #PHMFellowJC |
| Dan Herchline @herchd How would this change if we trained residents to do more peer assessment? #phmfellowjc |
| Med Peds Hospitalist @medpedshosp @herchd @kedkyler @STangGirdwood Is a great point. The outstanding seniors set themselves apart from the crowd - they should be throwing pearls and pointers during rounds. At least in a couple patients. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC @WadeNHarrison Indeed! Bidirectional feedback is fundamental! #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc T2. Often times the nurses or families will provide feedback about the team during indirect supervision, which is helpful. I also think if you create an environment that’s open you’ll get feedback from interns abt seniors & Vice versa #PHMFellowJC |
| John @jmomdphd @herchd I think the bigger question is can a peer really provide sufficient evaluation of @acgme milestone-based core competencies? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @AlexHoganMD @herchd @kedkyler Yes, need to think about patient flow and early discharges. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: Where else do you pull your data for assessments from? #phmfellowjc |
| #PHMFellowJC @PHMFellowJC RT @herchd: How would this change if we trained residents to do more peer assessment? #phmfellowjc |
| Kate Kyler, MD @kedkyler @herchd We do observed H&Ps with the medical students. For the interns/residents, I hear their assessments of new admissions in the afternoon, can gauge their strengths/weaknesses from those interactions. But missing the interactions w families #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @AlexHoganMD @kedkyler @PHMFellowJC This gets at what our main priorities should be. Do we value $ over educational experience? Can we truly optimize both? #phmfellowjc |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @STangGirdwood @AlexHoganMD @PHMFellowJC Similar for me #PHMfellowJC |
| John @jmomdphd RT @kedkyler: @herchd We do observed H&Ps with the medical students. For the interns/residents, I hear their assessments of new admissions in the afternoon, can gauge their strengths/weaknesses from those interactions. But missing the interactions w families #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @freckledpedidoc 360-degree evaluations! #PHMFellowJC |
| Kate Kyler, MD @kedkyler @freckledpedidoc I imagine soliciting feedback from other staff and parents may be eye opening from time to time (whether positive or negative!). Maybe I should be doing that regardless of how I'm supervising rounds! #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @acgme Probably not right now, but could it be something to strive for? #phmfellowjc |
| Anika Kumar, MD (she/her) @freckledpedidoc @jmomdphd @AlexHoganMD @herchd @kedkyler @PHMFellowJC We addressed this at my old institution. We customized a workflow that allowed for it. Often the attendings would see dcs independently during resident education time. #PHMFellowJC |
| John @jmomdphd @kedkyler @herchd Agree @kedkyler. And I never know when certain situations will present themselves on rounds. My routine presence guarantees I will witness a valuable interaction when it happens. #PHMFellowJC |
| John @jmomdphd @herchd @acgme Maybe? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC While medical decision making can be assessed without being rounds, can we accurately assess interactions between residents and families/relationship building (an @acgme competency) if we're not in the room. Perhaps asking nurses and other staff? #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @kedkyler It’s actually 1 of my favorite things about providing indirect supervision! I learn more about the team by supervising the team than I do when I am supervising #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp T2 - this is a good question. Direct observation is very valuable. But a discussion and conversation with the residents can show their knowledge and judgement. For example after rounds, we can touch base and decide further management w/o addl direct obs #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @herchd @jmomdphd @AlexHoganMD @kedkyler @PHMFellowJC Can we actually say that increased "intern speaking time" meant better education? Perhaps, the education comes when the attending is speaking? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @jmomdphd: @kedkyler @herchd Agree @kedkyler. And I never know when certain situations will present themselves on rounds. My routine presence guarantees I will witness a valuable interaction when it happens. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Great points everyone! Time for question 3! T3: How might learning actually be enhanced in an indirect supervision model? Don't forget to use #PHMFellowJC and T3 in all your tweets! https://t.co/DwgFx0BG7u |
| Alex Hogan, MD, MS @AlexHoganMD @herchd @jmomdphd @kedkyler @PHMFellowJC I would consider a short LOS a value added for patient experience, not quite that strong of a dichotomy of $ vs 🎓 #PHMFellowJC |
| Wade Harrison @WadeNHarrison @PHMFellowJC @acgme I think this is a great reason that having either direct or indirect supervision as a standard maybe makes less sense than switching it up by day, week, etc. Balance the benefits of autonomy with observation/evaluation. #PHMFellowJC |
| Dan Herchline @herchd A lot of it comes down to who is able to make these assessments accurately as @jmomdphd pointed out. #phmfellowjc |
| John @jmomdphd @WadeNHarrison @PHMFellowJC @acgme But I want to be the cool attending that lets residents round by themselves! #FOMO #PHMFellowJC |
 | Terry Kind, MD MPH @Kind4Kids For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC @AlexHoganMD @herchd @kedkyler Day workflow has strong impact in the academic interaction.#PHMfellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @PHMFellowJC @acgme I solicit feedback from families when I provide indirect supervision. The nurses, PCNAs, RTs are always happy to provide feedback too #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @PHMFellowJC @acgme I think the rapport/relationship would be relatively easy to find out about by asking nursing and/or asking the family/patient when the attending sees them. #PHMfellowJC |
| John @jmomdphd Another great read! #PHMFellowJC |
| Wade Harrison @WadeNHarrison @jmomdphd @PHMFellowJC @acgme Coffee and donuts are also cool... #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @WadeNHarrison: @PHMFellowJC @acgme I think this is a great reason that having either direct or indirect supervision as a standard maybe makes less sense than switching it up by day, week, etc. Balance the benefits of autonomy with observation/evaluation. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC T3 - It will foster more independent thought process and autonomy. #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @WadeNHarrison @PHMFellowJC @acgme Great idea. At my med school, we had direct supervised rounds by the service attending one day a week, and indirect supervision the other 4 days, but there were teaching attendings for the med students on 2 of those 4 days. #PHMFellowJC |
| Alex Hogan, MD, MS @AlexHoganMD Time alone, without attending presence is where i think I learned the most. I was alone the in the #PICU overnight in residency which made me confident/competent? Time alone with families remains my fav time of the day. #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @WadeNHarrison @jmomdphd @PHMFellowJC @acgme Can confirm! #PHMfellowJC |
| John @jmomdphd T3: Indirect supervision probably affords more opportunity to make independent decisions #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @jmomdphd @WadeNHarrison @PHMFellowJC @acgme @Hagedorn_MD had his senior residents round by themselves at the community site and they definitely thought he was the cool attending. #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @AlexHoganMD @herchd @jmomdphd @kedkyler @PHMFellowJC Adding value to patient experiences is something that we can teach our learners so there is some educational value #PHMFellowJC |
| Kate Kyler, MD @kedkyler T3: Indirect supervision really forces the resident team to make the final call on clinical decisions, to handle difficult conversations with families, to teach all levels of learner. Like how I felt as a fellow leading the team for the first time was educational! #PHMFellowJC |
| Dan Herchline @herchd T3: Indirect supervision may actually promote resourcefulness if residents don't have an automatic out/answer readily available. It may also make them more uncomfortable with #uncertainty #phmfellowjc |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T3: Lessons that often stay w/me are ones where mistakes (fortunately not serious ones) were made. As long as safety isn't compromised, allowing residents to implement their plans may enhance learning. I wonder though if it may lead to delay of appropriate care. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC, T3: That said, in med school, we had indirect supervision on rounds in #PedsHM. Seniors said they'd find the attending immediately after rounds to run the list & make sure plans were sound. It was a missed learning opportunity not to be part of discussion. |
| John @jmomdphd @kedkyler @kedkyler Do you think everyone routinely makes decisions that they wouldn’t have made in the presence of an attending? Or, are they more likely to instead say, “I need to discuss this with my attending after rounds”? #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @STangGirdwood @WadeNHarrison @PHMFellowJC @acgme In Medicine we round on the sickest patients and the new ones. The old ones we may do table rounds. This combines direct and indirect supervision. If not busy, we do bedside rounds with all. #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @jmomdphd @herchd @acgme Maybe not so much formal assessment but I do feel the adult learning theory points noted in the study are relevant and valid #PHMfellowJC |
| Dan Herchline @herchd Sorry *comfortable* #phmfellowjc |
| #PHMFellowJC @PHMFellowJC @Kind4Kids Thanks for the resource! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @Kind4Kids: For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @jmomdphd @kedkyler In my opinion, this depends on the residents’ self confidence & the culture created by attendings. #PHMFellowJC |
| Kate Kyler, MD @kedkyler Will definitely be reading post-#PHMFellowJC. Thanks! |
| Med Peds Hospitalist @medpedshosp RT @Kind4Kids: For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Med Peds Hospitalist @medpedshosp Promoting Resident Autonomy During Family-Centered Rounds: A Qualitative Study of Resident, Hospitalist, and Subspecialty Physicians. - PubMed - NCBI #PHMFellowJC https://t.co/B3ZOmOeWRP |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @freckledpedidoc @PHMFellowJC @acgme Great idea to solicit feedback from families. When I see a patient after my residents have for an admission, I tell my families that my job is to make sure that my residents have done a good job explaining the diagnoses and plan to the family. #PHMFellowJC |
| John @jmomdphd @freckledpedidoc @kedkyler I’ve found that a slight head nod when an intern is 99% confident in a difficult decision can do wonders for improving autonomy on rounds. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @BlakeCirks: @PHMFellowJC @acgme I think the rapport/relationship would be relatively easy to find out about by asking nursing and/or asking the family/patient when the attending sees them. #PHMfellowJC |
| Wade Harrison @WadeNHarrison @jmomdphd @kedkyler Most of the time I think it would result in more decisions. Obviously attending dependent but I feel like sometimes when there are issues of style variations interns/residents will hedge making a decision to get the attending to voice their thoughts #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @AlexHoganMD: Time alone, without attending presence is where i think I learned the most. I was alone the in the #PICU overnight in residency which made me confident/competent? Time alone with families remains my fav time of the day. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @BlakeCirks @WadeNHarrison @jmomdphd @acgme Attendings are being compared to coffee and donuts. There's always a first in #PHMFellowJC |
| Dan Herchline @herchd Definitely builds confidence in the learners from anecdotal experience. #phmfellowjc |
| Kate Kyler, MD @kedkyler @freckledpedidoc @jmomdphd I think they would be more likely to confidently state the answer they were thinking, without having the opportunity to look over to the attending to double check. I think the majority have the right answers. Though @anika has a point, too! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC We need to teach our residents to be okay with #uncertainy and be honest about it with families and patients. #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @PHMFellowJC T3 indirect feedback forces me to commit to a decision in the moment and I feel I learn more at that time, or realize I actually don't know something. Both of which enhance my learning. #PHMfellowJC |
| Wade Harrison @WadeNHarrison @AlexHoganMD @BlakeCirks @jmomdphd @PHMFellowJC @acgme The evidence is in. @AlexHoganMD is definitely a cool attending with data like that. #PHMFellowJC |
| Dan Herchline @herchd Would indirect supervision do anything to mitigate this issue of "style differences" and help residents form their own style? #phmfellowjc |
| #PHMFellowJC @PHMFellowJC @jmomdphd @kedkyler Do you think that saying the latter statment may cause families to wonder why the attending isn't on rounds and question cohesiveness of the team? #PHMFellowJC |
| Dan Herchline @herchd RT @PHMFellowJC: We need to teach our residents to be okay with #uncertainy and be honest about it with families and patients. #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @herchd And this is fundamental- we need to be encouraging and create a safe environment. #PHMFellowJC |
| John @jmomdphd @PHMFellowJC @kedkyler Absolutely, I do. I’ve seen it happen. Not often, but often enough. While the learners are absolutely important to me on rounds, so is the experience the patient and family is having while on my service #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @WadeNHarrison: @jmomdphd @kedkyler Most of the time I think it would result in more decisions. Obviously attending dependent but I feel like sometimes when there are issues of style variations interns/residents will hedge making a decision to get the attending to voice their thoughts #PHMFellowJC |
| Wade Harrison @WadeNHarrison @herchd I think so. It's easier to have those discussions somewhat removed and not not in the flow of rounds where it could feel more directive or undermining. #PHMFellowJC |
| Dan Herchline @herchd @PHMFellowJC @jmomdphd @kedkyler I feel like it all comes back to being OK with not knowing every answer and learning how to deal with and be open about uncertainty #phmfellowjc |
| Kate Kyler, MD @kedkyler @PHMFellowJC @jmomdphd Yes, I think some families would feel that way. Esp families who know the hospital system and training hierarchy better #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC T3: Forces the residents to commit to a plan and handle potentially difficult conversations, but attending should obviously still be available as needed eg for family meeting. It might also force the senior to step up as more of role model for interns/students |
 | indy_med @indy_med RT @Kind4Kids: For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Med Peds Hospitalist @medpedshosp @jmomdphd @PHMFellowJC @kedkyler By all means. A hospital is a Hospital. We are here for patient care. Education is a collateral benefit. #PHMFellowJC |
| John @jmomdphd @herchd @PHMFellowJC @kedkyler Agreed. But is it different saying “I don’t know” in the presence of an attending versus in the absence? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Time flies when you're having fun! Last question! Our polls showed a variety of responses in terms of experience and comfort with direct vs. indirect supervision on rounds. T4: How do you think these results might be different (or not) in #PedsHM? Use #PHMFellowJC and T4! https://t.co/JWju2CMGnW |
| John @jmomdphd RT @PHMFellowJC: Time flies when you're having fun! Last question! Our polls showed a variety of responses in terms of experience and comfort with direct vs. indirect supervision on rounds. T4: How do you think these results might be different (or not) in #PedsHM? Use #PHMFellowJC and T4! https://t.co/JWju2CMGnW |
| Anika Kumar, MD (she/her) @freckledpedidoc @herchd That’s exactly the point of indirect supervision! There isn’t 1 way to treat all patients. We all have our own styles and we should encourage our learners to develop their own styles #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Family experience needs to be considered. Any patients or families out there that can chime in? What goes through your mind when a resident says, "I need to ask attending about that after rounds"? Does it build confidence or make you wonder where attdg is? #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @freckledpedidoc @herchd And the variety of attending styles is enriching for the residents #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @PHMFellowJC @kedkyler There won't always be the attending crutch and I definitely feel that saying "I don't know" when you're one-on-one with a family is an important skill to learn. #phmfellowjc |
| #PHMFellowJC @PHMFellowJC RT @jmomdphd: @herchd @PHMFellowJC @kedkyler Agreed. But is it different saying “I don’t know” in the presence of an attending versus in the absence? #PHMFellowJC |
| Dan Herchline @herchd RT @freckledpedidoc: @herchd That’s exactly the point of indirect supervision! There isn’t 1 way to treat all patients. We all have our own styles and we should encourage our learners to develop their own styles #PHMFellowJC |
| John @jmomdphd @herchd @PHMFellowJC @kedkyler But how do I give feedback on your ability to acknowledge uncertainty of I’m not there to watch it? #SoMeta #MindBlown #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC Families must acknowledge that we work as a team and decisions are well thought and deliberate. #PHMfellowJC |
| Kate Kyler, MD @kedkyler T4: The culture surrounding autonomy is so different in #pediatrics. In this study, the standard practice was to have indirect supervision. I doubt that's the norm in #PedsHM. #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @jmomdphd @kedkyler As a resident I'd be more likely to commit to decision. But I don't have a problem admitting to families if I really don't know the answer or need to "get back to you" or "review that topic" or "let me check with the attending". #PHMfellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc T4. I think 1 of the challenges in #pedsHM is that there is a culture of fear that something may be missed during indirect supervision because there is a belief that children are more medically fragile than adults. #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T4: I would be most curious about parental perspective of not having the supervising physician during rounds for their child. I would imagine most would be okay with it. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood #PHMFellowJC T4: I have some questions about logistics - what are attendings doing during rounds instead? Are they watching orders be placed or doing other work? When do you see early discharges? Do they leave work later b/c they don't start seeing patients til after rounds? |
| Blake Cirks, MD @BlakeCirks @jmomdphd @kedkyler Also, with texting I can get an answer within seconds if needed from attending #PHMfellowJC |
| Alex Hogan, MD, MS @AlexHoganMD Thanks everyone, this was great(if not a bit stressful/fast paced)! I've got a newborn to attend to who definitely needs direct supervision! #PHMFellowJC |
| John @jmomdphd @medpedshosp @PHMFellowJC The first thing I saw to new patients is that we work as a team. I don’t think it’s fair to say families must acknowledge this, however. #PHMFellowJC |
| Dan Herchline @herchd T4: I really struggle with this question. I know the culture in Peds is different but should it be? What is the fundamental difference between the two settings? #phmfellowjc |
| #PHMFellowJC @PHMFellowJC RT @jmomdphd: @herchd @PHMFellowJC @kedkyler But how do I give feedback on your ability to acknowledge uncertainty of I’m not there to watch it? #SoMeta #MindBlown #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @PHMFellowJC @kedkyler Probably where debriefs and reflection come into play although these can be pretty time consuming. #phmfellowjc |
| Anika Kumar, MD (she/her) @freckledpedidoc I think if we eliminate the doubt or the fear that something may be missed we instill more confidence in our learners and we create a more collaborative culture #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @AlexHoganMD @PHMFellowJC I think @CHLA_PCCM would have been too crazy w/out attending available (they also covered CVICU at night) but during the day we rounded w just fellow which I think was good for promoting their autonomy and thus ours by extension #PHMFellowJC |
| Wade Harrison @WadeNHarrison T4: When parents are only able to be in the hospital for short periods b/c of work, other kids, etc. how would this work in times that you need the decision maker present #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @BlakeCirks @jmomdphd @kedkyler But does texting always convey all the details that are needed if they weren't there to hear all of the discussion? #PHMFellowJC |
| Dan Herchline @herchd Sounds like there's an interesting study brewing here...#phmfellowjc |
| Kate Kyler, MD @kedkyler @BlakeCirks @jmomdphd Agreed, that's exactly how I felt as a resident. The few times I rounded without the attending were empowering for those reasons, and I've never been afraid of simply saying "that's a good question... let me circle back with you in a couple of hours" #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @AlexHoganMD Thanks for joining us! You can catch up on the rest through #PHMFellowJC! |
| Wade Harrison @WadeNHarrison @PHMFellowJC @BlakeCirks @jmomdphd @kedkyler If it doesn't those texts can become a phone call #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp T4- When I trained in Med-Peds at @metrohealthCLE - we had lots of autonomy; after AM rounds we admitted patients, took decisions, etc. At night we were alone; even in the PICU. Lots of indirect supervision. And we owned the reaponsibility. And pts did well! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: T4: T4: I really struggle with this question. I know the culture in Peds is different but should it be? What is the fundamental difference between the two settings? #phmfellowjc |
| John @jmomdphd T4: I’m going to offer a different point of view. There is a lot of inference that our medicine colleagues are “doing something more right” than #PedsHM. Maybe equally important ask is why hasn’t medicine adopted the #PedsHM culture? #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @STangGirdwood I start rounding like 30-60 minutes when I provide indirect supervision. During that time there are many things that I do, both patient-care and not patient-care related. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Debriefing with residents is always key to understand residents' thought process in decision making and encounters with families, especially difficult ones. #PHMFellowJC |
| John @jmomdphd Excellent point #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @STangGirdwood I’ve never had a family complain that I wasn’t at the bedside (including physician families) #PHMFellowJC |
| Kate Kyler, MD @kedkyler @STangGirdwood Once I rounded without the attending (as a fellow). Rounds went great, I loved it. But the post-rounds rounds? Not so much. Took forever. A patient left before the attending had a chance to see them. Lots I would do differently logistically there. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @WadeNHarrison: T4: T4: When parents are only able to be in the hospital for short periods b/c of work, other kids, etc. how would this work in times that you need the decision maker present #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @jmomdphd @PHMFellowJC Sure thing- we must explain expectations and process. I meant by acknowledging - that families understand the workflow and system after being explained #PHMFellowJC |
| Wade Harrison @WadeNHarrison @jmomdphd Excellent point. Particularly considering the results were non-significant but there is the question of no difference vs. wide CIs #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @herchd #PHMFellowJC is all about generating inter-institutional collaboration - let's do a study together! |
| Alex Hogan, MD, MS @AlexHoganMD @jmomdphd @PHMFellowJC I've added the PM rounds to my routine. It's lovely most of the time, defuses situations sometimes, and leads me to getting home late too often... #PHMFellowJC |
| John @jmomdphd @freckledpedidoc @STangGirdwood Is not complaining the same as being dissatisfied? I struggle with this. #PHMFellowJC |
| Dan Herchline @herchd Fascinating twist! I imagine they would have just as much trouble changing to our culture as we would have changing to theirs. #phmfellowjc |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids #PHMFellowJC T4: I think we’re generally more conservative in #PedsHM, plus many parents (esp of complex kids) know to ask for the attending or subspecialist esp if residents seem unsure of plans... |
| Kate Kyler, MD @kedkyler @jmomdphd We need you (or somebody) to do this study in #PedsHM to see if the error rate is different! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @jmomdphd playing devil's advocate. Is there only one right answer? Probably depends on the residents, the attendings, the institution, the patients, etc. Multifactorial! #PHMFellowJC |
| John @jmomdphd @kedkyler @kedkyler Multi-site study? @STangGirdwood @DrJenChen4kids #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @kedkyler Agree, it’s very much not the norm in #PedsHM (maybe that could be a survey study?) #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @jmomdphd @STangGirdwood Well, I don’t phrase it that way. Most families are happy to see 1 doc come without a team of 10 following them. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @kedkyler @STangGirdwood Early discharges and patient flow must be considered especially in #PedsHM with short LOS. #PHMFellowJC |
| Kate Kyler, MD @kedkyler @jmomdphd @STangGirdwood @DrJenChen4kids 🤯 #PHMFellowJC |
| Med Peds Hospitalist @medpedshosp @jmomdphd Is not "more right". Is different. I try not to be too prescriptive of how to do things. But the increased autonomy is a prize the residents gain. #PHMFellowJC |
| John @jmomdphd @PHMFellowJC I don’t think there is one right answer. But I’m also not convinced we as a field know what the right answer for rounds looks like yet. #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @kedkyler @STangGirdwood @DrJenChen4kids The groundwork is already there! #phmfellowjc |
| #PHMFellowJC @PHMFellowJC This has been an awesome #PHMFellowJC discussion tonight! What last thoughts do you have about the topic? What is the biggest learning point you will take away from tonight's chat? How would you summarize the chat for your colleagues? |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC @jmomdphd And even within an institution - @freckledpedidoc and myself may have different rounding styles. And this is good for residents! More variety. #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @jmomdphd We probably need to ask what the purpose of rounds is and whether having an attending physically present on rounds achieves that purpose? #PHMFellowJC |
| Dan Herchline @herchd @jmomdphd @PHMFellowJC I often feel that we are very constrained by convention and culture. How would we shape rounds if we could create the perfect scenario? #phmfellowjc |
| John @jmomdphd @medpedshosp @PHMFellowJC @freckledpedidoc Agreed 100%! #PHMFellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @herchd @jmomdphd @kedkyler @STangGirdwood In #JHMchat yesterday the adult hospitalists seemed to be impressed almost none of us were using docusate often in #PedsHM lol #TWDFNR #PHMFellowJC |
| Wade Harrison @WadeNHarrison @jmomdphd @PHMFellowJC For sure, imagine this same study was repeated in peds with standard rounds being direct supervision and it finds similar results. The discussion looks very different that direct supervision is preferred. Inertia and prevailing culture are powerful. #PHMFellowJC |
| Blake Cirks, MD @BlakeCirks @PHMFellowJC I think this is so much dependent on the team that is on service. Some of my colleagues would love this and others would not like it at all. Should be tailored to the team with the primary focus on safely providing the best education and treatment #PHMfellowJC T4 |
| #PHMFellowJC @PHMFellowJC RT @PHMFellowJC: @jmomdphd We probably need to ask what the purpose of rounds is and whether having an attending physically present on rounds achieves that purpose? #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @herchd: @jmomdphd @PHMFellowJC I often feel that we are very constrained by convention and culture. How would we shape rounds if we could create the perfect scenario? #phmfellowjc |
| Dan Herchline @herchd We can always strive to improve patient safety, the patient experience, and education for trainees. We need to start thinking outside the box for creative solutions to optimize all three! #phmfellowjc |
| John @jmomdphd #PHMFellowJC For what it’s worth, I practice both direct and indirect supervision. And I think both have their ups and downs. |
| #PHMFellowJC @PHMFellowJC RT @WadeNHarrison: @jmomdphd @PHMFellowJC For sure, imagine this same study was repeated in peds with standard rounds being direct supervision and it finds similar results. The discussion looks very different that direct supervision is preferred. Inertia and prevailing culture are powerful. #PHMFellowJC |
| Kate Kyler, MD @kedkyler I'll continue to wrestle with optimizing resident autonomy with my love of talking on rounds! Maybe the best way to keep me quiet is for me to consider backing away completely on occasion? Until then, I'll keep trying to be a #NINJA #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @BlakeCirks: @PHMFellowJC I think this is so much dependent on the team that is on service. Some of my colleagues would love this and others would not like it at all. Should be tailored to the team with the primary focus on safely providing the best education and treatment #PHMfellowJC T4 |
| Med Peds Hospitalist @medpedshosp @DrJenChen4kids @herchd @jmomdphd @kedkyler @STangGirdwood Indeed! Peds leads on a lot of things - champions on #hvc, #familycenteredrounds, #antibioticstewardship etc! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC Thank you to all our #PHMFellowJC participants tonight! It was a great discussion. Special thanks to @herchd for guest moderating and generating excellent questions for this chat! We will be going to a bimonthly schedule, so our next chat will be May 14, 9 pm EST. https://t.co/5vwm6XL5x0 |
| #PHMFellowJC @PHMFellowJC Sad that the next #PHMFellowJC won’t be for another 2 months? Stay tuned for a potential new #PedsHM chat opportunity coming to a Twitter near you!! https://t.co/tfCBJYgjMm |
| #PHMFellowJC @PHMFellowJC RT @kedkyler: I'll continue to wrestle with optimizing resident autonomy with my love of talking on rounds! Maybe the best way to keep me quiet is for me to consider backing away completely on occasion? Until then, I'll keep trying to be a #NINJA #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc @kedkyler I love interacting with children & families so I end up talking too much! #PHMFellowJC |
| Dan Herchline @herchd Thank you so much for the opportunity! This was an absolute blast and truly enjoyed hearing some incredibly smart people talk about a topic near and dear to my heart. #phmfellowjc |
| Med Peds Hospitalist @medpedshosp @PHMFellowJC @herchd Many thanks for an awesome chat!!! I ended up staying all of it - the discussion was excellent - very insightful. #PHMFellowJC |
| John @jmomdphd Thanks for joining, @medpedshosp #PHMFellowJC |
| Anika Kumar, MD (she/her) @freckledpedidoc Thanks #PHMFellowJC for another great chat! I encourage folks to join #HHSVaxChat tomorrow at 1pm EDT! |
 | Jake Prunuske, MD, MSPH @jprunuske RT @Kind4Kids: For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Dr. Jennifer Chen, MD FAAP 林 明 堯 @DrJenChen4kids @c_diazepine @herchd @jmomdphd @kedkyler @STangGirdwood Common pre/post-op constipation management, like I remember seeing it a lot on surgery or Ob/Gyn as a med student #PHMFellowJC |
 | Chris Bonafide, MD, MSCE (he/him) @chris_bonafide This sums it up really well @herchd - we need to get really clear on defining the essential goals of rounds and then design systems likely to get us the outcomes we've targeted - and study them. No staffing model is too crazy to try once... #blowupthesystem #phmfellowjc |
| Anika Kumar, MD (she/her) @freckledpedidoc RT @herchd: We can always strive to improve patient safety, the patient experience, and education for trainees. We need to start thinking outside the box for creative solutions to optimize all three! #phmfellowjc |
| #PHMFellowJC @PHMFellowJC RT @chris_bonafide: This sums it up really well @herchd - we need to get really clear on defining the essential goals of rounds and then design systems likely to get us the outcomes we've targeted - and study them. No staffing model is too crazy to try once... #blowupthesystem #phmfellowjc |
| John @jmomdphd @chris_bonafide @herchd Agree 100% @chris_bonafide #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC @chris_bonafide @herchd Always brings us back to the question, what is the purpose of rounds? Thanks for the insight @chris_bonafide! #PHMFellowJC |
| #PHMFellowJC @PHMFellowJC RT @freckledpedidoc: Thanks #PHMFellowJC for another great chat! I encourage folks to join #HHSVaxChat tomorrow at 1pm EDT! |
| John @jmomdphd RT @chris_bonafide: This sums it up really well @herchd - we need to get really clear on defining the essential goals of rounds and then design systems likely to get us the outcomes we've targeted - and study them. No staffing model is too crazy to try once... #blowupthesystem #phmfellowjc |
| Dan Herchline @herchd RT @chris_bonafide: This sums it up really well @herchd - we need to get really clear on defining the essential goals of rounds and then design systems likely to get us the outcomes we've targeted - and study them. No staffing model is too crazy to try once... #blowupthesystem #phmfellowjc |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @chris_bonafide: This sums it up really well @herchd - we need to get really clear on defining the essential goals of rounds and then design systems likely to get us the outcomes we've targeted - and study them. No staffing model is too crazy to try once... #blowupthesystem #phmfellowjc |
| Terry Kind, MD MPH @Kind4Kids Was great to work on this with @Jbbeck7 way back when he was @childrenshealth #PHMfellowJC |
| Blake Cirks, MD @BlakeCirks RT @Kind4Kids: For how attendings promote resident autonomy on rounds (in pediatrics, on family centered rounds), you might find our article adds to the discussion https://t.co/jeGkGqt3Qb #PHMfellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @herchd: Always disappointing when education seems to fall by the wayside! I feel like trying to find even the 1-2 minute gaps for a quick teaching point can really spice up rounds and break the monotony. #phmfellowjc |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood @medpedshosp @herchd @kedkyler I can attest to @herchd being an outstanding senior when I was a first year attending as a chief resident. He did excellent teaching on rounds and I learned quite a bit from him! #PHMFellowJC |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @herchd: How would this change if we trained residents to do more peer assessment? #phmfellowjc |
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