Education Reboot

Hi everyone,

With the pandemic winding down (hopefully), we can finally start to tackle deep educational questions, which COVID kept us from addressing. The questions include daunting challenges and exciting opportunities:

1. Goodyer: Because available spots on the firm are currently limited, many Traditional residents graduate without experiencing Goodyer, missing key opportunities to learn non-ICU cardiology. Next year, with more interns entering our program, we should be able to add PGY1s to the service, so most if not all Traditional residents can rotate on Goodyer at least once during training.
2. Evaluation and feedback: For too long, our program has struggled with both the quantity and quality of feedback. To be fair, many of you reliably provide exceptional feedback but, sadly, many requests on MedHub never return- sometimes because they go to the wrong person and sometimes because they’re ignored. Moreover, comments are often littered with meaningless suggestions like “read more” or “keep up the good work,” which don’t help trainees improve their performance. Next year, under the leadership of Drs. Matt Grant and Paul Bernstein, we plan to resurrect “Feedback Fridays” to ensure time is set aside to provide feedback; pilot a smartphone app to ease documentation; and offer specific guidance to faculty and residents to improve the quality of their assessments and advice.
3. Conference Time: Morning Report remains our most popular teaching conference, but the 9:30A start time keeps many residents from attending, particularly because non-East Pavilion teams continue to round. We’ve tried other times, including 7:30A and 11A, without increasing attendance, and reports from peer programs suggest afternoon Report would fail too. During this year’s interview season, we had substantially better attendance at noon, so next year, we’re going to pilot lunchtime report. Doing so will mean our popular noon didactics would be held at another time. Thankfully, all didactic conferences are recorded and, regardless of when they’re held, residents can watch the videos whenever time allows. We don’t know if the new system will work, but it’s worth piloting.
4. Conference Attendance and Venue: It is longstanding program policy that all residents should attend Report and didactic lectures. Philosophically, we value trusting residents to attend these conferences whenever they can, barring medical emergencies and conflicts, which is why we don’t take attendance. This philosophy will remain, though it’s important to state clearly that attendance is expected, because the teaching is high quality and essential. We’ve also learned over the past year that virtual learning has expanded opportunities for residents to attend conferences when they couldn’t come in person, for example when they’re off site. Remote learning has facilitated joint conferences, for example, combining VA and YNHH Report. Next year, we plan to offer hybrid conferences, combining both remote and in-person learning. It’s important to get back together again, to share meals and coffee, but we also want to offer remote learning to those who can’t otherwise attend.
5. Journal Club: Next year, Drs. Joseph Vinetz and Rupak Datta will be assuming leadership of Journal Club. They’re planning an exciting curriculum that will focus on topics like statistics and study design. They will also offer guidance on article choice and preparations to maximize the value of these essential conferences.
6. Expanded ambulatory and quality/safety education: While our current conference schedule offers robust exposure to inpatient topics, we’ve had an insufficient number of conferences focusing on ambulatory clinical problems as well as quality and patient safety. With the help of our CRQS and ambulatory Chiefs, we hope to rectify this deficit this year.
7. Team Structures: One of our program’s distinguishing and most attractive features is the 1:1 resident to intern ratio. Our system offers many benefits, including enhanced teaching and mentorship opportunities as well as resident continuity when sister residents have the day off. The 1:1 ratio also allows more residents to access specialty rotations. That said, we have to acknowledge that our system places a lot of residents on service at the same time, which thins our backup pool and limits other experiences residents could have. Some have also asked if a 1:2 model would better prepare residents for larger patient loads after they graduate. To be sure, our residents do manage large loads throughout residency, for example in the MICU, where the ratio is 1:2, and on days off where the ratio is functionally 1:2. At the VA, where we hope to eliminate 28-hour call next year, the ratio would also be 1:2. So, at present, we will continue 1:1 on most firms, and we believe we’re providing an ideal balance of comfortable staffing and stretch experiences.
8. New Admissions: As the hospital gets increasingly busy, more patients than ever are spending extended periods in the ED, waiting for floor beds to open. As a consequence, many patients are “admitted” by hospitalists, which means interns are getting more holdovers and fewer fresh admissions. In theory, interns could go to the ED to admit these patients, but since we can’t know which floor patients will ultimately go to, we’d risk having interns admit patients they would never see again. We could solve this problem by eliminating geographic admitting, but doing so would undermine the huge benefits of assigning teams to specific locations. Perhaps the issue will resolve as the pandemic subsides, but we can’t be sure. We don’t have any specific plans yet to address this issue, but we need to monitor the problem and work to return the numbers of new admissions and holdovers back into appropriate balance.
9. Expand upon our successes: We had a lot of exciting new initiatives this year that we plan to build upon, including:
   1. POCUS teaching, particularly with under the leadership of Dr. Joseph Donroe and our POCUS residents.
   2. Expanded procedure training under the leadership of our Resident Procedure Team in collaboration with our hospitalist colleagues
   3. Continued anti-racism training, particularly with the official unveiling of the RBAM curriculum and continuing to highlight the impact of racism and bias in our teaching conferences
10. New initiatives: We also have new opportunities to pursue, including:
    1. Enhanced ambulatory geriatrics teaching under the leadership of Dr. Jennifer Ouellet and others.
    2. Increased use of the sim center
    3. Expanded ACLS training under the guidance of Dr. Elliot Miller with continued support from hospital leaders such as Laura Devaux and Kevin Sigovitch
    4. Creating protected teaching time on inpatient services
    5. Exposure to patient populations that we don’t see often enough (e.g., patients with sickle cell disease)
    6. Developing a night curriculum

It’s an amazing coincidence that COVID-numbers are decreasing as the new academic year approaches. Though it would be a mistake to assume the pandemic is ending, it’s not unreasonable to return our attention to crucial educational challenges and opportunities. As you can see, the list is long and undoubtedly incomplete, and we need your feedback. The fact that we had as successful a year as we did testifies to our program’s creativity and resilience. Special thanks go to the Chiefs for leading us and to all our residents for being flexible, enthusiastic learners. Thanks also go to residency and department leadership, the Executive Council, the PEC, and, especially, the many residents who gave me honest, constructive feedback and advice throughout the year. This is the kind of spirit that will lead us into an exciting, productive academic year, which starts just two months from now.

Have a good Sunday, everyone,

Mark