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Five Strategies for Early Career, Academic Hospitalists


 

One of the challenges a new academic hospitalist faces is trying to become a valued member of the teaching faculty. You are intent on becoming that next great attending you have always aspired to be; however, no one has clearly guided you on making this transition. In our experience, a handful of common teaching pitfalls frequently unravel the best efforts of young hospitalists. Below, you will find five strategies to take your teaching to the next level.

1. Don’t Try to Be Attending AND Resident.

Being a hospitalist attending is distinctly different than being a resident. It certainly is not being a “super-resident,” PGY-4, or PGY-17 for the team. When challenged with a new role and greater responsibility, it is natural to default to a more comfortable position (i.e., the hands-on mindset of the resident), but by doing so, you encroach on the work of the actual resident on your team. Adult learning theory teaches that it is responsibility that is the cornerstone of adult motivation. Trainees must have a chance to perform the work expected of their position without interference.

Let the resident be the resident. To reach this goal, set clear expectations and discuss the expectations up front. Make sure that you draw a sharp line between where the responsibility of the resident ends and yours begins. Have your resident help set her own expectations for the team, as well. This empowers the resident and also gives you insight into her view of the team dynamics. Your expectations should vary with the ability of the learner and the time of year. For example, the degree of autonomy that you may give a second-year resident in July is much less than what you might give a ready-to-graduate, third-year resident in June.

If granting autonomy makes you uncomfortable, observe your trainees from a distance for your own reassurance. Read the electronic medical record in depth; follow up on orders after attending rounds. If you don’t like a treatment decision, step in without inducing undue shame. After all, this is why residents are still in training, and it gives you the chance to demonstrate how to turn good care into great care.

2. Make Sure You Get to Know Your Trainees

Getting to know your trainees seems so simple that it often gets overlooked. Yet this may be the way your teaching and role modeling make their greatest impact. For adults to thrive in a learning environment, inclusion is key. There is no better way to feel included than to feel known. Inclusion allows learners to feel comfortable with being vulnerable by answering questions, asking questions, interacting, and participating in a meaningful manner on rounds. Consider your own behavior: How comfortable are you asking a question among a large audience of strangers versus asking the same question in a small group of friends? Inclusion will affect behavior.

Engage in “biographic rounds” near the start of your time together. As the attending, set the example by telling your trainees about yourself. Let them know where you are from, where you trained, what led you to choose hospital medicine, and some details about what you do in your spare time. Personal information will help break down the artificial walls that separate attendings from trainees.

Allow every member of your team to tell his or her story. It may not seem like much to you, but the effect on learners has been well established. If you invest in them, they will invest in the team.

3. Make Time to Observe Your Learners

You are responsible for evaluation and feedback of all your learners. Many factors contribute to poor feedback, but one of the most important is that new attendings often do not make a conscious effort to observe their learners. These attendings struggle to give meaningful feedback.

Take time and take notes:

  • Take the time to watch your resident respond when the student is presenting her patient.
  • Take time to allow the resident or intern to conduct bedside rounds on his patient.
  • Take time to stop by on call to watch a student, intern, or resident take a history and perform a physical exam.

Even if you are unable to observe the whole encounter, there is little that gives you as much insight into your trainees as seeing them perform even part of a history and physical exam on a new patient. With time, a series of small observations will add up to a large number of specific comments.

Take notes on your trainees’ actions as you might do for your patients. This way, you have a record of what they did well and what needs work. Specific feedback will show that you paid attention and took the time to care about them as you would your patients.

4. Don’t Keep Your Thoughts to Yourself

All the facts your trainees need to learn can be found in textbooks and online resources. It is hard to compete with that amount of data. Access to these resources is greater than ever now, because residents can use their smartphones to find detailed information on any disease imaginable. It can be quite challenging for a trainee to apply this information to real patients, however.

Your job is akin to that of a syndicated columnist who is paid to give an informed narrative on the facts of the day. You must explain how the facts actually matter to patient care.

Think out loud. Explain your thoughts as much as possible. Do not assume that even your most senior trainees understand why you recommend a certain test or treatment. It is like algebra, where the teacher would never accept your answer unless you showed your work. For the sake of your learners, you must always “show your thinking.” They will learn as much from your clinical reasoning as they can from any canned talk on a subject.

5. Explicitly Plan Time for Teaching

“Thinking out loud” is a great way to teach, but a prepared talk can go into more depth on a topic. Yet how to find the time? The demands of a busy clinical service can overwhelm the best of intentions. Preparation is key. Good teaching does not happen by chance.

Set aside time for formal teaching outside of rounds. Be explicit as to when this will happen. Tell your team a day before, so they can prepare themselves or clear their time.

Have a handful of “canned” talks that you can give on topics related to common situations encountered in the hospital. They need not last more than 10 minutes. Always leave time for questions, and do your best to make them interactive. Even on a busy service, 10-15 minutes is reasonable for a brief, focused teaching session.

In Sum

Being an academic hospitalist with teaching responsibilities is highly rewarding. But becoming that next “great attending” requires an ongoing commitment to acquiring and developing your teaching skills.

Consider attending the SHM annual meeting or the Academic Hospitalist Academy to gain further knowledge on how to enhance your teaching career. In the meantime, try and practice some of the above tips—your learners may thank you. TH

Dr. Burger is associate program director of internal medicine residency in the Department of Medicine at Mount Sinai Beth Israel and assistant professor of medicine at Icahn School of Medicine at Mount Sinai, both in New York City. Dr. Miller is chief of the division of general internal medicine, associate chair of education, and associate professor in the Department of Internal Medicine at Saint Louis University.

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