Student and Staff Member
Kapo Tam, USCF Medical Center
Martine Sargent, MD, emergency physician at San Francisco General Hospital, (left) demonstrates how to use ultrasound to identify the major blood vessels in the neck of UCSF research assistant and procedure volunteer Ian McAlpine (on the gurnee) while Daniel Montes, MD, (center) and Reina Rodriguez, MD, hospitalists from Alta Bates Summit Medical Center in Oakland, Calif., look on.
Mini-college participants were issued temporary visitor privileges at UCSF, name badges and lab coats. “So much of our planning for this experience was about getting [participants] into the hospital, and to offer [them] a set of knowledge and skills that may be new or taught in a new way, which [they] can apply in [their own] hospitals,” says Arpana R. Vidyarthi, MD, a hospitalist at UCSF and mini-college co-chair.
The first session, hosted by Gurpreet Dhaliwal, MD, assistant professor of medicine, nocturnist, and recipient of a distinguished teaching award at UCSF, led participants through an exercise in clinical reasoning, using a challenging case to exercise diagnostic skills. “When you leave medical training, the assumption is that you’re done, and you will get better and better on the job somehow through experience,” Dr. Dhaliwal explained. However, there is little in the literature addressing how doctors actually get better and what separates those who continue to improve from those who plateau in their careers. “What are the things doctors do to put themselves in the upper 10% of diagnosticians? We know from other fields that innate smartness rarely counts the most, and that expertise is not something that necessarily comes with experience.”
Dr. Dhaliwal recommends a program of “progressive reinvestment” in diagnostics—a deliberate practice of challenging mental processes and learning something new from every case. He also suggests regularly seeking feedback from peers, tracking down what happened to patients treated and whether the discharge diagnosis matched the hospitalist’s initial assessment, and even practicing diagnostic skills with sample cases like the New England Journal of Medicine’s “Case Records of the Massachusetts General Hospital.”
Kapo Tam, USCF Medical Center
Dr. Josephson explains how to conduct a fast but high-yield neurological exam on the run in the hospital setting. The three-day mini-college limited participation to 27 hospitalists in order to facilitate small-group learning.
Participants broke into small groups to visit hospital wards with UCSF neurologists and intensivists, discuss actual cases and practice their examination skills at the bedside. H. Quinny Cheng, MD, a hospitalist and director of the UCSF’s medical consultation and neurosurgery co-management services, walked them through current research and controversies in the pre-operative evaluation and management of surgical patients, including recent data on the use of anti-coagulants, beta blockers, deep vein thrombosis prophylaxis, and drug-eluting coronary artery stents. UCSF respiratory therapist Brian Daniel, RRT, reviewed recent advances in ventilator equipment, including the high-flow nasal cannula.
S. Andrew Josephson, MD, a neurologist and director of the neuro-hospitalist program at UCSF, says hospitalists generally do not have time for full neurological workups on their patients. He suggests high-yield results can be derived from quick assessments of patients’ language, gait, and visual fields.
Kapo Tam, USCF Medical Center
Dr. Lewis (left) practices central venous access technique under the watchful eye of Dr. Kwan.
“I thought the neurology session was fantastic,” says participant Marcus Zachary, MD, group leader for Cogent Healthcare of California at St. Francis Memorial Hospital in San Francisco. “I know across the country hospitalists are being asked to bear a heavy load in this area, and we’re not really prepared. Neurologists don’t want to come into the hospital, and hospitalists increasingly are plugging the gap.”