The Hospital Medicine Reengineering Network (HOMERuN) is a rapidly growing collaborative made up of more than 50 Hospital Medicine groups from academic and non-academic hospitals across the United States.
It can be challenging for academic hospitalists to balance the increasing clinical demands from hospital systems and resident perceived time constraints. We present a series of quick evidence-based educational tips to help hospitalists improve the efficiency and effectiveness of teaching rounds in this evolving landscape.
Maximizing Direct Observation Skills to Improve Feedback
By Eliza Bullis, MD and Christina Tsui, DO
Scenario:
It's the end of a very busy teaching week. As you prepare to meet with each learner for end of the week feedback, you struggle to formulate specific and actionable feedback for each learner. It seems they all did well overall, but you want to provide more insights for their growth rather than just "good job" and "read more."
Tip: Create a log of direct observations for each of your learners adding to it each day. Include something specific that they did well and one thing they might try differently. Utilize a variety of different snap shots of directly observed skills and interactions to create a more comprehensive, objective assessment of your learners' strengths and areas for growth. Reference your log of observations to provide high quality, specific summative feedback.
High yield opportunities for observation:
Before the day begins
Ask each learner what type of patient interactions are most challenging for them. Offer to observe that encounter and give direct feedback afterwards.
Pre-round on a select patient with the medical student. This enables you to observe the student taking a brief history and targeted physical while also counting as your patient visit for the day.
During rounds
Bedside round on select patients and focus on the communication between the student or intern as they present the daily plan to the patient.
During a new admission, observe part of an admission history and physical. For example: "Let's do the volume assessment when I join you."
As the team completes tasks
Utilize everyday interactions such as calling a consultant, nurse, or family member to assess the learner's interprofessional and interpersonal communication skills.
Assess triage and communication skills by observing responses on team group chat conversations.
Observe discharge counseling and patient education around transitions of care. For example: "I'll join you for the anticoagulation counseling this afternoon."
Sample database of observations to provide summative feedback for each team member.
This can be added to your paper patient list, to-do list, or electronically on a note taking app.
Learner
Encounter
Reinforcing (something done well to continue)
Constructive (something to improve on)
Jessie PGY1
Calling cardiology for consult
Prepared relevant history/labs/data ahead of time. Led with primary question. Clear, well formulated question for cardiology consultant.
Next time, relay urgency of consult and method/timeline for follow up.
Amal M3
Prerounds on Mrs. S
Pivoted and expanded hypothesis-directed history when patient reported new abdominal pain, and did a good job localizing the pain on exam.
Next time, spend more time on the abdominal exam and always include peritoneal signs to rule out a surgical abdomen.
