Grand Rounds Recap - 7/2/14

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EM: Past, Present and Future with Dr. Pancioli

  • Emergency Medicine started in 1960s with first "ER group" starting out in 1961. At that time the ED was the weakest and most neglected department in the hospital and was staffed by a variety of physicians (IM, family med, surgery, derm, etc), none of them EM trained.
  • Bruce Janiak was the first EM resident with the first EM residency at UC in 1970. This was a 2 year program with only 2 dedicated ED months.
  • ACEP was started in 1968 with only 8 initial members
  • EM was first a co-joint board in 1979 and became a primary board only in 1989
  • First ABEM exam was given in 1980 to 1600 people
  • 1982: ACGME approves EM training
  • EM now at UC: we are the 4th largest fiscal department of the hospital and one of the most respected departments. This is due to all the hard work and battles that our colleagues had to fight in the past decades.
  • Current EM in the US: 4200 EDs with 120 million ED visits/year
  • EM future: will become more competitive (just look at all the billboards), we will need more beds, and we will have more subspecialties.

Giving Bad News with Dr. McDonough

  • We give bad news in the ED very frequently: patient death, acute critical illness, new life-threatening or terminal illness, medical errors
  • Giving bad news in the ED is tough for a few reasons: we have no previous relationship with the patient,  the patient may not trust you, patient may have been previously normal, and you are very busy already
  • Tips for successful delivery of bad news:
    • Use the word "dead"
    • Use the social worker as a resource: ask them to come into the room with you and ask them in advance who is in the room and what their reaction might be
    • Do not bring your phone into the conversation, pass it to the attending.
    • Be mindful of personal safety: sit by the door and if the situation gets sticky, get out.
    • Cut to the chase: families want to know what is going on, so don't delay this by using medical jargon and giving unnecessary details
    • Do not say " I know how you feel" but it is ok to say "I am sorry" as this does not mean admission of guilt
    • Give a patient/family a fair warning by saying " I have some bad news"
    • When discussing a difficult diagnosis, say what you know and don't make up answers. Let patients know that while you may not have answers to all of their  questions, you will set them up with appropriate follow up/consult
  • Tips for admitting medical errors:
    • Admit guilt when it is your fault but do not throw anybody under the bus if it is not your fault
    • Explain to the patient what is being done in order to ensure that this mistake will not happen again
    • Be sympathetic, clear and honest

How to Give a Lecture with Dr. Miller

  • Adapt lecture styles of those you admire
  • Thank those who invite you for the opportunity to lecture
  • Formula to a good lecture P3 = Prepare + Practice + Pitch
  • Prepare
    • Plan: do your research; learn your audience; find out your audience's motivations, incentives and distractions,
    • Prioritize: Set a goal for yourself and your learners
    • Personalize: why is this topic relevant to your audience
  • Practice
    • Pillars: ethos (credibility of the speaker), pathos (emotional connection to audience), logos (logical argument)
    • Present: practice your presentation in front of somebody. Your colleagues may be too wrapped up in the material that you present and may not pay enough attention to the mechanics of your presentation. Accept feedback, be malleable and brainstorm different approaches
    • Predict: Visualize how you will deliver your lecture, what your tone will be and how the timing will work
  • Pitch
    • Punctuality: be on time and end on time, transition every 10 minutes to keep your audience involved
    • Participation: have a dialogue with your audience but do not pimp. Interaction promotes active learning, heightens attention and motivation and increases satisfaction
    • Passion: Look at your audience, have fun, move deliberately, pause and give it your personal best
  • Errata
    • Be careful with jokes, especially in groups where you do not know everyone personally
    • Anticipate questions and consider preparing extra slides to answer common questions
    • Tell you audience what you are going to tell them, then go ahead and tell them, then tell them what you just told them