#2 Level Up Your Rounding Skills with Drs. Geoff Stetson and Jennifer Spicer

December 21, 2021 | By Sarah Phoebe Roberts

Rounding, Teaching, and Team-building with the MedEdTwagTeam

Summary

Drs Geoff Stetson (@GStetsonMD) and Jennifer Spicer (@JenniferSpicer4) from the @MedEdTwagTeam take us on a deep dive on how to run effective teaching rounds.  We’ll help you improve your skills in creating rapport and inclusion, share concrete tips to be a better ally and upstander for your team, help you find a balance between autonomy and availability, and figure out how to fit teaching into a busy schedule.  Your team will thank you!

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Credit

• Show Notes: Sarah Roberts 
• Infographic and Cover Art: Andrew DeLaat
• Hosts: Christopher J. Chiu MD, Molly Heublein MD, Era Kryzhanovskaya MD   
• Editor: Clair Morgan of nodderly.com
• Guest: Geoff Stetson MD, Jennifer Spicer MD MPH

CME Partner: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Show Segments:  

• Intro, disclaimer, guest bio
• Guest one-liner
• Picks of the Week
• Case from Kashlak
• Creating Rapport on the Team
• Preparing for rounds
• Allyship and Upstanding
• Availability vs Autonomy
• Conveying Expectations
• Assessment and Evaluation
• Teaching Pearls
• Take Home Points
• Outro

Clinical Education Pearls

1. Promote trainees’ autonomy while providing support and encouraging open communication
2. Discuss allyship and upstanding from the start, and check in with your team about how to respond to and debrief from microaggressions. 
3. Normalize making mistakes and foster a ‘growth mindset’ that emphasizes improvement over perfection

Level Up your Rounding Notes

Check out the @mededtwagteam’s  tweetorial on clinical teaching.

Preparing for Rounds

Consider reaching out to the senior resident a week or two in advance to connect and discuss roles on the team, structure of rounds, preparing them to lead from day one.  Depending on your service, it may be best to start off the first morning sharing the plan for the day, then set the expectation that the senior resident/fellow is going to be leading things from then on.  

Consider reaching out to the prior attending about what specific learners are working on, while keeping in mind that this can perpetuate bias, so keep an open mind.

Create Rapport and Foster Inclusion 

Make sure to introduce all members of the team and take some time to get to know each other as individuals.

Start with an open ended ‘getting to know you’-type question.  Instead of asking people where they’re from (which can have loaded connotations), try: “what does home mean to you?” or “what’s a food that reminds you of home?” 

Set goals with learners and ask what they want to accomplish.  Dr Spicer tries to share her values for the team without a long intro spiel.  (Lane 2013)

Allyship and Upstanding 

Allyship as an attitude and a commitment to helping everyone feel comfortable in the clinical setting, and then upstanding is the act of demonstrating allyship.

Justin Bullock, MD’s recent paper is a great resource on how to address microaggressions in the clinical setting. He breaks it down into three steps: pre-brief, the actual addressing of the microaggression in the moment, and then a debrief.  

A pre-brief could be saying ‘Bias and discrimination are present in our clinical space and microaggressions are going to happen.  Whether they’re based on race, gender, sexual orientation, or body habitus, biases are going to happen.  And I want to be the best ally I can for all of you.  Not every learner wants the same thing, and it’s really important to ask them deliberately ”‘if something were to happen, what would you like me to do?”  Dr Stetson discusses this as a whole group, because some people might not know how to answer, but others may, and it can be enlightening.

In the moment: When handling a microaggression, remain conscientious of your position and privileges and honor the lived experiences and biases trainees have likely encountered. 

Debrief: Allow team members to have agency in responding to the incident.  What happens in the instance is important, but making sure everyone knows you’re on their team upfront and then talking about it and getting feedback on how you did is really important afterwards.

Availability vs Autonomy

Share your cell phone number and create a secure team group chat (e.g. WhatsApp).  Appropriately lighthearted conversation and humor helps build rapport. 

Promote trainees’ autonomy while reassuring learners you are supportive.  Consider checking in in person or via text at the end of the day/shift or before bed.  The extent and frequency of contact will vary by trainee (e.g. a 2nd year resident may have different support needs than a fellow).   Dr Spicer’s strategy is to spend the first two days closely monitoring learners’ practice to get a sense of their skillset and comfort level, and to gauge what areas the trainee may need more support in.    Dr Stetson monitors how closely a resident checks in with questions/insecurities.

Be open with the team about the preparation you are doing ahead of rounds to complete necessary work, allow rounds to focus on sharing discussion instead of reiterating data if you’ve already reviewed it.

Convey Clear Expectations 

Reduce mental load by sharing important basics– when does the team meet, when to eat, etc

Consider emailing a brief summary (one-pager) to share in advance that addresses goals and expectations for the team, but be aware that this does not convey tone.  

Assessment and Evaluation

Reassure learners that it’s okay to make mistakes: foster a ‘growth mindset’ among the team that emphasizes learning and applying feedback to improve performance, not perfection.  Model learning from one’s mistakes; acknowledge your own knowledge gaps and opportunities to improve.   

Teaching Pearls

Cultivate humility and challenge impostor syndrome by being transparent about what you know and don’t know and the strategies you use to refresh your own clinical knowledge.  Cultivate curiosity and let trainees teach you or look for answers together.  

When teaching on rounds, choose a single pearl to teach for each patient.  Think about this ahead of time and prepare one thing for established patients.  A tip from Dr Chiu: write down the teaching pearls you go over while rounding, and send a summary email to the team every day.  The length of the summary helps assess whether you spent enough time–or too much time–rounding.

Commit to a time to teach!  Set aside 10 minutes before rounds or cap rounds at 90 minutes to create space for 15 minutes of focused, didactic teaching to learners.  Limit rounds to seeing 4-5 patients that have learning opportunities and see other patients by yourself (Gonzalo JGIM 2013).

Learn to write learning objectives to focus your teaching.   Bloom’s taxonomy is a great starting point for optimizing learning objectives to take your teaching from ‘average’ to ‘great’ (Adams 2015). 

Take home Points

Being a good teacher requires preparation and intention.  

The learning climate and the environment you set on the team is the most important thing to the success of learners: so before all else, make the team environment fun, comfortable, and one where learners are encouraged to grow. 

Links

1. Mindset: The New Psychology of Success by Carol Dweck
2. Doctors’ Orders: The Making of Status Hierarchies in an Elite Profession by Tania M. Jenkins
3. The Human Doctor podcast by Dr. Kimberly Manning and Dr. Ashley McMullen
4. Era’s pick of the week: Mi Goals Goal Digger planner
5. Chris’ pick of the week: Trapper Keepers are back in style
6. Bullock, Justin L. MD, MPH; O’Brien, Meghan T. MD, MBE; Minhas, Prabhjot K. et al. No One Size Fits All: A Qualitative Study of Clerkship Medical Students’ Perceptions of Ideal Supervisor Responses to Microaggressions, Academic Medicine: November 2021 – Volume 96 – Issue 11S – p S71-S80 doi: 10.1097/ACM.0000000000004288
7. How Learning Works: Seven Research-Based Principles for Smart Teaching by Susan A. Ambrose, Michele DiPietro, Michael W. Bridges, Marie K. Norman, Marsha C. Lovett
8. Small Teaching: Everyday Lessons from the Science of Learning by James M. Lang
9. Make It Stick: The Science of Successful Learning by Peter C. Brown, Henry L. Roediger III, Mark A. McDaniel 

Goal

Listeners will review best practices for attending on a hospital team to aid learner development.

Learning objectives

After listening to this episode listeners will…  

1. Identify key practices for successful teaching on your team in the hospital
2. Define allyship and upstanding
3. Describe techniques to balance autonomy and availability as the attending 
4. Identify specific approaches to integrating teaching into hospital rounds

Disclosures

Dr Jennifer Spicer and Dr Geoff Stetson report no relevant financial disclosures. The Curbsiders Teach report no relevant financial disclosures. 

Citation

Spicer J, Stetson G, Chiu C, Kryzhanovskaya E, Heublein M. “#2 Level Up your Rounding Skills”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/teach. Dec 21, 2021.