#26 Pearls from the Alliance of Academic Internal Medicine AIMW23: Feedback, Failure, and Clinic Transformation

April 18, 2023 | By Molly Heublein

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Part 1 with Drs. Kate Cahill, Shobhina Chheda, Anne Montgomery, and Abby Spencer

Join us as we sit down in person with Drs. Cahill, Chheda, Montgomery, and Spencer to talk about our favorite parts of Alliance for Academic Internal Medicine AIMW23 in Austin, TX April 2023.  We cover the importance of setting boundaries, improving continuity clinic experiences, using radical candor in feedback conversations, and more.  Dr. Chheda even brings us to tears with her discussion of using failure and sharing vulnerability to grow and support each other.  Get inspired to make the most out of your next conference and build your skills as a medical educator!

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Show Segments:

1. Dr. Shobhi Chheda’s Introduction
2. Dr. Kate Cahill’s Introduction
3. Wellness Takes Homes – Set Boundaries
4. Women in Medicine Precourse – learn from failures
5. Dr. Montgomery – Transforming Continuity Clinic
6. Update on Medical Education Scholarship – Narrative Evaluations
7. Faculty Development Strategies to Optimize Milestones 2.0 Assessments
8. Radical Candor in Feedback Conversations
9. Dr. Abby Spencer’s Introduction
10. Dr. Spencer’s Pearls
11. Responding to Microaggressions
12. How to Make the Most of a Conference

Pearls from Alliance for Academic Internal Medicine #AIMW23 Show Notes

Wellness – Setting Boundaries

Dr. Cahill highlights some main points from the Wellness Precourse.  We are all leaders if we impact other people.  It is important to set boundaries for ourselves, and as leaders, we should be helping others set boundaries.  Dr. Cahill’s take home is to help her team set boundaries; specifically she recommends establishing expectations for when responses are needed and giving people the space not to reply on nights and weekends.

Women in Medicine Leadership Development Precourse: Failing Forward: When Silver Linings Come with the Clouds

Presented by Dr. Rakhee Bhayani with panel speakers Drs. Grey, Mourad, and Spencer

Dr. Chheda and Dr. Spencer share main takeaways from the Women in Medicine Leadership Development Precourse which focused on learning from failures and sharing vulnerability.  Vulnerability can be used to tap into your “superpower”. Write your own story, don’t let others take the pen.  Be scared and then do it anyway. 

A Five-Year Plan for Resident Clinic Transformation  

Presented by Drs. Doroshow, Larson, and Surkis from Main Line Health System

Dr. Montgomery spoke about the highlights of this workshop on transforming continuity clinics.  There is a  shortage of primary care graduates. Main Line Health System shared their success with transforming their ambulatory curriculum.  Having institutional and stakeholder buy-in is key.  Identify the drivers of dissatisfaction that are unique to each primary care training experience to be the target of interventions. This work takes time. Dr. Montgomery is starting a new residency program and plans to take home tips on how to improve patient continuity,  optimize the EMR, and enhance office efficiency.  Even for residents who are not going into primary care, this training is important as most physicians will have ambulatory clinic time.

Predictors of Faculty Narrative Evaluation Quality in Medical School Clerkships, by Mooney et al

This study looked at the quality of narrative evaluations using the Narrative Evaluation Quality Instrument (NEQI).  The longer the delay in completion of  an evaluation, the lower the quality of the evaluation.  Women faculty were found to provide higher quality written evaluations.  Reassuringly, the gender of the learner did not impact the quality of evaluations.  

Faculty Development Strategies to Optimize Milestones 2.0 Assessments

Workshop presented by Drs. Cahill, Jeremiah, Khawaja, and Simmons

Dr. Cahill and her group presented techniques for improving feedback from faculty. This session was full of valuable take home tips you could operationalize at your institution. They used a multi-component approach to training faculty on the milestones including short asynchronous audio slideshows, “Faculty Five in 5” (available on youtube), and standardized pocket feedback cards.    

Dr. Cahill’s 5 Step Approach to Feedback: 

1. Map the month: Anticipate what kind and how many evaluations you will need to complete. Determine overlap with learners.
2. Develop situational awareness: Create feedback goals based on time you will be together (a learner you will overlap two days with is very different from one you will spend two weeks with; a medical student is expected to show certain skills that will differ from a third-year resident).
3. Create a template: Make a shorthand summary of the topics the formal evaluation covers (note specific milestones) with the goal of knowing what you are looking for in your learners before your time together.
4. Observe and record: Develop a system for recording observations and capture your thoughts in real time.
5. Submit: A completed clinic evaluation is better than a perfect but incomplete evaluation. 

Making a small upfront investment in time can go a long way. 

He Didn’t Just Say What I Think He Did, Did He? Addressing Racism, Harassment, and Microaggressions in the Clinical Learning Environment

Presented by Drs. Akhtar, Banerjee, Fletcher, and Vipler (of Penn State University and the University of Colorado)

Microaggression Bystander Intervention Training: LIFT

Presented by Ananthakrishnan MD, DiNicola, Govindraj MD, and Visconti MBA

A workshop about how to respond to microaggressions. Ask your learners at the start of your time learning together, “I hope these don’t happen, but unfortunately microaggressions do occur.  If a microaggression occurs while we’re on service together, how would you like us to handle that?” Some learners may prefer to speak up for themselves, while others would expect the attending to step in, while others may be most comfortable talking it through privately after the fact.

Tips for how to Make the Most of a Conference

Preplan who you most want to meet and what topics you most want to cover. Get together with your team to divide and conquer.

Think about who is not present at the conference. If you see material that they could benefit from, pass it on.

Take time for those hallway conversations to build relationships and share ideas.

Plan for post-conference CME time to reflect on the conference.  Take a day to reflect on your own, or plan a meeting for the attendees from your institution after the conference to talk about what you want to bring to your organization. If you don’t take time to consolidate what you have learned and plan how you are going to apply this new information, your progress will be limited. 

Links

Mooney CJ, Pascoe JM, Blatt AE, Lang VJ, Kelly MS, Braun MK, Burch JE, Stone RT. Predictors of faculty narrative evaluation quality in medical school clerkships. Med Educ. 2022 Dec;56(12):1223-1231. doi: 10.1111/medu.14911. Epub 2022 Aug 23. PMID: 35950329.

Goal

Listeners will be served delicious knowledge food from #AIMW23.

Learning objectives

After listening to this episode listeners will…

1. Review key academic internal medicine conference (AIMW23) practice-changing pearls.
2. Receive updates on medical education and pearls for clinician educator careers.

Disclosures

Drs. Kate Cahill, Shobhina Chheda, Anne Montgomery, and Abby Spencer report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Cahill K, Chheda S, Montgomery A, Spencer A, Heublein M, Kryzhanovskaya E. “#26 Pearls from the Alliance of Academic Internal Medicine AIMW23: Feedback, Failure, and Clinic Transformation”. The Curbsiders Teach Podcast. https://thecurbsiders.com/teach.  April 18, 2023.