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This is not a Nephrology bashing thread, I swear! Lol
I previously did academic faculty for a year with residents fellows before I moved onto private practice and voluntary faculty (meaning if my patients are in the hospital, I see my own patients but involve the residents and/or fellows on the case if it is on the housestaff floor and/or is an interesting case, respectively). Therefore, I do a lot of heavy lifting myself. When no housestaff are involved, I write all the notes (like real notes, not that copy and paste BS autopopulate one line BS - then again I am a Generation Y who grew up with computers and can type very fast), do all the usual care coordination stuff with case management etc..., then follow up the same patients outpatient. I do my own billing (the EMR i use makes this easy) and coding, quality metrics, prior authorizations (the online portals makes this easy no excuses), and all the other stuff ancillary stuff. The point I am making is I am a very "do as I say and as I do" person. If i have housestaff on a case, I would round appropriately (versus a private treating the residents like PAs) and take some time to teach stuff. But if I notice an omission in the presentation or physical or something, I would not go all high and mighty. I would say okay lets see the patient and examine.
I've read this book so I will go to the lengths of doing all the less common physical exam techniques as a matter of principle in front of housestaff. Then comment how useless some of these things are in the current era (when patients are not waiting until the utmost end of TB hemorrhagic pericarditis as in the early 20th century, the Beck's triad for cardiac tamponade is a less sensitive set of physical exam findings) of medicine and with the obesity epidemic, many of these exam findings are not very robust. But we will still do them! If anything, I do it just so I can show those older attendings who keep lamenting "no one does physical exam anymore" that people still do it. I'd like to see Sir William Osler try to have a conversation with the modern patient population.
Then I bust out my smartphone ultrasound and start doing POCUS.
This whole process takes more time, but this "do as I say and as I do" approach works better for reinforcing key concepts to housestaff. I make up for the "lost time" by simply using the EMR very efficient on two screens (Extend) and typing super duper fast.
What is the point of this thread? Looking back on my medical training, there was a LOT of "do as I say, not as I do" approach from attendings (in IM and the subspecialties I trained in) and a lot of blame game. Well why didnt' you do this? Why not? You should have done this. Why not? Ok... nvm ill do it myself go write the notes for me on time. There was seldom meaningful rounds outside of computer rounds. Some attendings did walk to the bedside but it was just to listen to the patient complain about the food and stuff and the attending would just do a basic auscultation or something.
The only hands on attendings I had in my residency and fellowships were the ICU attendings. But academic ICU is just designed to be hands on from the procedures, POCUS, bedside TEEs, trach placement, etc...
I do realize why this is the case. There are so many paperwork and documentation requirements these days. But rather than complain about that, I just leverage technology to my benefit and become much faster and more efficient. Dual screens with extend and typing at 150WPM is the key. These are fairly easy from anyone from Gen Y onward who grew up with computers. But fret not boomers, when I become old, I will probably yell at the clouds about why holographic technology sucks and "in my day, I actually typed on a keyboard!"
Anyway, what is your teaching style?
I previously did academic faculty for a year with residents fellows before I moved onto private practice and voluntary faculty (meaning if my patients are in the hospital, I see my own patients but involve the residents and/or fellows on the case if it is on the housestaff floor and/or is an interesting case, respectively). Therefore, I do a lot of heavy lifting myself. When no housestaff are involved, I write all the notes (like real notes, not that copy and paste BS autopopulate one line BS - then again I am a Generation Y who grew up with computers and can type very fast), do all the usual care coordination stuff with case management etc..., then follow up the same patients outpatient. I do my own billing (the EMR i use makes this easy) and coding, quality metrics, prior authorizations (the online portals makes this easy no excuses), and all the other stuff ancillary stuff. The point I am making is I am a very "do as I say and as I do" person. If i have housestaff on a case, I would round appropriately (versus a private treating the residents like PAs) and take some time to teach stuff. But if I notice an omission in the presentation or physical or something, I would not go all high and mighty. I would say okay lets see the patient and examine.
I've read this book so I will go to the lengths of doing all the less common physical exam techniques as a matter of principle in front of housestaff. Then comment how useless some of these things are in the current era (when patients are not waiting until the utmost end of TB hemorrhagic pericarditis as in the early 20th century, the Beck's triad for cardiac tamponade is a less sensitive set of physical exam findings) of medicine and with the obesity epidemic, many of these exam findings are not very robust. But we will still do them! If anything, I do it just so I can show those older attendings who keep lamenting "no one does physical exam anymore" that people still do it. I'd like to see Sir William Osler try to have a conversation with the modern patient population.
Then I bust out my smartphone ultrasound and start doing POCUS.
This whole process takes more time, but this "do as I say and as I do" approach works better for reinforcing key concepts to housestaff. I make up for the "lost time" by simply using the EMR very efficient on two screens (Extend) and typing super duper fast.
What is the point of this thread? Looking back on my medical training, there was a LOT of "do as I say, not as I do" approach from attendings (in IM and the subspecialties I trained in) and a lot of blame game. Well why didnt' you do this? Why not? You should have done this. Why not? Ok... nvm ill do it myself go write the notes for me on time. There was seldom meaningful rounds outside of computer rounds. Some attendings did walk to the bedside but it was just to listen to the patient complain about the food and stuff and the attending would just do a basic auscultation or something.
The only hands on attendings I had in my residency and fellowships were the ICU attendings. But academic ICU is just designed to be hands on from the procedures, POCUS, bedside TEEs, trach placement, etc...
I do realize why this is the case. There are so many paperwork and documentation requirements these days. But rather than complain about that, I just leverage technology to my benefit and become much faster and more efficient. Dual screens with extend and typing at 150WPM is the key. These are fairly easy from anyone from Gen Y onward who grew up with computers. But fret not boomers, when I become old, I will probably yell at the clouds about why holographic technology sucks and "in my day, I actually typed on a keyboard!"
Anyway, what is your teaching style?
