Two Pills Tips: Making Rounds More Well-Rounded!

09/04/18 • 8 min

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Resources: http://pediatrics.aappublications.org/content/early/2015/12/07/peds.2015-3679 https://www.ncbi.nlm.nih.gov/pubmed/?term=24004439 This topic is a little different from our didactic-focused interventions. However, for those of us who participate in rounds or any experiential education in patient care, I think it is an important question. When I think about rounds, I think about how beneficial it can be for all participants. The process encourages attendings or faculty to teach, residents to both teach and learn as part of practice, and students to learn. However, I have also seen a less enthusiastic approach to rounds. Sometimes, it is just getting through the morning to move on to discharges, clinic follow up, etc. So, I started thinking-how can we make rounds a more well-rounded experience? Bedside rounds, or family-centered rounds in pediatrics, can be defined as conducting attending rounds, including patient presentations and discussions, in the patient’s room with nursing and family present. If you look around an ICU team (as an example) and consider the amount of salaries standing in a circle (physicians, residents, nurses, pharmacists, case managers, social workers, dieticians, PT/OT, and more)-it would behoove us to make the best use of each professional’s time. Areas of education in rounds include skills such as bedside physical examination teaching, effective communication, and encouragement of trainee independence. A first step to improving the educational experience on rounds is to have a specific plan/road map. Preparation instills confidence in both the teacher and the learner and facilitates the learning process. It allows you to maximize the learning outcomes rather than just repeating the same process day after day. Defining each person’s role on the team has multiple benefits to improving education on rounds. This ensures that each person is involved, breaks down barriers between educator and learner, engages the team, maintains interest, ensures efficient rounds, validates the learner’s input, and allows equal opportunities between learners. Devise a plan beforehand on what can be taught to act as a guide but still be flexible to improvise. No two days of rounds will be the same. Having a plan also allows for good time management and prioritizes educational opportunities to focus on the learner’s needs. I have seen this be successful in a variety of ways. For example, presentations and team goals can be set at the beginning of the week. Each presentation is then planned and topics are decided on, therefore providing clear expectations. Some attendings will choose to review a certain article in the main journal of their expertise. It becomes a group discussion facilitated by the attending and allowing the attending to provide his/her expertise. Some residents have created quizzes based on topics discussed during the week. Other residents may opt to review an OB strip each week or an EKG each week just to provide exposure to the team. If you are able to collaborate with another department, maybe your team visits radiology once weekly, pathology once weekly, or microbiology once weekly. One resident I worked with had a focus on physician wellness and started each day of rounds with DzGratitude Roundsdz where each team member said something that they were grateful for..... Full content available at twopillspodcast.com

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Follow the Yellow Brick Road!

Interview with Dr. Diana Rangaves! Dr. Diana Rangaves is a pharmacist, philanthropist, and ethics professor turned writer. An accomplished educator, award-winning teacher, and business professional, she uses her powers for good. Diana is a foster mom for PapHavenRescue.org and lives in California with her dogs and pasture pets, in their forever home. She is the author of Embrace Your Excellence: A Psychopharmacology Primer and Mirror to the Soul and Escape into Excellence: Building a Foundation for Honest Decision-Making. References: The Four Agreements, Don Miguel Ruiz The Power of Myth, Joseph Campbell A New Kind of Science, Stephen Wolfram Resources: The Wizard of Oz, Alice in Wonderland, and Carpool Karaoke with Paul McCartney Questions? Comments? Recommend someone for an interview? Contact us [email protected] or find us on twitter @twopillspodcast! Highlights (full transcript at www.twopillspodcast.com): My teaching strategies are related to reading apprenticeship. In reading apprenticeship, we use interactive keywords and think aloud's, think pair and share, questions, and we map things. Critical thinking skills are embedded in reading apprenticeship. It is so important that once a student leaves school, they have those tools in the real world. For those of you who are considering a career in Health Sciences, you can change your environment, use your degree for multiple reasons, you are not just boxed in. After teaching for a while, I realized I could be teaching the same few courses forever. After a while, you can't integrate new stuff. I ended up writing two textbooks. They're called “Embrace Your Excellence” and “Escape Into Excellence.” “Escape into Excellence” talks about ethics and how to develop critical-thinking skills. It uses real-life case studies. It takes you from the beginning about what is ethics, what are values, how do we learn our values-all the way full circle to passing and death. How do we stand in silence and honor the people in our lives we care about who are ready to pass? “Embrace Your Excellence” is a psychopharmacology book. It introduces people to mental health, mental health issues, the pharmacology involved, including opiates and hallucinogenics. It adds the holistic piece to it with real life student cases and students writing about their experiences. It helped create a full package that students like. A lot of it was written by students for students. When I wrote, “Escape into Excellence,” we determined that all author royalties would go back to charity. Education is so important. For both “Embrace Your Excellence” and “Escape into Excellence,” all author royalties go back to Santa Rosa Junior College Foundation to support education. The royalties of my children's values book, “The Adventures of Rosie Posie Papillion,” go to pap haven rescue. It's a heart project and labor of love to impact and give back. We had to learn these skills on the fly when we got out, when we read a book, and here is a textbook that schools can use to further that endeavor. One topic was IV therapy. I brought in empty vials and bags and tubing. I gave them a scenario that included stuffed animals like dinosaurs, poodles, and others. Each doll had a flash card around their neck with a scenario. It Incorporated education, pharmacology, and calculations. Each team had a team leader who read the case. Each team member then took one of the questions And explained the answer to the other students. Each team member had a teaching moment. It gives them confidence, practice speaking, and all in a peer environment that was safe. No one was judging them, no one giving them a certain number of points, and it was a very relaxed environment. They were able to do every sensory experience within that one exercise. It is applicable to any topic. Don’t ever be afraid to step into the unknown. Fear is the worst reason in the world to do somethi

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Playing Your Cards Right with Dr. Meghan Jeffres!

Questions? Comments? Recommend someone for an interview? Contact us [email protected] or find us on twitter @twopillspodcast! Highlights (full transcript at www.twopillspodcast.com): Meghan Jeffres graduated pharmacy school from University of Wyoming, PGY1 at Intermountain Healthcare in Salt Lake City Utah, PGY2 at Barnes-Jewish Hospital in St. Louis Missouri, Assistant to Associate professor at Roseman University College of Pharmacy in Las Vegas Nevada, then back to Assistant at the University of Colorado Skaggs School of Pharmacy. She loves creating, doesn’t mind assessing, hates writing about it. L: I just have to say after knowing Meghan and working with her, I disagree with that last sentence. She is fantastic at all three of those. M: Quality of output does not necessarily mean enjoying the process. But thank you. I came in to Academia through the side door. The first classroom I was in was at Roseman, which is a 3 year accelerated program with a block schedule. Students are in class from 8 to 3 and you are responsible for that day. You have six hours to teach and spend that time with them. You are forced to schedule time in your lectures to do things. The time management is an interesting process to learn. Roseman really focused on Mastery of learning and it was a 90% pass-fail curriculum. On average, your curriculum should be 1⁄3 to 1/2 Active Learning. Since then, I have become an advocate for active learning. Now, I'm really looking at the scholarship of active learning. One thing that I thought would be mundane was going through worksheets. In the classroom, as infectious disease teachers, there is no standard textbook. We are often creating our own content. I give them that basic information ahead of time in a flipped classroom kind of way. Then, in class, we go through a skeleton of a workbook. I thought students might find it boring, but they are so into it. They think it's really effective. Handouts, worksheets, workbooks, or something I do all the time. Surprising part is that it is effective and yet rudimentary. It's not graded and all of it is focused on their learning and their benefit. What has not been effective was taking ID fundamentals and skipping a couple of steps. That led to asking them to apply things that they were maybe not ready for. That can be very frustrating for even your highest achieving students. It will cause them to check out. There has to be gradual steps from memorization to application in the real world. There can be assuming that they can make connection or links that haven't been assessed yet in the classroom. For someone who is new to teaching, I think the best thing is to sit in the classroom. It does not have to be your content area. You should go listen to both clinical and science folks. It takes time, but your first year as faculty is when you probably have the most flexibility to do it. If there is another pharmacy school nearby, broaden your horizons and go there to listen. There are two things to look for. One is what is the teacher doing and two how are the students responding. Sometimes it's hard to take something that you created and put it out into the world, even to your own classroom. It will be critiqued and picked apart. There's a concern that they will hate this thing that you developed or put time into. Is it going to be embarrassingly terrible? You have to be risk tolerant. It also comes with practice. You also get much better at planning. You do not want to wing it or just have it be a free-for-all. Things go sideways quickly. It comes from repeated efforts of trying new things. You will just get better at trying new things. That in itself is a skill. When I was first introduced to strength finders, I thought that was such a great concept. Stop trying to fix what you're bad at and go ahead and spend time in what you're good at. That felt like a permission slip for me. One of the