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ALiEM’s Greatest MEdIC Hits for New Academic Faculty: A Curated Collection of 8 Cases

Ok, while we congratulated the senior residents in our last piece, but let’s be honest, YOU (the junior faculty members) are the ones who TRULY should be congratulated. You’ve survived residency, and now you’re the boss!

You’re probably sighing with relief at the moment. But eventually, you’ll ask yourself: “Now, what’s next?” Well, yet again, the ALiEM MEdIC team has some resources for you!

medic document

As a new faculty member at an academic or community teaching site you have entered a vast and complicated world! Academia can be a stressful and confusing world. That is why four years ago, we started the ALiEM Medical Education in Cases series. In a few days, we will be officially releasing our MEdIC Series Volume 3 e-book as well. Stay tuned! (Hint: the link may already be on our MEdIC home page!)

Below is a curated collection of cases we think are especially important for junior faculty members to read and consider.

The MEdIC Team Recommendations for New Attendings

1. The Case of the Patient with a No Learner Policy (Case 3.2)

As new faculty, you’ll never have to introduce yourself again as “the resident doctor”. However, what happens when patients refuse to see your learner and only wish to speak to you, “the real doctor”. This case provides scripts and tips that residents and new faculty can use to help patients understand the team based approach to care in teaching hospitals and how to debrief with residents during these encounters. Patients are not obligated to have learners. Knowing how to educate patients about how learners benefit care can go miles to building a therapeutic relationship and defusing tensions.

2. The Case of the Unexpected Outcome (Case 1.9)

While we recommended this for the senior residents last week as well, we feel that this case is also very important for new faculty members who are starting out in independent practice. Despite the best training, good intentions, and conscientious practice, at some point we are all going to miss a diagnosis. Unfortunately, this inevitability does little to soften the blow when we hear our colleague say “Remember that patient…”. This case explores exactly this scenario and is helpful reading for junior faculty both before and after they have their first “miss.”

3. The Case of the Late Letter (Case 2.4)

We all go through it…. the dreaded residency matching process in which we scramble to find that last reference letter to complete our portfolio. As electives season starts, you may soon be on the other end of a letter of recommendation! But how do we go about this process and when is it reasonable to ask a faculty member for a letter? This case provides guidance not only to our medical student cohort but also to our junior faculty members who are still learning to navigate and balance the challenges of clinical medicine, student education and administrative responsibilities.

4. The Case of the FOAM Faux Pas (Case 2.8)

Social media use is ubiquitous by trainee. Anecdotally, junior Faculty are both active on social media and much more likely to be connected on social networks with their trainees and other health professionals. As a result, they are not as well equipped to police unprofessional behavior online and more likely to see it. This case provides guidance on what to do when you see inappropriate or unprofessional behavior online.

5. The Case of the Fibbing First Year (Case 3.7)

Maybe you never ever lied or exaggerated as a trainee, but now that you’re an attending, you might find that sometimes the residents start to fib around you. This case highlights a situation that many of us have encountered – a student who fabricates some details of the patient history to appease their supervising staff. Why do these learners feel pressured to fib in the clinical setting when lives are literally at stake? Do faculty influence or even bring out this behaviour in their learners? How do we approach cases like these and prevent them from occurring?

6. The Case of Shifting Expectations (Case 4.5)

Junior and senior staff alike struggle with the overconfident senior resident. How do we help guide and develop their clinical practice, loosen the proverbial leash to foster independence and maintain control of “our” department at the same time?

7. The Case of the Failure to Fail (Case 4.8)

This case discusses one of the most bemoaned problems in medical education: the failure to identify, effectively assess, and remediate learners that are not meeting expectations. As anyone who has failed a learner before knows, it is often a lot less work and hassle to “pass the buck” and let someone else deal with this. However, intrinsically we know that for the safety of our patients, we need to do better. This case provides guidance to junior faculty struggling with how to address the struggling learner.

8. The Case of the Lazy Learners (Case 4.6)

The hidden curriculum is pervasive in medicine. Often, we are so embedded in the culture of our profession it may be difficult to spot its often nefarious features. This case raises awareness of the potential impact of the flippant comments that we may hear or make in the course of our workday that contribute to this culture and provides a roadmap for how we may address them with timely, specific feedback. It is essential reading for new Faculty who are well positioned to improve the culture of their educational programs and health system.

Teresa Chan, MD
ALiEM Associate Editor
Emergency Physician, Hamilton
Assistant Professor, McMaster University
Ontario, Canada + Teresa Chan
Brent Thoma, MD MA
ALiEM Associate Editor
Emergency Medicine Research Director at the University of Saskatchewan
Editor/Author at CanadiEM.org
Brent Thoma, MD MA
Alkarim Velji

Alkarim Velji

Emergency Medicine resident
University of Manitoba;
Junior Editor, Canadiem.org
Tamara McColl, MD FRCPC MEd(c)

Tamara McColl, MD FRCPC MEd(c)

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba
S. Luckett-Gatopoulos, MD MSc

S. Luckett-Gatopoulos, MD MSc

Emergency Medicine resident
McMaster University
Junior Resident Editor, BoringEM.org