What is "contextualizing" patient care?

StethoscopeZoomMedicine is as much about Science as it is about Art. This is no better illustrated than an educational intervention study about “contextualizing” patient care, published in JAMA.

What is contextualization?

It is the “process of identifying individual patient circumstances (their context) and, if necessary, modifying the plan of care to accommodate those circumstances”. In other words, this is care beyond the evidence-based guidelines, beyond standardized quality measures, and beyond the checklists.

(more…)

2016-11-11T19:00:27-07:00

Article Review: Student documentation in the chart

MedicalRecord

Do you have medical students rotating in your Emergency Department? Are they allowed to document in the medical record?

Charting in the medical record is the cornerstone of clinical communication. You document your findings, your clinical reasoning, and management plan. The medical record allows communication amongst providers. Chart documentation is a crucial skill that every medical student should know, as stated by the Association of American Medical Colleges (AAMC).

(more…)

2016-11-11T19:00:30-07:00

Article Review: Rethinking the premed requirements

PremedThink back to your college years. Remember those premed courses that you had to take? Biology, chemistry, physics… oh my. How helpful were these in your preparation for medical school and clinical practice?

In 1981, the Association of American Medical Colleges assembled a group, the General Professional Education of the Physician and College Preparation for Medicine (GPEP) to relook at these premed requirements. In 1984, the published a report “Physicians for the Twenty-First Century”. They advocated that the intensive premed requirements overly skews students’ education towards a “narrow objective of medical school admission”. Education is not balanced to include broader liberal arts learning, which may teach students more about humanistic values and communication skills. 

(more…)

2016-11-11T19:00:31-07:00

Article Review: Use of Effective Questioning

3D Character and Question MarkAsking effective questions is a valuable skill for any teacher. As a junior faculty member working to improve my teaching, I’m often in awe of my more experienced colleagues when I have the chance to watch them teach. At times, it’s quite easy to pick out the skills that they put into action but occasionally, their expertise is much more subtle.

Effective questioning falls into this category.

(more…)

2016-11-18T10:05:48-07:00

Article Review: Premature diagnostic closure


DrugsAlocholYou are taking care of a patient, who frequently presents to the ED for polysubstance use. You are pretty sure his altered mental status is from polysubstance use again. He was found in his home next to drug paraphernalia. He intermittently becomes severely agitated, and so you give him sedatives. He has a low-grade fever, but you attribute that to his psychomotor agitation and likely stimulant use. Because he remains confused and lethargic after 8 hours, you admit him to an inpatient team to await further metabolism of his recreational drugs and your sedation medications.

 The next day, you learn that had meningoencephalitis.

(more…)

2016-11-11T19:00:36-07:00

Article Review: Evaluating students using RIME method

GradeHow do evaluate medical students and residents, who are rotating through your Emergency Department? Do you have a structured framework for assessing their competencies?

Have you heard of the RIME method of evaluating learners on their clinical rotation? Dr. Lou Pangaro (Vice Chair for Educational Programs in the Dept of Medicine at the Uniformed Services University) published a landmark article in 1999 on his simple yet effective approach in evaluating medical students and residents. I had the pleasure of briefly meeting Dr. Pangaro when he gave CDEM’s keynote speech in 2008. 

(more…)

2016-11-11T21:41:13-07:00