Grand Rounds Orientation and Lecture on Teaching Hospitals

1. Amiri Medical Education Grand Rounds Orientation and Lecture on Teaching Hospitals Fahad Al-Ghimlas, MD September 22, 2014

2. Thanks to.. • Anil Thussu • Awsan Al-Muhaini • EhabMakram • Eisa Al-Khaldi • Faisal Al-Roumi • Ghadeer Akbar • M. Kapoor • Manal Al-Zaabi • Nada Al-Hasan • Narayanan • NoorAlmutairi • Talal Muzaffar • Raja Dashti

3. Thanks to.. • Anil Thussu • Awsan Al-Muhaini • EhabMakram • Eisa Al-Khaldi • Faisal Al-Roumi • Ghadeer Akbar • M. Kapoor • Manal Al-Zaabi • Nada Al-Hasan • Narayanan • NoorAlmutairi • Talal Muzaffar • Raja Dashti

4. Just the Start! Yet Should be Good One!

5. Amiri Medical Education Grand Rounds Orientation Fahad Al-Ghimlas, MD September 22, 2014

6. Amiri Educational Committee – • Also Supporting.. • AMSD • AMIRI Group (Amiri Medical Initiative for Research and Innovation) • Amiri website • Teaching undergrad and postgrad students and residents • Exam preparation

7. Amiri Educational Committee – • Current Responsibilities and Objectives.. • Morning Report • Grand Rounds • Morbidity and Mortality Rounds • Summarizing and Preparing Guidelines, Teaching Materials, and Handouts  

8. Amiri Educational Committee – • Current Responsibilities and Objectives.. • Morning Report • Grand Rounds • Morbidity and Mortality Rounds • Summarizing and Preparing Guidelines, Teaching Materials, and Handouts    

9. Grand Rounds • Modified format • Feedback is religiously collected • Attendance is rigorously monitored • Food: healthier choices

10. Grand Rounds • Modified format • Feedback is religiously collected • Attendance is rigorously monitored • Food: healthier choices

11. Amiri Hospital Grand Rounds Presenters # Potential Presenters 96

12. 2013/14 Rounds Report

13. Grand Rounds • Modified format • Feedback is religiously collected • Attendance is rigorously monitored • Food: healthier choices

16. Name (NOT unit)

17. Amiri Medical Education System

18. Amiri Medical Education System

19. More to Come.. SLIDE FROM LAST YEAR’S ORIENTATION • Visiting speakers ✔ 9 Presentations (2 local) • Online videoconferencing with Harvard Medical School In progress – Soon • Journal clubs and critical appraisal sessions Planned for 2014/15 • Hands-on workshops ✔ and in progress

23. More to Come.. • Collaboration with other internal medicine-related departments • Medico-Radio • Online communications

24. Housekeeping Notes for Grand Rounds • You are not alone! • Vibrating mobiles save battery.. May be! • Shhhhhhh! • Be in time and use it wisely! • Curb your enthusiasm • Pardon our ignorance! Feedback is religiously collected Attendance is rigorously monitored Food: healthier choices Feedback is religiously collected Attendance is rigorously monitored Food: healthier choices

25. Concluding Remarks (Part-1) • There is continuing need for improvement • SUCCESS has U in it • Support to the committee is needed • We need internal and external feedback!

26. Thanks in advance to.. • The New Team! - All are welcome!

27. It is Not the Start.. It is the Journey! Football League Amir Cup Crown PrinceCup Al-Arabi Al-Qadsia Thanks!

28. Amiri Medical Education • Are Teaching Hospitals Patient-Centered?‘Do Not Learn On Me..!’ Fahad Al-Ghimlas, MD September 22, 2014

29. My reply ‘That’s not the way we do things here. This is a teaching hospital, where residents or/and students participate in your care’.

30. My reply ‘That’s not the way we do things here. This is a teaching hospital, where residents or/and students participate in your care’. If you don’t want residents or students participating in your care, you should go somewhere else.’

31. My reply ‘That’s not the way we do things here. This is a teaching hospital, where residents or/and students participate in your care’. If you don’t want residents or students participating in your care, you should go somewhere else.’

32. Mrs. A • 76 frail lady, in casualty • Known to have “asthma” • Admitted already, waiting for a bed • Cough, febrile, and pancytopenia

33. Mrs. A • She doesn’t want “student doctors” taking care of her. • She wants “real doctors,” not ones who are “still learning.”

34. Today, most teaching hospitals.. • Staff nonteaching services (including staff on locum) • Admit more patients to nonteaching services (despite large government subsidies for their teaching status) Reilly BM. N Engl J Med. 2014 Jul 24;371(4):293-5

35. Today, most teaching hospitals.. • Staff nonteaching services (including staff on locum) • due to.. • - restrictions on residents’ work hours tighten, • - caps on teaching census shrink, • - number of federally funded positions for graduate medical education remains fixed, and • - hospital executives (including many trained as physicians) value patient throughput more than medical education. Reilly BM. N Engl J Med. 2014 Jul 24;371(4):293-5

36. My Reply.. ‘That’s not the way we do things here. This is a teaching hospital, where residents or/and students participate in your care’.

37. Differential “Treatment” for the “Demanding” • Instead of saying ‘my way or the highway’, I would say.. • ‘Not a problem, ma’am. I’ll make sure I will personally be responsible for your care.’

38. Is It a Good Differential “Treatment”? • Won’t she receive better care on the teaching service? • Am I not learning myself?!! • Residents: they make me look better!

39. Is It a Good Differential “Treatment”? I am a competent clinician but I remember by working with residents and students: • Mrs. M. (Kuwait) – severe pernicious anemia explained her dyspnea as intern heard the diastolic rumble I had missed. • Mr. R. (Kuwait) – raging illness stumped me cold until a junior staff taught me about FMF. • Mrs. K. (Canada) – near-fatal drug addiction remained undiscovered until a medical student made the effort to bond with her family.

40. But who has the time? Even if.. • evidence of superior quality of care in teaching hospitals was more convincing — • we could explain teaching hospitals’ lower patient-satisfaction scores • would it matter in Mrs. A.’s case? Evidence Next Slide

41. To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics (2006–09) • Teaching • Council of Teaching member (Half-Teaching) • Non-Teaching 273 852 3,684

42. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Shahian DM, et al. Acad Med 2012; 87:701-8.

43. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Education Personnel Shahian DM, et al. Acad Med 2012; 87:701-8.

44. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Expense per case Shahian DM, et al. Acad Med 2012; 87:701-8.

45. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Process Measure Heart Attack Heart Failure Shahian DM, et al. Acad Med 2012; 87:701-8.

46. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Process Measure Pneumonia Surgical care improvement project Shahian DM, et al. Acad Med 2012; 87:701-8.

47. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Outcome Measure 30-day mortality Shahian DM, et al. Acad Med 2012; 87:701-8.

48. Teaching vs. Non-teaching: CC Teaching Half-Teaching Non-Teaching Patient experience measure Shahian DM, et al. Acad Med 2012; 87:701-8.

49. Patient-Centeredness • Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. • "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." Institute on Medicine. Retrieved 26 November 2012. • Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. Jo Anne L. Patient Advocacy for Health Care Quality. • Given that non-consumer stakeholders often don't know what matters most to patients regarding their ability to get and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation. Sepucha, Karen; Uzogarra, Barry, O'Connor, Mulley (2008). Patient Educ Counsel. 73 (3): 504–510.

50. Patient-Centeredness • Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. • "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." Institute on Medicine. Retrieved 26 November 2012. • Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. Jo Anne L. Patient Advocacy for Health Care Quality. • Given that non-consumer stakeholders often don't know what matters most to patients regarding their ability to get and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation. Sepucha, Karen; Uzogarra, Barry, O'Connor, Mulley (2008). Patient Educ Counsel. 73 (3): 504–510.