Clifton Lee
1. You served as Region 4 co-chair of the Academic Pediatric Association. Can you tell us more about the APA, and why we should get involved with our regional group?
I was the Region 4 co-chair of the Academic Pediatric Association (APA) from 2015-2018. The APA is the home for all academic pediatricians, and region 4 represents all academic institutions in Maryland, District of Columbia, Virginia, and North Carolina. My involvement was rather happenstance. At the end of a regional conference, there was an announcement for volunteers to serve on the conference planning committee. And, I raised my hand and volunteered. That was the one of the best decision of my professional life. I was able to work with a group of dedicated individuals from all across the region. Planning for the regional conference and to see it come to fruition was the highlight of the year! Couple of years later, I was asked to serve as one of the co-chairs of Region 4, and with it came more responsibilities, but serving in this capacity was the best 3 years for me. I can call everyone who worked on the conference planning committee my colleagues as well as my friends. I have learned a lot about putting together a successful conference as well as the opportunity to network with the leadership of the APA. That was more than worth raising my hand. You should totally be involved with your regional group. Present your research and quality improvement projects. Network with fellow academics from hospital medicine as well as general pediatrics. For trainees and junior faculty, the regional conference is a great venue to get feedback. The feedback you get from the regional conference will help you for submission to PAS. I promise you. The APA is a fantastic organization, and you will learn a lot. If you want to get involved, it only takes raising your hand.
2. Being a co-director of the M3 pediatric clerkship and program director of the pediatric hospital medicine fellowship at Children’s Hospital of Richmond at VCU keeps you pretty busy. How do you balance your time between education and your own clinical duties?
Ah… The eternal question of balance. That is the million dollar question. As much as I try to find the right balance between work and home, I try to do the same with different responsibilities. For me, having a passion for medical education is key. Besides caring for the hospitalized children, teaching and mentoring are what keep me going and wake me up in the morning. Not just teaching and mentoring, but being involved in an administrative capacity, making sure the clerkship is running smoothly, and finding new and innovative ways to teach medical students. To see a brand new third year medical student starting out and to see the same student choosing pediatrics and matching and somehow I had something to do with that is priceless. Same thing with being a fellowship director. I get to shape the path of a young physician who will become an important cog in the wheel that is PHM. It is an awesome responsibility and an enjoyable one too. Fortunately, both positions come with “protected time” which means less clinical time. That is key. There is no way I can be an effective clerkship director, a fellow director, and a hospitalist all with 100% commitment. That will never work. That’s where “the balance” comes from. For all junior folks out there, a bit of advice. Find your passions, but also realize that you don’t have to do everything all at the same time. Meaning, if you come across an opportunity that you want, but it doesn’t come with some time off from clinical work, then it is better to not accept it. Believe me. There will be others, and your partner will thank you for it!
3.Along the same lines, you have been awarded numerous teaching awards including the Irby-James Award for Excellence in Clinical Teaching, a top teaching award from the VCU School of Medicine. What is your teaching style? What tips do you have for hospitalists that are just starting out and want to improve their teaching skills?
Everyone wants to be a teacher, but only a few are very good about getting the point across. I like to improvise different techniques depending on the situation. For example, teaching during rounds is much different than when I am teaching during the afternoon with the resident team. During rounds, it is all about the “just in time” technique. Teach them one important point per patient encounter. Something easy to remember without spending too much time. When I am in the team room teaching in the afternoon, I may start with the student presenting a new admission. At the end, I might ask a question like “Does this patient (with uncomplicated SSTI) really need a blood culture?” While waiting for an answer, I will pull out the appropriate article that answers the question. I am an old school guy so I will make copies of the article beforehand, but using an iPAD with articles saved on the “Cloud” also works. Disclaimer: I don’t do the latter, so don’t ask me! This method takes some work from me beforehand, but it is totally worth it. Students and residents learn from the patients so it is relevant and providing an article is good for “evidence based teaching.” I also like to tell stories (think about the attendings who start their talks with “when I was you age…”). This one takes a few years of experience, but once you start to have experience, the stories will come. I still tell the story about when I was an intern in the ED and took care of a child with meningococcemia and had to take Rifampin, but no one told me about my secretions turning orange. That actually happened to me. I laugh about it now, but back then, I thought I was dying! Recently, I received an email from a fourth year student who thanked me for telling me that story. He said that he would never forget about that side effect from Rifampin and that he still laughs whenever he thinks about me telling the story. That is all the validation I need. No teaching award can top that although receiving a teaching award is nice too! If you are starting out, think about those who taught you and left a lasting mark on you. You can mimic their styles and eventually you will develop your own teaching style.
4. What is COMSEP that you are involved with?
COMSEP (comsep.org) stands for Council on Medical Student Education in Pediatrics. It is “an international community of educators who are passionate about advancing the art and science of medical student education in pediatrics.” It is the MUST organization to join if you are even remotely interested in teaching medical students. I became a member when I started out as the clerkship director. Unlike other organizations, COMSEP’s mission is all about medical education. I have learned a lot by attending the annual conferences which in itself is an example on learning while having fun. I have never attended a medical conference where there is an evening outing for the entire conference attendees which includes dancing! I was a little (okay, a lot) taken aback at first, but I have come to realize that it is okay to have some fun even at a medical educators conference. The COMSEP website has plenty of resources to get you started (just check out the Educator Resources section). Join today. You will be glad you did!
5. You have been a co-author on numerous interesting cases including “Remembering MUDPILES: A Case of Unexplained Metabolic Acidosis” in Hospital Pediatrics, “An Unexpected Case of Intestinal Ischemia (Meckel’s Diverticulum)” in Consultant for Pediatricians, and “Recalcitrant Tachypnea in a 2 Month Old Boy” in Pediatrics in Review. How do you find so many interesting cases? And what advice do you have to someone interested in publishing a case?
Answer: Interesting cases are all around us. Just waiting to be told. And willing students and residents who want to be part of that story. I am just there as a facilitator. Or a tour guide, if you will. I got to admit that sometimes it takes a bit of encouraging from me to get the process started, but they see the excitement on my face (this only works part of the time), but whatever it takes, right? I tried to lure them in and tell them about the possibility of presenting at SHM or PHM since these conferences will accept clinical conundrums. At the same time, we talk about the possibility of manuscript preparation for submission. It is a fantastic ride—going from an idea to getting the acceptance email from the journal. If you are interested in publishing a case, my first advice would be find a mentor who can guide through the process. If you are a junior faculty, find someone who is more senior who has done these before and knows the ropes. Next is to find help. It is always good to find a friend or two to help divide the labor. On a side note, make sure you discuss authorship order beforehand. It will save time and prevent headaches later. Come up with realistic deadlines and encourage (not nag) your friends to finish their portions. Do the literature search early. If there are plenty of recent case reports on your topic, perhaps it is not worth it. Don’t forget about pictures (with proper consent, of course) and radiographic images. It helps to move things along if you are first going to submit an abstract to SHM or PHM since they have firm submission deadlines. Manuscript preparation can happen afterwards. Have fun with them!
6. As co-author on “Are Scores from NBME Subject Examinations Valid Measures of Knowledge Acquired During Clinical Clerkships?” in Academic Medicine, what are your thoughts on the topic?
This was an interesting study. Standardized method of measuring medical knowledge during the clinical clerkship is an important part of the overall evaluation and grading. However, during the clinical phase of medical education, performance on the wards and clinics are just as important. Unfortunately, students don’t learn everything they need for the NBME subject examination from the clinical rotations so there lies the dilemma. One of the conclusions from this study was that “these findings call into the question the validity of using scores from Subject Examination as a high-stakes assessment of learning in individual clerkships.” Soon after this study was published, Jayakumar published a commentary titled: The Motivational and Evaluative Roles of NBME Subject Examinations (Academic Medicine: October 2017-Volume 92-Issue 10-p. 1363-1364). The author stated that because medical students are only exposed to a fraction of the conditions in a given specialty due to the length of time spent on any particular specialty, “subject examinations, which are designed to test on a broad range of conditions, play a complementary role by motivating students to develop breadth in a field.” This is tough. On the one hand, you need an objective way to measure acquired medical knowledge during a clerkship. On the other hand, good test takers will always do well with standardized tests. Plus, is that the mark of an excellent physician? There is no right answer here. Many clerkships, including Pediatrics, still rely on the NBME subject examination. I am fortunate enough to be selected as a member of the NBME/COMSEP Pediatrics Subject Exam Item Writing and Review Group. We met in February 2020 to review the current bank of examination questions and to make them more relevant for the third year medical student during the clinical rotation. It was an eye opening experience for me to see how a question is created, edited, and eventually make it into the subject examination. We are hopeful to create more questions that are relevant to the students during the pediatric clerkship.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Answer: Two things. First, I want to express my gratitude to all of the medical providers who are out on the frontlines fighting the current COVID-19 pandemic. I realize that things will never be the same again, and there will be a “new normal” for all of us. From the first responders to doctors, nurses, respiratory therapist, and everyone who makes the healthcare system churn and take care of the patients, my deepest gratitude and thanks. Where I live, things are not as crushing as New York or other hot spots across our country. We have seen cases and taken care of patients. We do the best we can and try to adjust to the changes that have happened as a result. My hats off to everyone who get up and go to work, knowing what you are up against. It is a true testament to our profession. Second, medical education never stops, pandemic or not. I have gotten fairly savvy with Zoom now as it is the preferred platform to deliver medical education to my students. We recently completed the M4 Pediatric Bootcamp for the graduating students matched into Pediatrics. Although nothing will replace the face-to-face interaction, it was still a great learning environment. Enclosed is a picture of the students. I usually take a group photo at the end of the Bootcamp. There was a group photo this year too. Just not the picture that I expected. So keep teaching out there, medical educators!!
I was the Region 4 co-chair of the Academic Pediatric Association (APA) from 2015-2018. The APA is the home for all academic pediatricians, and region 4 represents all academic institutions in Maryland, District of Columbia, Virginia, and North Carolina. My involvement was rather happenstance. At the end of a regional conference, there was an announcement for volunteers to serve on the conference planning committee. And, I raised my hand and volunteered. That was the one of the best decision of my professional life. I was able to work with a group of dedicated individuals from all across the region. Planning for the regional conference and to see it come to fruition was the highlight of the year! Couple of years later, I was asked to serve as one of the co-chairs of Region 4, and with it came more responsibilities, but serving in this capacity was the best 3 years for me. I can call everyone who worked on the conference planning committee my colleagues as well as my friends. I have learned a lot about putting together a successful conference as well as the opportunity to network with the leadership of the APA. That was more than worth raising my hand. You should totally be involved with your regional group. Present your research and quality improvement projects. Network with fellow academics from hospital medicine as well as general pediatrics. For trainees and junior faculty, the regional conference is a great venue to get feedback. The feedback you get from the regional conference will help you for submission to PAS. I promise you. The APA is a fantastic organization, and you will learn a lot. If you want to get involved, it only takes raising your hand.
2. Being a co-director of the M3 pediatric clerkship and program director of the pediatric hospital medicine fellowship at Children’s Hospital of Richmond at VCU keeps you pretty busy. How do you balance your time between education and your own clinical duties?
Ah… The eternal question of balance. That is the million dollar question. As much as I try to find the right balance between work and home, I try to do the same with different responsibilities. For me, having a passion for medical education is key. Besides caring for the hospitalized children, teaching and mentoring are what keep me going and wake me up in the morning. Not just teaching and mentoring, but being involved in an administrative capacity, making sure the clerkship is running smoothly, and finding new and innovative ways to teach medical students. To see a brand new third year medical student starting out and to see the same student choosing pediatrics and matching and somehow I had something to do with that is priceless. Same thing with being a fellowship director. I get to shape the path of a young physician who will become an important cog in the wheel that is PHM. It is an awesome responsibility and an enjoyable one too. Fortunately, both positions come with “protected time” which means less clinical time. That is key. There is no way I can be an effective clerkship director, a fellow director, and a hospitalist all with 100% commitment. That will never work. That’s where “the balance” comes from. For all junior folks out there, a bit of advice. Find your passions, but also realize that you don’t have to do everything all at the same time. Meaning, if you come across an opportunity that you want, but it doesn’t come with some time off from clinical work, then it is better to not accept it. Believe me. There will be others, and your partner will thank you for it!
3.Along the same lines, you have been awarded numerous teaching awards including the Irby-James Award for Excellence in Clinical Teaching, a top teaching award from the VCU School of Medicine. What is your teaching style? What tips do you have for hospitalists that are just starting out and want to improve their teaching skills?
Everyone wants to be a teacher, but only a few are very good about getting the point across. I like to improvise different techniques depending on the situation. For example, teaching during rounds is much different than when I am teaching during the afternoon with the resident team. During rounds, it is all about the “just in time” technique. Teach them one important point per patient encounter. Something easy to remember without spending too much time. When I am in the team room teaching in the afternoon, I may start with the student presenting a new admission. At the end, I might ask a question like “Does this patient (with uncomplicated SSTI) really need a blood culture?” While waiting for an answer, I will pull out the appropriate article that answers the question. I am an old school guy so I will make copies of the article beforehand, but using an iPAD with articles saved on the “Cloud” also works. Disclaimer: I don’t do the latter, so don’t ask me! This method takes some work from me beforehand, but it is totally worth it. Students and residents learn from the patients so it is relevant and providing an article is good for “evidence based teaching.” I also like to tell stories (think about the attendings who start their talks with “when I was you age…”). This one takes a few years of experience, but once you start to have experience, the stories will come. I still tell the story about when I was an intern in the ED and took care of a child with meningococcemia and had to take Rifampin, but no one told me about my secretions turning orange. That actually happened to me. I laugh about it now, but back then, I thought I was dying! Recently, I received an email from a fourth year student who thanked me for telling me that story. He said that he would never forget about that side effect from Rifampin and that he still laughs whenever he thinks about me telling the story. That is all the validation I need. No teaching award can top that although receiving a teaching award is nice too! If you are starting out, think about those who taught you and left a lasting mark on you. You can mimic their styles and eventually you will develop your own teaching style.
4. What is COMSEP that you are involved with?
COMSEP (comsep.org) stands for Council on Medical Student Education in Pediatrics. It is “an international community of educators who are passionate about advancing the art and science of medical student education in pediatrics.” It is the MUST organization to join if you are even remotely interested in teaching medical students. I became a member when I started out as the clerkship director. Unlike other organizations, COMSEP’s mission is all about medical education. I have learned a lot by attending the annual conferences which in itself is an example on learning while having fun. I have never attended a medical conference where there is an evening outing for the entire conference attendees which includes dancing! I was a little (okay, a lot) taken aback at first, but I have come to realize that it is okay to have some fun even at a medical educators conference. The COMSEP website has plenty of resources to get you started (just check out the Educator Resources section). Join today. You will be glad you did!
5. You have been a co-author on numerous interesting cases including “Remembering MUDPILES: A Case of Unexplained Metabolic Acidosis” in Hospital Pediatrics, “An Unexpected Case of Intestinal Ischemia (Meckel’s Diverticulum)” in Consultant for Pediatricians, and “Recalcitrant Tachypnea in a 2 Month Old Boy” in Pediatrics in Review. How do you find so many interesting cases? And what advice do you have to someone interested in publishing a case?
Answer: Interesting cases are all around us. Just waiting to be told. And willing students and residents who want to be part of that story. I am just there as a facilitator. Or a tour guide, if you will. I got to admit that sometimes it takes a bit of encouraging from me to get the process started, but they see the excitement on my face (this only works part of the time), but whatever it takes, right? I tried to lure them in and tell them about the possibility of presenting at SHM or PHM since these conferences will accept clinical conundrums. At the same time, we talk about the possibility of manuscript preparation for submission. It is a fantastic ride—going from an idea to getting the acceptance email from the journal. If you are interested in publishing a case, my first advice would be find a mentor who can guide through the process. If you are a junior faculty, find someone who is more senior who has done these before and knows the ropes. Next is to find help. It is always good to find a friend or two to help divide the labor. On a side note, make sure you discuss authorship order beforehand. It will save time and prevent headaches later. Come up with realistic deadlines and encourage (not nag) your friends to finish their portions. Do the literature search early. If there are plenty of recent case reports on your topic, perhaps it is not worth it. Don’t forget about pictures (with proper consent, of course) and radiographic images. It helps to move things along if you are first going to submit an abstract to SHM or PHM since they have firm submission deadlines. Manuscript preparation can happen afterwards. Have fun with them!
6. As co-author on “Are Scores from NBME Subject Examinations Valid Measures of Knowledge Acquired During Clinical Clerkships?” in Academic Medicine, what are your thoughts on the topic?
This was an interesting study. Standardized method of measuring medical knowledge during the clinical clerkship is an important part of the overall evaluation and grading. However, during the clinical phase of medical education, performance on the wards and clinics are just as important. Unfortunately, students don’t learn everything they need for the NBME subject examination from the clinical rotations so there lies the dilemma. One of the conclusions from this study was that “these findings call into the question the validity of using scores from Subject Examination as a high-stakes assessment of learning in individual clerkships.” Soon after this study was published, Jayakumar published a commentary titled: The Motivational and Evaluative Roles of NBME Subject Examinations (Academic Medicine: October 2017-Volume 92-Issue 10-p. 1363-1364). The author stated that because medical students are only exposed to a fraction of the conditions in a given specialty due to the length of time spent on any particular specialty, “subject examinations, which are designed to test on a broad range of conditions, play a complementary role by motivating students to develop breadth in a field.” This is tough. On the one hand, you need an objective way to measure acquired medical knowledge during a clerkship. On the other hand, good test takers will always do well with standardized tests. Plus, is that the mark of an excellent physician? There is no right answer here. Many clerkships, including Pediatrics, still rely on the NBME subject examination. I am fortunate enough to be selected as a member of the NBME/COMSEP Pediatrics Subject Exam Item Writing and Review Group. We met in February 2020 to review the current bank of examination questions and to make them more relevant for the third year medical student during the clinical rotation. It was an eye opening experience for me to see how a question is created, edited, and eventually make it into the subject examination. We are hopeful to create more questions that are relevant to the students during the pediatric clerkship.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Answer: Two things. First, I want to express my gratitude to all of the medical providers who are out on the frontlines fighting the current COVID-19 pandemic. I realize that things will never be the same again, and there will be a “new normal” for all of us. From the first responders to doctors, nurses, respiratory therapist, and everyone who makes the healthcare system churn and take care of the patients, my deepest gratitude and thanks. Where I live, things are not as crushing as New York or other hot spots across our country. We have seen cases and taken care of patients. We do the best we can and try to adjust to the changes that have happened as a result. My hats off to everyone who get up and go to work, knowing what you are up against. It is a true testament to our profession. Second, medical education never stops, pandemic or not. I have gotten fairly savvy with Zoom now as it is the preferred platform to deliver medical education to my students. We recently completed the M4 Pediatric Bootcamp for the graduating students matched into Pediatrics. Although nothing will replace the face-to-face interaction, it was still a great learning environment. Enclosed is a picture of the students. I usually take a group photo at the end of the Bootcamp. There was a group photo this year too. Just not the picture that I expected. So keep teaching out there, medical educators!!