Jacques-Brett Burgess
1. You are the pediatric clerkship director for the Traverse City Campus of the Michigan State University College of Medicine. What are the benefits and barriers to educating medical students at a community site?
Michigan State University College of Human Medicine Students are prepared to receive the bulk of their training in a community setting and the Traverse City Campus is no exception. We do often hear from students that it is their perception that some of their colleagues are receiving a more robust pediatric experience with rotations on campuses that contain a children’s hospital. In response to this feedback, we created and secured an experience where, by design, they travel and spend a portion of their rotation at a children’s hospital, then return to us.
Interestingly, we also hear the opposite view from our medical students in that they appreciate the one on one experience with a pediatric attending physician which they definitely receive in Traverse City, providing them the spotlight with patients, procedures, medical staff and their supervising physician. Overall, our students experience the core pieces of both clinical worlds and appreciate the variety.
Additional trials that are certainly not unique to a community site, but perhaps more evident, is the lack of teaching resources. Unlike the primarily academic institution, we do not have numerous residents and fellows to assist our attendings with teaching. This means our students have to simply jump into our dynamic and rapid moving process of patient care.
2. Congratulations - you are part of SHM’s Senior Fellows Class of 2018. For those individuals less involved in SHM, can you tell us more about SHM and how your membership has enhanced your career?
The Society of Hospital Medicine, SHM, provides insight and inspiration to be a specialist in hospital medicine. Each year the society provides more comprehensive and practical information that is directly applicable to our day to day practice of clinical and non-clinical duties. Personally, I have participated in, the larger national meetings, pediatric-specific gatherings and the leadership courses offered by SHM. Meeting content is up to date and at the leading edge of what we face each day as hospitalists.
Several members of iNDIGO Health Partners traveled to the leadership course together and capitalized on some of our down time together. We took this unique opportunity provided by being in one place, gathered in one room, and applied newly learned concepts to our group and some of its struggles. Using the information real time made a measurable impact on our larger team’s navigation and course.
SHM is a working society and I encourage those in their initial years of hospital medicine to join. There is great opportunity for educational materials, standards for practice and networking with others in like groups, centers, and surroundings. My senior fellow status has been an honor to be granted and I share it with pride.
3. In the past, you served as the physician champion for the Northern Michigan Pediatric Sepsis initiative. What was the driving force behind that initiative and how has it evolved?
One of my observations in caring for both adults and children is that pediatric hospital medicine is trailing behind our adult colleagues given the relative infancy of our formal organization as pediatric hospitalists. In other words, adult hospital medicine is further in its journey given it started sooner. The approach to pediatric sepsis is a perfect example. Our geographical region was in great need for an organized and structured approach to this relatively common concern and diagnosis in children. We needed a formal process; knowing timelines and expectations could save pediatric lives.
Our inquiry offered great opportunity and was near ideal in timing. The national sepsis team included pediatric specifics in the guidelines for the first time since their publication, simultaneous with our effort. An initiative was born.
We concluded that providing our region awareness, education and a systematic approach to pediatric sepsis would serve patient care and safety. Our team created clinical orders that fit with what a small community hospital had resources to provide and outlined both protocol and medication dosing. Our team expanded on the pediatric sepsis guidelines, built clinical order sets, and then disseminated the information in a paper booklet and electronic order set for those sharing our electronic health record.
4. You have a Master of Public Health, MPH, from the University of Michigan. How have you utilized this in your career as a hospitalist and what advice do you give learners when they ask you about pursuing an MPH?
This is a challenging question to answer given we often are uncertain of exactly where our knowledge came from; my time at the University of Michigan School of Public Health taught me biostatistics, epidemiology, health behavior and health education, health administration, world health, and so much more. I am confident this education has integrated into my practice each and every day both in direct patient care and in strategic meetings.
This degree supplemented my critical thinking of clinical medicine for the individual and the community. It has complimented my medical school education in countless ways. My advice for those contemplating an MPH would be first to combine your medical degree with your MPH and save yourself a year of tuition and time; medical school is expensive enough. Pursue an MPH if you are contemplating global medicine, leadership in your community, or if your vision puts you working with a larger population on a regular basis.
5. As a board-certified physician in both Internal Medicine and Pediatrics, you have a unique perspective that other hospitalists do not. In what leadership, QI, or research positions do you see other Med-Peds graduates serving and why?
A combined Internal Medicine and Pediatrics residency uniquely juxtaposes the care for adults and children. Perhaps one of the underappreciated abilities one can gain in this training is the ability to carry teachings from each discipline to the other, then influence the approach of the group. This is similar to what athletes call cross training. Some overlap occurs for the athlete with all physical activity, and they build strength and talent in the process.
In a similar way, there are many likenesses in the processes needed to care for adults and children, and much like cross training, it makes the graduate stronger than they may have been if they pursued one discipline. While using the highlights of both specialties, a Med-Peds graduate can make great contributions to most research, leadership and quality efforts, by leveraging common ground and respecting differences.
As medical providers and leaders continue to work toward more Lean thinking and accomplishing more with less, we must share our successes and learn from our colleagues who have captured efficiency and effectiveness. Our combined teaching in Internal Medicine and Pediatrics allows us to pull together great teams of people and learn from one another. Med-Peds graduates have many opportunities to serve in medicine both clinically and administratively.
6. In your Northern Michigan practice, some of the hospitalists provide nighttime telemedicine at rural hospitals. You have been quoted as saying, “A virtual connection provides opportunity to put a pediatrician at the bedside, real time, in an effort to augment current clinical care, assist with a medical disposition, and guide that child to the most appropriate resources and secure great care close to home.” For those of us unfamiliar with telemedicine, how does this work and what types of consultation/advice is provided? How does billing/payment work?
Our team is in the infancy of telehealth and my answer will certainly contain a great deal of vision. Telehealth has many possibilities and most of us use it already by discussing patients over a telephone and viewing an electronic health record that is shared with the other provider on the phone with us. In short, we are discussing great patient care, real time, with data, and making counseled decisions as a team, all with an electronic connection.
Take the above scenario and add the ability to visualize a patient, listen to a heart and lungs, look in the patient’s ears, interview caregivers, and review medical records in parallel. Now our team can connect to a small emergency department over one hour away, help a front-line provider care for a child and make decisions about next steps in their care. This level of service is not always required, but certainly can add to the care for a measurable number of patients for a region.
Such a connection is similar to high definition television, streaming music, or the use of a product like face time. This is technology most use daily which they are quite comfortable. Now it has a role in our medical world and can complement the great care our teams are providing.
Billing is based on state requirements and regulations, but most locations are reimbursing for this work. Documentation for a clinical visit is generated at the origination facility, where the patient is located, based on what care is provided. Specific codes correspond to care provided much like a face to face visit.
7. As the leader of a subcommittee working on preparedness plans and drills for pediatric patients, you are responsible for organizing basic drills for emergency situations at your institution. How do you go about training staff and what lessons have you learned from this role that our readers might implement at their home institutions?
My mentors taught me, work really hard to avoid surprises that do not involve cake. By practicing scenarios and running simple drills, we discover something about process, clinical care or equipment that we did not know before. As a community hospital, we try to prepare for the odd and unexpected by practicing the basics. We run mock codes every month, recommend scavenger hunts for medical equipment and include all the usual suspects we would ask to attend a real emergency.
I tell our team we are practicing for our performance, and preparation plus choreography is mission critical. We practice communication, read back of information, push everyone to speak up and use a questioning attitude. An additional recommendation is to run mock drills in odd places. We took this advice and ran a scenario in our on-sight child care environment. Our team discovered most did not know how to get there quickly, where to find necessary equipment, and which floor the so-called green room was on.
Use audio and video, run complete events and include first responders plus as many others that might be involved, even a parent actor. We hosted a scenario with a critical airway brought in by our emergency services that required a trip to the operating room to secure a definitive airway then transfer to an outside institution with a pediatric intensive care unit. All participants were engaged, and we used audio plus video recording that was later viewed by each of us and utilized as a teaching tool. This is equivalent to the professional sport teams watching footage of their games. Outstanding material with near endless educational opportunity.
Next steps for us include disaster preparedness which incorporates building call lists for care teams, counting equipment available, and how we will identify children that may not know their names or medical history. This is a large effort and stems from our earlier work, so I recommend starting simple, small, and manageable. Most are eager to get more comfortable with pediatric care and appreciate the practice.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
“Not everything that can be counted counts, and not everything that counts can be counted.” (William Bruce Cameron). A great statement reminding us as clinicians that just because an outside force can impose a core measure or indicator, this rarely guarantees that is meaningful for our patients. As clinicians, trained in medicine, it is our primary objective to deliver great care to our patients individually, locally, and even globally. This is no easy task, and we need help, but let us not forget our primary objective is clinical medicine and advocating for our patients when we participate in larger decision-making forums. Hospitalists are experts in hospital medicine, this is our specialty.
It has become near standard in our discussions as clinicians to remind one another that we were not taught business in medical school. Take this idea out of context and it contains no logic at all. Let us focus on our strengths, which is serving our patients. In our challenged and complex medical system, we need a team with members filling each role humbly and all to bring their best. Most importantly, we must come together as a larger group and respect one another’s differences with willingness to serve our patients, their families and communities.
It is still an honor and privilege to deliver outstanding medical care to our patients and their families. Honestly, the key pieces of doing this job well are empathy, listening and willingness to commit to the right thing for the patient in front of us. Take this principle to work each day and we will likely do well most of the time. At times, things will go wrong, let us count on one another when this happens.
Our future holds a great number of challenging decisions to be made and I am confident we can make them together, as a team, with our patients at the center. No, clinicians are not all business minded, we trained to be great clinicians. Some of us are willing to step into the waters of business and lead, but great leadership does not mean sacrificing our talents, values and medical training. Instead, it is the ability to help craft positive change by complementing our clinical talents with good business practice, all for those we serve. Yes, as leaders, we are servants. Let us remember that, it is our job to come to the negotiation table and help our team make difficult decisions with limited and precious resources.
Michigan State University College of Human Medicine Students are prepared to receive the bulk of their training in a community setting and the Traverse City Campus is no exception. We do often hear from students that it is their perception that some of their colleagues are receiving a more robust pediatric experience with rotations on campuses that contain a children’s hospital. In response to this feedback, we created and secured an experience where, by design, they travel and spend a portion of their rotation at a children’s hospital, then return to us.
Interestingly, we also hear the opposite view from our medical students in that they appreciate the one on one experience with a pediatric attending physician which they definitely receive in Traverse City, providing them the spotlight with patients, procedures, medical staff and their supervising physician. Overall, our students experience the core pieces of both clinical worlds and appreciate the variety.
Additional trials that are certainly not unique to a community site, but perhaps more evident, is the lack of teaching resources. Unlike the primarily academic institution, we do not have numerous residents and fellows to assist our attendings with teaching. This means our students have to simply jump into our dynamic and rapid moving process of patient care.
2. Congratulations - you are part of SHM’s Senior Fellows Class of 2018. For those individuals less involved in SHM, can you tell us more about SHM and how your membership has enhanced your career?
The Society of Hospital Medicine, SHM, provides insight and inspiration to be a specialist in hospital medicine. Each year the society provides more comprehensive and practical information that is directly applicable to our day to day practice of clinical and non-clinical duties. Personally, I have participated in, the larger national meetings, pediatric-specific gatherings and the leadership courses offered by SHM. Meeting content is up to date and at the leading edge of what we face each day as hospitalists.
Several members of iNDIGO Health Partners traveled to the leadership course together and capitalized on some of our down time together. We took this unique opportunity provided by being in one place, gathered in one room, and applied newly learned concepts to our group and some of its struggles. Using the information real time made a measurable impact on our larger team’s navigation and course.
SHM is a working society and I encourage those in their initial years of hospital medicine to join. There is great opportunity for educational materials, standards for practice and networking with others in like groups, centers, and surroundings. My senior fellow status has been an honor to be granted and I share it with pride.
3. In the past, you served as the physician champion for the Northern Michigan Pediatric Sepsis initiative. What was the driving force behind that initiative and how has it evolved?
One of my observations in caring for both adults and children is that pediatric hospital medicine is trailing behind our adult colleagues given the relative infancy of our formal organization as pediatric hospitalists. In other words, adult hospital medicine is further in its journey given it started sooner. The approach to pediatric sepsis is a perfect example. Our geographical region was in great need for an organized and structured approach to this relatively common concern and diagnosis in children. We needed a formal process; knowing timelines and expectations could save pediatric lives.
Our inquiry offered great opportunity and was near ideal in timing. The national sepsis team included pediatric specifics in the guidelines for the first time since their publication, simultaneous with our effort. An initiative was born.
We concluded that providing our region awareness, education and a systematic approach to pediatric sepsis would serve patient care and safety. Our team created clinical orders that fit with what a small community hospital had resources to provide and outlined both protocol and medication dosing. Our team expanded on the pediatric sepsis guidelines, built clinical order sets, and then disseminated the information in a paper booklet and electronic order set for those sharing our electronic health record.
4. You have a Master of Public Health, MPH, from the University of Michigan. How have you utilized this in your career as a hospitalist and what advice do you give learners when they ask you about pursuing an MPH?
This is a challenging question to answer given we often are uncertain of exactly where our knowledge came from; my time at the University of Michigan School of Public Health taught me biostatistics, epidemiology, health behavior and health education, health administration, world health, and so much more. I am confident this education has integrated into my practice each and every day both in direct patient care and in strategic meetings.
This degree supplemented my critical thinking of clinical medicine for the individual and the community. It has complimented my medical school education in countless ways. My advice for those contemplating an MPH would be first to combine your medical degree with your MPH and save yourself a year of tuition and time; medical school is expensive enough. Pursue an MPH if you are contemplating global medicine, leadership in your community, or if your vision puts you working with a larger population on a regular basis.
5. As a board-certified physician in both Internal Medicine and Pediatrics, you have a unique perspective that other hospitalists do not. In what leadership, QI, or research positions do you see other Med-Peds graduates serving and why?
A combined Internal Medicine and Pediatrics residency uniquely juxtaposes the care for adults and children. Perhaps one of the underappreciated abilities one can gain in this training is the ability to carry teachings from each discipline to the other, then influence the approach of the group. This is similar to what athletes call cross training. Some overlap occurs for the athlete with all physical activity, and they build strength and talent in the process.
In a similar way, there are many likenesses in the processes needed to care for adults and children, and much like cross training, it makes the graduate stronger than they may have been if they pursued one discipline. While using the highlights of both specialties, a Med-Peds graduate can make great contributions to most research, leadership and quality efforts, by leveraging common ground and respecting differences.
As medical providers and leaders continue to work toward more Lean thinking and accomplishing more with less, we must share our successes and learn from our colleagues who have captured efficiency and effectiveness. Our combined teaching in Internal Medicine and Pediatrics allows us to pull together great teams of people and learn from one another. Med-Peds graduates have many opportunities to serve in medicine both clinically and administratively.
6. In your Northern Michigan practice, some of the hospitalists provide nighttime telemedicine at rural hospitals. You have been quoted as saying, “A virtual connection provides opportunity to put a pediatrician at the bedside, real time, in an effort to augment current clinical care, assist with a medical disposition, and guide that child to the most appropriate resources and secure great care close to home.” For those of us unfamiliar with telemedicine, how does this work and what types of consultation/advice is provided? How does billing/payment work?
Our team is in the infancy of telehealth and my answer will certainly contain a great deal of vision. Telehealth has many possibilities and most of us use it already by discussing patients over a telephone and viewing an electronic health record that is shared with the other provider on the phone with us. In short, we are discussing great patient care, real time, with data, and making counseled decisions as a team, all with an electronic connection.
Take the above scenario and add the ability to visualize a patient, listen to a heart and lungs, look in the patient’s ears, interview caregivers, and review medical records in parallel. Now our team can connect to a small emergency department over one hour away, help a front-line provider care for a child and make decisions about next steps in their care. This level of service is not always required, but certainly can add to the care for a measurable number of patients for a region.
Such a connection is similar to high definition television, streaming music, or the use of a product like face time. This is technology most use daily which they are quite comfortable. Now it has a role in our medical world and can complement the great care our teams are providing.
Billing is based on state requirements and regulations, but most locations are reimbursing for this work. Documentation for a clinical visit is generated at the origination facility, where the patient is located, based on what care is provided. Specific codes correspond to care provided much like a face to face visit.
7. As the leader of a subcommittee working on preparedness plans and drills for pediatric patients, you are responsible for organizing basic drills for emergency situations at your institution. How do you go about training staff and what lessons have you learned from this role that our readers might implement at their home institutions?
My mentors taught me, work really hard to avoid surprises that do not involve cake. By practicing scenarios and running simple drills, we discover something about process, clinical care or equipment that we did not know before. As a community hospital, we try to prepare for the odd and unexpected by practicing the basics. We run mock codes every month, recommend scavenger hunts for medical equipment and include all the usual suspects we would ask to attend a real emergency.
I tell our team we are practicing for our performance, and preparation plus choreography is mission critical. We practice communication, read back of information, push everyone to speak up and use a questioning attitude. An additional recommendation is to run mock drills in odd places. We took this advice and ran a scenario in our on-sight child care environment. Our team discovered most did not know how to get there quickly, where to find necessary equipment, and which floor the so-called green room was on.
Use audio and video, run complete events and include first responders plus as many others that might be involved, even a parent actor. We hosted a scenario with a critical airway brought in by our emergency services that required a trip to the operating room to secure a definitive airway then transfer to an outside institution with a pediatric intensive care unit. All participants were engaged, and we used audio plus video recording that was later viewed by each of us and utilized as a teaching tool. This is equivalent to the professional sport teams watching footage of their games. Outstanding material with near endless educational opportunity.
Next steps for us include disaster preparedness which incorporates building call lists for care teams, counting equipment available, and how we will identify children that may not know their names or medical history. This is a large effort and stems from our earlier work, so I recommend starting simple, small, and manageable. Most are eager to get more comfortable with pediatric care and appreciate the practice.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
“Not everything that can be counted counts, and not everything that counts can be counted.” (William Bruce Cameron). A great statement reminding us as clinicians that just because an outside force can impose a core measure or indicator, this rarely guarantees that is meaningful for our patients. As clinicians, trained in medicine, it is our primary objective to deliver great care to our patients individually, locally, and even globally. This is no easy task, and we need help, but let us not forget our primary objective is clinical medicine and advocating for our patients when we participate in larger decision-making forums. Hospitalists are experts in hospital medicine, this is our specialty.
It has become near standard in our discussions as clinicians to remind one another that we were not taught business in medical school. Take this idea out of context and it contains no logic at all. Let us focus on our strengths, which is serving our patients. In our challenged and complex medical system, we need a team with members filling each role humbly and all to bring their best. Most importantly, we must come together as a larger group and respect one another’s differences with willingness to serve our patients, their families and communities.
It is still an honor and privilege to deliver outstanding medical care to our patients and their families. Honestly, the key pieces of doing this job well are empathy, listening and willingness to commit to the right thing for the patient in front of us. Take this principle to work each day and we will likely do well most of the time. At times, things will go wrong, let us count on one another when this happens.
Our future holds a great number of challenging decisions to be made and I am confident we can make them together, as a team, with our patients at the center. No, clinicians are not all business minded, we trained to be great clinicians. Some of us are willing to step into the waters of business and lead, but great leadership does not mean sacrificing our talents, values and medical training. Instead, it is the ability to help craft positive change by complementing our clinical talents with good business practice, all for those we serve. Yes, as leaders, we are servants. Let us remember that, it is our job to come to the negotiation table and help our team make difficult decisions with limited and precious resources.