Jennifer O'Toole
1. You headed up the 2018 PHM conference in Atlanta. What are some of the challenges that go into organizing the PHM conference? And in what new directions would you like to see it head?
PHM has grown tremendously over the past five years and has truly become the premiere educational experience for pediatric hospitalists. In response to the growth of PHM as a specialty, the content has expanded to meet the needs of hospitalists as clinicians, researchers, educators, improvement scientists, advocates, leaders, and global health experts. This expansion and the expertise of the PHM community has definitely made it difficult to fit in all the amazing content submitted into 3½ days! This was a definite challenge for us with the 2018 meeting; a good challenge, but a challenge none the less. In order to meet the needs of our diverse community we added more session types, shortened session length, and expanded options for pre-courses. Planners of future meetings will have to continue to think creatively on how to offer robust content that meets the learning needs of the diverse PHM community, and yet still promote a small community atmosphere with lots of opportunities to network and share ideas.
2. In your paper “Families as Partners in Hospital Error and Adverse Event Surveillance” in JAMA Pediatrics, you showed that including families in error and adverse event surveillance increased overall error detection rates by 16% and adverse event detection rates by 10%. In real life, how do you encourage and incorporate families into safety within a hospital when it feels uncomfortable to do so?
As a hospitalist I think the best way we can incorporate patients and families as part of our error surveillance and safety initiatives is to give patients and families a voice during their hospitalization. This all begins with patient and family centered rounds. If we engage patients and families by speaking with them in a way that is appropriate for their level of health literacy, encourage them to speak up, and create an environment of psychological safety, they will be more likely to speak up when they have a concern or see an error. As care providers we then have to be open to feedback and constructive criticism. This requires the entire care team to recognize that feedback or criticism provided by patients and families is not about them personally; rather, about the system as a whole and how it functions.
3. You have participated numerous times in the speed mentoring at PHM, which has been widely popular. What advice would you have given to yourself 10 years ago?
Wow. Now that’s an intriguing question! I think I would have advised myself to have faith that you can actually do the things that seem so daunting early on in your career. I always tell my residents, “You don’t even know what you are capable of yet.” I would have told myself the same thing 10 years ago. In addition, I would have given the advice to put forth great effort in building your local and national network; it is through these relationships and connections that truly amazing things happen! Lastly, your career is a marathon and not a sprint. You don’t have to accomplish everything at once. Be thoughtful and strategic when you do things in your career, and be sure to set aside an ample amount of time to take care of yourself and the ones you love.
4. You are a med-peds hospitalist, program director of Cincinnati’s Combined Internal Medicine and Pediatrics Residency Program, and authored a paper in Hospital Pediatrics on “The Practice Patterns of Recently Graduated Internal Medicine-Pediatric Hospitalists.” What are some unique opportunities to engage med-peds hospitalists at our own institution? With the recent board certification, how do you council med-peds residents interested in hospital medicine?
If you have a Med-Peds program or community at your home institution I would strongly encourage you to reach out to them! Med-Peds physicians, and more specifically Med-Peds hospitalists, can really enhance your practice given their expertise in adult and transition medicine. We have a thriving Med-Peds hospitalist group here in Cincinnati and I think these folks enrich and strengthen our PHM community. Specific areas where our Med-Peds hospitalists have helped to educate or expand the practice of our local PHM community is in the area of point-of-care ultrasound, care of young adults in children’s hospitalists, and management of substance abuse disorders and venous thromboembolisms.
Now that PHM is an official subspecialty of the ABP, my counseling for my Med-Peds residents who are considering careers in hospital medicine has certainly evolved. We have a thriving PHM fellowship, including a Med-Peds hospital medicine option, here in Cincinnati. Having seen firsthand the impressive skillsets our fellows develop during their time in fellowship and the projects they have participated in, I am a HUGE supporter of PHM fellowship training. Many of my residents that are considering careers in hospital medicine would like a pursue a combined Med-Peds option. Because of this I encourage all of them to reach out to PHM fellowship program directors to see if they would be willing to consider a Med-Peds hospital medicine fellowship option in their own program if one doesn’t already exist. Now, not all residents considering careers in hospital medicine will want or be able to do a fellowship. In the end, it is an individual choice. I stress to them that an educated decision that takes into account skill development needs, personal factors, future employability (based upon training and board certification status), and earning potential is paramount. There is no right or wrong choice, however they must make sure the choice is well informed and right for them.
5. As someone very involved in medical education, what are the best resources and conferences for younger pediatric hospitalists looking to get involved in medical education? How would you suggest getting involved when first starting out?
I highly recommend both the APEX program and the APA’s Educational Scholars Program to early career faculty with an interest in medical education. Both of these programs not only give you excellent training, but also provide you with opportunities for local and national mentorship, as well as the chance to build a network of peers from across the country. I would also encourage early career folks to get involved in various subcommittees in our three societies (AAP, APA, and SHM) that focus on education skill development and projects. If folks are serious about a career in medical education they should also consider pursing a Masters degree in one of many programs across the country that are focused on medical or health professions education. This not only gives you great training in educational theory, but also educational scholarship and leadership. And, don’t be afraid to ask your institution/employer to help with tuition or FTE support. Institutions/employers are often very interested in ways to invest in their employees and help make them successful!
6. Since 2010, you have been the site principal investigator at Cincinnati Children's for the I-PASS Study Group and have collaborated on the initial I-PASS Handoff Study, the AHRQ-funded Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program, and the Patient and Family Centered I-PASS Study. What is the secret to the success of I-PASS, and what is the next step for this group?
One of my daughter’s sports teams had a t-shirt a few years ago that had the phrase “teamwork makes the dream work” on the back. I cannot think of a better phrase to describe the I-PASS Study Group. The group’s focus on the team and valuing every member is truly the “secret sauce” behind our success. Even from our earliest days, our most senior leaders in the group valued each member’s opinion, skillset, and previous experience. I was a very early career faculty member when I joined the I-PASS Study Group, and I always felt equal to and valued by everyone on the team. I also knew the team was invested in me and my personal and professional development. As the years have passed, those of us that were very early in our careers when we joined the I-PASS Group have had the opportunity to give back to the team by mentoring and developing those folks early their careers just joining the group. It’s the circle of life at its finest. Any group that that makes team development, respect, and valuing the contributions of every member their mission will be destined for great success.
As for what’s next for I-PASS, a great deal of our focus now is how we can spread the work we have done around transitions of care and patient and family-centered rounds outside of pediatrics and outside of the inpatient setting. As a Med-Peds hospitalist, I am especially interested in spreading our Patient and Family-Centered I-PASS work to adult hospitals and hospital medicine groups. Patient and family-centered rounds are now standard practice in pediatric hospitals across the US, and I’d love to see the same happen for hospitalized adults!
7. A paper you published in the Journal of Graduate Medical Education in December 2015 looked at creating a teaching development assessment tool (TDAT) for the evaluation of attending physicians on inpatient rounds. Can you talk more about it and how to implement it?
This was a tool my colleagues and I created as part of a Master Educator Fellowship here at Cincinnati Children’s Hospital. The tool created to evaluate the teaching and coaching skills of a supervising attending on an inpatient ward service. During the study we used it to observe and provide feedback to the faculty and fellows on our inpatient teaching services. The tool could be easily adapted for use at your institution and is a great vehicle for multi-source feedback. While most folks tend to think of using it to provide feedback to new or early career folks, it can also serve as a great development tool for mid and late career folks. Everyone should continue to hone their skills as an educator throughout their careers!
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I think I’ve said enough in this piece, so I’ll just leave folks with two of my favorite quotes.
"Alone we can do so little, together we can do so much." --Helen Keller
“I don't know exactly what's next but I'm stepping forward with grit anchored in grace."--Julie Graham
PHM has grown tremendously over the past five years and has truly become the premiere educational experience for pediatric hospitalists. In response to the growth of PHM as a specialty, the content has expanded to meet the needs of hospitalists as clinicians, researchers, educators, improvement scientists, advocates, leaders, and global health experts. This expansion and the expertise of the PHM community has definitely made it difficult to fit in all the amazing content submitted into 3½ days! This was a definite challenge for us with the 2018 meeting; a good challenge, but a challenge none the less. In order to meet the needs of our diverse community we added more session types, shortened session length, and expanded options for pre-courses. Planners of future meetings will have to continue to think creatively on how to offer robust content that meets the learning needs of the diverse PHM community, and yet still promote a small community atmosphere with lots of opportunities to network and share ideas.
2. In your paper “Families as Partners in Hospital Error and Adverse Event Surveillance” in JAMA Pediatrics, you showed that including families in error and adverse event surveillance increased overall error detection rates by 16% and adverse event detection rates by 10%. In real life, how do you encourage and incorporate families into safety within a hospital when it feels uncomfortable to do so?
As a hospitalist I think the best way we can incorporate patients and families as part of our error surveillance and safety initiatives is to give patients and families a voice during their hospitalization. This all begins with patient and family centered rounds. If we engage patients and families by speaking with them in a way that is appropriate for their level of health literacy, encourage them to speak up, and create an environment of psychological safety, they will be more likely to speak up when they have a concern or see an error. As care providers we then have to be open to feedback and constructive criticism. This requires the entire care team to recognize that feedback or criticism provided by patients and families is not about them personally; rather, about the system as a whole and how it functions.
3. You have participated numerous times in the speed mentoring at PHM, which has been widely popular. What advice would you have given to yourself 10 years ago?
Wow. Now that’s an intriguing question! I think I would have advised myself to have faith that you can actually do the things that seem so daunting early on in your career. I always tell my residents, “You don’t even know what you are capable of yet.” I would have told myself the same thing 10 years ago. In addition, I would have given the advice to put forth great effort in building your local and national network; it is through these relationships and connections that truly amazing things happen! Lastly, your career is a marathon and not a sprint. You don’t have to accomplish everything at once. Be thoughtful and strategic when you do things in your career, and be sure to set aside an ample amount of time to take care of yourself and the ones you love.
4. You are a med-peds hospitalist, program director of Cincinnati’s Combined Internal Medicine and Pediatrics Residency Program, and authored a paper in Hospital Pediatrics on “The Practice Patterns of Recently Graduated Internal Medicine-Pediatric Hospitalists.” What are some unique opportunities to engage med-peds hospitalists at our own institution? With the recent board certification, how do you council med-peds residents interested in hospital medicine?
If you have a Med-Peds program or community at your home institution I would strongly encourage you to reach out to them! Med-Peds physicians, and more specifically Med-Peds hospitalists, can really enhance your practice given their expertise in adult and transition medicine. We have a thriving Med-Peds hospitalist group here in Cincinnati and I think these folks enrich and strengthen our PHM community. Specific areas where our Med-Peds hospitalists have helped to educate or expand the practice of our local PHM community is in the area of point-of-care ultrasound, care of young adults in children’s hospitalists, and management of substance abuse disorders and venous thromboembolisms.
Now that PHM is an official subspecialty of the ABP, my counseling for my Med-Peds residents who are considering careers in hospital medicine has certainly evolved. We have a thriving PHM fellowship, including a Med-Peds hospital medicine option, here in Cincinnati. Having seen firsthand the impressive skillsets our fellows develop during their time in fellowship and the projects they have participated in, I am a HUGE supporter of PHM fellowship training. Many of my residents that are considering careers in hospital medicine would like a pursue a combined Med-Peds option. Because of this I encourage all of them to reach out to PHM fellowship program directors to see if they would be willing to consider a Med-Peds hospital medicine fellowship option in their own program if one doesn’t already exist. Now, not all residents considering careers in hospital medicine will want or be able to do a fellowship. In the end, it is an individual choice. I stress to them that an educated decision that takes into account skill development needs, personal factors, future employability (based upon training and board certification status), and earning potential is paramount. There is no right or wrong choice, however they must make sure the choice is well informed and right for them.
5. As someone very involved in medical education, what are the best resources and conferences for younger pediatric hospitalists looking to get involved in medical education? How would you suggest getting involved when first starting out?
I highly recommend both the APEX program and the APA’s Educational Scholars Program to early career faculty with an interest in medical education. Both of these programs not only give you excellent training, but also provide you with opportunities for local and national mentorship, as well as the chance to build a network of peers from across the country. I would also encourage early career folks to get involved in various subcommittees in our three societies (AAP, APA, and SHM) that focus on education skill development and projects. If folks are serious about a career in medical education they should also consider pursing a Masters degree in one of many programs across the country that are focused on medical or health professions education. This not only gives you great training in educational theory, but also educational scholarship and leadership. And, don’t be afraid to ask your institution/employer to help with tuition or FTE support. Institutions/employers are often very interested in ways to invest in their employees and help make them successful!
6. Since 2010, you have been the site principal investigator at Cincinnati Children's for the I-PASS Study Group and have collaborated on the initial I-PASS Handoff Study, the AHRQ-funded Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program, and the Patient and Family Centered I-PASS Study. What is the secret to the success of I-PASS, and what is the next step for this group?
One of my daughter’s sports teams had a t-shirt a few years ago that had the phrase “teamwork makes the dream work” on the back. I cannot think of a better phrase to describe the I-PASS Study Group. The group’s focus on the team and valuing every member is truly the “secret sauce” behind our success. Even from our earliest days, our most senior leaders in the group valued each member’s opinion, skillset, and previous experience. I was a very early career faculty member when I joined the I-PASS Study Group, and I always felt equal to and valued by everyone on the team. I also knew the team was invested in me and my personal and professional development. As the years have passed, those of us that were very early in our careers when we joined the I-PASS Group have had the opportunity to give back to the team by mentoring and developing those folks early their careers just joining the group. It’s the circle of life at its finest. Any group that that makes team development, respect, and valuing the contributions of every member their mission will be destined for great success.
As for what’s next for I-PASS, a great deal of our focus now is how we can spread the work we have done around transitions of care and patient and family-centered rounds outside of pediatrics and outside of the inpatient setting. As a Med-Peds hospitalist, I am especially interested in spreading our Patient and Family-Centered I-PASS work to adult hospitals and hospital medicine groups. Patient and family-centered rounds are now standard practice in pediatric hospitals across the US, and I’d love to see the same happen for hospitalized adults!
7. A paper you published in the Journal of Graduate Medical Education in December 2015 looked at creating a teaching development assessment tool (TDAT) for the evaluation of attending physicians on inpatient rounds. Can you talk more about it and how to implement it?
This was a tool my colleagues and I created as part of a Master Educator Fellowship here at Cincinnati Children’s Hospital. The tool created to evaluate the teaching and coaching skills of a supervising attending on an inpatient ward service. During the study we used it to observe and provide feedback to the faculty and fellows on our inpatient teaching services. The tool could be easily adapted for use at your institution and is a great vehicle for multi-source feedback. While most folks tend to think of using it to provide feedback to new or early career folks, it can also serve as a great development tool for mid and late career folks. Everyone should continue to hone their skills as an educator throughout their careers!
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I think I’ve said enough in this piece, so I’ll just leave folks with two of my favorite quotes.
"Alone we can do so little, together we can do so much." --Helen Keller
“I don't know exactly what's next but I'm stepping forward with grit anchored in grace."--Julie Graham