Jimmy Beck
1. As a member of the AAP Education Task Force Subcommittee on High Value Care, you have created numerous MedEd Resources for faculty development and teaching high valued care to learners. One of the resources is a high valued care rounding tool, but some hospitalists and learners are hesitant to discuss high valued care during family centered rounds. What recommendations do you have for incorporating HVC into rounding and what are some dos and don’ts of talking about cost and the unknown/lack of evidence in front of families?
Based on some of my recent research, we know that parents of hospitalized children want to engage in cost discussions. However, parents want these discussions to be optional and tailored to their individual needs and values. Unfortunately, there aren’t any easily defined factors (e.g., socioeconomic status, medical complexity) that can help us predict which families want to talk about cost. It makes sense that we screen all families, possibly at the time of admission, for their interest in having cost discussions at some point during their child’s hospitalization.
I think incorporating HVC into rounds is our responsibility. We need to make decisions that are best for our patients, and concurrently use our limited health care resources wisely. HVC doesn’t have to dominate rounds. While our tool has 10 potential items, simply asking our learners and ourselves questions such as “what are both sides of the coin for getting this CBC? The benefits and the harms?” and asking patients/families, “What concerns do you have and what is important to you,” can go a long way to ensure that we are practicing HVC.
2. In your article “Failure Is an Option: Using Errors as Teaching Opportunities” (Pediatrics 2018 Mar; 141(3)), you discuss missed opportunities to teach students to respond to and learn from errors. You mention a method of debriefing using IHELP – Introduction, Homework, Emotional Support, Learning, Plan. How has this method been received by students? Do you propose a similar method with residents and peers?
I’ve used this framework a lot with students, residents and even peers and, anecdotally, it’s been received well. But I’m still not sure the field of medicine is ready to embrace mistakes like most other fields have. I recently experienced one of my most epic teaching failures. I was on service and created a mistake “calendar” for our team. For the first 2-3 days, I wrote my mistakes on a dry erase board in our team room, and then invited everyone else to start documenting their mistakes if they wanted. Even though I ensured that my list of mistakes was infinitely longer than everyone on my team, I don’t think it was well received by my team and I heard from other residents that they would not have participated if they had been on my team. I definitely want to try this to do this again, but I think next time I will need to better prepare my learners and explain the rationale, in order to get their investment.
3. In addition to presenting the top 10 articles at PHM, you published an article “Electronic resources preferred by pediatric hospitalists for clinical care” (J Med Libr Assoc. 2015 Oct;103(4):177-83), where you conclude that many pediatric hospitalists tend to utilize less rigorous electronic resources such as UpToDate and Google. What resources do you find helpful? How do you curate your literary diet/regimen from the high-volume output of the medical field? How do you screen abstracts and decide which papers to read fully?
So to be clear, I do use UpToDate and Google. But I think it is also super important to keep up with and understand how to appraise the primary literature. I use PubMed the majority of the time, particularly when I am on service. When I can associate an article to a patient that I am taking care of, then the subject and details resonate more strongly and I retain the information. Also, I utilize their automated search function to find new articles on any topic of interest. For example, every 2 weeks I get email alerts when new articles on High Value Care are published. I also receive monthly emails from a variety of journals such as JAMA Peds, Pediatrics, Hospital Peds, and other med education journals. I scan the table of contents and read interesting articles time permitting.
4. You have led national presentations and written articles on High Value Care, Quality improvement (QI), Medical Education, and comparative effectiveness research (CER). Although hospitalists are supposed to be a “jack of all trades,” many of us find it difficult to be well versed in all of these things and many leaders in pediatric hospital medicine specialize in one field. How have you been able to maintain a diverse profile and be well versed in all of your fields of interest?
During my fellowship, I had a variety of amazing mentors and this allowed me to dabble in a bunch of different areas. My decision to pursue a fellowship was the single best decision of my career. Luckily, I was able to do my training at one of the best fellowship programs in America, Children’s National, where I received valuable mentorship. In addition, I completed the fellowship relatively early on when there weren’t that many fellowships available. There were more mentors than fellows at that time. I was able to develop relationships which lead to workshops, manuscripts, and projects in a variety of areas. In my old age, I’ve since narrowed my focus to High Value Care and medical education topics which I think is ultimately important for most hospitalists to do.
5. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I can’t take credit for this phrase, but I really like it. “It’s called NetWORKING and not NetRELAXING for a reason.” No matter if you are an introvert or an extrovert, networking, especially in our field, is a critical skill, but that’s only half the battle. It’s equally important to follow up with people after the initial meeting, and when given the opportunity to collaborate and work together, it’s important to show appreciation for their collegiality and mentorship. That’s my two cents.
Based on some of my recent research, we know that parents of hospitalized children want to engage in cost discussions. However, parents want these discussions to be optional and tailored to their individual needs and values. Unfortunately, there aren’t any easily defined factors (e.g., socioeconomic status, medical complexity) that can help us predict which families want to talk about cost. It makes sense that we screen all families, possibly at the time of admission, for their interest in having cost discussions at some point during their child’s hospitalization.
I think incorporating HVC into rounds is our responsibility. We need to make decisions that are best for our patients, and concurrently use our limited health care resources wisely. HVC doesn’t have to dominate rounds. While our tool has 10 potential items, simply asking our learners and ourselves questions such as “what are both sides of the coin for getting this CBC? The benefits and the harms?” and asking patients/families, “What concerns do you have and what is important to you,” can go a long way to ensure that we are practicing HVC.
2. In your article “Failure Is an Option: Using Errors as Teaching Opportunities” (Pediatrics 2018 Mar; 141(3)), you discuss missed opportunities to teach students to respond to and learn from errors. You mention a method of debriefing using IHELP – Introduction, Homework, Emotional Support, Learning, Plan. How has this method been received by students? Do you propose a similar method with residents and peers?
I’ve used this framework a lot with students, residents and even peers and, anecdotally, it’s been received well. But I’m still not sure the field of medicine is ready to embrace mistakes like most other fields have. I recently experienced one of my most epic teaching failures. I was on service and created a mistake “calendar” for our team. For the first 2-3 days, I wrote my mistakes on a dry erase board in our team room, and then invited everyone else to start documenting their mistakes if they wanted. Even though I ensured that my list of mistakes was infinitely longer than everyone on my team, I don’t think it was well received by my team and I heard from other residents that they would not have participated if they had been on my team. I definitely want to try this to do this again, but I think next time I will need to better prepare my learners and explain the rationale, in order to get their investment.
3. In addition to presenting the top 10 articles at PHM, you published an article “Electronic resources preferred by pediatric hospitalists for clinical care” (J Med Libr Assoc. 2015 Oct;103(4):177-83), where you conclude that many pediatric hospitalists tend to utilize less rigorous electronic resources such as UpToDate and Google. What resources do you find helpful? How do you curate your literary diet/regimen from the high-volume output of the medical field? How do you screen abstracts and decide which papers to read fully?
So to be clear, I do use UpToDate and Google. But I think it is also super important to keep up with and understand how to appraise the primary literature. I use PubMed the majority of the time, particularly when I am on service. When I can associate an article to a patient that I am taking care of, then the subject and details resonate more strongly and I retain the information. Also, I utilize their automated search function to find new articles on any topic of interest. For example, every 2 weeks I get email alerts when new articles on High Value Care are published. I also receive monthly emails from a variety of journals such as JAMA Peds, Pediatrics, Hospital Peds, and other med education journals. I scan the table of contents and read interesting articles time permitting.
4. You have led national presentations and written articles on High Value Care, Quality improvement (QI), Medical Education, and comparative effectiveness research (CER). Although hospitalists are supposed to be a “jack of all trades,” many of us find it difficult to be well versed in all of these things and many leaders in pediatric hospital medicine specialize in one field. How have you been able to maintain a diverse profile and be well versed in all of your fields of interest?
During my fellowship, I had a variety of amazing mentors and this allowed me to dabble in a bunch of different areas. My decision to pursue a fellowship was the single best decision of my career. Luckily, I was able to do my training at one of the best fellowship programs in America, Children’s National, where I received valuable mentorship. In addition, I completed the fellowship relatively early on when there weren’t that many fellowships available. There were more mentors than fellows at that time. I was able to develop relationships which lead to workshops, manuscripts, and projects in a variety of areas. In my old age, I’ve since narrowed my focus to High Value Care and medical education topics which I think is ultimately important for most hospitalists to do.
5. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
I can’t take credit for this phrase, but I really like it. “It’s called NetWORKING and not NetRELAXING for a reason.” No matter if you are an introvert or an extrovert, networking, especially in our field, is a critical skill, but that’s only half the battle. It’s equally important to follow up with people after the initial meeting, and when given the opportunity to collaborate and work together, it’s important to show appreciation for their collegiality and mentorship. That’s my two cents.