The Use of Telemetry Monitoring Among General Medicine Patients

Objective: To determine why and when general medicine non-ICU patients are upgraded from a non-telemetry level of care to telemetry monitoring at Thomas Jefferson University Hospital (TJUH). Comparison of the reasons for initiation of continuous ECG monitoring with the AHA and ACC guidelines would provide a greater understanding of the applicability of these recommendations to non-ICU general medicine patients. This information can provide guidance to identify areas of intervention to decrease inappropriate and/or overutilization of telemetry. The ultimate goal is to identify general medicine patients who are likely to benefit from continuous ECG monitoring, without negatively affecting clinical outcomes for those who do not receive cardiac monitoring.https://jdc.jefferson.edu/patientsafetyposters/1025/thumbnail.jp

From the Desk of the Residency Program Director

To the Friends of the Department of Medicine: I am honored to be given the opportunity to lead this talented group of residents as they travel down the path toward completion of their residency training. On September 1st, Dr. Gregory Kane took the reins as the Interim Chair of the Department of Medicine here at Jefferson. A new Program Director could not ask for a more staunch supporter of education to occupy that role than Dr. Kane. This edition of The Forum showcases the broad variety of patients our residents and students encounter during their training. The submissions to this journal, in light of the workload they carry, is a testament to the dedication and level of engagement demonstrated by our residents and students. We’ve survived some major challenges this year through their enthusiasm, hard work, creativity and camaraderie

Patient Interview Simulator: An innovative tool to learn and practice clinical medicine

Purpose: There is a lack of materials for simulating and testing the medical diagnostic procedure. Studies show that this is a trend nationwide, where not enough emphasis is put on clinical skills acquisition and assessments. We have designed a simulator to supplement the integration of medical knowledge in clinical scenarios. We designed this tool to be used as an add-on to medical school curricula. Methods: Twenty second-year medical students participated in this innovative project, as they had the necessary foundations of medical knowledge, and have not had many patient interactions yet. During the pilot study, participants played four cases regarding chest pain, and we analyzed their feedback using the first level of the Kirkpatrick scale. We used this level of the scale to determine the enjoyment of the simulator and whether participants would be willing to continue using it as a supplement. Results and Conclusions: 71% of responders (n=14) said they would use this game as a supplement in medical education. 94% of responders (n=17) reported that the game was very intuitive to learn. 73% of responders (n=15) reported they would likely play this game again. The results indicate that there is interest in this simulator as a supplemental educational tool. This simulator allows for practical application of the vast information we acquire as students, without the medical risks of clinical practice. This innovation is of benefit to students by increasing experience and providing a great supplement to medical schools

Recognizing Burnout: Arts-Integrated Workshop

Burnout is common among medical trainees but can be difficult to teach. Arts-integrated curricula can increase learner engagement with a difficult topics, teaching both the core subject area and an art skills, with learning objectives in both. This is a novel arts-integrated workshop run by the authors at Thomas Jefferson University Hospital for Internal Medicine residents (and subsequently for learners in other specialties and institutions). Please see additional materials for facilitator notes as well as handout. Learning Objectives: 1. Discuss professional emotions and behaviors related to burnout 2. Identify compositional techniques that enhance the meaning of an image 3. Create a photograph representing burnou

Pulmonary Mucormycosis in a patient with Acute Myeloid Leukemia

Introduction Mucormycosis is a rare fungal infection that is common amongst uncontrolled diabetics and immunocompromised patients. The most common clinical presentation is rhino-orbital-cerebral infection, which typically affects diabetics with ketoacidosis.1 Less commonly, pulmonary mucormycosis can occur in patients with hematologic malignancy, solid organ transplant and patients taking steroids or deferoxamine.1 The following report describes a 25-year-old male with Acute Myeloid Leukemia (AML) who developed a pulmonary mucormycosis infection. With a mortality rate of about 87%, this case represents a favorable outcome for a rare and often lethal diagnosis. Case Description A 25-year-old male with no past medical history presented to the hospital after two weeks of fatigue, shortness of breath and epistaxis. Lab work revealed leukocytosis with 43% blasts, anemia and thrombocytopenia. A bone marrow biopsy confirmed the diagnosis of AML. After admission, the patient developed persistent fevers and CT scan demonstrated ground-glass opacities in bilateral lung fields. Blood and sputum cultures, respiratory viral panel and acid fast studies were negative and the patient was started on antifungals and broad spectrum antibiotics. Bronchoscopy with bronchoalveolar lavage did not reveal an infectious source. The patient underwent induction chemotherapy with idarubicin and cytarabine, which was initially well tolerated. However, he soon developed neutropenic fever, hypoxia, and a non-productive cough. The treatment was broadened from vancomycin, zosyn and micafungin to meropenem and ambisome. Cultures remained negative during this time and subsequent imaging revealed right-middle and left-upper lobe consolidations with a central lucency

We Are What We Pre-Attend To Be: Piloting a Pre-Attendingship Rotation in Hospital Medicine

Problem Definition New-to-practice attendings (NPTAs) lack readiness for independent practice Graduated autonomy – understood but not structurally enforced in residency training Curricular expectations not explicitly defined despite experiential differences between graduate training levels of PGY2 and PGY3 internal medicine residents Although residents achieve competencies established by the ACGME prior to graduation, NTPAs feel unprepared suggesting opportunities to change the clinical learning environment to increasehttps://jdc.jefferson.edu/medposters/1022/thumbnail.jp

Patient Safety Escape Room: A Graduate Medical Education Simulation for Event Reporting.

Introduction: Although residents are on the front lines of patient care, they enter few formal patient safety reports on the adverse events and near misses they witness. Demonstrating the rationale and mechanics of reporting may improve this. Methods: We designed and implemented an escape room patient safety simulation to incorporate active learning, gamification, and adult learning theory into intern patient safety onboarding. Interns from all sponsoring institution programs participated, identifying, mitigating, and reporting a range of patient safety hazards. Props and faculty time were the major resources required. Results: One hundred twenty interns participated in this simulation in June 2018. Forty-one percent reported previous training on reporting errors, and only 5% had previously entered an event report. Average confidence in ability to identify patient safety hazards improved after the simulation from 6.35 to 8.00 on a 10-point rating scale. The simulation was rated as relevant or highly relevant to practice by 96% of interns. Discussion: Several factors contribute to a low error-reporting rate among house staff. We developed a simulation modeled on popular escape room activities to increase awareness of safety hazards and ensure familiarity with the actual online reporting system our interns will use in the clinical environment

Finding the \u27QR\u27 to Patient Safety: Applying Gamification to Incorporate Patient Safety Priorities Through a Simulated \u27Escape Room\u27 Experience.

Medical errors are the eighth leading cause of mortality in the United States and contribute to over one million preventable injuries. In an effort to prevent medical errors, reporting systems serve as invaluable tools to detect patient safety events and quality problems longitudinally. Historically, trainees (i.e., students and residents) rarely submit incident reports for encountered patient safety threats. The authors propose an immersive learning experience utilizing gamification theory and leveraging the increasingly popular ‘escape room’ to help resident trainees identify reportable patient safety priorities. All 130 incoming intern physicians at the Thomas Jefferson University (Jefferson) were enrolled in the Patient Safety Escape Room study as part of their residency orientation (June 2018). The residents were randomly divided into 16 teams. Each team was immersed in a simulated escape room, tasked with identifying a predetermined set of serious patient safety hazards, and successfully manually entering them into the Jefferson Event Reporting System within the time allotted to successfully ‘win the game’ by ‘escaping the room’. Quick response (QR) codes were planted throughout the activity to provide in-game instructions; clues to solve the puzzle; and key information about patient safety priorities at Jefferson. All participants underwent a formal debriefing using the feedback capture grid method and completed a voluntary post-study survey, adapted from Brookfield’s Critical Incident Questionnaire (CIQ). The study was IRB exempt. Thematic analysis of the post-activity CIQ survey ( n = 102) revealed that interns were engaged during the immersive learning experience (n = 42) and were specifically engaged by having to independently identify patient safety threats (n = 30). Participants identified team role assignment (n = 52) and effective communication (n = 26) as the two most helpful actions needed to successfully complete the activity. Participants were overall surprised by the success of the education innovation (n = 45) and reported that it changed how they viewed patient safety threats. Areas for improvement include clearer game instructions and using a more streamlined event reporting process. The escape room patient-safety activity allowed interns to actively engage in an innovative orientation activity that highlighted the importance of patient safety hazards, as well as providing them with the opportunity to document event reports in real-time. Next steps will include longitudinally tracking the quantity of error reports entered by this cohort to determine the effectiveness of this educational intervention

The Vice Chair of Education in Emergency Medicine: A Workforce Study to Establish the Role, Clarify Responsibilities, and Plan for Success

ObjectivesDespite increasing prevalence in emergency medicine (EM), the vice chair of education (VCE) role remains ambiguous with regard to associated responsibilities and expectations. This study aimed to identify training experiences of current VCEs, clarify responsibilities, review career paths, and gather data to inform a unified job description.MethodsA 40‐item, anonymous survey was electronically sent to EM VCEs. VCEs were identified through EM chairs, residency program directors, and residency coordinators through solicitation e‐mails distributed through respective listservs. Quantitative data are reported as percentages with 95% confidence intervals and continuous variables as medians with interquartiles (IQRs). Open‐ and axial‐coding methods were used to organize qualitative data into thematic categories.ResultsForty‐seven of 59 VCEs completed the survey (79.6% response rate); 74.4% were male and 89.3% were white. Average time in the role was 3.56 years (median = 3.0 years, IQR = 4.0 years), with 74.5% serving as inaugural VCE. Many respondents held at least one additional administrative title. Most had no defined job description (68.9%) and reported no defined metrics of success (88.6%). Almost 78% received a reduction in clinical duties, with an average reduction of 27.7% protected time effort (median = 27.2%, IQR = 22.5%). Responsibilities thematically link to faculty affairs and promotion of the departmental educational mission and scholarship.ConclusionGiven the variability in expectations observed, the authors suggest the adoption of a unified VCE job description with detailed responsibilities and performance metrics to ensure success in the role. Efforts to improve the diversity of VCEs are encouraged to better match the diversity of learners.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/1/aet210407_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/2/aet210407.pd