Tuesday, September 8, 2015

Preconference Tidbit #12 -- What pattern would you teach?

by Paul Uhlig

Yesterday's Tidbit contrasted two patterns for patient care, one traditional and the other collaborative. Tonight's Tidbit assumes that 1) you are a health care teacher, and 2) you are comfortable with both patterns.

The Tidbit tonight is a question...Which pattern would you teach your students?

A case can be made that teaching the traditional pattern is very important. Students need to learn the expected routines of their profession. For example, in the profession of medicine, the medical student is taught from day one that he or she will be "presenting the patient" on rounds, and there is an expected pattern that should be followed. It is what has always been done. It is part of learning to be a doctor. Learners will be judged and tested on their ability to present patients completely and concisely, using a traditional pattern.

Alternatively, a case can be made that the traditional pattern of presenting patients on rounds needs to be fundamentally redesigned for collaborative care. The traditional pattern that has been taught for years unintentionally produces distance from patients, and is highly physician-centric from the perspective of other health professionals. It doesn't serve collaborative care well. Something new and different is needed. A new kind of doctor is needed. The world is changing. We need to change with it, and help lead that transformation.

So, which pattern will you teach? As you think about this, don't forget that many forces are in place that support and expect a traditional approach to care. These include peer pressure, time pressure, standards for educational evaluation, documentation requirements for reimbursement, accountability standards for program accreditation, and expectations of learners themselves. Making changes in routines may be difficult.

As a way of seeing what others are doing, you might be interested in the video below.

Dr. Eric Warm is a Professor of Medicine and Director of the Internal Medicine Residency at the University of Cincinnati College of Medicine. The video shows Eric with a rounding team, conducting a simulation that explores an alternative approach for presenting patients at the bedside.


There is not an easy answer to this question, but collaborative care needs something different. We will explore this during our meeting.

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