Today was our first day of the Rheumatology Friday School Block and part of our Resident As Clinician Educator for All (RACE 4 All) curriculum!
From 1-3pm, RACE Track Director, Dr. Supraja Thota shared tips on how to be an amazing team leader and teach on rounds. She included a mini-workshop on the “holdover game,” helping residents to make holdovers into a rich, interactive cognitive reasoning exercise that can help avoid anchoring!
From 3-5pm, residents and interns gathered in small groups to come up with creative questions to test their co-residents on the clinical manifestations, work up and treatment of SLE! Dr Maripat Corr from our Rheumatology Department then reviewed SLE with us! With her help, and the help of our new resident experts in SLE, we were able to answer all the fun (but difficult) questions made by each small group! While we were able to cover a lot, learning about SLE is not restricted to Friday School! Check out this amazing article on SLE for the internist in the Annals of Internal Medicine! Click Here!
We were lead today through some interesting high yield Osteoporosis learning objectives by our RACE track resident Dr. Kusuma Pokala and endocrinologist Dr. Gina Woods. Our residents took on the challenge of teaching each other and we took our newfound knowledge through a Jeopardy game to solidify this information! We then learned about common dermatologic conditions that general internists may encounter with the help of Drs. Natasha Carter, Laura Romero and Joyce Yuan. Thank you all for helping our residents with our virtual learning experiences!
Today we had a multitude of interesting talks covering a range of GIM topics. Dr. Eduardo Gruvald led us through medical management of Obesity. Then Dr. Chad Wadell gave us some insight into what to be aware of for job contract negotiations. Finally Dr. Anna Quan reminded us of the components of the knee and shoulder exam and led us through some high yield cases!
For our last neurology/emergency medicine Friday school session, our residents and interns tested their knowledge of neurology by working through several simulation sessions, courtesy of NCC expert Dr. Cynthia Gonzalez! We then learned about stroke syndromes and management! Check out the link below for some of the pearls from the sim sessions!
YAY Friday School! This Friday, Dr. Dan Sweeney (PCCM) and our awesome PCCM fellows (Mazen Odish, Jacob Bailey, Erica Lin, Jeff Barry) taught us how to perform a FAST exam, and how image the aorta, the IVC, the femoral and popliteal veins to look for DVT. We practiced on a simulator, and on LIVE models, including a very nice volunteer with Polycystic Kidney Disease.
Our residents then participated in a workshop facilitated by our multi-disciplinary Palliative Care team and members of the HEAR (Healer Evaluation Assessment and Referral) program (including Rachel Accardi, Courtney Sanchez, Chris Onderdunk, Dr. Maria Tiamson-Kassab) on how to lead a debrief following a difficult patient event. Critical leadership skills and part of our RACE (Resident As Clinician Educator) Curriculum!
I want to take this opportunity to stress that if any of you are struggling with the impact of a difficult patient encounter, a loss or medical error, I urge you to seek help to process this important event. Being a physician is an incredibly rewarding, but also difficult job! The program is here to support and help you. You can also come to any of the chief residents, or program leadership with your concerns about yourself or your colleagues. I promise they will be addressed with sensitivity and confidentiality. I have included some resources below for the Healer Education Assessment and Referral (HEAR) Program.
We had a terrific Friday school this afternoon! First a panel of patients who had undergone renal transplant shared their experiences with our residents, facilitated by transplant nephrologist Dr. Mita Shah. Next, Residents worked through advanced cases of Acute Kidney Injury with Dr. Tyler Woodell, while Interns talked through Acute Kidney Injury with Dr. Scott Mullaney.
Finally, UCSD Med/Peds 2019 graduate Dr. Grant Meyer, Med/Peds R2 Dr. Nicky Herrick, and UCSD GIM (4th & Lewis) attending Dr. Julie Sierra spoke to us about the important role physicians can play in Advocacy efforts.
The Cardiology Friday School block continues with a great afternoon didactic session!
Our senior residents received a discussion by Dr. Lori Daniels (Cardiology) regarding the use and interpretation of cardiac biomarkers, specifically highly sensitive Troponin-T (hsTnT) and NT-proBNP. UCSD was one of the first sites to adopt the use of hsTnT, which has led to drastic reductions in ED length of stay during ACS rule outs.
Katrina Derry, PharmD gave a fantastic talk regarding the pharmacoeconomics of cardiac medications. She highlighted tenets of pharmacoeconomic analysis and discussed the basis of utilizing Incremental Cost-Effectiveness Ratio (ICER). We also discussed real world examples of SGLT2 inhibitors compared to GLP-1 agonists.
In our combined resident and intern didactic session, Dr. Howie Tran (Heart Failure/Transplant/Mechanical Circulatory Support) gave a great primer on guideline directed medical therapy, the evidence to support the use of each agent, as well as a discussion on CardioMEMs, a remote pulmonary artery pressure sensor that has led to drastic reductions in heart failure readmissions at UCSD and other sites. We also broke up into small groups to do case-based learning about the indications and study results for SGLT2 inhibitors, angiotensin receptor-neprilysin inhibitors (ANRI) and CardioMEMs. We also used the opportunity to discuss recent trial results from DAPA-HF and PARAGON-HF that had been just presented at the European Society of Cardiology conference in Paris.
Thank you to all our expert discussants for an exciting and educational afternoon!
Today, we learned about dementia, how to disclose the diagnosis, and the challenges around this disease. This is HIGH YIELD stuff. Dementia is like the last frontier, where clinical acumen is necessary. We do not have one test that gives a slam dunk diagnosis. To start if you are thinking about dementia, you need to consider depression and delirium. According to Dr. Sladek, these are the three a”D”go’s! You also should think about the reversible causes. Reversible causes make up <1% of dementia but you can save someone’s life. Alzheimer’s disease is the most common, but there are other types of dementia you need to know. Check out this list:
Friday school this week was the last session of our ultrasound curriculum for the academic year! HUGE shout-out to our amazing chief residents, Dr. Kevin Eng and Dr. Jack Temple, for putting together a phenomenal curriculum! Also thank you to Dr. Dan Sweeney and all of the other faculty and fellows for helping to facilitate all the sessions! The residents also had another journal fight club today. This week’s topic was the use of antipsychotics for the treatment of ICU delirium. We had great article presentations by Drs. Justin Chen, Jeremy Kong, Carlos Lago-Hernandez, and Karen Yun, followed by a lively debate between Drs. Jeremy Hirst and Bob Owens (co-author of the Mind-USA trial)!! Here are the articles we discussed: Quetiapine ICU Delirium CritCareMed 2010 Quetiapine vs Haloperidol Drug Design 2013 HOPE-ICU JAMA 2013 MIND-USA NEJM 2018 Our winner this time was Dr. Bob Owens – his award is that he gets to be Brad Pitt on the Journal Fight
Today our residents and interns had the opportunity to practice revealing a diagnosis of dementia and their goals of care conversations with standardized patients in our professional development center. Thank you to all of our geriatrics, palliative care, primary care, and pulmonary critical care faculty who helped to facilitate the session! You can find the original article outlining the SPIKES framework to help with patient conversations here. Our residents also got a chance to learn and practice tai chi (outside, so they got some vitamin D also!) with tai chi master, Dr. Jesse Tsao. Remember this has been shown to decrease fall risk and chronic pain! They finished off the afternoon with a session on billing & coding with Dr. Deanna Hill – with a game created by our very own Dr. Joe Meserve!