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Chief Residents Meeting Workshops

Workshop Session I
Sunday, March 18, 2018
3:00 p.m. to 4:00 p.m. 

101. Let’s Get Physical…In The Classroom: Employing Novel Teaching Techniques to Connect Residents Back to the Physical Exam

Physical examination is the cornerstone of medical practice. This bedside art is now competing with the increasing demands of electronic documentation and hospital-specific throughput metrics for post-graduate trainees. Traditionally, the physical exam is learned during “attending rounds” which fosters bedside learning and builds on skills developed in medical school. However, there are few dedicated physical exam teaching curricula in practice in the postgraduate setting. While the art of physical examination does require hands-on learning at the bedside, the classroom can be a complementary platform for the delivery of content that enhances bedside didactics. This workshop will help participants develop physical exam teaching skills that can be implemented during daily conference or in other classroom settings. In the proposed curriculum, we employ the use of “BST” (Bite Sized Teaching) methods developed at our institution for the delivery of high-impact, memorable content in 8-10 minutes. This approach will allow the educator to break down each topic by organ system into a case-based session, imprinting onto the residents who leave each teaching session having acquired one new skill they can put into practice. The participation and attendance of a master clinician to each session is key. Having these individuals in the audience allows for questions and anecdotal advice. Using this format, each encounter will empower residents to apply their newly-acquired skill at the bedside. This teaching method can be applied to nearly any topic in medicine, and beyond medicine to transform medical education in training programs.

Educational Objectives:

  • Develop curriculum goals for teaching the physical exam in a classroom setting.
  • Applying “BST” (Bite Sized Teaching) method to the resident audience, meaning short (8-10 minute) high-yield digestible content for learners, to deliver instruction on physical examination.
  • Develop a list of teaching topics.

Catherine Bartnik, MD, MPH
Alejandra Bustillo, MD
Tyler Peck, MD
Andrew Allen McCue, MD
Emory University School of Medicine 

102. Journal Club for the Millennial Learner

Learning how to interpret and evaluate medical literature and evidence based medicine is a critical skill for physicians and a vital part of the graduate medical education. Though learning this process is imperative, the traditional Journal Club format of a resident presenting the article to an audience of their peers often leaves much to be desired and can be tedious and boring for the audience and presenter alike. To better engage the millennial learner, our residency implemented an innovative and lively format where the resident teams are challenged with a clinical question based on a short, relevant clinical vignette and are then responsible for justifying their plan to an audience. This interactive workshop will provide a platform for attendees to review the various Journal Club formats used at their institutions before reviewing the approach we have adopted in our program. Through a mock session, audience members will gain valuable insight into designing and implementing a system from selecting the clinical questions to finding and presenting the articles.

Educational Objectives:

  • Share and evaluate the various formats used to educate residents on critical review of the literature.
  • Describe an innovative format designed to teach residents to perform literature reviews to answer a clinical question.
  • Gain appreciation for the importance of a systematic but engaging journal club format for the millennial learner.

Asha De, MD
Tara Brown, MD
Brandon William Kuiper, MD
San Antonio Uniformed Services Health Education Consortium
(Wilford Hall Medical Center) 

Rechell G. Rodriguez, MD
Uniformed Services University of the Health Sciences
F. Edward Hebert School of Medicine

103. Residency Driven Research Curriculum Expansion

This workshop will focus on enhancing your program’s research curriculum with an emphasis on teaching residents research skills, supporting collaboration to increase productivity in scholarly activity, and empowering residents as drivers of improvement. Though resident participation in research is particularly sought after by residents interested in fellowship training and/or academic careers, a scholarly project is also an ACGME resident requirement and can prove to be a valuable learning experience for all residents. Our workshop will assist program leaders with implementation of curricula designed to improve residency productivity and participation in scholarly activities. We will discuss barriers including inadequate time, mentorship, funding, resident attitude, and program culture, and ways to overcome these barriers to optimize resident engagement in scholarly activity. We will describe implementation of elements integral to successful residency research programs including research education curricula (didactic and small group formats), the concept of a research director and residency research committee, development of a research “track”, protection of resident time and the development of specific requirements for participation in scholarly activities. Additional topics may include building a program for career guidance and mentorship, and development of a resident/mentor research database. With completion of this workshop, participants will possess an action list that can be used to identify weaknesses in specific programs, and includes steps to take to immediately begin improvement in their program’s research and scholarship curriculum. With completion of this workshop, participants will be well equipped to increase resident success in scholarship during residency and beyond.

Educational Objectives:

  • Participants will learn about methods to support resident education and meaningful engagement in research in their residency programs.
  • Participants will identify strengths and barriers to success in their own programs’ research curricula.
  • Participants will apply learned strategies to overcome barriers and create new platforms for research productivity specific to their programs’ needs.

Nathan Denlinger, DO
Kyle R. Stinehart, MD
Lauren JoAnn Hassen, MD, MPH
David A. Wininger, MD
Ohio State University College of Medicine 

104. Chief Resident Mistakes Workshop

“All men make mistakes, but only wise men learn from their mistakes.” - Winston Churchill. Here is your opportunity to learn from other chief resident's mistakes. In this workshop you will be presented with case vignettes of several commonly reported chief resident mistakes featured in the Textbook for Today's Chief Resident. Faculty will guide a group discussion on how the mistake happened and explore strategies to avoid similar mistakes during your chief resident year. The learners will dissect each scenario in “real time” with the help of the faculty and in doing so re-orient them-selves to their new leadership position. Facilitators will guide the group discussion and solicit the audience to augment the discussion with mistakes they have witnessed their own chief resident make. After completing this workshop, chief residents cannot expect to have a mistake free year but will have their eyes and minds opened to potential pitfalls they will face, learn strategies to avoid them, and realize how easy it is to make a mistake even with the best of intentions.

Educational Objectives:

  • Recognize and understand common mistakes made by chief residents.
  • Learn strategies to avoid common chief resident mistakes.
  • Appreciate the complex role played by the chief resident and leverage it to minimize mistakes. 

Jess D. Edison, MD
National Capital Consortium 

George R. Mount, MD
Patricia A. Short, MD
Madigan Healthcare System 

Rachel Robbins, MD
Dwight David Eisenhower Army Medical Center 

105. Culture Change—Creating your Program Social Media Footprint!

Building a robust program social media (SM) presence is increasingly important for residency programs as Millennial applicants and residents use these platforms to engage with residency program communities. Social Media can help programs improve social connectedness, enhance resident wellbeing, advance medical knowledge, and recruit top applicants to their programs. Chief residents are ideally positioned to lead creation of or enhancing existing accounts to maximize exposure and impact. Join us as we detail how to effectively use Instagram and Twitter to build a strong SM presence and demonstrate use of available analytics to track your successes. We will help you set up your program accounts and/or increase your program’s SM exposure by utilizing popular existing hashtags (e.g. #residencylife), creating program-specific searchable hashtags (e.g. #stvimwellness), and optimizing account interactivity and visibility. We will capitalize on the micro-community within the workshop itself to improve program exposure and impact by following, liking, and re-tweeting attendee posts. Prepare to leave this session with the foundation for your program’s Instagram and Twitter accounts literally in hand!

Educational Objectives:

  • Understand the importance of residency program social media accounts in enhancing program connectivity, wellness, and recruitment.
  • Learn how to manage, maintain, and maximize exposure to social media accounts assigned to the program by capitalizing on the power of likes, comments, follows, shares, retweets, and #hashtags.
  • Understand social media analytics and how to improve post exposure and viability for your residency program.

Laurel B. Fick, MD, FACP
Yogitha Potini, MD
Katherine Axon, MD
St. Vincent Hospital and Health Care Center 

106. Teaching the Unteachable: Linking Evidence Based Medicine and Technology to Teach Diagnostic Reasoning

One important job of clinician-educators is to teach students and residents how to reason through diagnostic dilemmas. This is often done by educators sharing their mental model and diagnostic reasoning on rounds. However, rarely are diagnostic decisions quantified and articulated in a way that learners can truly understand the utility and limitations of various tests. This disconnect can lead to learner frustration when they have a teacher who has a different diagnostic approach – one that is more “conservative” or “test-heavy” than they are. This should serve as a valuable learning opportunity where different aspects of diagnostic reasoning are “mapped out” in a way that elevates learner understanding of the process. One reason for this missed learning opportunity is lack of educator comfort with concepts such as pretest probability, action thresholds, and likelihood ratios. Another is that clinicians are unaware of simple tools available on smartphones and tablets that allow for fast, real-time integration of these concepts into rounds. These tools can help educators seamlessly integrate quantified diagnostic reasoning into rounds, and give learners tools to better articulate their thought process.

During this workshop chief residents will be challenged to become comfortable with the often inexact science of determining a pretest probability. They will learn about action thresholds in diagnostic reasoning, and how they contribute to differences in clinician approaches to diagnosis. They will also use likelihood ratios to properly interpret test results, and learn how to use simple smartphone applications to integrate this process into clinical teaching.

Educational Objectives:

  • By the end of this workshop, attendees will be able to teach how to generate specific pretest probabilities and action thresholds (test and treat) for clinical scenarios.
  • By the end of this workshop, attendees will be able to teach the use of likelihood ratios to arrive at appropriate posttest probabilities, and relate this to stated action thresholds.
  • By the end of this workshop, attendees will be able to demonstrate the use of smart phone applications for real-time teaching of the diagnostic process using pre/posttest probabilities, action thresholds, and likelihood ratios while on rounds with learners.

Benjamin Kinnear, MD
Matthew Kelleher, MD
Courtney Ohlinger, MD
University of Cincinnati College of Medicine 

Jonathan L. Tolentino, MD, FAAP, FACP
Stony Brook University School of Medicine

107. Problem Based Learning in Graduate Medical Education: How to Make It Work

Problem based learning (PBL) has not been widely adapted in graduate medical education. In Modified PBL (mPBL) structure, the focus lies on self-directed learning and discussing learning objectives (LO’s) derived from clinical cases in the presence of a multidisciplinary team of experts. The LO’s are derived in a shorter first session in the presence of core faculty/chief residents in small groups. Residents are then able access a video/podcast (developed by teaching faculty) relating to several teaching topics of the case. The second session the following day revolves around discussion of LO's with active facilitation by experts to ensure real time patient based learning with input from specialists of varied fields. The learning is led by residents, while faculty facilitation is centered on more concrete understanding of medical concepts as well as correct interpretation of information and literature. These case based, and peer-taught sessions are in line with adult learning theory. The small group discussions allow learners to make the transition from knowledge gathering to analysis, application and practical utility of knowledge with the ultimate goal of having the learner apply the assimilated knowledge into clinical practice. We utilize cases from the Cleveland Clinic Internal Medicine Case Review Index. Each case is reviewed by the curriculum team and appropriate multi-system faculty facilitators are identified and invited. An added advantage is the ability to assess Medical Knowledge (MK) and Interpersonal and Communication Skills (ICS) milestones after each session while providing verbal feedback to the learner.

Educational Objectives:

  • To demonstrate the components of an effective PBL curriculum for residency programs.
  • To introduce new and robust methods of medical teaching into graduate medical education.
  • Demonstrate how PBl can enhance content knowledge in residents while simultaneously fostering the development of communication, problem-solving, critical thinking, collaboration, and self-directed learning skills.

Jamal H. Mahar, MD
Abby L. Spencer, MD
Carlos Isada, MD
Mohammad Mohmand, MD
Cleveland Clinic Foundation 

108. Introducing the Resident Check In Tool: Identifying Struggling First & Second Year Residents

It is May of your chief resident year. What if an Internist tells you that an intern portrayed poor clinical judgment, organization, and will not be ready for their senior year? What if this notification occurred mid year and on review of their evaluations, there were no identifiable concerns? Now imagine that intern as a new second-year resident who admits they are struggling with their new role? This unfortunately can and does happen for new interns and senior residents alike. This workshop will help you conceptualize different ways to identify residents who may experience challenges with this transition.

In this small group, you will brainstorm important red flags or characteristics to help diagnose at-risk interns. This session will introduce the Intern Check-in Tool—first introduced at last year’s APDIM. Our form works to engage second and third year residents to analyze their intern's performance and ways to improve throughout the year. This dialogue occurs after completion of an inpatient service rotation with a simplified form in a “yes, no, non-applicable” format to guide the evaluator’s thought process. After completing this workshop, you will be able to adopt similar check-in materials at your home institution, discover struggling interns and methods to enact positive change. As a bonus, we will also be introducing a pilot check in tool for new second year residents. In contrast to the intern portion of the check-in tool, interns and/or fellows & attendings will complete a similar form discussing second year residents. Specifically, this tool will emphasize more tasks, milestones suitable to second years in their new roles as leaders and organizers of a medical team.

Educational Objectives:

  • Identify benefits of early evaluation and intervention of interns and second year residents.
  • Learn how to develop a meaningful, specific screening process to assess interns and new seniors.
  • Learn how to implement an accessible check in tool to impact resident improvement.

Jennifer Michelle Ray, MD
Daniel Sisbarro, MD
Joshua Newman, MD
Stritch School of Medicine Loyola University of Chicago 

109. Preventing Burnout Before It Starts: Innovative Wellness Initiatives for Intern Orientation

Burnout occurs in up to three-quarters of medical residents and is associated with detrimental consequences for trainees and patients. In this interactive session, we will share fresh ideas from various institutions where wellness initiatives have been successfully incorporated into intern orientation curricula. Orientation is a crucial time to empower interns to: 1) understand the definition of burnout and its prevalence, 2) develop skills for resilience, and 3) prioritize wellness as a longitudinal component of their professional development. First, we will apply the “Think-Pair-Share” model to empower interns to anticipate their own personal challenges and to brainstorm coping strategies with their peers. Next, based on the theories of positive psychology and reflective practice, we will describe the “Three Good Things” framework to teach interns to identify positive experiences at the end of each day. To promote wellness longitudinally, we will discuss various ways to facilitate mentoring relationships between upper level residents and interns. We will also describe an initiative in which interns write encouraging, self-addressed letters during orientation that will be delivered to themselves in February, when burnout rates are highest. Finally, we will share the concept of intern orientation as the start to a longitudinal wellness curriculum. After this session, participants will be equipped with practical steps and a "How-To" Guide to incorporate wellness initiatives into intern orientation at their residency program.

Educational Objectives:

  • Apply the Think-Pair-Share model and the “Three Good Things” framework to develop skills for resilience among interns.
  • Describe the use of mentorship and letter writing to promote longitudinal wellness.
  • Provide a practical framework for implementing a wellness curriculum during your residency program’s intern orientation.

Emily Insetta, MD
Johns Hopkins University/Bayview Medical Center 

Alex Glaser, MD
Hari Shankar, MD
Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania 

Julie Gemmill, DO
Stony Brook University School of Medicine 

110. Every Bite Matters: Incorporating Bite-sized Morsels of Evidence-Based Medicine (EBM) into Clinical Education

Application of evidence-based medicine (EBM) improves delivery of patient-centered, cost-effective care and can illustrate the rationale behind the clinical decision-making process. However, the practical concepts of EBM are difficult to teach and apply to clinical reasoning and problem-solving, and exposure to EBM in isolated settings decreases the ability of the learner to understand and retain those concepts. Chief residents have a unique opportunity to interact with residents and medical students in several different educational settings, from morning reports to bedside teaching to structured lectures. The timely and context-driven delivery of bite-sized EBM pearls during educational periods, such as morning reports, and at the bedside, such as while attending on the wards, can help cement EBM into daily teaching. Providing these morsels of educational content in small, relevant bites allows an often difficult topic to become more palatable and digestible. Trainees are also more likely to retain EBM knowledge when taught in a format that is applicable to the patients they are treating. This interactive workshop will incorporate examples of applicable EBM concepts and creative strategies for incorporation of EBM education into existing educational and clinical activities. Participants will brainstorm how to incorporate EBM into their curriculum and practice teaching an EBM topic in small groups with the goal of leaving with a framework for implementing effective EBM teaching, as well as a toolkit of examples for use at their own institutions. Lastly, innovative strategies developed during the in-session brainstorming will be disseminated to participants via email after the workshop.

Educational Objectives:

  • Discuss common and useful EBM concepts, and illustrate the importance of incorporating EBM into clinical practice.
  • Identify barriers and limitations to teaching EBM in multiple settings, including as a part of a formal curriculum, educational conferences, and informal clinical venues.
  • Demonstrate how to teach bite-sized morsels of EBM content in clinical teaching across various formats and settings.

Michael Joseph Schnaus, MD
Minneapolis VA Health Care System

Jess DeLaune, MD
University of Florida College of Medicine 

Erika Zevin, MD
Indiana University School of Medicine 

Nicholas Ingraham, MD
University of Minnesota Medical School 

Workshop Session II
Monday, March 19, 2018
8:00 a.m. to 9:30 a.m.

201. Flip Your Questions: Getting the Biggest Bang for Your Buck on Teaching Rounds

HGTV popularizes transforming run-down homes into gorgeous properties. By the same token, this workshop is designed to help participants transform boring questions like “what is the most common cause of acute upper GI bleed?” into thought-provoking questions like “what features of this case make you confident this is NOT a lower GI bleed?” This workshop is designed to help chief residents new to the teaching attending role ask thoughtful questions that will tease out the clinical reasoning of various levels of learners. This workshop will focus on a 3-concept model in developing thought-provoking questions: learner, level, and length. To unpack these concepts, participants will watch a sample case presentation and practice writing questions. The facilitators will guide them through a technique to analyze their own questions, followed by a brief introduction to Bloom’s taxonomy of learning domains. In small groups, participants will play a game modeled on “Apples to Apples” in which they will practice writing higher-order questions that also target the appropriate level of a given learner. The workshop will conclude with a de-brief session with the entire group that integrates the three concepts into a coherent mental model; hand-outs will be given that will help facilitate high-order question asking during rounds.

Educational Objectives:

  • Transform questions from ones that gather facts to ones that facilitate clinical reasoning.
  • Identify questions that are higher-order on Bloom’s taxonomy.
  • Tailor questions to different levels of learners.

Kristen Fletcher, MD
John Ragsdale, MD, MS
University of Kentucky College of Medicine 

202. Variety is the Spice of Life: Expanding Report Style Repertoire to Engage Learners and Excite Teachers

The highlight of chief year is assuming the role of educator, and one of the hallmarks of an effective chief is the ability to present a variety of report styles. The ability to adapt report allows conferences to tackle learning objectives in novel ways, and gives chiefs an opportunity to periodically reinvigorate their own teaching engagement. Additionally, chiefs who are able to integrate learning objectives into an online resource further elevate clinical education by creating a reference that encourages self-directed learning outside of didactic sessions.

This workshop is designed to give chiefs a toolbox to successfully assume the role of expert educator. We will review six different report formats that target independent educational goals, and novel ways to incorporate online resources to expand teaching outside of the conference room. A chief who completes our workshop will leave with the skills and techniques he or she needs to be an effective educator; these skills will improve not only chief efficacy but also chief satisfaction —after all, variety is the spice of life!

Educational Objectives:

  • Chiefs will review six report styles that are effective methods of presenting different learning objectives. These styles include—stacked chalk talks: the educator presents a case and identifies two-to-three salient clinical topics, each of wh
  • Chiefs will apply the six teaching styles in small groups to develop a learning plan for a case. After reviewing the six styles, participants in our workshop will break into six small groups; each group will be given the same case, and will develop a cas
  • Chief residents will integrate their conference material with web-based content. This portion of the workshop will give residents the tools to develop an online forum for dissemination of their high-yield teaching points. This will include modalities such as blogs and social media, which our program has used to give house-staff a portable learning environment to increase teaching impact. 

Alex Glaser, MD
Rebecca Lauren Davis, MD
Hari Shankar, MD
Amy S. Korwin, MD
Raymond and Ruth Perelman School of Medicine
at the University of Pennsylvania

203. From the Ground Up: Fostering a Culture of Clinical Reasoning by Optimizing Your Morning Report

While components of clinical reasoning are infused into standard residency education, explicit instruction regarding these principles is often lacking. When learning is systematic and standardized, it is easier to identify knowledge gaps and facilitate remediation. Over the last 4 years at our institution, we have attempted to disseminate a common language and schematic for learning clinical reasoning and it is slowly changing the culture of improved medical decision making among our housestaff.

One obvious area to optimize teaching sound medical decision making is the age-old tradition of morning report. Morning report already targets clinical reasoning by expecting a Socratic discussion of a case, but often this discussion is not standardized and early chiefs feel underprepared to keep the group on task, probe for meaningful information, highlight appropriate teaching points and remediate faulty reasoning. In this interactive workshop, we will teach rising chiefs a systematic way to create a culture of clinical reasoning starting with morning report.

During this workshop, we will (1) discuss the common language of clinical reasoning, (2) introduce common biases, (3) provide a framework of the clinical reasoning process, (4) teach how to ensure correct problem representation and summary statements and finally, (5) propose ways to quickly remediate faulty clinical reasoning. Chiefs will leave with more confidence in their skills and a structure to use while facilitating morning report.

Educational Objectives:

  • To define common “clinical reasoning” terms and understand how using the language of clinical reasoning fosters the culture of clinical reasoning.
  • To illustrate the framework of the clinical reasoning process.
  • To describe 3 ways to identify and remediate faulty clinical reasoning on-the-spot in morning report.

Anna Donovan, MD
Amy Lu, MD
Deborah J. DiNardo, MD
Eliana Bonifacino, MD
University of Pittsburgh School of Medicine

204. The Doctor Will "Tweet" You Now: Incorporating #hcsm into Your Residency Program

Communication for and amongst physicians is dramatically evolving in the social media era. Analysis of the impact of healthcare social media (HCSM) repeatedly draws attention to its educational and professional development value, focusing on the power to rapidly connect users through interactive platforms. Social media provides residency programs the ability to gather and disseminate knowledge in novel ways. The public, open-access format of Twitter allows physicians at all stages of training to interact locally, regionally, nationally, and globally. Additionally, social media platforms allow educators the opportunity to reinvigorate existing curricula and create new ones through the application of adult learning theory. Frameworks mirroring Blooms Taxonomy and RIME (Reporter, Interpreter, Manager, Educator) can be applied to demonstrate progressive skill in the use of HCSM.

Despite the established and proposed value of HCSM, providers and institutions may feel significant discomfort regarding its use. As a result many programs and individuals underutilize social media, targeting only the lower levels of competency. Chief residents and junior faculty are more likely to be “digital natives,” and thus are poised to drive more aspirational implementation at their institutions.

During this workshop we aim to provide a rapid yet broad introduction to the principles and best practices of HCSM. We will present learners with tools and a vocabulary to demonstrate the value of creating a mature social media presence for their program. In a deeper dive, we will explore novel applications of HCSM to the Clinical Learning Environment. Break out exercises will involve hands-on practice HCSM platforms.

Educational Objectives:

  • Broadly define HCSM and describe its value in the modern healthcare landscape.
  • Categorize various uses of HCSM using a modified version of Blooms Taxonomy.
  • Identify "next steps" to enact upon return to your institution with a goal of implementing a successful HCSM program.

Rebecca C. Jaffe, MD
Gretchen Diemer, MD
Sidney Kimmel MedicalCollege at Thomas Jefferson University 

Avital O'Glasser, MD
Oregon Health & Science University School of Medicine

205. The Seven Habits of Highly Effective Chiefs

Each chief resident, co-chief team, and residency program is unique. Chiefs will encounter challenges throughout their year that will require very different management strategies to successfully overcome. Regardless of the varying styles and goals that each chief brings, certain chief skills are universally essential. Once mastered, these habits can be employed to tackle the myriad of challenges that chief residents face during their year.

  1. Play to Your Strengths: Some duties need to be addressed by the whole chief group. Many tasks are more effectively managed by one or two chief residents.
  1. Agenda Setting: Chief residents need to identify their personal goals for the year early on and must be deliberate in laying out an agenda to achieve these goals.
  1. Saying No: No chief will have a successful year without learning when it is reasonable to say no and how to say no without alienating people.
  1. Giving Constructive Feedback: The ability to give feedback (to both residents and faculty) in an effective, nonjudgmental way, improves both chiefs’ and residents’ leadership skills.
  1. Presenting a Unified Front: Like children trying to split parents, residents will try to split their chiefs. Communication among chiefs is essential so that they stay on the same page with housestaff.
  1. Delegating: Ask: “Is this chief work?” If not, who is the most appropriate person to address this issue?
  1. Empower Your Housestaff: Appropriately empowering housestaff helps foster leadership and conflict resolution skills among residents and minimizes chiefs’ risk of developing burnout. 

Educational Objectives:

  • Identify the primary skills that all chief residents need to have in their arsenals to ensure a successful year.
  • Recognize challenges to successful implementation of the seven necessary habits.
  • Strategize concrete solutions to overcome pitfalls in implementation of the seven habits. 

Amy Kennedy, MD
Jennifer Corbelli, MD
Clark Veet, MD
University of Pittsburgh School of Medicine

206. Cracking the Code to Clinical Reasoning Education: The Power of Metacognition

Cognitive errors contribute to one third of medical errors and are often associated with higher morbidity. Despite their importance, efforts to avoid medical errors have focused primarily on system issues. In this era of healthcare reform and culture of patient safety, trainees need structured curricula that promote strategies to minimize cognitive errors. 

Clinical reasoning is the art of making accurate diagnoses and developing appropriate treatment plans. It is the internist’s scalpel through which we help or harm our patients. Metacognitive strategies have been promoted to improve clinical reasoning and uncover unconscious cognitive biases that may jeopardize care. However, multiple challenges hinder incorporating metacognition and clinical reasoning discussions into various educational activities.

This interactive workshop will underscore the value of metacognition and clinical reasoning discussions as a platform to promote patient safety. Via small and large group activities, participants will brainstorm strategies to mitigate the challenges associated with incorporating clinical reasoning in various educational settings. In a case based activity, participants will utilize metacognitive strategies to reflect upon their cognitive biases which might have contributed to cognitive errors. Then, through a guided discussion, the group will gain tips on moderating interactive case conferences that highlight clinical reasoning and cognitive biases. The presenters will also share their experience creating a popular Clinical Reasoning Conference at the Cleveland Clinic. 

By the end of the session, participants will leave with materials containing practical strategies to incorporate clinical reasoning in various educational settings at their home institution.

Educational Objectives:

  • Identify the value of metacognitive strategies to prevent cognitive biases and promote optimal clinical reasoning.
  • Develop strategies to successfully incorporate discussion of clinical reasoning in case conferences, intern/morning reports, and dedicated clinical reasoning conference.
  • Brainstorm approaches to promote clinical reasoning on teaching rounds and in the resident outpatient clinic.

Ali Mehdi, MD
Abby L. Spencer, MD
Megan Ann McGervey, MD
Susan Vehar, MD
Cleveland Clinic Foundation 

207. Human Knot vs. Happy Hour: Enhancing Teamwork, Resiliency, and Identity Formation During Intern Orientation and Beyond

Every year, residency programs implement orientations for incoming residents to welcome them to the proverbial family. These orientations are often clinically-focused, created to promote institution-specific knowledge. Team-building activities, which promote resiliency and development of group identity, are often an afterthought.This workshop will present real-world examples of successes and failures from multiple orientation curricula across several institutions focused on the effectiveness of various activities based on the cognitive psychology behind these tasks. We will review team building literature and promote understanding of its four general components including goal setting, interpersonal relations, role clarification, and problem solving. As a large group, participants will critique resident-level experiences over a multi-year span. We will explore activity satisfaction versus perceived effectiveness of a variety of orientation events with the goals of: creating unit cohesion, improving communication in the clinical setting, promoting resiliency, and developing respect and trust among new housestaff. Participants will work in small groups to share their own orientation experiences and develop goals of their orientations. They will also explore how these activities could be effectively employed at other times throughout the year. Participants will then select from a number of team-building activities, identify their own limitations, and tailor their orientations to their pre-specified goals. Attendees will leave the session with a toolbox of exercises, which they can use to enhance residency cohesion, promote resiliency, and develop respect and trust among new housestaff at their home institutions.

Educational Objectives:

  • Develop a toolbox of exercises for effective team-building based upon cognitive principles.
  • Demonstrate strategies that foster resiliency.
  • Determine potential methods to enhance the professional identity among new housestaff.

Benjamin S. Vipler, MD
David S Oliver, DO
Erin Vipler, MD
Naval Medical Center (Portsmouth)

208. Running a Morning Report with Unscripted Cases

Residents have rated morning report as their most important educational activity (Ways et al., Arch Int Med, 1995). While senior and chief residents are usually responsible for facilitating a morning report, many receive little or no training on how to do so effectively. It is common for morning report cases to be selected in advance, with hours spent developing slide shows and teaching points. Extensive case preparation may pressure the facilitator to speak as a content expert and lead to a low level of learner interaction.

In this workshop, we will present Impromptu Case Facilitation (ICF), an approach to running morning reports with unscripted and spontaneously presented cases that are unknown to both the facilitator and audience. By discussing a case using ICF, the facilitator shifts his/her focus from content mastery to clinical reasoning and decision-making. Rather than powerpoint slides and bulleted teaching points, the case – and the real-life challenges facing the presenting physician—becomes the focus.

Attendees will learn how to facilitate an unscripted morning report case and review effective strategies for dealing with uncertainty, encouraging audience participation, redirecting incorrect learner responses, utilizing content resources in real time, and providing teaching points on-the-fly.

Although leading the discussion of an unscripted case may seem daunting, we will show that ICF reduces facilitator pressure to be the content expert. By mastering a few key skills, participants will learn to harness the collective knowledge of the room and focus on clinical reasoning, while allowing conference attendees to interact and teach each other.

Educational Objectives:

By the end of the workshop, attendees will be able to:

  • Prepare a general outline for an Impromptu Case Facilitation, with variation for different types of cases (e.g. full-length case vs. short case vs. clinical image).
  • Identify components of effective real-time conference facilitation, such as time management, whiteboard management, and identification of key learning points, which can also be used in other case-based teaching sessions.
  • Recognize techniques for managing the unique learning environment of an unscripted morning report, including strategies for redirecting incorrect responses and variations in management, optimizing audience participation, framing precise questions, and sharing teaching responsibilities.

Daniel Wheeler, MD
University of Minnesota Medical School 

Juan N. Lessing, MD
University of Colorado School of Medicine 

Manuel Diaz, MD
Jessica Beaman, MD
University of California-San Francisco School of Medicine

209. The Art of Etiquette and Administration During Chief Year: What IM Residency Does Not Teach You

The transition from being an internal medicine resident to becoming a chief medical resident is abrupt and intimidating. The expectation for most chief medical residents is to work as expert clinician educators, administrators, and facilitators. Chief medical residents are often not trained adequately to manage the administrative components and inner workings of an internal medicine residency program when their chief residency year begins. The goal of this workshop is to provide practical skills to the logistical and administrative aspects of chief residency year, including email etiquette, schedule management, and meeting demeanor.

Educational Objectives:

  • Learn the components of making an email professional and effective. Practice writing emails based on the email’s objective, whether it is to ask for administrative help, promise the residents a deliverable, or engage multiple groups in a conversation.
  • Develop a systematic approach to creating individual and group chief calendars with residency events, reminders, and tasks to be shared and divided amongst the chief group to maximize productivity, eliminate redundancies, and avoid errors.
  • Practice leading a meeting, including agenda setting and managing difficult situations, such as voicing opinions that may conflict with other administrators’ viewpoints.

Atsuko Yamahiro, MD, MPH, AAHIVM
Case Western Reserve University (MetroHealth) 

Sauda Bholat, MD
Angela Kang, MD
Yale-New Haven Medical Center (Primary Care)

210. Effective Feedback

Interns and residents greatly value the mentorship they receive from chief medical residents. An important part of mentorship is giving effective feedback, which can be challenging in many situations.

In this interactive workshop, we will discuss anticipated barriers to giving feedback, effective strategies for giving feedback, and practice giving feedback.

Educational Objectives:

  • Discuss anticipated barriers to giving feedback.
  • Identify successful feedback strategies.
  • Practice giving feedback using strategies discussed.

Maria A. Yialamas, MD
Joel T. Katz, MD
Harvard Medical School Brigham and Women's Hospital

Workshop Session III
Monday, March 19, 2018
1:15 p.m. to 2:45 p.m. 

301. Technology in Residency Training

Modern residency training programs face several educational barriers including the exponential increase in medical information, duty hour restrictions, having residents scattered at multiple sites, and the changing nature of learners. Our workshop seeks to help educators identify these barriers that are unique to their programs, as well as those common to all programs. We will then equip them with the skills and tools within technology that can help them overcome these barriers, based on our experience within our own residency program at Weill Cornell Medical Center. Important tools include digital learning platforms (iTunes U, schoology), scheduling and evaluation resources (medhub, amion), digital communication tools (slack, mailchimp), presentation tools (powerpoint, prezi), visual learning tools (GoAnimate), and medical apps and literature curation tools. Examples of important skills include judicious use of technology (when to use technology and when less is more), and optimal use of technology (for example, how best to use the presentation tools).

Educational Objectives:

  • Identify educational barriers that technology can help to overcome.
  • Learn how to use technology tools to overcome barriers.
  • Learn important principles for use of technology.

Harpreet Bhatia, MD
Hana Lim, MD
Zaid Almarzooq, MD
Weill Cornell Medicine

302. Emotional Intelligence for Chief Residents—You Can't Have That Milk!

Residency training is inherently stressful and requires skills that many learners may not possess. These include efficiency, organization, and the ability to communicate effectively with patients, families, and many others. On the road to being an effective physician and team member, sometimes things go awry. Residents must recognize early on the way one interacts with others can have far reaching effects. When skills such as respecting the thoughts and feelings of others, harnessing self-control and self-assessment, and empathy fall by the wayside, a certain degree of tension is created that will rapidly become destructive.

This workshop will provide Chief Residents with an understanding of the key concepts of Emotional Intelligence and how they can be utilized to lead to a better understanding of one's self and resident group. The workshop will begin with a historical review of Emotional Intelligence and then move to a discussion of its four components. Examples will be given along the way to demonstrate how Chief Residents can become more effective and influential in their own interactions with others-including the residents in their program. A breakout session will allow participants to spilt up into small groups to discuss several real life scenarios using the components of Emotional Intelligence and then report potential concerns and solutions to the large group. A deliverable will include a bibliography and laminated handout reviewing the key components of Emotional Intelligence.

Educational Objectives:

  • Understand the concepts that make up Emotional Intelligence and learn how they can be applied to lead one to become a stronger Chief.
  • Utilize Emotional Intelligence to help one's residents become more effective, collaborative, and self-aware in their relationships with others.
  • Appreciate that Emotional Intelligence can be learned and most successful leaders possess a high degree of Emotional Intelligence.

Matthew Burday, DO
Joseph Deutsch, MD
John Donnelly, MD
Sidney Kimmel Medical College
at Thomas Jefferson University/Christiana Care Health Services 

Brian M. Aboff, MD, MMM
Virginia Commonwealth University School of Medicine

303. We’re Changing What, When?! Effective Leadership During Times of Change

The transition from residency to chief year places rising Chief Residents in a unique position to be privy to planned yet unannounced changes within their program leadership and curricular structure. With ongoing updates from the ACGME and innovations in medical education, changes in residency training are inevitable. Even during times of crisis or change, Chief Residents must be effective leaders in supporting and advocating for the residents they represent, while also upholding their program's values. In some instances, Chief Residents must enact or promote changes that arise from residency leadership or above. In others, Chief Residents must advocate for change on behalf of the residents. Finally, given the current era of social and political volatility, Chief Residents must role model leadership in advocacy, thoughtful discourse, and diplomacy when outside changes affect the program. During this workshop, you will learn the basic principles of change management and skills to promote resident growth within a culture of change. We will discuss different strategies to deal with change using a case-based approach from real-world experiences at our institution.

Educational Objectives:

  • Develop a toolbox of strategies and basic principles for effective change management.
  • Identify and anticipate potential changes that may arise during your chief year.
  • Apply the strategies to real-life scenarios that would require implementation of varied forms of effective leadership.

Alejandra Bustillo, MD
Mayur D. Mody, MD
Spencer Maddox, MD
Andrew Allen McCue, MD
Emory University School of Medicine

304. You’ve Got Mail—Leveraging Electronic Communication to Manage Information Overload, Improve Compliance and Get Your Points Across

Electronic communication via emails is an integral part of any professional organization. When used well, emails can be a powerful tool for data organization, communication and time management.

Chief medical residents receive and send multiple emails daily. Emails can be used as a means of communication with program leadership, hospital administration and residents, to document and keep track of events and encounters, and as a tool for coordination of teaching engagement, among other uses.

The biggest challenge of electronic communication is information overload. Tools provided in this workshop will help the participants to write emails that their recipients will want to read and prioritize when skimming through their inbox. Those tools will guide the users to write emails that are clear, easy to read and provide all the relevant information in an accessible way.

Being an effective communicator will help your recipients deal with electronic information overload, prioritize your communications, and result in greater compliance. Participants will break into small groups to review sample emails and discuss methods by which their readability and structure contributes to their impact or lack thereof. This will lay the foundation for looking at electronic communication objectively.

Structured guidance for meaningful and efficient use of electronic communication is lacking in most medical and academic training programs. We will utilize and practice a standardized approach to email creation, as well as demonstrate tangible strategies for optimizing email organization, storage and retrieval.

Educational Objectives:

  • Understand the importance and relevance of electronic communication, as well as the various uses of emails in the many functions of the chief resident.
  • Recognize the pitfalls and common mistakes which make electronic communication less effective.
  • Use valuable tools and concrete techniques for meaningful, effective and efficient electronic communication.

Olga Karasik, MD
Kelli King-Morris, MD
University of Central Florida College of Medicine 

Lawrence B. Wolf, MD, FACP
Maimonides Medical Center

305. Working Against the Clock: Effective and Educational Outpatient Precepting.

Precepting in the primary care setting thrusts chief residents into an unfamiliar and uncomfortable place. Most new chief residents have plenty of teaching experience in the inpatient setting, but the outpatient setting is usually a foreign space providing new challenges to providing effective and thoughtful educational experiences for their learners. This workshop is designed to prepare chief residents for this new role and offers strategies and techniques to improve their outpatient teaching skills.

Workshop participants will learn about how to approach outpatient precepting as a chief resident as well as how to work with their residents in the clinic. Further, participants will learn how to use their residents’ needs to guide their precepting styles in order to make each precepting encounter valuable and educational. Different precepting models such as the “one minute preceptor” and SNAPPS will be introduced and discussed. Additionally participants will discuss strategies, techniques and practices to develop professionally as an outpatient educator while practicing in real time with different simulated residents to gain comfort in this new setting.

Educational Objectives:

  • Determine and recognize different learners’ educational needs in the outpatient setting.
  • Use and practice different precepting strategies to inform their precepting style based on their learner’s need.
  • Understand the different outpatient precepting models.

Mat Kladney, MD
Lauren Shapiro, MD
Albert Einstein College of Medicine 

Linda Wang, MD
Montefiore Medical Center/Albert Einstein College of Medicine (Wakefield Campus) 

Iman Hassan, MD
University of Pittsburgh School of Medicine

306. Making it Stick: Applying the Science of Learning to Everyday Teaching in the Clinic and on the Wards

Many commonly used teaching strategies in medical education are rooted in tradition rather than science, and can actually be counterproductive. For example, encouraging re-reading and repetition of tasks creates an illusion of mastery for learners but is not the most effective way to cultivate deep understanding or long-term retention. By adopting evidence-based teaching strategies, we can foster more durable and complex mastery of medical knowledge for our learners. In this workshop, we will discuss evidence-based teaching strategies and how to apply them to make everyday teaching more effective, whether in the classroom, clinic or on the wards.

The workshop will begin with an introduction to the growing body of literature behind the science of learning.This literature draws from many fields including psychology, cognitive sciences, education, and anthropology. Specifically, we will discuss how the brain encodes, consolidates, and later retrieves learned information. This understanding of the mechanics of memory has informed the development of specific evidence-based teaching strategies that foster development of deep and well-connected neural pathways that make information retrievable when needed.

We will then discuss and demonstrate several of these evidence-based teaching strategies including promoting retrieval, introducing desired difficulties, spacing out practice, interleaving, and self-explanation. Small groups will brainstorm applications of these strategies during lectures, in clinic, and on the wards, and we will debrief in the large group adding examples from our own teaching. Workshop participants will leave with a handout containing a toolkit of evidence-based teaching strategies and practical ways to implement them.

Educational Objectives:

  • Describe the basics of our current understanding of how the brain encodes, consolidates, and retrieves learned information.
  • Understand the reasoning behind evidence-based teaching strategies such as promoting retrieval, introducing desired difficulties, spacing out practice, interleaving, and self-explanation.
  • Identify practical applications of these evidence-based strategies to improve everyday teaching during lectures, in clinic, and on the wards.

Andrew Klein, MD
Melissa A. McNeil, MD
Etsemaye Paulos Agonafer, MD
University of Pittsburgh School of Medicine

307. Standing Room Only- How to Vitalize Morning Report

Morning Report is an interactive and educational session that is a core tradition of nearly all residency programs. Over the decades, Morning Report has evolved from housestaff presentations of unsupervised overnight admissions framed for resident scrutiny and proper patient care, to a more structured and learner centered approach, with the focus being placed on case based medical information and critical reasoning. While creating a meaningful, well attended, and vibrant Morning Report is a rewarding experience, it also poses a formidable challenge to residency leadership. In this collaborative workshop, we will engage the audience in addressing the following topics:

  • Why is Morning Report still a viable and important tool for education
  • What are possible approaches that can be taken to improve relevance and effectiveness of Morning Report sessions 

We will review what is known from the literature, explore the obstacles to an effective clinical educational exposure system, and provide innovative and diverse tools to help your program create an engaging Morning Report. Additionally, we will share our experiential knowledge and anecdotal perspectives on the creative changes our institution has implemented in its Morning Report program. During this seminar the audience will be asked to participate in giving feedback on our innovative program structure whilst discussing their own experiences. Upon completion of this workshop, we will have developed strategies that will be instrumental in cultivating a successful Morning Report.

Educational Objectives:

  • Review and discuss the literature on the value and opportunity provided by Morning Report.
  • Learn innovative ways to thoughtfully adapt Morning Report to the unique needs of a training program.
  • Explore strategies of creating a positive and academic resident culture eager for prioritizing effective learning opportunities. 

William J. Leland, MD
Brian Francis Simpson, MD
Yuxuan Mao, MD
Puneet Singh, MD
Brody School of Medicine at East Carolina University

308. Precept like a pro! Enhancing Your Teaching Toolkit in a Few Short Steps

In this interactive workshop, we will provide participants with the knowledge and skills to precept residents and students in outpatient and inpatient clinical settings LIKE A PRO! We will describe and demonstrate several different popular and effective precepting models including the One Minute Preceptor (OMP), SNAPPS, and Peyton’s Four-Step Approach. Time will be allowed for participants to practice these skills and discuss strengths and challenges of these different precepting models. In addition, the presenters will discuss how precepting can be performed effectively in the presence of a patient. All participants will leave with several resources that they can bring back to their home institutions for reference and further practice.

Educational Objectives:

  • Describe and demonstrate steps to the One Minute Preceptor (OMP), SNAPPS and Peyton’s Four-Step Approach teaching models.
  • Identify pros and cons to implementing OMP, SNAPPS, and Peyton’s Four-Step Approach teaching models.
  • Discuss how to incorporate these precepting models in the presence of the patient (i.e., at the bedside) in both the outpatient and inpatient setting.

Patricia Ng, MD
Stony Brook University School of Medicine 

Paul O'Rourke, MD
Kerry Sheets, MD
Johns Hopkins University/Bayview Medical Center 

William Joseph Carroll, MD
Stony Brook University School of Medicine

309. Navigating Through Diagnsotic Uncertainty: Tactics to Promote Informed Diagnostic Reasoning

By nature, Chief Residents are always hungry to grow their capabilities to practice more insightfully, teach more artfully, and thereby lead more effectively. Chief Residents as educators are frequently faced with the challenge to not only use diagnostic reasoning to arrive at the correct diagnosis and role model effective reasoning but also to engage more novice diagnosticians to grow their clinical wisdom and ability to articulate components of their diagnostic reasoning.

This workshop will provide interactive opportunities for Chief Residents to expand the tools in their clinical care and educational repertoire that can accelerate their ongoing professional development and grow their confidence as educators and clinical supervisors. In this workshop common challenges faced by internists when encountering diagnostic uncertainty will be illustrated and highlighted. The workshop will build on adult-learning principles and social cognitive theory to help chief residents incorporate explicit medical decision making and clinical problem solving. Real case-based clinical and educational predicaments will be used to discover and explore our cognitive vulnerabilities and various approaches to navigate through them, including when and how to integrate systematic research evidence to inform diagnostic reasoning. We will demonstrate use of these tactics within a range of clinical teaching venues in which Chief Residents commonly work: inpatient wards, ambulatory clinics, and clinical case seminars.

Educational Objectives:

  • Practice identifying vulnerabilities in diagnostic reasoning.
  • Apply tailored educational tactics to clinical teaching opportunities.
  • Create individualized action plans that promote more informed diagnostic reasoning.

Joseph F. Szot, MD
Manish Suneja, MD
Mark C. Wilson, MD
University of Iowa Roy J. and Lucille A. Carver College of Medicine

310. Creating Health Policy and Advocacy Experiences for Residents: A Toolkit

Teaching systems based practice involves not only the immediate context of care but also the larger policy environment which impacts health care decision making. Physician voices are powerful in the policy arena, particularly in times of great political turbulence surrounding health care. Residents who understand the impact they can have on policy as it affects their patients and their careers are more likely to continue to be advocates after they graduate. Many residency training programs struggle to find ways to bring this teaching to residents in a way that fits with their busy schedules and has direct experiential impact. Here we propose two models for incorporating direct health policy and advocacy experiences – one as a longitudinal ambulatory elective, and one as a single ambulatory block. Based upon these models from Duke and NYU, this workshop will outline the necessary elements of a health policy curriculum and describe resources needed to create learner-driven advocacy experiences. Participants will discuss individualized plans in small group format and discuss in the larger group. Participants will create their own toolkit for building a curriculum in health policy and advocacy at their institution. Resources for identifying and tracking legislative issues as well networking with local and national advocacy organizations will be provided.

Educational Objectives:

  • Build a toolkit of resources for establishing a health policy curriculum at participants' institutions.
  • Demonstrate how to make health policy and advocacy teaching tangible and accessible to programs.
  • Troubleshoot questions and concerns in branching out into health policy education in residency training.

Daniella Zipkin, MD
Alex H. Cho, MD
Duke University School of Medicine 

Jennifer G. Adams, MD
Kathleen Hanley, MD
New York University School of Medicine

Workshop Session IV
Monday, March 19, 2018
3:00 p.m. to 4:30 p.m. 

401. Do You Want to Teach? We’ve Got Content: How to Find and Use Existing Educational Resources to Enhance Your Teaching Skills

Being a chief resident means wearing several hats and performing several duties that are integral to the operation of any residency program. One of those roles is residency education and curriculum planning and execution. Chief residents are expected to prepare and deliver educational content that is engaging, relevant and practical to the learner. To facilitate this function, chiefs have to have access to educational tools and resources that facilitate their work and enhance their teaching skills. In addition, having access to educational content will help chief residents engage busy faculty who might not have the time to develop content but would be willing to participate in teaching if content was already available. In this workshop, we will provide a list of online educational resources and suggestions on how they can be utilized to develop and deliver educational sessions. In addition, attendees will have the opportunity to discuss and share ideas on additional resources and ways it can be incorporated into their curriculum. Furthermore, we will describe how these resources can be used to implement active learning methods. Our goal for this session is to empower you with tools that can assist in developing your skills as a medical educator.

Educational Objectives:

  • Learn how to use and navigate existing online educational resources for developing effective teaching material.
  • Develop an interactive and engaging teaching sessions using an online educational resources.
  • Describe various innovative active learning pedagogies that can be incorporated into your teaching.

Abdo Asmar, MD, FASN, FACP
Jelena Catania, MD
Allison Carilli, MD
University of Central Florida College of Medicine

402. Struggling is Universal: Real-World Approaches to Learner Remediation

One critical function of competency-based assessment is to determine which learners are in need of individualized coaching and remediation. Additionally, in the contemporary era, physician burnout is a major driver of performance issues and necessitates additional tools to assess for and address burnout in concert with skill development.

Entry ticket: We will ask participants to write down one challenge they face in learner remediation.

30 minutes: Representatives from three residency programs will briefly share their approaches to competency assessment, with a focus on one of the following areas:

Topic 1: systematic identification of underperforming residents

Topic 2: remediation practices for common performance issues

Topic 3: infrastructure and resources available to support struggling residents' mental health and wellness

20 minutes: Participants will break up into 3 small groups (assigned to one of each of the three topics) to reflect on the models presented and to compare and contrast their own residency programs' processes for addressing these issues.

10 minutes x 3 topics = 30 minutes: Each group will be responsible for reporting out:

  1. common practices
  2. innovative examples
  3. a dilemma to pose to the rest of the participants (followed by moderated group problem-solving)

5 minutes:

Exit ticket: Participants will take the challenge they wrote down at the beginning of the session and write down a solution for the problem that they learned from the session. We will ask participants to share insights.

Educational Objectives:

  • To compare and contrast competency assessment models for identifying struggling learners.
  • To describe remediation strategies for common performance issues and to incorporate specific screening tools for learner burnout within program assessment.
  • To devise concrete ideas for refining their own processes for competency assessment and resident remediation.

Grace C. Huang, MD
Harvard Medical School Beth Israel Deaconess Medical Center 

Melver L. Anderson, MD, FACP
University of Colorado School of Medicine 

Sarah Hartley, MD
University of Michigan Medical School

403. Implementation of Chief Resident Led Direct Observation and Evaluation of Internal Medicine Residents in an Outpatient Clinic Setting

Direct observation is critical in assessing residents’ readiness to practice independently. However, this rarely occurs in a consistent manner in the outpatient clinic due to time constraints of supervising faculty. Therefore, we developed and implemented a direct observation program in which residents are observed by chief residents during outpatient clinical encounters. During these encounters, residents’ skills in patient communication, history taking, physical exam, and assessments relating to ACGME milestones and core competencies were assessed. A chief resident joins the resident for an encounter and evaluates them using a standardized form that focuses on milestones. This form was created by the chief residents with faculty guidance using frame-of-reference. After the encounter, the chief resident selects two areas for improvement to share with the observed resident and the resident’s preceptor for ongoing coaching. For each of the two items for improvement, there are standardized resources that are provided to the resident for self-review. The chief resident then submits the evaluation form to the resident’s portfolio to be used in their semi-annual reviews and by the Clinical Competency Committee. To determine the frequency of direct observations and their perceived educational value at our institution, we are surveying our residents and supervising faculty before and after implementing this formal direct observation program.

Educational Objectives:

  • Explore the feasibility of implementing increased direct observations in your residency continuity clinic.
  • Troubleshoot an example milestone-based standardized direct observation tool for components that will enhance your program’s competency assessments.
  • Generate ideas for improving assessment, feedback and coaching of resident progress on the relevant milestones in your program’s continuity clinic settings.

Kristin Koenig, MD
Jared Moore, MD
Patrick Dooling, MD
Zachary Garrett, MD
Ohio State University College of Medicine

404. Chief Resident as a Third Year Resident : Challenges & Victories

Chief residency is challenging as a fourth year but is even more daunting as a third year due to voluminous administrative responsibilities along with educational obligations. This workshop is aimed at sharing our experience and mentoring incoming third year chief residents for battles ahead. We will aim to shed light on different responsibilities and unique situations facing a third year chief resident. By the end of this workshop all attendees should be able to improve communication between co-chief residents and program leadership, serve as advocates for the residency class and develop a fair approach in dealing with difficult situations.

Educational Objectives:

  • Being a leader amongst your peers and improving transparency on decision making and policies within the department.
  • How to approach interview season, residents requesting off's for fellowship and job interviews.
  • Having to deal with disciplinary issues an divide and conquer ;sharing responsibilities to equalize the burden.
  • Creating channels of communication between the chief residents.
  • Dealing with disagreements within a small group and learning on how to be on the same page.
  • Developing a relationship with the ancillary staff and advocating for the residency class.
  • Implementing new ideas and enhancing quality improvement.
  • Engaging junior residents in administrative capacities.

Maanit Kohli, MD
Skand Shekhar, MD
Kavya Patel, MD
Paris Charilao, MD
Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School 

405. Chief Negotiator: Skills for the Medicine Department, not just the State Department

Successful chief residents are skillful negotiators. An intern wants to go to a wedding instead of their ICU call; the program leadership wants to create time in the already full ambulatory rotation to implement a new curriculum on measuring quality; the program director wants to restructure the ICU call schedule to decrease the total number of residents needed on the rotation. All of these situations require negotiation to reach a mutually beneficial outcome.

Historically, emotion has been viewed as a barrier to reaching an agreement. In the classic book on negotiation Getting to Yes by Fisher, Ury, and Patton, readers are advised to “separate the people from the problem”. However more recently, there has been interest in the study of emotion in negotiation. Multiple articles and books have been published showing that understanding, channeling, and learning from emotions leads to more successful negotiation.

In this workshop, we will discuss strategies to effectively use emotion in negotiation, including how to:

  1. Be mindful of your emotions going into the negotiation
  2. Name emotions in others
  3. Take action on your emotions when beneficial
  4. Compartmentalize your emotion if not beneficial
  5. Recognize what throws you off emotional balance during a negotiation and learn strategies to regain your cool.

Educational Objectives:

  • Recognize the importance of emotional awareness in negotiation.
  • Practice regulating emotion and creating an ideal climate for negotiation.
  • Implement strategies to use emotion in creative and adaptive ways.

Amy Lu, MD
Shanta M. Zimmer, MD
Eliana Bonifacino, MD
Clark Veet, MD
University of Pittsburgh School of Medicine

406. The Chief Resident and the CCC – Explore your new role on the Clinical Competency Committee

The Clinical Competency Committee (CCC) is challenged with the important task of confidently determining whether a resident has met their PGY specific milestones. As new junior faculty and CCC member, a Chief Resident plays an important role in this process. Unfortunately, many Chief Residents are unfamiliar with the responsibilities and purpose of this committee. This workshop explores the role of the Chief Resident on the CCC. Workshop faculty will give a brief description of the composition, responsibilities, and purpose of the CCC. Attendees will be given an opportunity to observe the CCC in action, review common scenarios involving concerns for resident competency, and observe how the CCC might handle such scenarios. Additionally, attendees will be exposed to important CCC functions, to include review of resident progress in ACGME milestones and development and implementation of remediation plans. Attendees will leave with an enhanced appreciation of the important role a chief resident plays on the Clinical Competency Committee.

Educational Objectives:

  • Understand the composition, responsibilities, and purpose of the Clinical Competency Committee.
  • Have an opportunity to review common scenarios involving concerns for resident competency and how the Clinical Competency Committee might handle such scenarios. Gain exposure to important CCC functions, to include review of resident progress in ACGME mile
  • Recognize the important role a chief resident plays on the Clinical Competency Committee.

George R. Mount, MD
Patricia A. Short, MD
Madigan Healthcare System 

Joshua S. Hawley-Molloy, MD
San Antonio Uniformed Services Health Education Consortium

407. Your Chiefly Role as an Inpatient Attending -- Moving Beyond "Seen and Agree"

Identified roles of the Chief Resident include leader, administrator, educator, mentor, and counselor (Hinchey 2016). For many Chief Residents, the role also includes attending on the inpatient service. Common feelings prior to attending for the first time include excitement, angst, enthusiasm and anxiety. It is a role that is unfamiliar and demanding for any new faculty member, but presents special challenges for the Chief Resident.

This workshop is designed to prepare rising Chief Residents for this challenge - what to anticipate as a teacher, leader of the team, and manager of an inpatient service in today’s fast-paced world. Specific topics we will review will include:

  1. The many roles of an attending (teaching, patient care, reviewing notes, giving feedback, completing evaluations);
  2. Setting expectations for the team;
  3. Rounding (how to organize and prioritize);
  4. Tips on how to support the upper level resident while allowing for autonomy;
  5. Teaching (bedside teaching, the “30 second preceptor” method for clinical teaching, SOAPS/SAFER model for feedback on oral presentations);
  6. Balancing the attending physician’s role in patient care and as a supervisor (when to intervene, when to sit back);
  7. Teaching learners at different levels (senior residents, interns, medical students);
  8. Feedback and/vs evaluations;
  9. Challenges (self-confidence, urge to micromanage, and the perception from self and others such as nursing, senior residents, and faculty that the Chief Resident is still a “resident”).

Educational Objectives:

  • Understand the complicated and multifaceted role of the attending on an inpatient service.
  • Have the tools needed to set expectations for the team, balance demands of teaching and patient care in a busy clinical setting, and give timely and effective feedback to learners at multiple levels.
  • Feel more comfortable and prepared to attend on an inpatient team.

William Novak, MD
Donald R. Bordley, MD, MACP
University of Rochester School of Medicine and Dentistry 

Debra L. Bynum, MD
Maureen Catherine Dale, MD
University of North Carolina School of Medicine

408. From Mini-Me to Yao-Ming: Adjusting Your Psychological Size to Maximize Impact as a Chief Resident

The transition from resident to chief resident can be difficult owing to new teaching roles and leadership positions, as well as drastic responsibility changes. The chief resident role comes with high expectations based on past performance; however, the skill set needed to excel as a resident does not guarantee success as a chief resident. These roles can be accompanied by a number of overt and implicit expectations, in which the chief resident is expected to perform adroitly. Chief residents are often underprepared for this transition as many have no training in leadership and management, meeting facilitation and presentation, or teaching theory and methodology. This gap in training is felt perhaps most acutely when new chief residents assume the role of the attending physician. New chiefs may struggle to adapt to their ever-changing environments as well as to the highly variable clinical and administrative responsibilities they suddenly face. In the capacity of being a new attending physician, many chief residents also feel as though they are imposters and that they need to “know everything”. These new roles and responsibilities often require very different approaches which can be challenging for new chief residents. One universal method of addressing these gaps is to adjust psychological size; defined as the perceived status one person has relative to another. During this interactive workshop incoming chief residents will learn methods of altering their psychological size to allow them to work effectively with individuals that range from the hospital CEO to newly branded medical students.

Educational Objectives:

  • Explain three key components involved in the concept of psychological size.
  • Describe how you would modify your behavior to increase or decrease psychological size according to situation and stakeholders.
  • List three statements you can use to adjust your psychological size when working with learners and three statements when interacting with colleagues/supervisors.

Patrick Rendon, MD
Justin Roesch, MD
University of New Mexico School of Medicine 

Winter Williams, MD
University of Alabama School of Medicine 

Deepa Bhatnagar, MD
Tulane University School of Medicine

409. Above, Beside and Below: Exploring the Tenets of Multi-Directional Leadership in Graduate Medical Education

As leaders in GME, we are in the unique position of mentoring and managing our residents, while simultaneously working for and learning from our senior staff and administrators. In the military realm, this paradigm can be particularly challenging due to the added stressor of military rank and the role it plays on hierarchy in the workplace--skills of multidirectional leadership are, therefore, a necessity. Multidirectional leadership skills are highly useful outside of military medicine, since both the military and civilian settings have individuals who are not formally recognized as leaders but can have a profound impact on GME. Our workshop will assist in developing techniques for multidirectional leadership by teaching techniques for giving constructive, real-time feedback to senior staff, maintaining control of session and enabling the audience to teach their subordinates and peers similar skill sets. Using a set of basic principles, participants will work through real-life scenarios using small group and open forum discussion to generate approaches and potential resolutions that will facilitate workshop participants in leading from above, beside, and below.

Educational Objectives:

  • Demonstrate comfort in addressing and giving feedback to senior leaders.
  • Learn ways to successfully present ideas to senior leadership to affect change in your program.
  • Demonstrate tactics to maintain control of session in scenarios with multiple leadership echelons.

Rachel Robbins, MD
Meredith Hays, DO
Dwight David Eisenhower Army Medical Center 

Jess D. Edison, MD
National Capital Consortium

410. Improving Chief Residents’ Ability to Recognize and Supportively Address Burnout in a Peer – a Communication Strategy Workshop

Burnout amongst residents has become an increasing concern and has been associated with unprofessional behaviors, medical error, and depression. Many wellness curricula focus on educating trainees on promoting individual wellness and resilience through mindfulness, reflective practice, and personal wellbeing activities. However, interventions that focus on training residents to identify the first signs of peer burnout are lacking. Further, residents often receive no formal training in the communication skills necessary to engage their peers in discussions regarding burnout. While rates of burnout are often defined by standardized assessments delivered during training or after burnout is identified, chief residents serving on the front lines of medical training may often identify peer distress as it is developing, making them uniquely positioned to screen for burnout.

This is a novel communication skill-building workshop focused on training chief residents to identify and screen for burnout in their peers. We will first present a leadership framework to identify thriving versus struggling residents and describe communication strategies for beginning discussions regarding burnout. The workshop will include a simulated interaction between a chief resident and an intern experiencing burnout, as demonstrated by workshop presenters. Using critically placed “time outs,” moderators will engage participants in a facilitated discussion utilizing the communication framework to screen for burnout in the intern. Participants will brainstorm strategies to employ as we work through the simulated encounter. Small groups will then brainstorm resources in their own institutions to help support trainees experience burnout and will develop an action plan for linking trainees to these resources.

Educational Objectives:

  • Recognize and describe common burnout symptoms in residents.
  • Describe communication strategies used to effectively screen for burnout in a peer.
  • Identify resources for individuals struggling with burnout within their own institutions and develop a personalized implementation plan to link trainees to these resources.

Oana Tomescu, MD, PhD
Parul Agarwal, MD
Samantha Parker, MD
Raymond and Ruth Perelman School of Medicine
at the University of Pennsylvania

Margaret Horlick, MD
New York University School of Medicine