Jennifer Hayashi

The use of social media to supplement resident medical education – the SMART-ME initiative

Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1-5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (p<0.001 for the change). The percentage of residents using the application at least once a week also increased from 11.4 to 60.0% (p<0.001). Almost all residents (38 of 40) felt that social media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Conclusion Residents believe social media could be used for medical education. After we launched a Twitter page for medical education, there was a significant increase in the use and frequency of Twitter for resident medical education over the ensuing 6 months. Further research should be performed to see if social media can impact overall medical knowledge and patient care, and whether longer term use is maintained.Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1–5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (p<0.001 for the change). The percentage of residents using the application at least once a week also increased from 11.4 to 60.0% (p<0.001). Almost all residents (38 of 40) felt that social media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Conclusion Residents believe social media could be used for medical education. After we launched a Twitter page for medical education, there was a significant increase in the use and frequency of Twitter for resident medical education over the ensuing 6 months. Further research should be performed to see if social media can impact overall medical knowledge and patient care, and whether longer term use is maintained.

Home-based primary care: a needed primary-care model for vulnerable populations.

Home-based primary care has a long history in American medicine, and its prevalence is again increasing slowly in the United States in response to a changing demographic, societal, and health-policy climate. There are many models of home-based primary care, including private practice, academic, Veterans Affairs-associated, and concierge practices. There is a growing body of literature supporting the effectiveness of the medical house-call model. New healthcare reform initiatives could further impact the number and size of home-based primary-care practices, including the Independence at Home and the Accountable Care Organization demonstration projects.

Workforce Development in Geriatric Home Care

With the rapidly aging population, it is anticipated that within two decades several million more individuals in the United States with functional impairment and serious ill health will need home health care. This article discusses workforce development, which is a critical issue for future planning, as recently highlighted by the Institute of Medicine (IOM). Key aspects of recruitment, training, and retention of home care workers are discussed, including those who provide basic support for activities of daily living as well as a variety of skilled professionals: therapists, nurses, pharmacists, and physicians. Although the geriatric workforce shortage affects all care settings, it is especially critical in home health care, in part because we are starting with far too few clinicians to meet the medical needs of homebound elderly. A combination of actions is needed, including educational programs, such as those developed by the American Academy of Home Care Physicians (AAHCP), changes in financial incentives, and changes in the culture and practice of health care, to make the home the primary focus of care for these vulnerable, underserved individuals rather than an afterthought.

House calls and the ACGME competencies.

Background: The Accreditation Council for Graduate Medical Education (ACGME) “core competencies” (patient care, medical knowledge, interpersonal and communication skills, practice-based learning, and systems-based practice) are challenging to achieve in todays complex, high-acuity, hospital-based setting. House calls provide unique clinical exposure to opportunities for learning the ACGME competencies in a single integrated experience. We review the medical literature on the educational value of house calls and describe a pilot questionnaire of housestaff perceptions of the value of house calls in addressing all of the competencies. Description: Focused literature review and questionnaire. Evaluation: A substantial body of literature supports our hypothesis that house calls expose residents to all of the ACGME competency domains. Residents actively engaged in house call training perceive that their experiences allow them to fulfill all of the ACGME competencies. Conclusion: House calls provide an ideal and highly valued opportunity for internal medicine residents to learn the ACGME competencies.

Graduate Medical Education in the Freddie Gray Era

In the wake of the death of Freddie Gray and the protests over unjust treatment of black Americans, the internal medicine residency program at Johns Hopkins launched a curriculum aiming to provide tools for improving population health and reducing health disparities.

How to Perform a House Call

This chapter addresses the general approach to conducting a home-based medical encounter, clinical factors that are especially important to focus on in providing care for patients who cannot routinely leave their homes for office visits, and the basic equipment needed for home-based medical care. The medical equipment used in home-based medical care is essentially the same as that used in a typical office visit, and many ancillary services ordered in an office visit can also be performed in a patient’s home. Home-based medical care provides unique opportunities for the clinician to perform a comprehensive assessment of the patient, understand social determinants of health that impact the patient’s care, and integrate these factors into highly patient-centered care plans. This approach balances evidence-based medicine with patient prognosis, preferences, and ability to travel to a medical center for specialized testing or treatment. Similarly, preventive screening and health maintenance in the homebound population require an individualized approach that includes an understanding of prognosis, as well as disease and screening-test characteristics.

Introducing home-based medical care

As the population ages, home-based medical care becomes increasingly important in the care of frail, functionally impaired older adults. Unfortunately, formal education in home-based medical care is limited, and misconceptions abound. This book is intended to be a practical clinical reference for health care providers who practice medicine in the home. Home-based medical care is highly relevant to the evolving health service delivery system in the USA, but terminology related to this field can be confusing. We adopt the term “home-based medical care” to emphasize the relevance of this practice model as part of the contemporary health care system.