Innovative Teaching using an index card Attending rounds

Innovative Teaching using an index card “Attending rounds in your pocket” Adam Segal, MD

My last medicine block • Typical team: – 3 rd year resident – 2 interns – Sub-I – 2 3 rd year medical students – Me

Initial teaching session • Discussion of case with the team DISASTER!

My teaching goals • Make it fun/ engaging • “Show the magic” • Teach clinical reasoning 1. “Triggers” = provide distinguishing/ differentiating information 2. Generate a broad differential and work-up 3. Understand “why”

Index card • Index card with 3 -4 details given to the learner – Review during down time – Generate a complete differential and work-up – Present to the group the next day – Most likely diagnosis – Show they solved the problem

76 M Acute renal failure Carotid bruit BP 104/78 Lisinopril Renal US: 8 cm Left kidney ; 11 cm Right kidney

72 M Recent falls Orthostatic hypotension 4+ proteinuria

18 F Obese Hypertension Seizure

44 F Nigerian SOB Pulmonary edema PMI not displaced EKG only significant for LAH

34 M Chronic diarrhea Kidney stones Hyperparathyroidism

48 F K 2. 8 HCO 3 32 BP 112/74 Concerned about her weight Aldosterone level elevated Renin level elevated

The result • • • Transformed teaching experience Medical students engaged Enthusiasm of the students infectious Challenged all learners irrespective of their level Goal Achieved: – Fun – Clinical Reasoning taught • Generated broad differentials • Identified clinical ‘triggers’ • Addressed ‘Why’

“I loved the index card problems. It was much more fun to ponder the connection between “ 8 cm kidney, " "12 cm kidney, " "normal BP, " "lisinopril, " and "PVD, " than to just read about renal artery stenosis in a textbook. (And 3 months later, I still remember what I learned!) I think this also provides students with positive reinforcement, which is very encouraging since we are still in the learning stage. The format is also fun because it turns research into a very useful and high-yield game. D, A and I really did like figuring these out. Thank you for making my first couple of weeks on Medicine fun. : )”

Some important teaching principles: 1. If what you’re doing isn’t working, stop doing it and experiment 2. Enthusiasm is infectious…. 3. Learners should be actively involved 4. Receive immediate feedback