In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence.  Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways. Learning to unlearn In med school, learners amass an ...

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Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, ...

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Picture this. You walk into your doctor’s office for an urgent visit for new distressing symptoms.  He (or she) takes your blood pressure, temperature, heart rate.  All within normal limits.  He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two.  You ask him what he thinks is going on. The quandary If it’s a slam dunk diagnosis, the branch point in ...

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What do you do when your ideal residency program does not exist?  This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception.  I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what ...

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Match Day: It’s among the most memorable moments of medical school, a time when students, friends, family and faculty gather to open those coveted white envelopes. It’s the symbolic first step out of medical school and into residency, and a tradition that is beloved by many. Yet the matching process is viewed by those outside of the medical profession (and to some within it) as a very odd way to ...

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"Old school" is difficult, but doable for teaching attendings.  While prioritization is the key, having a basic framework will help. Here are my personal keys: 1. Sit at the bedside and retake the history of present illness on those patients in whom taking the history is clearly a key.  For example, someone admitted with presumed community acquired pneumonia should have a short history including fever and perhaps night sweats and possible rigors.  ...

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More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field. First, ...

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On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident. The fact is that we aren't really sure what the best way to choose residents is. First, here's what we really do. A 2011 
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The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase. For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring. I am currently applying to internal medicine-primary care ...

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"A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)" begins the press release. As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the "CLER Program:"

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of ...

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