Project ECHO in NY Times Article

Very interesting article from The New York Times about Project ECHO which combines video teleconferencing and training from specialists that equip primary care providers with the knowledge to take care of complex patients. For example, a family medicine doctor treating a patient’s hepatitis C with antiviral therapy with the guidance of liver specialists remotely because the patient lives too far from the liver clinic. Check out the article below:

The Chief Resident’s Role

What we actually do as your chief residents?

We are in a unique position, as we have just finished residency training and are now overlooking the house staff. Our roles are comprised of administrative, clinical and educational components.

Clinical Role: We will be attendings on the wards at both PMH and the VA. This entails the typical duties of any other attendings. Furthermore, we are involved in resolving conflicts between services, ensuring patient safety across all of our services, and fielding patient transfer requests from outside hospitals.

Administrative Role: This a role that you are used to seeing us in as we make your schedules, organize the noon conferences, speakers, intern chart conference, arrange coverage for fellow residents. We work with Dr. Johnson, Dr. Kazi, and the associate program directors on improving the residency and its curriculum as well as trouble-shooting problem areas that you, as residents, bring to our attention. We represent the house staff at many administrative meetings at Parkland, University and VA hospital. We organize the events, transportation, dinner venue for the interview season for upcoming applicants. We run morning report at Parkland and the VA as well as Weissler Conference.

Teaching: In addition to arranging the conferences and working on curriculum, we are most excited about the opportunity to teach directly, at the individual level. This will occur in places like morning/afternoon report, on rounds while on service.

Mentors: This is the role that is often not seen, as it’s typically on an individual level, though it’s a role we are very excited about. Throughout the year, some of you may experience hardships or obstacles, have questions or concerns regarding patient care, or have ideas for systems improvement. As your chief residents, we will work with you to get things back on track, help solve patient care issues, and discuss the systems changes that may help to improve our experience here as housestaff. This usually involves frequent meetings to check how you’re doing, reviewing the care of your patients together, and having you complete short courses of modules.

What are our expectations of you?

We want you to be a more knowledgeable, professional and caring clinician by the end of your second year. It is our hope that you’re not content with “getting by,” but want to improve, learn more, and build on the foundation that has been laid this past intern year.

Thus we expect you to be on time for morning report and conferences, to dress appropriately (shirt, tie and slacks for men, business casual for women), particularly at morning report and on the Ward services. Beyond this, we want you to become excellent educators, making an effort to teach to your medical students and interns whenever possible during rounds and with short dedicated lectures. We hope your interactions with nurses, med techs, pharmacists and other specialty services are respectful.

What are our expectations for ourselves? And we want you to hold us accountable to this.

We want to be the tools and resources that allow you to flourish as an upper level resident in this residency. This is a quote from a paper from Yale about the chief resident’s role regarding the house staff.

“The chief residents are responsible for creating a space, both physical and psychological, where the house staff feels safe to express their neediness, fragility, doubt, fear, and anxiety while receiving encouragement and support.”
We hope to encourage and support you this coming year and will go out of our way to help you become the best resident physician you can be.

Just like you guys have big learning curve becoming upper level residents, we also have a learning curve as chief residents and we will learn together what works and what doesn’t. We look forward to the transition to the new hospitals and rotations and working together to enhance this residency.

What to do with all that fluid?

At yesterday’s morning report in Parkland we had a great discussion about treating ascites. Below is a link to the most updated guidelines regarding ascites management in cirrhosis from the American Association for the Study of Liver Diseases (AASLD) published in February 2013.

Some key points from the guidelines include:
-Since bleeding is uncommon during diagnostic paracentesis, routine prophylactic use of platelets and fresh frozen plasma are not recommended (Class III, Level C).
-Initial laboratory tests for ascitic fluid should include cell differential count, ascitic total protein and SAAG (Class I, Level B).
-Sodium restriction (less than 2000mg per day) and diuretics (spironolactone with or without furosemide) is first line therapy in cirrhotics with ascites (Class IIa, Level A).

Once a week antibiotics? Interesting NEJM Article!

This week at morning report we discussed about the increasing prevalence of multi-drug resistant organisms making it harder for clinicians to treat patients with severe infections. In the most recent issue of The New England Journal of Medicine, a trial was published that looked at once a week dosing versus daily dosing of antibiotics for skin infections. Click on the link below to read the article!

NEJm article


UTSW Internal Medicine

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