Grand Rounds Recap 07.15.20
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LEADERSHIP CURRICULUM: MENTORSHIP WITH DR. PAULSEN
Effective mentorship increases academic productivity, promotion, and satisfaction for both the mentor and mentee.
“Great stuff doesn’t usually come from a singular mind”
Definitions:
Advisor: Senior advisors answer specific questions asked by the junior advisee; tends to be a finite relationship
Mentor: Mentor intentionally directs and transfers specific knowledge, skills, and experience to the mentee; tends to be a longitudinal relationship with reciprocal benefits
Coach: Facilitates leader’s self-discovery through directed questions and use of objective data; tends to focus on motivation, values, and performance
Sponsor: Sponsors are high ranking people that use their influence to advocate for the sponsee, pulling them up along side of them
Barriers to Mentorship:
Mentors: Not feeling like an expert, not having had mentors yourself
Both: Time, not knowing how, not knowing expectations, lack of structure
Mentees: Can’t find someone that does what you do or looks/acts like you, don’t want to be a burden, don’t want to ask
System Fixes
Mentor of the moment: Take a second to ask one question, which serves as micro-mentorship that leads to culture shift
Mentoring teams: Diverse pool of perspectives, spreads the load, creates a safety net
Peer Coaches: Data and facilitated reflection to gain insight into performance, helps with accountability
Reverse Mentoring: Junior provides guidance on topics of technological and cultural relevance, increased retention of millennials, promotes diversity and culture change
Personal Fixes as the Mentee
Define your goals and specific needs, using self-assessment and a mentorship agreement
Use an individualized development plan to identify targeted areas of development, methods and timeline to get there, responses and meeting frequency, and oversight if obligations are not met
Underpromise and overdeliver
Make the ask, be engaged, say “Thanks!”
MedEd: SIMULATION & GAMIFICATION WITH DR. LANG
History of Simulation
In 1934, simulation was born to train pilots. In 1964, the first description of the programmed patient used for medical education was published out of USC. In 1967, “Sim One '' was built with more functionality than exists even today in most sim models, including fasciculations and hypoepiglottic ligament for intubation, but died in 1974 without being rebuilt.
Why do we do it?
Patient safety: In response to the article “To Err is Human” identifying preventable patient errors
Education: There are generational differences in learning with millennials being more receptive to collaboration, online forums and flexibility
Technology: Means to deliver unique content
Gamification
“The craft of deriving all the fun and addictive elements found in games and applying them to real-world or productive activities”
Examples include medical jeopardy, escape rooms, medical education apps, and even question banks
Be creative, use technology, add competition
Steps to Creation
Establish who your learners are
Come up with your goals
Write your case; decide on logistics
Adjust signal-to-noise (i.e. distractions increase stress/anxiety of the case)
Add in something to do
Plan to debrief, which is often the hardest part (i.e. establish basic assumptions including everyone is intelligent, capable, caring, and wants to improve; questioning actions to understand decision-making process rather than critique decision itself)
QUARTERLY SIM WITH DR. IPARRAGUIRRE
Refractory V-Fib Arrest/eCPR
STEMIs can often lead to arrhythmia, including V-Tach and refractory V-Fib.
Unstable V-Tach deserves electricity, even if the patient is talking. Proceed with synchronized cardioversion and consider midazolam as an adjunct, though it has not been proven to have retrograde amnesia. Pain is better than death.
While simultaneously completing ACLS and STEMI management, consider ECMO; activate early and aggressively.
Additional therapies to consider are esmolol and dual sequence defibrillation, though the evidence doesn’t should mortality benefit.
Be comfortable with your equipment, such as the LUCAS device. Not knowing how to place the LUCAS, which is needed for ECMO cannulation at UCMC, can lead to more time off the chest unless mitigated with practice in placement.
