Dr. Hellmann: Reporting from the ABIM Meeting

by Academy of Clinical Excellence on February 17, 2010

February 6, 2010
Palm Spring, California

Dear All:

I hear snow is falling in Baltimore so it may be cruel to report from the ABIM meeting in Palm Springs where it is about 70. Perhaps the joke will be on me when I try to fly back to Baltimore this weekend.

This ABIM meeting is the winter retreat, which brings together both the directors (about 24 people) and the foundation (about 15 people including yours truly). Some guests were also invited including Drs. Boulware (head of the RRC), David Irby (vice dean for education at UCSF), Molly Cooke (heads the teaching academy at UCSF), and Anders Erickson (a professor of psychology at Florida who has devoted his career to studying how people become expert at things--he has introduced the concept of "deliberate practice" as the means to mastery of playing chess, the cello, or doctor).

The Chair of the Board of Directors is Wendy Levinson, who is Chair of Medicine at Toronto (she gave grand rounds here a few years ago). She has focused the retreat on competency based learning.

Dr. Larry Smith of Mt. Sinai (and the Dean for one of the new medical schools opening in a year) riveted the group by detailing examples of bad outcomes that can be attributed to our failure to ensure competency in diagnosis and treatment.

One of the other guests is Dr. Diane Wayne, the program director at Northwestern. She has performed a number of important studies that demonstrate her program's ability to define rigorous training modules that teach residents to become competent in performing various procedures. One of her projects uses the simulation lab for training residents how to insert central venous catheters, which resulted in a decrease in line infections and saved the hospital 700k (to say nothing of the benefits to patients). Her work has shown that residents who go through her training program also need fewer tries to insert a central venous catheter and puncture the artery significantly less often. With the dean's support (Larry Jamison, the dean at Northwestern, is an ABIM director), the efforts to formally teach and test for competencies have extended to several of their fellowship programs.

If we really put the patient, family and community first, how would we design our educational programs at Bayview to ensure the competency of our trainees?

This ABIM conference dovetails with a book I am reading. One of the chapters of The Innovators Prescription, by Clayton Christensen (Harvard business school professor), describes the difference in training that one of his colleagues experienced when he worked one summer at an American car manufacture and one summer at Toyota (the pre-this year Toyota!). His job at both places was to install the front passenger seat. At the American plant he was told the steps, given an overview and then put on the line. He had 58 seconds to do it. Although he was technically gifted (a graduate of MIT), he repeatedly failed and had to stop the assembly line.

At Toyota, he was told at orientation that he had the privilege of installing the passenger seat, and that the process required him to master 7 specific steps. Each step was described in detail. Moreover, he was not allowed to go to step 2 until he had demonstrated mastery of step 1. He was told the training duration could vary from 2 hrs or 2 wks--what was not allowed to vary was the (perfect) result.

Time for us to do more? Do more with simulation? Do more to verify that our trainees are competent listening to the heart, listening to the patient, ordering tests, doing ultrasound, doing bronchoscopy (Landon)?? Etc

Excited by what more we can contribute.

Stay warm,

David Hellmann, MD

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internal medicine July 30, 2012 at 7:42 am

There should be more programs/courses designed to cater the patients and the community more effectively. A lot of patients are already stressed with their illness and the tests that they are taking. It would be great if our medical practitioners can be trained to know how not to add more to the patients' stress.

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