Well Jen, that was really great.
It's so challenging to do evidenced based medicine instruction
in the hospital setting.
>> Absolutely. >> It's such a different environment.
And I've got to commend you.
That was, you really got to some of the really important salient points.
In a really efficient way.
And I think if we were thinking back, as I'm reflecting back to
my encounter with the student in the outpatient setting.
It felt like I was able to spend a lot more time, but in the hospital setting
if you're on rounds, things I would imagine get a lot more rushed.
Now I'm wondering if you could reflect a little bit on your encounter with
the student in the hospital setting.
You were standing outside the door.
Did that efficiency worry you in any way or
what are some tips that you used to kind of figure what you're going to be
using there because it's a little bit more pressed for time?
>> The efficiency really is hard to balance efficiency and actually being able
to teach the student at the same time especially in the clinical context.
So when we're standing outside of a patient's room,
now often people get a little bit bored while you're talking to them.
And they're standing there and they kind of want to see the patient and
kind of get work rounds moving, so that they can get the work done and
take care of the patient.
But I think what's really important is to emphasize to them
what questions we're asking and to really define those questions so that
they know to come back later and actually find the answer to those questions.
The luxury that we have is that I know in the In the out patient setting,
like in your example, you're taking care of the patient who's there in real time.
My patients are there all day long.
>> Interesting. >> So
we do have the luxury of coming up with the question in the clinical setting and
then revisiting later in the afternoon.
>> So, in other words, you actually have a little bit more time than it may appear
because you're there on rounds but you're there all day as well and
the patient's there so you come back- >> Sure.
>> At future times.
So I notice that a little bit because you really got to the question
really well quite quickly.
>> Mm-hm.
>> And then, you all just left to do the search afterwards.
Did that feel like the way that you would normally do that?
Or would you do things differently?
>> You know what, that usually is the way that we do things because we just define
the question and we know we have some time to come up with the answer.
So, generally speaking,
I identify a specific person to look up the information.
And I identify a timeframe too because I want to give them some responsibility
to do it.
And then my job is to come back and revisit it and
make sure that I ask them the answer to the question.
It reinforces that evidence based medicine is important and
also gets to the answer of our question.
>> Wow, what a great technique.
So you get the student to come back to you maybe an hour later or
a couple of hours later since you have that time.
Now if someone was saying, boy I just don't have that time to stand outside
the door, but we have these conversations often with patients in the room.
So if you werein the patient's room,
would that encounter have gone differently for you?
>> It would have gone a little bit differently,
it's always different when you're inside the patient's room.
So, when we're defining the question a lot of times in the patient's room,
we speak in more layman's terms, so that we're not speaking over the patient but
rather to the patient.
Then they can be a partner in actually coming up with the answers to
the questions and maybe they can say when we're coming up with outcomes,
maybe my outcome isn't this, maybe my outcome is this instead.
>> I see. >> This is what I'm looking for.
So, it was actually can be very helpful.
I think the one thing that attendings fear, is that when they're coming up with
questions inside the room and patients are listening.
That the patients will lose confidence in them not
knowing the answer to the question.
What's really important is that we say to the patients that we like anyone else
are living in a time where more information is coming about all the time.
And that we really want to make sure that we take care of them in the best way
possible with the gold standard.
And that maybe we don't know the answer to this question right now but that we will
go find the answer, and we will come back so that they're taken care of.
>> So you don't think that is a vulnerable point?
You actually talk about that with the patient.
What a great approach.
Do you find that, that works with patients?
>> I do because I think that they really know that you really want to take care
of them and that you're spending the extra special time
to make sure that your decision is the correct decision for them.
>> Wow, fantastic.
Well, that's been great Jen.
Thank you for sharing that with us.
>> All right, thank you.
Sally Santen, M.D., Ph.D.Associate Professor - Emergency Medicine
