Emory TEACH 12
The Academy has developed a set of core behaviors called the "Emory Teach 12" that we believe physicians should model to promote the goals described below:
- The central roles of humanism, professionalism and caring in patient care.
- The primacy of the doctor-patient relationship in clinical teaching.
- The importance of teaching at the bedside.
- The critical value of bridging the gap between the basic sciences and clinical medicine.
- "Teaching the Human Dimensions of Care in Clinical Settings" by Branch, William T.Jr MD; Kern, David MD; et al. JAMA, September 5, 2001; vol 286(9);pp 1067-1074
- "A Good Clinician and a Caring Person: Longitudinal Faculty Development and the Enhancement of the Human Dimensions of Care" by Branch, William T. Jr MD; Frankel, Richard Phd; et al. Academic Medicine: January 2009-Vol. 84(1): pp 117-125
- "The Lost Art of Caring: A Challenge to Health Professionals, Families, Communities, and Society" by Leighton Cluff M.D., Robert Binstock, Ph.D., The Johns Hopkins University Press, 2001
- "J. Willis Hurst, His Life and Teachings" by Mark E. Silverman, M.D., W. Bruce Fye, M.D., Foundations for Advancement in Medical Science, 2007
- Chapter 2, Selected Essays by J. Willis Hurst, "What Do Good Doctors Try to Do?"
- Chapter 3, Reflections and Jottings, "Patients and Patient Care"
- "The Doctor" starring William Hurt
Be Curious about physiology, about epidemiology, about outcomes. Ask why. Ask yourself. Ask the literature. Ask colleagues. Ask the patient. Be a lifelong learner.
- Curiosity - An essay by Faith Fitzgerald, Professor of Medicine and Associate Dean of the Humanities and Bioethics at UC-Davis really crystallizes the importance of curiosity in medicine.
- "Curiosity's curious influence on medical doctors" A brief commentary urging us as doctors to “live what we teach, stimulat[ing] our students to change their perspectives and engage with their peers.”
Video - Emory faculty and learners talk about the importance of curiosity in their work.
Dig in to stories of those who stayed curious!
1. "The Meaning of it All" by Richard P. Feynman
2. "Galileo's Finger: The Ten Great Ideas of Science" by Peter Atkins
3. "Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis" by Lisa Sanders
Quick tips for the faculty
- Assign one of the above articles to your team to read and discuss ways to maintain the value of curiosity at a time when length of stay and other factors are limiting time
- Challenge your residents and students to identify a scholarly article (not UpToDate) that pertains to each patient they admit
- Make a habit of reading the “Clinical Implications of Basic Research” series in the NEJM.
- Bench to the bedside article:The Monocyte in Atherosclerosis - Should I Stay or Should I Go Now?
Be Passionate about your patient, about your specialty, about the disease, about teaching.
Read the Articles!
- This article from Dr. Stuart Munro, titled “Balance, Safety, and Passion: Three Principles for Academic Leaders” is an essay from the perspective of an academic physician on how to balance passion for the profession with other values.
“Medicine, Preserving the Passion in the 21st Century,2nd ed.” is a book from Phil Manning and Lois DeBakey containing stories from different physicians and how they have maintained the passion for their work over the years.
Quick Tips for Faculty
The series “A Piece of my Mind” in JAMA and “On Being a Doctor” in the Annals of Internal Medicine regularly tell stories from physicians about their work and highlight aspects of humanism in medicine. Sharing them with, or assigning them for learners can help keep the focus on person-centered care and the patient-doctor relationship.
Be Prepared to teach, to learn, to help, to participate, to give feedback.
Be Prepared to teach
Be Prepared to give feedback
- “Teaching in the Hospital (ACP Teaching Medicine Series) by Wiese”
- “Teaching in Your Office: A Guide to Instructing Medical Students and Residents (ACP Teaching Medicine Series) by Alguirre”
Be Exemplary as a role model. Teaching by example. Mentoring can be rewarding.
The Impact of Role Models on Medical Students: This paper by Wright et al explores the relationship between clinical role models during medical school and the students' choice of clinical filed for residency training. The study is conducted on the graduating class of 146 students at McGill University School of Medicine using a 60-item questionnaire focusing on role modeling in medical school.
Role Modeling in Physicians’ Professional Formation: Reconsidering an Essential but Untapped Educational Strategy: In this manuscript Kenny et al. identify foundational questions regarding role models and professional character formation; describe major social and historical reasons for inattention to character formation in new physicians; draw insights about this important topic from ethics and education theory; and suggest the practical consequences of this work for faculty recruitment, affirmation, and development.
Attributes of Excellent Attending Physician Role Models: The case-control study by Wright et al. identifies attributes that distinguish excellent clinical role models from their colleagues. Their data suggest that many of the attributes associated with being an excellent role model are related to skills that can be acquired and to behavior that can be modified.
Kathy Griendling: A Modest Molecular Biologist: The interview with Kathy Griendling, Vice Chair for Faculty Development at the DOM, reveals insight to the mind and passions of an exemplary mentor of students, residents, postdocs, fellows, and junior faculty.
Be A Listener to your patients, to their families, to your learners. When in doubt, ask the patient.
Healing power of listening in the ICU - editorial by Dr. Craig M. Lilly & Dr. Barbara J. Daly
Life at Grady: Hear my voice by Dr. Kimberly Manning
- A communication strategy & brochure for relatives of patients dying in the ICU by Dr. Alexandre Lautrette
- Valuing and appreciating what the family members have to say
- Acknowledging the emotions expressed by the family members
- Understanding who the patient was as a person, by listening to family members
- Eliciting questions from the family members
Patient Listening: A Doctor’s Guide
by Dr. Loreen Herwaldt
In the growing field of narrative medicine, physician Loreen Herwaldt uses the illness narratives of over two dozen writer-patients to teach listening skills to medical students, residents, physicians, and other health care providers.
Listen to your learners (medical students)
The Inner World of Medical Students: Listening to Their Voices in Poetry
by Dr. Johanna Shapiro
Shapiro analyzes poetry and creative writing from medical students to systematically understand their thoughts and feelings about life, the medical culture, socialization and the quality of their medical education. For clinician educators, this book addresses the reasons why medical students are often drawn to poetry as a way to confront their fears and experiences that emanate from their clinical training experiences.
A Doctor's Touch
by Dr. Abraham Verghese
“Patients complain that doctors spend too little time with them and don't listen, he says.” In our era of the patient-as-data-point, Abraham Verghese emphasizes the old-fashioned bedside chat, physical exam, and the power of informed observation.
Be Dedicated for life. Exhibit dedication in every aspect of your practice.
Read the Articles!
- "I'm Still Here" , exemplifies a young physician's dedication to her work and challenges older physician's who may question younger physician's dedication.
- In "My Heros", meet two older physicians whose lives were dedicated to the patients they served.
Dr. Leila Denmark-Pediatrician, Egleston's first female resident, practiced without office staff beyond the age of 100 and dedicated her life to taking personal care of her patients.
Dr. Russell Dohner-90 year old physician who practiced seven days a week and humbly dedicated his life to his patients.
- Learn how "Dedication and Compassion Define Field Medicine" at a combat hospital in Baghdad.
- This touching article, "An Overview of a Life", celebrates the life of one of the most admired and dedicated physicians in the history of medicine.
"J. Willis Hurst: His Life and Teachings" by Silverman, M. E., and Frye W. B.
This book delineates Dr. Hurst's dedication to teaching, the caring of his patients, and writing and research. For 30 years he was chairman of Medicine at Emory and after retirement, continued to write and teach physicians, young and old.
Dr. Lesley Miller is one of the lead physicians in the Grady Liver Clinic. This clinic, run by general internists, is dedicated to caring for, treating and educating patients affected by Hepatitis C. This video, put together by the CDC, highlights her dedication not only to patients but our learners as well. Dr. Miller also cares for patients coinfected with Hep C and HIV at the Ponce de Leon IDP clinic.
Be A Communicator to your patients, to your colleagues, to other healthcare professionals. Don't underestimate the influence of your spoken word.
There is an extensive literature on communication in medical settings, with abundant materials published on how to communicate with and educate patients, as well as on how to teach communication skills to learners at different levels. We have chosen resources this month that help our faculty think about how to go about improving the communication skills of their learners, with guidelines from well respected groups and individuals.
- Evidence-based competencies for improving communication skills in graduate medical education: A review with suggestions for implementation: This article, published in February 2013 establishes 12 areas of communication that all trainees in graduate medical education should become proficient in. These range from the basic, like the ability to take a history and physical, to the more complex, like counseling families and caregivers.
- Invite, Listen, and Summarize: A Patient-Centered Communication Technique: This paper offers an innovative communications technique to teach learners that emphasizes open-ended nquiry, empathy, and engagement to gather data. It can be helpful in clinical settings as an alternative to the typical physician-driven interview style, which focuses on yes-no questions.
- Teaching Medical Students and Residents Skills forDelivering Bad News: A Review of Strategies: This classic paper describes the well-known SPIKES protocol for delivering bad news to patients: S(etting), P(erception), I(nvitation), K(knowledge), E(mpathize), S(ummarize and Strategies).
- Teaching Communication in Clinical Clerkships: Models from the Macy Initiative in Health Communications: This is a comprehensive guide to areas of core competencies in communication for practicing physicians. They divide them into communication with the patient, about the patient, and about medicine and science. If you are interested in knowing what areas your learners need to be proficient in with regards to communication, this can be a one-stop shop.
Dr. Vince Marconi, Associate Director of the Ponce de Leon Center, talks about what it means to be a Communicator.
Be Professional in your ethics, in your words, in your interactions, in your mind. Remember...we all are intersted in what is best for the patient
The following articles and books, as well as a video, start scratching the surface of what it means to be practice professionalism as a physician.
- Dr. C. Ronald MacKenzie provides a general overview of medical professionalism in “Professionalism and Medicine”, beginning with its historical and ethical-philosophical foundations, followed by a discussion of its constituent elements and relevance to clinical care, concluding with a brief discussion of current concepts related to teaching of professionalism. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504270/
- In his editorial “What Does it Mean to be a Physician?” Dr. Michael Whitcomb discusses professional and humanistic behaviors that must be at the core of students’ understanding of what it means to be a physician. What does it mean to be a physician? Acad Med 2007 Oct;82(10):917-8. PMID: 17895647
- “Professionalism in Medicine: Results of a National Survey of Physicians” reports on a national survey of more than 3,500 physicians and concludes that although physicians agree with standards of professional behavior promulgated by professional societies, the reported behavior does not always conform to those norms.
- In our next article, Dr. Atul Gawande describes the sea change occurring in Medicine, changes which are increasing demand for physicians who are able to better work in teams, leaving “cowboys” who go it alone behind.http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html
The embedded video shows a TED talk from Dr. Gawande which touches on some of the same themes, including some thoughts about how physicians should manage complexity:
The book "Professionalism in Medicine: A Care-Based Guide for Medical Students" edited by Spandorfer, Pohl, Rattner and Nasca engages students and their teachers to reflect on cases that resonate with the experiences of life in medicine.
Be Thorough with your history, with your physical, with the chart, with your diagnostics. Role model the power of the history & physical examination as cornerstone diagnostic tools.
NPR: "The Fading Art of the Physical Exam"
This story reiterates the importance of laying hands on a patient, both for diagnostic purposes and in building a relationship with our patients. It also introduces the Stanford 25, a list of 25 essential bedside physical exam techniques as outlined by the Stanford University School of Medicine.
Abraham Verghese: TED Talk "A Doctor’s Touch"
Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam... and informed observation.
- "Revitalizing the History and Clinical Examination" - American Journal of Medicine, Vol 125 (no 4), April 2012
This commentary in the American Journal of Medicine examines why modern physicians tend to rely more on technology than on their history-taking and physical examination skills and reiterates why the history and physical exam are essential and unique tools in our diagnostic arsenal as well as in building the doctor-patient relationship.
- "Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital" - Arch Intern Med Vol 171 (No. 15), Aug 2011
This prospective study examined the utility of the history and physical examination performed by seasoned residents and faculty members in making accurate diagnoses in patients with diverse clinical presentations the Emergency Department. The patient's history was the key element in performing diagnoses alone, as well as in conjunction with the physical examination or basic tests. The physical examination doubled the diagnostic power of the history and 60% of patients were correctly diagnosed on admission on the basis of the history and physical alone. 90% of correct diagnoses were made on admission using the history, physical and basic tests.
- Fantastic resources for polishing and teaching physical examination skills:
- Bates' Guide to Physical Examination and History-Taking - Lippincott Williams & Wilkins (good basic text for re-learning physical examination skills)
- Sapira's Art and Science of Bedside Diagnosis - Jane M. Orient (incredibly engaging textbook that provides historical context and teaching points for all levels of learners)
- Mosby's Guide to Physical Examination - Henry Seidel (good basic text for re-learning physical examination skills; smaller pocket-sized guide also available)
Be There physically, mentally, emotionally, ethically. The engaged attending is a catalyst for excellent education and patient care
Read The Articles
- “Being in the Present Moment: Developing the Capacity for Mindfulness in Medicine” discusses skills of being present in the moment. It helps us think about directing our attention and avoiding distractedness, ultimately very challenging skills in today’s world of unending distractions and clinician’s desires to be ever present and ever responsive. Oftentimes, we need to put everything else aside, and simply listen to our trainee, listen to our patient and gain the trust, respect and admiration that will come from that.
- “Do Something” by Emory’s own Dr. Kimberly Manning offers a reflective look at one of the core reasons of why we are doctors: for people. Sometimes, even if we can do nothing else, we can ‘Be There’ for our patients…spend precious time and accept and express true emotion.
Tips for Faculty
The NYTs article, “How Mindfulness Can Make for Better Doctors” reminds us as physicians to be mindful of what we love to do, and do it with vigor and intensity. When we feel and display the enthusiasm that drove us into the field of medicine that we practice, we can then be more thoughtful and intentional about eliminating (or at least reducing) distractions when with patients or while teaching trainees. In essence, we can ‘Be There’ for them, and help them maintain confidence and comfort in us.