How to Prevent Clinical Atrophy

Transcription

1 How to Prevent Clinical Atrophy Elton Chambers, MD

2 What are you talking about? The problem How to find clinical experience The answer

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4 The Problem For the last 3 years you have spent about 8,500 hours taking care of patients YEAR 1: 70 hours x 49 weeks YEAR 2: 55 hours x 49 weeks YEAR 3: 50 hours x 49 weeks

5 The Problem There are 26,280 hours in 3 years. You have slept roughly 6,500 hours during this time. 8,500 hours/19,780 hours = 43%

6 The Problem Next year this number will be drastically reduced So is this a problem?

7 The Problem An Example Resuscitation Training: Curran et al studied the retention of neonatal resuscitation skills after standard and simulated training and found a significant decline in performance over 4 months, without improvement in skill retention on retraining with simulation Curran VR, Aziz K, O'Young S, Bessell C. Evaluation of the effect of a computerized training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn Med 2004;16:

8 The Problem I m worried that I have become less skilled as a pediatrician after this year

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10 Outlets for continued practice Make it part of your job next year Moonlighting At home Near by Free clinics Other perks of being a chief

11 Make it part of your job Our contract requires clinical time as a hospitalist 1 weekend a month 6 weeks a year

12 Make it part of your job The possibilities are endless Primary care clinic? Newborn nursery? Level 2 nursery? Emergency room? Outreach clinics?

13 Make it part of your job Make sure it is something that you are interested in! Serve a mutual purpose But don t do something you hate for a year *Find someone to help you with this.

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15 Moonlighting At home (your institution) Near by (the private world)

16 Moonlighting Your Institution No more credentialing Familiar You know the nurses, you know how to get around Same computer system You have residents Maybe less paperwork (no offense) Same DEA license No malpractice coverage worries Usually protected by the institution in other ways as well

17 Moonlighting The Private World More credentialing Give at least 3 months for this A new place Wandering around a different hospital is a little scary at first Different computer system Fee-associated DEA license This will cost around $500 No residents You may want to do things on your own Malpractice

18 Malpractice Next year What you have is what you have Most private groups have a locums rider Ask about this! Occurrence Claims made

19 Malpractice Occurrence Insures for any incident that occurs while the policy is in effect, regardless of when a claim is filed This is the best

20 Malpractice Claims made Covers policyholders for alleged acts of malpractice that take place and are reported to the carrier during the policy period You will not be covered for after the fact claims Unless you have tail coverage. PLEASE GET TAIL COVERAGE!

21 Malpractice Claims made Covers policyholders for alleged acts of malpractice that take place and are reported to the carrier during the policy period You will not be covered for after the fact claims Unless you have tail coverage. PLEASE GET TAIL COVERAGE! Check out the tail length as well

22 Malpractice Coverage amounts Occurrence: $1-2 million Claims made: $1-2 million Tail will be about half of that ~ $1 million You can buy additional tail coverage

23 Q1GjopH_1r0/TaBv24nzkDI/AAAAAAAABQA/fHkohawL0x4/s1600/Awkward-Family- 46.jpg

24 Free Clinics Where to look You probably refer patients to these clinics Local churches Protect yourself first How are the physicians that work there covered? Be careful!

25 Perks of being a chief Morning report Read about every diagnosis You want to look like you are chief for a reason Press the faculty on why certain decisions were made, or why they would have done things differently

26 Perks of being a chief What s happening on the wards Be nosy! Talk with your co-chief about what you would have done. Is there a rare case in the hospital? Talk to the team about seeing that patient

27 Perks of being a chief Morbidity and mortality Journal clubs Local conferences Regional/national conferences

28 Academic half-day An agreement between the chiefs and the PD Sharpen your skills during this time Study for boards Work on your research Maybe you can talk to your PD this week about an academic half-day

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30 One more word of advice Don t spread yourself too thin

31 QUESTIONS? /7pBZWVXybdc/s1600/ole0.jpg

32 QUESTIONS? Thanks for your attention!