Newsletter
January 2020

This edition features:
The Quality Improvement & New Models of Care Pillar  

What are some of the topics covered in this paper?
This article, through its description of a unique initiative as an offshoot of the General Internal Medicine (GIM) Residency Training Program at the University of Toronto and University Health Network, manages to integrate a consideration of many topics within Medical Teaching and Education. The paper describes a journal club emanating from the residency program that utilizes a group peer mentoring methodology.  It helped to ease the transition to full practice for these recently graduated very senior GIM residents.
 
Why might a clinical teacher in the health professions read this paper? What are some take home messages?
These tips are intended as a springboard for broad reflection on teaching points and for possible application to your clinical teaching.

Journal clubs are effective teaching settings for a variety of medical education purposes.  An evidence base exists for them (BEME Review 16: Med Teach 2011; 33: 9–23). “If a JC is being designed for residents, the content should be directly applicable to patient cases they find problematic, enabling application of evidence in a real-time setting; didactic support could be provided based on an educational needs assessment ...  Critical appraisal and discussion of clinical applicability could be facilitated by senior clinicians … enabling the transfer of discussion into practice.”  While most literature deals with formalized structured journal clubs, less formal and more fluid but regular discussion of journal articles on a clinical team is generally popular and enhances learning among trainees.
 
Group peer mentorship has also been described in a variety of settings and its success in the GIM context described in the current article replicates other experiences delineated earlier. Pololi et al (Acad Med 2002; 77:377–384) developed a “collaborative, … peer-group, mentoring program … based on Rogerian and adult learning principles, the program incorporated development of skills in key areas for career development, a structured values-based approach to career planning, and instruction in scholarly writing.” This technique lends itself very favourably to junior faculty groups and could easily be applicable to clinical teachers. With a similar degree of positivity to that described by MacMillan et al, Pololi’s group “participants developed a sense of personal transformation and empowerment.”
 
Important issues for both Journal Club design and Group peer mentorship are those of sustainability and maintenance of enthusiasm and momentum. As clinical teachers consider the use of these teaching techniques and settings, they might specifically plan for how they could continue to flourish into the future, particularly after their initial champions have moved on.

QI & New Models of Care Featured Activity 

Under the leadership of Tom MacMillan, the GIM clinics at Toronto Western Hospital were redesigned in 2016, aimed to enhance the patient experience and provide timely access to comprehensive GIM services.  This reimagined model meant keeping patients out of hospital when they did not need to be there and, for those who did need to be admitted, getting them discharged sooner.  From an educational perspective, it allowed us to enhance the training in new models of ambulatory care that we provide to our trainees.  Clinic volumes have increased by nearly 200% since 2016, recent data collected from referring physicians and patients suggests that we are likely preventing a significant number of admissions and are facilitating earlier hospital discharges (in about 30-50% of cases), and recent patient experience data shows 99% of patients and their families rated their experience with the healthcare team as good/very good.

In November, the clinic was formally named the G. Raymond Chang Complex Medicine Teaching Clinic, honouring the legacy, generosity, and vision of Ray Chang, lifelong friend to Dr Herbert Ho Ping Kong.   

The 2nd Annual HoPingKong Workshop in Complex Medicine

OVERVIEW 
A core competency of a General Internist is that of expert diagnostician. General Internists, particularly those with an outpatient practice, are often asked to see patients referred from the Emergency Department or from primary care providers, with constellations of symptoms, signs, and investigations, around which diagnostic uncertainty exists. It is often the goal of the referring physician that the consultant consider rare conditions with which they may have only passing familiarity, or with which they may be completely unfamiliar. The referring physician may also not have found, or even be suspicious of, a unifying medical diagnosis, but seeks a second opinion, or reassurance that it is unlikely an important diagnosis has been missed.

The achievement of proficiency in the care of this patient population, and in answering complex questions effectively, requires a unique skillset and extensive clinical experience, which is most often acquired after training, when exposed to these questions in practice. 

This workshop aims to hone the unique skillset required for this practice, with a focus on ambulatory medicine, although the concepts covered are also relevant to a hospitalist practice.​

DETAILS
The 2nd annual 1-day workshop will include interactive rare diseases case discussions, expert panel presentations with a focus on the care of marginalized patients, as well as audience Q&A. 

This workshop has been integrated into the University of Toronto General Internal Medicine trainees’ formal curriculum (PGY4 and 5), and is open to GIM trainees across the country as well as practicing general internists, family medicine, and emergency physicians.

Event Date: Friday May 15, 2020 10am-4pm; Registration required 

Additional Info: https://www.thehopingkongcentre.com/workshop-in-complex-medicine 

Frankfurter, C., Venus, K., & Frost, D. (2019). Minding The Gap: Severe Anion Gap Metabolic Acidosis Associated With 5-Oxoproline Secondary To Chronic Acetaminophen Use. Canadian Journal of General Internal Medicine, 14(4), e43-e49.

Gewarges M, Gencher J, Rodin G, Abdullah N. Medical Assistance in Dying: A Point of Care Educational Framework For Attending Physicians. Teach Learn Med. 2019 Nov 4:1-7. [Epub ahead of print] PMID: 31682469

Rawal S, Srighanthan J, Vasantharoopan A, Hu H, Tomlinson G, Cheung AM. Association Between Limited English Proficiency and Revisits and Readmissions After Hospitalization for Patients With Acute and Chronic Conditions in Toronto, Ontario, Canada. JAMA. 2019 Oct 22;322(16):1605-07. PMID: 31638666

Caron F, Garg A, Kaplovitch E, et al. Venous Return Assist Devices for Intermittent Claudication: A Randomized Controlled Trial Utilizing a Sham Comparator. Journal of Vascular Medicine and Surgery. 2019 Sep 24; 7(3):1-7.

Upcoming Conferences 
CCME April 18-21, 2020; Vancouver BC
SGIM May 6-9, 2020; Birmingham AL