A novel hospitalist peer observation program to improve educational and operational rounding practices.

Academic hospitalists must balance trainee education with operational demands to round efficiently and optimize hospital throughput. Peer observation has been shown to support educator development, however, few hospitalists have formal training to optimize both skill sets. We sought to extend and adapt peer observation programs to equally focus on education and operations-based outcomes. During the 2-year study period, 76 of 98 (78%) eligible faculty participated in a structured, real-time peer observation program. Immediately after observing a peer, 42% of respondents planned to adopt an operations-related rounding behavior. Following program completion, 77% of respondents endorsed the implementation of a new rounding behavior learned from a peer, with a third of these behaviors related to clinical operations. Ninety-five percent of respondents endorsed at least a moderate degree of program satisfaction. High levels of engagement and sustained behavior change following program participation suggest clinical operations are an important addition to peer observation programs and faculty development initiatives.

Twelve tips for excelling as an introvert in academic medicine (at all levels).

BACKGROUND: Introverted individuals comprise up to half of the population, but are often overlooked in a culture that privileges extraversion. This misunderstanding of introversion has downstream effects for introverts in academic medicine, including lower grades on clinical rotations, increased stress, and under-representation in leadership positions. AIMS: To increase support for and awareness of the unique strengths of introverted individuals at all stages of a career in academic medicine. DESCRIPTION: This article offers twelve tips, based in the educational, business, and personality literature, to empower introverted students, residents, and faculty members for success in academic medicine. While many of the tips apply broadly, certain tips may be more relevant to those in a particular career stage. CONCLUSION: Increased understanding of the natural tendencies and strengths of introversion will promote a more inclusive working environment for all personality types in medicine and allow introverts at all levels of training and practice to thrive.

The Fostering Resilience through Art in Medical Education (FRAME) workshop: a partnership with the Philadelphia Museum of Art.

Background: Provider burnout remains a serious problem facing medical training programs and has been shown to affect more than half of internal medicine residents. In addition to broader efforts to revamp a health care system that contributes to this epidemic, exposure to the medical humanities offers potential to promote engagement, resilience, and restoration of meaning in residents' daily lives. Objective: We aim to create a reproducible, evidence-based workshop utilizing artful thinking routines to prepare trainees to combat burnout with reflection, perspective-taking, and community-building. Methods: A single, 4-hour workshop for senior internal medicine residents, centered on visual artistic analysis, was offered in June 2017 at the Philadelphia Museum of Art. Pre- and post-workshop burnout metrics and survey evaluation data were analyzed using a mixed-methods approach. Results: Workshop participation was offered to 29 internal medicine residents, of whom 17 (59%) participated. All survey respondents (n=13) rated the workshop as excellent and would recommend it to colleagues. Moderate decreases in the observed frequencies of both high emotional exhaustion scores (64.7% before the workshop to 55.5% following the workshop) and high depersonalization scores (70.6% before the workshop to 55.5% following the workshop) were observed. Conclusions: While results are preliminary in nature, the workshop was received favorably and demonstrated modest decreases in emotional exhaustion and depersonalization. We are encouraged to explore and repeat this workshop with modifications to identify its optimal position in the broader landscape of emerging wellness curricula.

Extranodal Rosai-Dorfman Disease Presenting as a Mediastinal Mass with Pulmonary Artery Invasion.

Rosai-Dorfman disease (RDD) is a rare, nonmalignant disorder of histiocyte proliferation typically involving the cervical lymph nodes. However, a subset of patients with RDD will display extranodal manifestations that are highly variable in presentation, more challenging to diagnose, and less likely to spontaneously regress compared to nodal disease. While case reports of extranodal involvement in nearly every organ system exist, documented instances of mediastinal and pulmonary artery involvement are particularly rare. This study describes the case of a middle-aged woman presenting with new onset right heart failure who was found to have extranodal RDD in the form of a large mediastinal mass with invasion and occlusion of the main pulmonary arteries.