Don't Be THAT Guy: Tips From a Third-year Medical Student

I've heard quite a few of my classmates comment that they discovered the “real personalities” of many of their colleagues in the third year of medical school, when students begin to practice clinical medicine. There are a number of pressures that push people to be petty, selfish, and annoying – academic pressure, the pressure to impress your residents and attendings, the attempt to get more experience than the next guy.

And it’s not just medical school. As pressure mounts in nursing school, pharmacy school, or whichever health care path you choose, unfortunate new attitudes and behaviors can rise to the surface. Everyone goes through this, and I think everyone makes at least a few mistakes through the process.

At the end of my third year, I put together this list of things I learned to be a better student (and a better person!). The people that stick to these principles are respected, well-liked, and I think, generally happier. I also think they are far more professional than their counterparts.
My hope in sharing these tips is to create some dialogue about the importance of professionalism.

Each week for the next month, I’ll share 3-4 lessons I’ve learned and invite you to share similar stories and experiences of your own.

(As a disclaimer, I’m sure I’ve made ALL of these mistakes and probably still slip up. No one is perfect, but being conscious of these mistakes has really helped me grow throughout the year.)

Without further ado, here are my first three tips:

1. Roundsmanship. Don't make your classmates/residents/anyone look bad. If you know an answer to a question that the attending is asking and your intern doesn't, don't jump in with it. If your classmate is slipping up, don't blurt it out. It will itch, and you will want to say it (because it feels great to actually know the answer), but it is an important and difficult skill to develop knowing how and when to say it to show your knowledge while not throwing others under the bus. Sometimes you won’t even realize that this is what you’re doing until later, but believe me, there is one right way to do it and many wrong ways.

2. Humility. Don't look down on anyone and find the fine line of respecting yourself and making yourself to be a respectable professional without overstepping your boundaries. (In other words, don't be constantly hiding in the shadows, but know how and when to speak; it is rarely about you). You’ll encounter people of all levels of training that treat you like dirt, and it should just go to show you that it has nothing to do with your experience or rank –everyone should be treated with respect. The classic example of this going wrong is the OR – scrub techs berating medical students, for example. Just roll with it and learn from it, and remember that people react the exact same when you do it to them. I found that just by being nice and acknowledging the roles that other people play, everyone was suddenly bending over backwards to help me out.

3. Don’t Complain. Ever. You will have to do a lot that you think is a waste or possibly beneath you. Don't complain about it. Everyone hates people that complain. You will become well known for it. In fact, you won't even realize that you're complaining until you are critical of yourself about it. Don't talk about things being unfair to you, or about how someone else got to do something, got time off, etc. Remember, the people you’re complaining to have probably dealt with much worse!

- Lakshman Swamy, MD/MBA Candidate, 2013, Boonshoft School of Medicine at Wright State University

ProjectConnect: A Quality Improvement Project for … Quality Improvement Projects

The Tulane University IHI Open School Chapter, the first one in Louisiana, was founded in December 2010. In just one year, we've seen our membership grow to more than 70 members that have initiated multiple quality improvement projects at Tulane Medical Center.

Organizing all of those projects, ironically, turned into a quality improvement project itself.

Let’s first step back a bit. We started holding monthly meetings in early 2011, open to medical students and faculty, to discuss quality improvement related topics in health care, many of which were based on modules available on the IHI Open School website. After speaking with many students and faculty who attended those initial gatherings, we began to understand that our medical community was full of enthusiastic faculty and students who wanted to get involved with quality improvement at Tulane. However, we didn't really know how to get started connecting everyone with this shared interest and enthusiasm. We made solving this problem our main goal.

We decided that the most effective quality improvement project would be to connect the like-minded individuals in our medical community and enable them to actually do quality improvement. This is how we came up with ProjectConnect, an online quality improvement project repository and social network. We designed ProjectConnect with three goals in mind:

1. Provide a secure online platform to create, share, and manage quality improvement (QI) projects. 2. Facilitate collaboration and mentorship between Tulane faculty and medical students on QI projects. 3. Promote QI and patient safety awareness within the Tulane community.

After two months of internal meetings and guidance from our faculty advisor, Dr. Frank Rosinia, we submitted a formal business proposal to our dean's office, made a formal presentation, and secured funding for the development of ProjectConnect. We spent the next five months developing and testing the application. For example, we made sure students and faculty could log-in with their existing emails and that project data was visible to everyone after it was entered. Meanwhile, we continued holding Chapter meetings every six to eight weeks to build our chapter membership.

In August 2011, we held a faculty breakfast to unveil ProjectConnect. We asked the faculty – from Tulane Hospital, the medical school and the school of public health – to bring their laptops to breakfast so we could teach them how to log-in and enter projects into the system. (Gaining faculty support was crucial to our effort.)

Once we had some QI projects loaded, we scheduled a meeting to introduce ProjectConnect to our medical student community. The student response has been tremendous, and today there are more than 20 QI projects in the system in various stages of completion. A few examples of the work that’s going on:

• Improving patient handoff efficiency
• Reintroducing a surgical safety checklist in the ORs at Tulane
• Decreasing CLABSI rates
• Developing an effective method to train first- and second-year medical students in clinical documentation

Our Chapter continues to grow and the incoming student leadership has big ideas for developing a QI elective based on IHI Open School modules, with the goal of incorporating it into our medical school curriculum in 2012.

- Clinton Piper, medical student, Tulane University

Big Lessons: Chapters Share Learning from Event at the World's Largest Medical Center

Hi, y’all. I’m Rachel, a project coordinator at the IHI Open School. Some of you have probably seen my name at the bottom of emails or my smiling face at the IHI National Forum, but I’m still getting to know many of our students and Chapters. I got a great opportunity to do just that in my hometown of Houston late last year.

It was an experience that filled me with pride – and with help of Chapter Leader Joshua Liao, provided me with several lessons to share with new and experienced IHI Open School Chapter Leaders.

Early in the fall, I had the pleasure of working closely with Joshua, a third-year medical student and current IHI Open School Chapter Leader at the Baylor College of Medicine (BCM), to plan the first annual Houston IHI Open School Convention. The goal of the one-day convention at Texas Medical Center (the world’s largest medical center) was to use education and networking to expose attendees to important issues in patient safety and quality improvement.

The convention – a product of collaboration between IHI Open School Chapter leaders from BCM and the University of Texas Medical School at Houston – brought together student s and professionals from a wide array of educational institutions and hospitals from Houston and surrounding cities. It was inspiring and energizing, and surpassed all of the expectations we had set.

Following the convention, I asked Joshua to share details of the experience so that other Chapters could learn from them:

Who was involved in planning the event?
Early in the planning process, I took the lead in the overall vision for the event in terms of format, timing, content, and discussed these things with several other student leaders/officers before touching base with Rachel from the IHI Open School. Once that was broadly set, I moved forward with publicity with the help of a few other officers from the Baylor College of Medicine (BCM) Chapter –Jehan Alladina, Harman Kular – and Tyler Willliams , a medical student and IHI Open School Chapter Leader from UT-Houston Medical School. A number of other BCM and UT-Houston students – notably Varun Kumar, Jonathan Huang, and Mitchell George –helped with a number of pre-event and event-day responsibilities.

What topics did you include in your event agenda?
I chose two main topics - diagnostic error and safety culture - as the focuses for the event for three reasons: they are emerging, 'hot topic' issues in safety/quality, they are pertinent to the daily experience of health professions students, and we have a few of the nation’s leaders in these topics here in the medical center.

How did you select the speakers?
Given my desire to focus on safety culture and diagnostic error, Dr. Eric Thomas and Dr. Hardeep Singh were perfect choices. They are each leading researchers in these areas, respectively, and they are both very active in academic and educational roles within the UT-Houston and BCM communities.

How did you advertise the event?
I was admittedly ambitious with the scope of the event. I wanted to involve as many local Houston institutions as possible (whether they had IHI Open School Chapters or not), as well as a number of out-of-town chapters, knowing that regardless of eventual attendance, the effort and publicity from this kind of event would create important awareness and precedent for the future. As such, my team and I set out to advertise to all the hospitals and health professions schools (medical, physician assistant, pharmacy, nursing, etc.) in the medical center and also sent out invitations to other Chapters in surrounding cities. For local schools, we used paper flyers along with class-wide emails, and for hospitals we sent out invitation emails. For the Chapters and institutions further away, I drafted template letters that were sent to the appropriate deans, chiefs, and/or Chapter Leaders. We also set up a Facebook event to use social media to publicize the event and used eventbrite.com to set up an online invitation.

What was the biggest challenge you encountered during the planning process?
With the scope of this event, the biggest issue was date selection. Because everyone (speakers, student leaders, potential attendees) had increasingly busy schedules, choosing a date that worked for everyone proved to be a more difficult task that I originally imagined.

Is there anything that you learned about planning the event that other students would benefit from knowing?
Honestly, probably too many to count. But by way of overall lessons, I took away two big lessons from this event:

1. Don't be afraid to think big - While there's a time and place for smaller events, I think that if awareness and publicity of the Open School and safety/quality in general is a main goal, students shouldn't be afraid to think big (by inviting speakers, publicizing the a larger demographic, or selecting creative programming). As I learned, there are a lot of great secondary benefits to planning an event this way, even if the attendance doesn't reflect the number of invited students and professionals. From this event, I've already received several emails from people who've never heard of IHI wanting to join Chapters, and several leaders who weren't able to attend but mentioned they would love to be involved in something like this in the future. So in my case, thinking big created new connections and started new relationships that I couldn't have imagined beforehand.

2. Mind the details - For students who want to undertake planning a similar event, I would recommend that they do a large portion of groundwork before presenting or soliciting ideas from others. As mentioned before, in my experience, the planning process can stall in the early stages if student leaders wait on each other to get the ball rolling, which can be time consuming and very low yield. Whether the final agenda remains unchanged or not (in my experience it's actually a good sign if the agenda goes through multiple revisions!), having something concrete to present to other leaders and planners to discuss was immensely helpful. Because for better or worse, as one of the lead planners, the other leaders/organizers will be looking to you to fulfill that role to get the process started.

-Rachel Bissonnet, IHI Open School Project Coordinator

Wearing My IHI Blue Shirt Every Day

I couldn’t look away. I didn’t know what it was or where it came from, but I couldn’t look away. Was it someone’s sandwich wrapper? Perhaps it was a sheet of paper that someone was too lazy to toss? Either way, I had no choice.

I was compelled to pick a piece of dirty, white paper off the Orlando International Airport floor and throw it away.

You might be wondering why. (Or, you might not be very impressed: “Way to go, man. You picked up a piece of paper and threw it away. Do you want a medal?”) But it’s not so much that I picked it up. It’s why I picked it up.

And the reason can be summed up in five words: I’m an IHI Blue Shirt.

If you’ve ever been to an IHI National Forum, you’ve seen us. Flocks of us. We leave Boston’s Logan Airport by the dozens in early December – all of us bright-eyed, curious, and excited. We come home six days later – all of us bleary-eyed, content, and exhausted. The long hours in between are draining and intense. Sore feet, blisters, and sleep deprivation are more the rule than the exception.

Yet after my first experience in the blue polo shirts last week, it’s something I can’t wait to do again.

Let’s back up and define an IHI Blue Shirt. Technically speaking, we’re IHI staff members (mostly from our headquarters in Cambridge, MA), that come down to the National Forum and help make the 5,000-attendee event a success. More specifically, we run registration, check rooms, greet attendees, manage shuttle buses, create signs, maintain the staff office, provide first aid, dispense conference materials, communicate important updates to hotel staff, comprise the human wall during keynote sessions, and perform any other necessary job.

In short, IHI Blue Shirts exist to do one thing: Delight our National Forum attendees. Lost on your way to your session? Right this way, ma’am. Wondering what time the exhibit hall is open? It’s 11 - 2, sir. I hope you enjoy it. Think we can do something better next year? That’s a great idea. Let me share that feedback at tonight’s staff debrief. (And rest assured that we do discuss it!)

But I learned it’s more than just the simple tasks and extra assistance. It’s more than helping attendees wheel their luggage from one end of the hotel to the other. It’s more than walking more than 10 miles every day. It’s more than the 5 a.m. wakeups, countless paper cuts, and long stares at the gorgeous Florida sun (and glistening pools) through large hotel windows.

What is being an IHI Blue Shirt really all about? Simply put, it’s about going out of your way to help others. And the biggest life lesson I took away from my first week wearing an IHI Blue Shirt was that there’s no reason to ever take it off.

Even when the event ended at 5 p.m. on Wednesday, I wanted to help. I wanted to help clean up. I wanted to help people find the hotel lobby. I wanted to pick dirty pieces of paper off airport floors.

And in a moment of clarity (in between the hours of exhaustion), I realized that even though the experience lasts only one week each year, I should always “wear” my IHI Blue Shirt under my clothes. Why wouldn’t I hold doors, greet people with a smile, or point people in the right direction? Why wouldn’t I go out of my way to help others?

Come to think of it, what if we all wore our “Blue Shirts” every day? People would smile more. People would say “thank you” more. People would connect more. And maybe, just maybe, the world would be a better place.

I do, however, know one thing for sure: The floor of the Orlando International Airport would be cleaner.

- Mike Briddon, Managing Editor, IHI Open School

Tackling Quality Improvement Projects At Georgetown University

As the Community Manager of the IHI Open School, I have the joy of periodically visiting our Chapters to get to know them, hear about the exciting work they’re doing and, help with the challenges they face. This November, it was a pleasure to travel to Georgetown University for my first site visit.

What stood out most about the visit was the passion and energy this Chapter is putting toward its quality improvement projects.

Chapter founder, Dr. Daniel Alyeshmerni, a hospital resident, and Chapter leaders, James Cervantes and Mark Fischer, (both health systems administration students) are guiding many of the Chapter’s 70 students on eight different interprofessional projects at Georgetown University Hospital (GUH). IHI Open School Chapter at GU working group members: Cervantes, Horak, Alyeshmerni, Fisher and O’Mally

The group, which comprises students from medicine, nursing, health administration, and pharmacy, is working on these projects that began approximately 8 months ago:

- Central Line Associated Blood Stream Infections (CLABSI)
- Inpatient Handoff Communication
- Venous Thromboembolism (VTE) Prophylaxis
- Discharge
- Inpatient-Outpatient Handoffs
- Interdisciplinary Rounds
- End-of-residency Handoff Communication
- Hand washing

Just getting started can be a challenge, but the students at Georgetown have been both resourceful and creative. One of the project teams utilized the IHI Open School’s Mentor Matching Tool to identify mentor hospitals with similar demographics and low rates of CLABSI. After identifying New York Beth Israel and Swedish Medical Center as mentor institutions, the Georgetown team hosted regular conference calls with them to learn from what they were doing. From there, the CLABSI team went to hospital leadership, who recommended ideal units to pilot the project. And after initial success, they are now rolling these out to other units at GUH.

The eight projects are in various stages – some are just getting off the ground, others are already collecting data – but each one has the same goal: to improve care for patients in the hospital. (Note: Georgetown is serving as one of 20 test sites in the IHI Open School Quality Improvement Practicum. Click here to learn more.)

And, I was delighted to learn, the QI projects are only one initiative within this vibrant Chapter. Faculty advisors Bernard Horak, Professor of Health Systems Administration, and Dr. Eileen Moore, Assistant Dean for Community Education and Advocacy, along with other faculty members are committed to making this improvement work real and permanent. The group is also striving to:

- Engage more students in their Chapter
- Secure funding for Chapter events and activities
- Integrate QI in curriculum

Georgetown University recognized IHI with a certificate of appreciation for their educational contributions! (From left to right: Fischer, Horak, Cervantes, Perlo, Alyeshmerni and Moore).

Thank you, IHI Open School Chapter at Georgetown, for an excellent first site visit. After a day with your group, I am absolutely inspired by our community of healthcare professionals and can’t wait for the next site visit!

- Jessica Perlo, IHI Open School Community Manager

The Unique Path of a Clinical Nurse Leader

There are numerous pathways to becoming a Clinical Nurse Leader. The program lends itself to a diverse group of students, as there are no restrictions on the required undergraduate degree – as long as certain prerequisites are met. That being said, I thought it might be interesting to highlight the members of the cohort with whom I’m studying at the University of New Hampshire.

They truly are amazing individuals, striving through one of the most difficult programs and periods of their lives together because they hope to make a difference in the nursing profession.

What other nursing classroom in New Hampshire could you sit in and glance to your left at a thirty-year-old mother chatting about her 2- and 4-year old children; to your right and see a middle-aged man with a military crew cut fiddling with a tape-recorder; and straight ahead at a fresh-out-of-undergraduate woman color coordinating her notes? Add another 19 students ranging in age from 22 to 42, covering fields of study from archeology, to graphic design, to acupuncture, who all realized at some point along the way they wanted to switch gears and become a nurse.

Reaching the halfway point of this accelerated program has proven to be a test in survival skills. No one individual would have been at this point if not for the one sitting next to him or her; it’s been a real team effort. Anyone in this group would vouch for a sense of cohesion that has never been experienced. We’ve become almost like a family and are not competitive with each other, but, instead, genuinely supportive. This sort of respect and encouragement is the epitome of the CNLs role: empowering one another, transferring knowledge, continually communicating and collaborating.

But unfortunately, continual judgment is passed on this group of CNLs and other programs like this, for the program offers the opportunity to receive a master’s degree in nursing without going through a previous nursing curriculum, nor earning a previous nursing degree. Some veteran nurses are shocked to hear this. Others may even be insulted.

What we hope to prove collectively is not only ourselves as capable of the challenge and worthy of the profession, but also that this track offers a priceless combination of mind power, innovation, and knowledge. If you compile a group of type-A, self-competitive, driven people and put them in an accelerated year-round program, the outcomes can be truly amazing and innovative. Generation of ideas is incredible. Professors are often struggling to get through lectures due to the amount of questions and discussions that are held.

We may not step on the floor at the end of the program with the perceived equivalent clinical experience of other masters prepared nurses, but our life experiences and academics will guide us as we continue to learn and grow throughout our careers.

- Jessica Hatch, Nursing Student, University of New Hampshire

To hear more about Jessica and the clinical nurse leader role, see her first post here.

IHI Open School San Antonio Chapter shines in photo campaign

This fall, the IHI Open School launched a photo campaign to promote empathy, compassion, and patient- and family-centered care. We asked students, residents, faculty, and health professionals to put themselves in the shoes of a patient for one day and take a picture.

As you can see from the colorful collage here, the response was wonderful.
One chapter, the IHI Open School San Antonio Chapter, took center stage. Turning it into a Chapter activity, the members visited a local health care facility and snapped dozens of colorful pictures.

We asked them a Chapter leader Jessica Schwartz, a health care administration student at Trinity University, a few questions about the experience:

Why did you get involved in the photo campaign?
One of our faculty advisors called my attention to this photo campaign and I’m so glad that she did! The concept of asking future healthcare professionals to stop what they’re doing and force themselves to see healthcare from a different perspective is such a valuable opportunity. This process of viewing something familiar from a different vantage point can be quite educational, but also brings us back to what’s important: patient care.

Where did you go to take the pictures?
The Center for the Intrepid in Fort Sam Houston, Texas. Recurrent images of the patient’s perspective are generally in civilian hospitals and portray something negative. We decided to show something different. San Antonio has a large military population and unprecedented capabilities to not only treat them, but bring them to a level of physical and emotional strength thought to be impossible given these injuries.

Center for the Intrepid is an outpatient rehabilitation facility for soldiers who are active duty or veterans. This nationally recognized Armed Forces Rehabilitation Center was donated by more than 600,000 Americans. It offers state-of-the-art facilities for amputees and burn victims. Members of IHI Open School San Antonio were graciously welcomed into this incredible place to capture the miracles that occur there on a daily basis. The pictures that we have submitted include their “clinical, research, and administrative space, a gait lab, a computer assisted rehabilitation environment, a pool, an indoor running track, a two-story climbing wall, and a prosthetic fabrication lab” (CFI brochure).

Who knew the patient’s perspective could be so inspiring?

What were you looking for when you took the pictures?
I tried to capture a day in the life of a patient at Center for the Intrepid. This includes rehab facilities and prosthetics of all kinds in a military setting. I hoped to relay frustration, confusion, and loss, coupled with inspiration, perseverance, and strength.

What was the best picture you took? Why?
Sorry, but I have two! No. 6 and No. 11. (Both are below.)

Picture No. 6 is a detailed aerial view of many of the physical therapy exercises with natural light shining in on the beautiful facilities. It is evident here that you really have to put in work to improve.

Picture No. 11 is a simple image, but very impactful. Two prosthetic legs are seemingly crossed and casually leaning against the table, as if they were already attached to a human being. The running shoes send a powerful message to me. These are not ordinary walking shoes; it is clear that this person was/will be a competitive runner and/or is training for a physical challenge. This describes the majority of patients who come into CFI. They have been physically and mentally strong, focused, and competitive and they will do anything to return to that elite level. Of course there are running shoes already attached to prosthetics.

What lessons did you learn from participating?
I am thankful for this opportunity to further appreciate not only the patient perspective, but also the wounded soldier perspective and road to recovery. In addition to the outstanding capabilities of this facility, I was reminded how important the patient-provider relationship is for a full recovery. Both the patient and the providers (physicians, trainers, etc.) give over 100% every day to yield the best possible result. I walked out of there with a new view of patient care and a new perspective on life.