Summary - Morning Report • Noon Conference • Monday Didactics • Ambulatory Education • Resident Update Talk • Potpourri
Conferences are central to the UTSW IM resident education plan. These conferences offer a singular opportunity to learn clinical reasoning and didactic information in a low-pressure, interactive environment. Further, many of our ACGME requirements are fulfilled through our conferences.
What to do if you can’t make conference?
Patient care always comes before conference attendance. If you have a sick patient and need to be at bedside, that should always take precedent. Writing notes, completing signout, and returning pages about non-urgent orders can wait until after conference. If your attending isn’t allowing you to go to morning report, or if your rounding time interferes with morning report attendance, please let your site chief know.
Morning Report
Morning report is one of your opportunities to teach your colleagues and interact with expert faculty. Many of these cases form the foundation of Potpourri cases and several turn into published case reports. To ensure adequate teaching in diagnostic and clinical decision-making as well as a standardized educational environment, the chief residents have developed this guideline. The chief resident will discuss the case with the presenting resident in order to tailor the presentation and to develop teaching material. The resident is not responsible for presenting any teaching material, but they are welcome to if they express an interest.
Starts promptly at 9am from Monday to Thursday.
Case Types
- In general, cases with a known diagnosis are preferred. In these cases, the group works through the patient presentation, from history and physical, to labs and imaging, stopping to create and refine the differential along the way. At some point, the group will decide on the diagnosis and the resident will provide the clinical course and final diagnosis.
- Unknown diagnoses where you are seeking input from your colleagues can also create an interesting and entertaining report, however these require a deep knowledge of the patient’s history. If you are presenting this style, it would be most helpful if you are utilizing the facilitator’s specific expertise.
- Management dilemmas – these are cases where major management decisions had to be made in the middle of the night that had potential to impact the clinical course. These presentations lend themselves to exciting discussions where everyone can learn
- The final diagnosis does not have to be a "zebra": instead, many great cases result in known diagnoses but featured interesting decision points in the diagnostic workup or present a good opportunity for teaching fine points about the management of the case.
Finding a Case
During intern year and throughout your residency, you should be keeping a running patient list of all of the patients you have seen. Keep a separate list of the interesting cases that could be presented for morning report. Some specialist faculty discussants prefer to have a case in their chosen field; however, many of our regular morning report attendants like Dr. Kazi and Dr. Johnson like to discuss all kinds of cases.
Presenting the case
- Come prepared to the morning report with all needed information to answer questions from your colleagues. This may require creating a document beforehand with important labs and history. If you choose to bring your computer or smartphone, your colleagues should not have to wait for you to look up information when they ask questions.
- You should budget about 40 minutes from the beginning to the end of the case.
- You should have patient name and MRN available for the chief resident, however these are not necessary to give to the audience. The chief resident may request this information if the case would make a good potpourri case.
- The ideal case should start with a broad potential differential diagnosis that can be narrowed by focusing on specific aspects of the HPI/physical exam/labs (i.e. history of eating queso fresco = brucellosis).
- If your case hinges on specific imaging, tell the chief resident ahead of time so they can prepare the material for demonstration to the audience.
- If your colleagues are asking for history/exam/labs that were not checked or tested, feel free to use artistic license.
- If your audience is asking for the definitive diagnostic test too early, it is ok to say the test was obtained and is pending. This may tip off your audience to the diagnosis, however.
- Do not needlessly withhold important clinical information (i.e. minimizing the presence of adenopathy in a patient presenting with lymphoma).
Attendance Requirements
- In-person morning report attendance is required for all of the residents and interns on the following rotations. Please note that the in-person attendance requirement stands even if the conference is telecast to your clinical site.
- P Wards (all days except long call and post-long call)
- CUH Wards (all days except post-call)
- VA Wards (all days except post-call)
- CUH Eisenberg
- All inpatient consult services except CUH Liver (if attending multidisciplinary surgery rounds at 9am)
- Either virtual or in-person morning report attendance is required for all residents and interns on elective and EIOC.
- Any resident/intern on an outpatient rotation (+1 continuity clinics, hybrid, etc) is NOT required to attend morning report.
Noon conference
Arrive at 12:00 to get food; lecture will start at 12:10. Occurs Monday through Friday.
- Format: On most days, one lecturer will present a didactic conference which will be streamed to all three clinical sites.
- CUH: 2.109
- Parkland: WISH 4.131
- Floor Conference Room
- In-person attendance is required for residents and interns on the following rotations:
- All wards rotations (all days in call cycle)
- VA CPICU (unless patient acuity prohibits attendance)
- All inpatient consult services
- PRIME clinic residents view in-person at the VA site
- Virtual attendance is required for all residents and interns on elective, PCIM, and POB residents
- Taking lunch from noon conference and leaving without watching conference is unacceptable unless you are on a critical care (MICU/CCU/ACS) rotation or unless patient acuity prohibits your attendance.
Medical Student Attendance
- Medical students that are on our inpatient teams and consult services are invited to join noon conference lunch. Their names will be listed on the approved attendee list. A physical copy of the attendance list will be at both Parkland and CUH to mark their attendance.
- If you need to confirm that a student on our inpatient teams or consult services is on the approved list, please reach out to Agatha Villegas or Dr. Sarah Collins.
- Due to space limitations, we unfortunately cannot allow students/learners outside of our teams and services to join noon conference lunch in person. All are more than welcome to join virtually via Zoom.
Approved Visiting Resident Attendance
- Visiting Residents who have been approved by program leadership, the GME Office, and entered into MedHub, are eligible to attend noon conference in person at either Clements University Hospital or Parkland.
- Fellowship coordinators must notify either Stephanie Dye (i.e.; Parkland) or Maria Santos Garcia (CUH) prior to the resident rotating at that particular clinical site so that their names will be on the approved list.
Monday Didactics
Monday Didactics is an afternoon education series made up of:
- Simulation
- Interactive Ambulatory Discussion
- Discussing "tough topics" in medicine
- Career planning.
Attendance at Monday Didactics is mandatory. If you miss Monday Didactics, you will be charged PTO.
Past Monday Didactic Topics:
- Procedures – Central Lines, LP, Thora/Para
- Clinic Agenda Setting / Note writing + Billing/Coding
- Microagression/Difficult Patients
- Reflection Rounds
- Vital Talks (palliative care)
- Pericodes + Codes
- Quality Improvement
- MSK
- Supervising Codes
- Shared Decision Making + Deprescribing
- Financial Planning/Career planning
Resident Update Talk
Purpose
- 20 minute presentation on a topic of your choice with a rigorous and thorough discussion of the background and literature in the style of grand rounds
- Think of this as a mini-grand rounds. Through the development and delivery of a RUT:
- The resident will practice giving a scientific, evidenced-based talk to their peers.
- The resident will learn how best to educate their peers through visual media and clarity of speech.
- The resident will learn to engage the audience through the challenges of presenting remotely and Zoom.
Preparation
- Choose a clinical topic that is narrow enough in scope to allow a thorough, but not a comprehensive review of the literature.
- The topic may be an “entertaining” one but should still be intellectually rigorous – that is, you should be able to research a reputable body of literature or data to support your points.
- Think about your audience; the topic should be made interesting or relevant in some way to an internist.
- Refer to the resident website for a list of resident update topics that have been presented over the last three years. Try to avoid repeats within the past 2 years.
Timeline
- 6-8 weeks before: discuss your choice of RUT topic with your assigned chief. Your chief will give you feedback on the feasibility of your talk and how to turn it into an engaging presentation. If you’re struggling to choose a topic, consider reaching out sooner. Also, start identifying and approaching faculty mentors who are willing to mentor you and provide guidance on the content of your talk.
- 4-5 weeks before: create an outline/framework for the talk and begin reviewing articles that you will reference in the talk. Send your outline to your chief.
- 2-3 weeks before: create your slides and send to your mentor to give them adequate time to review. Your chief is available to review slides, practice the talk, discuss content, and whatever else might be helpful to you. Make sure to invite your mentor to your talk!
- 1 week before: send your slides to your chief resident mentor and schedule time to practice your talk with them.
Guidelines
For helpful pointers, please watch Dr. Khera's talk “How to give a scientific talk”
- Slides should be far less text and more graphics/pictures.
- Try not to read directly from your slides.
- Slides should prompt your points and/or clarify your points visually for your audience but should not be a “script.”
- Please see Tips for Content below for more suggestions.
- You will have the option of presenting via Zoom or presenting in-person at one of our clinical sites.
TIPS
- Content should not be a basic review of your subject if the basics of your subject are relatively well known. You can spend a few quick slides on the basics at the beginning of the talk, but then you should move into more interesting or novel material.
- Think about grand rounds – we don’t attend to learn the basics of a topic we should know from medical school. Rather, we want to hear an expert impart knowledge to us that is cutting edge or novel in some way. We want content that is taken a step further –how can you as an expert on your topic teach us something new, exciting, and fresh? Is there a new understanding of the mechanism? Is there a new way that practitioners are going about diagnosis or treatment? Are there new applications for quality improvement, personalized medicine, etc? Can we change something about how we care for our patients?
- Incorporating your own research is excellent, and incorporating the background of your research question with your data can be interesting for your audience. Consider letting the audience know what to expect from your talk and then remind them what they heard at the end.
- Consider creating suspense at the beginning of the talk that is fulfilled at the end.
Potpourri
Presenter Guidelines
- Presenting is an exercise in guidance. It is much harder than answering questions.
- Keep presentations concise and up-beat. Potpourri can be very stressful to an intern discussant, so bringing a collegial atmosphere is vital.
- The presentations are streamlined to include facts VITAL to solving the case. PMHx, Medications, FHx, SHx are cut/abridged unless needed to reach the diagnosis.
- Keep the case moving. Tricks to keep the case moving include reiterating case breadcrumbs to prompt the discussant to get certain studies or mention differential items.
- Prior to asking “What are your initial thoughts?” it is helpful to go through the HPI first. If the differential provided is nowhere near the answer, can lead the discussant in the right direction by providing extra clues, e.g. "You also found out this patient developed..." or "What if I told you..."
- If the person you’ve called upon is really flailing, move on and don’t let the fact that they don’t know the answer hang in the air. “Let’s look at some labs.” If you sense the discussant will continue to flail, you may explicitly point out the important lab or imaging data.
- Attendings will chime in. Feel free to invite specialty attending to come and comment on your case.
- At the end, thank the discussant. If an intern discussant, is nice to send them a text personally later, as well.
Discussant Guidelines
- You'll be asked to provide a differential and explain your clinical reasoning as we move through the case. The presenter will guide you through your reasoning and the data at hand.
- Being on stage is nerve racking! It is common to forget some of the differentials at hand when you're on stage. If this happens to you, don't panic. Talk out loud about your thought process and walk us through what you're thinking. Even if you forget the name of the diagnosis, tell us what you're thinking and we'll help walk you to the diagnosis.
- If you ask for a lab or imaging study that isn't provided, this probably means that the diagnosis you're thinking about isn't at play in this case.
- You'll be given the chief complaint of the patient before Potpourri. It may help to look up general schema for this chief complaint ahead of time. Consider search for diagnostic schema such as Clinical Problem Solvers.