Propelling My Career Forward With SHM’s Resident Travel Grant

At the beginning of residency, I knew I was going to be an endocrinologist...or so I thought. As it turns out, I was in for a surprise. Early in residency, I became interested in hospital medicine, quality improvement and medical education. As time went on, I realized these could be more than interests. They could be the foundations of a great career. Hospital medicine allows me to focus on general medicine in the inpatient setting, serving those who are acutely ill. In caring for these patients, I see opportunities to create high-value care improvement projects. I can then teach my trainees not only how to care for the patient in front of them, but how to improve quality for all patients.

As I finished intern year, I realized that I habitually ordered morning labs without thinking if they were clinically necessary. I found this unsettling—how could I be providing the best care for my patients with a test I couldn’t justify? This realization inspired me to spearhead a high-value care project, along with Sayo Adeyemo, focused on promoting mindful ordering habits to our residents. In other words, we wanted our residents to stop and think about why they needed a lab test before placing the order. Within a year, our residents decreased their total labs ordered per week by 20%. We utilized multiple interventions, including resident education, EMR changes, and highlighting the importance of resident-attending communication during rounds. Similar programs cited in the literature have struggled with sustainability. Because of this, each year we recruit champions from each residency class and actively work with our incoming interns. After three years, we are seeing culture change toward more mindful ordering, a key to our sustainability. I am pleased to share that we are currently working on expanding this initiative to other departments in our hospital. Through this initiative, I have collaborated with hospital leadership, attending physicians, and EMR technicians to create a culture of mindful lab ordering. These collaborations have shown me the critical role of the healthcare team in caring for our patients.

Last November, I was looking for conferences where I could present my work. I was introduced to the Society of Hospital Medicine through my local St. Louis Chapter. As trainees, we all know that obtaining funding can be difficult. My program director told me about the SHM Resident Travel Grant, and I decided to apply. Even though residents are salaried, I was touched by SHM’s willingness to provide financial support to residents who wanted to attend their conference. To me, this shows that SHM is committed to educating future hospitalists.

I remember several weeks later finding out that my project was accepted. I was ecstatic. A few days later, I learned I was selected for the SHM Resident Travel Grant, and I called my mentor bursting with excitement. For me, going to this conference meant two things: first, I could present and receive feedback on my scholarly work, and second, I was going on my first trip to Disney World. Ever since I was a kid, I dreamed of going to Disney World – I’m a Disney fanatic!

2018 was my first SHM annual conference. I thoroughly enjoyed networking, presenting my work and being selected as a Co-Chair of the Student and Resident Special Interest Group. My SHM experience solidified my interest in hospital medicine. (Don’t worry. I went to Disney the weekend before the conference, and it was AMAZING.)
This year, I am a chief resident at St. Louis University. I am developing a high-value care curriculum for residents and medical students and continuing to encourage mindful lab ordering. In addition, I am a JAMA Teachable Moment Editorial Fellow. This is a unique JAMA series promoting high-value care focused on patient encounters that share a story of misuse/overuse.
I recently experienced a few days of true hospital medicine as an attending. My first day it occurred to me that I was no longer the senior resident; I was the intern, the resident and the attending all in one. I was expected to fulfill all those roles at once. As hospitalists, we are the patient’s advocate. We diagnose, work with different consultants and ultimately decide the best plan for the patient with the patient through shared decision making.

My first solo admission to the hospital served as the perfect example of the challenge and excitement of hospital medicine. The patient was transferred from an outside hospital. I was sent to the wrong room with a vague sign-out of altered mental status with liver failure. I breathed a sigh of relief when I found the patient confused but stable. As I stepped out of the room to place some additional orders, I saw the nurse sprint toward the door. The patient was vomiting and shaking. Within seconds, I was back at the bedside, calling a code for respiratory arrest. After nine minutes of ACLS, we achieved ROSC and admitted the patient to the ICU. As my shock wore off, I realized that the quick work of the various members of the healthcare team—nursing, physician, respiratory therapy and others—had saved this patient’s life. As the hospitalist, I was responsible for the patient, and I was ready for that role. My residency at SLU had prepared me to manage these acute situations.

I encourage our residents who are interested in hospital medicine to consider presenting their work at the annual conference and to apply for the SHM Resident Travel Grant. You never know – maybe you will get to fulfill two dreams through SHM like I did and discover new opportunities that will propel your career forward.

To learn more about the SHM Resident Travel Grant, click here.

Link to SHM abstract on attending-resident communication:
Rawal, R; Adeyemo, O; Kunnath, P; Saad, H; Vartanyan, A; Schmidt, J. THE BARRIER TO MINDFUL LAB ORDERING: THE ATTENDING [abstract]. 

Link To SHM abstract on high-value lab initiative:

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Posted by Rachna Rawal on Oct 2, 2018 5:21 PM America/New_York