Sharing Your Teachable Moment As A Trainee

Author: Debapria Das, MD, PGY 2 , Saint Louis University, Department of Internal Medicine
Faculty Mentor: Rachna Rawal, MD, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh

Many of us compile a list of “interesting” patient cases hidden away in the depths of the hospital’s EMR. The ones that make you wonder how we deviated from clinical guidelines. The clinical presentation that raised more itching questions. The times those hoofsteps were a zebra. Randomized controlled trials are known to contribute to evidence-based medicine, but clinical vignettes are the building blocks of many of these practice changing studies. We all rely on our experience with these patient encounters to create our own “illness script” to guide us in future care. As physicians, we share these teachable moments to improve our practice. Trainees have a unique opportunity to share their teachable moments with physicians regionally and nationally. As a trainee, writing up a case is a great way to gain experience in medical education as well as in evidence-based medicine. I want to share my experience of how as a trainee, you know what a “good case” is, how to write it up, who can mentor you, and most importantly, where can you submit it.

Step 1: Picking THE Case
How do you know if you have a “good” case to write up? A senior resident or attending physician may say: “You should write this up!”. You should seize this opportunity if it arises. A good case is one that any physician can take away points to adjust their clinical thinking or practice. Do not feel discouraged if your clinical diagnosis is not “rare.” While rare diseases are interesting, they may not be the most practical for your readers. Most presentations may focus on an atypical presentation and progression of a common disease, a challenging diagnostic course, or have an unexpected outcome to treatment. A literature review can provide insight on what the current guidelines are and how your case either supports those guidelines, questions it, or deviates from it. If you and your team felt that your case had educational value, other physicians will feel the same. Even if your team may not have suggested writing up a case, use your colleagues as your sounding board - they may find it interesting too. Most conferences do not require patient consent to present; although, make sure to check your institution specific guidelines. If your patient is still available, this is a great time to obtain written consent in case your presentation is well received at a conference and you are interested in preparing a manuscript for publication.

Step 2: Finding THE Mentor
You found a teachable moment to share. Next, you need a faculty mentor. A good mentor will confirm that the case is appropriate to present and guide you through the remainder of the process. I recommend discussing the possibility of writing the case with the attending physician who took care of the patient with you. If you are unsure if you have a “good case”, they are a great resource in validating these suspicions. If there is a case you saw with them that you want to present, just ask!  The earlier in the process you ask, the faster your mentor will be able to help you formulate teaching points and guide you in collecting further diagnostic information. Mentors will assist with proofreading and provide previously accepted abstracts as templates. They can find additional conferences for you to submit your abstract to. Having an abstract to discuss often paves the way to build a lasting mentor-mentee relationship that you can rely on the rest of your career. What if your attending said they felt that the case was not educational or that they are unable to mentor? You can always ask your APDs/PD/Chief Residents for their opinion, and they can help you find a mentor to assist with the case. Remember, faculty WANT to be involved and WANT to mentor you.

Step 3: Overcoming Writer’s Block
Writing the abstract is the most dreaded part of the whole process. In order to prevent yourself from panicking, look up the deadlines for the conferences you are interested in. Try to set a personal deadline 1-2 weeks in advance from the final deadline to finish your first draft for review. In your initial writeups, you will go through many changes before your final submission. Keep the revised versions to look back on the changes made by your mentors and use this as a guide to improve your abstract writing skills over time. Generally, all clinical vignettes have the same components;
  1. Title: Think of a catchy title. Avoid the final diagnosis so that the audience can follow the story as it was presented to you.
  2. Learning Objectives: Typically you need 2-3 of these. I start my first draft with this section as it guides you in framing your abstract. When writing objectives you should always aim for active verbs to make short but impactful points.
  3. The Case: This should include a brief history of the present illness and physical exam/labs that are pertinent to the diagnosis or clinical thinking of your case. This is NOT a clinical note. This is a story of how your patient presented to the hospital and what happened in their clinical course that led to the final outcome.
  4. Discussion/Conclusion: This is the MOST important part. This is where you share why was this a teachable moment. What should your audience take away from the case? (Hint, you should be addressing your learning objectives here).
Step 4: The FINAL Submission
After you’ve put in all this work in your final abstract, PROOFREAD and make sure it’s in a preferred format for each conference. For example, SHM has clinical vignettes starting with the case, transitioning into the discussion and then the conclusion. Others require an introduction. Most importantly, stay within the character limit. You may not even be able to submit your abstract if it is over the limit; or worse, your conclusion will be cut off. Send drafts to your mentor early to allow time for revisions. Make the changes that make sense to you as it’s your abstract at the end of the day. Many conferences allow you to submit and present your case at others. You can submit the SAME abstract to DIFFERENT conferences. Create drafts specific to each conference. Most often, it involves rearranging your first draft and tailoring it to fit within the character limit.  If you are accepted to multiple conferences, you can always choose which to attend and have other authors attend the other conferences or withdraw your participation.

Writing cases has been a gateway for me into scholarly work. I eventually passed down my experience to others the more independent I became. I felt that I was able to share my teachable moments and improve my discussion skills. One thing I wanted to mention, is that here I focused on clinical vignettes, however the general process of choosing the topic, mentor, and writing the abstract are similar for research, quality improvement, and medical education abstracts. My hope is that this article will provide you a starting point for sharing your educational cases. Remember, if you found your patient taught you something, likely someone else will learn from your teachable moment as well.

SHM Abstract Submission Link:

Posted by Debapria Das on Oct 26, 2019 6:33 PM America/New_York