Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.

I have been in private practice as a gastroenterologist for 18 years. Many of us in gastroenterology and related fields have wondered how to navigate toward the next step in our careers. There are resources available to further our knowledge, add new skills, and fine tune personal talents to help position us for that next step.

Questions to ask at this stage are: What do I really want to do? Where do I see myself in 5-10 years? How do I go about achieving my target?

We come from different backgrounds including, broadly, academic clinical, academic research, basic science, clinical practice, and education. The next stage of these career paths can vary, and that should be kept in mind while choosing courses/programs. I reached out to two well-known gastroenterologists who have successfully changed their career paths after starting with different backgrounds.

Ronald Vender, MD, professor of medicine, associate dean of clinical affairs, chief medical officer, Yale University, New Haven, Conn.

Dr. Vender began in private practice gastroenterology after fellowship. His own trajectory has been one of “evolution” and has grown to the above titles through “incremental opportunity.” While reflecting on his career, Dr. Vender felt three main attributes were responsible: involvement in medical/GI societies, involvement in non-GI organizations, and engagement of needs for improvement at the hospital of practice. Opportunities became available by speaking up, raising issues, and demanding improvements. Dr. Vender’s involvement in both the private practice sector and hospital administration made his transition to hospital administration possible. This change was based on a “change in [him] and change in what [he] wanted to do.” His advice for all is to learn to say “yes” often in your early career and recognize when to say “no” later in your career.



John Allen, MD, MBA, clinical professor of medicine, University of Michigan, Ann Arbor

Dr. Allen started his career in the Veterans Affairs (VA) system, and during this time, he was exposed to research activities and learned research skills. His initial interest was in health care delivery, but this eventually changed to private practice gastroenterology. His exposure to information and the opportunity to learn about variations in practice and outcomes allowed him to maintain his interest in quality, which ultimately led to publications on colonoscopy quality. In his 40s he decided to obtain an executive master of business administration (EMBA), which he feels one should embark upon “when you have a problem to solve.” He has effectively moved from the VA system to private practice and now to academic medicine. Dr. Allen identified attending leadership conferences, engaging executive coaches, and participation in key committees as further opportunities to help you change careers. His prior work experience, education, and exposure enables him in his current position to help oversee a large department of medicine with 160 care sites, with quality and financials as key factors.

As we can see, there is no correct answer or set path for those of us wanting to change career directions. What was clear while speaking with both Dr. Vender and Dr. Allen was the importance of enthusiasm in solving issues, a willingness to commit to new projects, and an interest in exploring new areas.

Below is a brief overview of some degree programs that may help promote a change in your career path.
 

Masters in health care

This degree is aimed at those looking to advance their career in the field of health care in various locations, such as hospitals, clinics, and nonprofit organizations.¹ Length of prior health care experience will vary based upon program. Programs are administered on a full-time and part-time basis, as well as online and study abroad. Numerous specialties are offered such as medicine, nutrition, psychiatry, nursing, veterinary medicine, physiotherapy, biomedical engineering, medical laboratory studies, radiology, alternative medicine, and health care management, administration, or leadership.
 

Health care MBA

Master of business administration (MBA) programs in health care administration management are offered by several universities. Given their aim of imparting essential information on a broad range of topics relevant to the health care industry, they are usually quite rigorous. It is recommended that you pursue an MBA only after a few years of working in your chosen field of practice. Many institutions require GMAT scores with the application.^2-4

Executive MBA

EMBA programs are similar to health care MBAs in that they also include rigorous course work.⁵ EMBA programs are developed to meet the educational needs of managers and executives or physicians hoping to advance or change their career. Typically, students can earn an MBA in 2 years or less while working full-time. GMAT scores are required by most institutions offering EMBA.
 

Certification leadership programs

A benefit of leadership programs is that they help to develop a clear vision by creating a mission statement, goals, and action plans. Some notable programs include:

• American Gastroenterological Association leadership programs: Future Leaders Program, Women’s Leadership Conference, and Forward Program (new for 2019). These programs offer robust sessions which are well thought out and intended to advance the careers of traditionally underrepresented groups within the field of gastroenterology.⁶
• American Medical Association’s Women’s Leadership Certificate: This program was developed to promote knowledge and strong leadership, both within oneself and among others. Attendees are awarded with the “AMA Women’s Leadership Certificate” following the 2-day event.⁷
• Executive leadership training and development programs: As with many universities offer programs like these; for example, Harvard Medical School, Boston, offers a popular – and usually sold out – event for women titled “Career Advancement and Leadership Skills for Women in Health Care.”⁸
• American College of Healthcare Executives: Various conferences and educational meetings in addition to the annual ACHE Congress on Healthcare Leadership.⁹
• American Association of Physician Leadership: Physician executive accreditation along with career services, continued education, and publications.¹⁰

After reviewing the experiences of two well-known gastroenterologists and several of the available programs, the question to ask yourself is, “What’s next?” Most will likely have this question already in mind, so here are a few potential career directions/positions to consider:

Academic medicine: department chief, program director, director of endoscopy, chief medical officer

Private practice: managing director, director of endoscopy, finance director

Private sector: pharmaceutical industry, scientific advisor, medical director, medical insurance industry, malpractice insurance industry, medical informatics, public policy, private equity, entrepreneurial
 

Conclusion

In summary, there is no single answer nor a single program that fits everyone’s needs. Health care delivery and management/administration are complicated and will only continue to evolve. Consideration must be given to the fact that any change in one’s career direction needs time and commitment.

Here are some take-home points:

• You needs to be introspective about personal strengths and weaknesses and areas to focus on.
• Asking questions raised in the second paragraph will help you narrow options and choose the correct program.
• Enrolling in, and completing, your chosen program is crucial.
• Experience and exposure to issues are invaluable in building your skill set. As our featured leaders advised: “Put yourself out there.”
• Build your resume by listing any activity outside of clinical work that has contributed to enhancing your skills.

Good luck!

References

1. HealthcareAdministrationEDU.org. Master’s in Health Administration. https://www.healthcareadministrationedu.org.

2. Healthcare Management Degree Guide. https://www.healthcare-management-degree.net.

3. The Best Schools: The 15 Best Online MBA in Healthcare Management Degree Programs. https://thebestschools.org/rankings/best-online-mba-healthcare-management/.

4. US News. Best Executive MBA Programs. 2019. https://www.usnews.com/best-graduate-schools/top-business-schools/executive-rankings.

5. The Best Schools: The Best Executive MBA Programs Online & On-Campus. https://thebestschools.org/rankings/best-executive-mba-programs/.

6. AGA. https://www.gastro.org/.

7. AMA. https://www.ama-assn.org/about/leadership-development-institute.

8. Harvard Medical School. Career Advancement and Leadership Skills for Women in Healthcare. https://womensleadership.hmscme.com/.

9. American College of Healthcare Executives. https://www.ache.org/.

10. American Association for Physician Leadership. https://www.physicianleaders.org.
 

Dr. Alaparthi is in private practice in Hamden, Conn.; assistant clinical professor, Yale University, New Haven, Conn.; and assistant clinical professor, Quinnipiac University, Hamden. She is also an ex-officio member of the AGA Women’s Committee.
 

I have been in private practice as a gastroenterologist for 18 years. Many of us in gastroenterology and related fields have wondered how to navigate toward the next step in our careers. There are resources available to further our knowledge, add new skills, and fine tune personal talents to help position us for that next step.

Questions to ask at this stage are: What do I really want to do? Where do I see myself in 5-10 years? How do I go about achieving my target?

We come from different backgrounds including, broadly, academic clinical, academic research, basic science, clinical practice, and education. The next stage of these career paths can vary, and that should be kept in mind while choosing courses/programs. I reached out to two well-known gastroenterologists who have successfully changed their career paths after starting with different backgrounds.

Ronald Vender, MD, professor of medicine, associate dean of clinical affairs, chief medical officer, Yale University, New Haven, Conn.

Dr. Vender began in private practice gastroenterology after fellowship. His own trajectory has been one of “evolution” and has grown to the above titles through “incremental opportunity.” While reflecting on his career, Dr. Vender felt three main attributes were responsible: involvement in medical/GI societies, involvement in non-GI organizations, and engagement of needs for improvement at the hospital of practice. Opportunities became available by speaking up, raising issues, and demanding improvements. Dr. Vender’s involvement in both the private practice sector and hospital administration made his transition to hospital administration possible. This change was based on a “change in [him] and change in what [he] wanted to do.” His advice for all is to learn to say “yes” often in your early career and recognize when to say “no” later in your career.



John Allen, MD, MBA, clinical professor of medicine, University of Michigan, Ann Arbor

Dr. Allen started his career in the Veterans Affairs (VA) system, and during this time, he was exposed to research activities and learned research skills. His initial interest was in health care delivery, but this eventually changed to private practice gastroenterology. His exposure to information and the opportunity to learn about variations in practice and outcomes allowed him to maintain his interest in quality, which ultimately led to publications on colonoscopy quality. In his 40s he decided to obtain an executive master of business administration (EMBA), which he feels one should embark upon “when you have a problem to solve.” He has effectively moved from the VA system to private practice and now to academic medicine. Dr. Allen identified attending leadership conferences, engaging executive coaches, and participation in key committees as further opportunities to help you change careers. His prior work experience, education, and exposure enables him in his current position to help oversee a large department of medicine with 160 care sites, with quality and financials as key factors.

As we can see, there is no correct answer or set path for those of us wanting to change career directions. What was clear while speaking with both Dr. Vender and Dr. Allen was the importance of enthusiasm in solving issues, a willingness to commit to new projects, and an interest in exploring new areas.

Below is a brief overview of some degree programs that may help promote a change in your career path.
 

Masters in health care

This degree is aimed at those looking to advance their career in the field of health care in various locations, such as hospitals, clinics, and nonprofit organizations.¹ Length of prior health care experience will vary based upon program. Programs are administered on a full-time and part-time basis, as well as online and study abroad. Numerous specialties are offered such as medicine, nutrition, psychiatry, nursing, veterinary medicine, physiotherapy, biomedical engineering, medical laboratory studies, radiology, alternative medicine, and health care management, administration, or leadership.
 

Health care MBA

Master of business administration (MBA) programs in health care administration management are offered by several universities. Given their aim of imparting essential information on a broad range of topics relevant to the health care industry, they are usually quite rigorous. It is recommended that you pursue an MBA only after a few years of working in your chosen field of practice. Many institutions require GMAT scores with the application.^2-4

Executive MBA

EMBA programs are similar to health care MBAs in that they also include rigorous course work.⁵ EMBA programs are developed to meet the educational needs of managers and executives or physicians hoping to advance or change their career. Typically, students can earn an MBA in 2 years or less while working full-time. GMAT scores are required by most institutions offering EMBA.
 

Certification leadership programs

A benefit of leadership programs is that they help to develop a clear vision by creating a mission statement, goals, and action plans. Some notable programs include:

• American Gastroenterological Association leadership programs: Future Leaders Program, Women’s Leadership Conference, and Forward Program (new for 2019). These programs offer robust sessions which are well thought out and intended to advance the careers of traditionally underrepresented groups within the field of gastroenterology.⁶
• American Medical Association’s Women’s Leadership Certificate: This program was developed to promote knowledge and strong leadership, both within oneself and among others. Attendees are awarded with the “AMA Women’s Leadership Certificate” following the 2-day event.⁷
• Executive leadership training and development programs: As with many universities offer programs like these; for example, Harvard Medical School, Boston, offers a popular – and usually sold out – event for women titled “Career Advancement and Leadership Skills for Women in Health Care.”⁸
• American College of Healthcare Executives: Various conferences and educational meetings in addition to the annual ACHE Congress on Healthcare Leadership.⁹
• American Association of Physician Leadership: Physician executive accreditation along with career services, continued education, and publications.¹⁰

After reviewing the experiences of two well-known gastroenterologists and several of the available programs, the question to ask yourself is, “What’s next?” Most will likely have this question already in mind, so here are a few potential career directions/positions to consider:

Academic medicine: department chief, program director, director of endoscopy, chief medical officer

Private practice: managing director, director of endoscopy, finance director

Private sector: pharmaceutical industry, scientific advisor, medical director, medical insurance industry, malpractice insurance industry, medical informatics, public policy, private equity, entrepreneurial
 

Conclusion

In summary, there is no single answer nor a single program that fits everyone’s needs. Health care delivery and management/administration are complicated and will only continue to evolve. Consideration must be given to the fact that any change in one’s career direction needs time and commitment.

Here are some take-home points:

• You needs to be introspective about personal strengths and weaknesses and areas to focus on.
• Asking questions raised in the second paragraph will help you narrow options and choose the correct program.
• Enrolling in, and completing, your chosen program is crucial.
• Experience and exposure to issues are invaluable in building your skill set. As our featured leaders advised: “Put yourself out there.”
• Build your resume by listing any activity outside of clinical work that has contributed to enhancing your skills.

Good luck!

References

1. HealthcareAdministrationEDU.org. Master’s in Health Administration. https://www.healthcareadministrationedu.org.

2. Healthcare Management Degree Guide. https://www.healthcare-management-degree.net.

3. The Best Schools: The 15 Best Online MBA in Healthcare Management Degree Programs. https://thebestschools.org/rankings/best-online-mba-healthcare-management/.

4. US News. Best Executive MBA Programs. 2019. https://www.usnews.com/best-graduate-schools/top-business-schools/executive-rankings.

5. The Best Schools: The Best Executive MBA Programs Online & On-Campus. https://thebestschools.org/rankings/best-executive-mba-programs/.

6. AGA. https://www.gastro.org/.

7. AMA. https://www.ama-assn.org/about/leadership-development-institute.

8. Harvard Medical School. Career Advancement and Leadership Skills for Women in Healthcare. https://womensleadership.hmscme.com/.

9. American College of Healthcare Executives. https://www.ache.org/.

10. American Association for Physician Leadership. https://www.physicianleaders.org.
 

Dr. Alaparthi is in private practice in Hamden, Conn.; assistant clinical professor, Yale University, New Haven, Conn.; and assistant clinical professor, Quinnipiac University, Hamden. She is also an ex-officio member of the AGA Women’s Committee.
 

I have been in private practice as a gastroenterologist for 18 years. Many of us in gastroenterology and related fields have wondered how to navigate toward the next step in our careers. There are resources available to further our knowledge, add new skills, and fine tune personal talents to help position us for that next step.

Questions to ask at this stage are: What do I really want to do? Where do I see myself in 5-10 years? How do I go about achieving my target?

We come from different backgrounds including, broadly, academic clinical, academic research, basic science, clinical practice, and education. The next stage of these career paths can vary, and that should be kept in mind while choosing courses/programs. I reached out to two well-known gastroenterologists who have successfully changed their career paths after starting with different backgrounds.

Ronald Vender, MD, professor of medicine, associate dean of clinical affairs, chief medical officer, Yale University, New Haven, Conn.

Dr. Vender began in private practice gastroenterology after fellowship. His own trajectory has been one of “evolution” and has grown to the above titles through “incremental opportunity.” While reflecting on his career, Dr. Vender felt three main attributes were responsible: involvement in medical/GI societies, involvement in non-GI organizations, and engagement of needs for improvement at the hospital of practice. Opportunities became available by speaking up, raising issues, and demanding improvements. Dr. Vender’s involvement in both the private practice sector and hospital administration made his transition to hospital administration possible. This change was based on a “change in [him] and change in what [he] wanted to do.” His advice for all is to learn to say “yes” often in your early career and recognize when to say “no” later in your career.



John Allen, MD, MBA, clinical professor of medicine, University of Michigan, Ann Arbor

Dr. Allen started his career in the Veterans Affairs (VA) system, and during this time, he was exposed to research activities and learned research skills. His initial interest was in health care delivery, but this eventually changed to private practice gastroenterology. His exposure to information and the opportunity to learn about variations in practice and outcomes allowed him to maintain his interest in quality, which ultimately led to publications on colonoscopy quality. In his 40s he decided to obtain an executive master of business administration (EMBA), which he feels one should embark upon “when you have a problem to solve.” He has effectively moved from the VA system to private practice and now to academic medicine. Dr. Allen identified attending leadership conferences, engaging executive coaches, and participation in key committees as further opportunities to help you change careers. His prior work experience, education, and exposure enables him in his current position to help oversee a large department of medicine with 160 care sites, with quality and financials as key factors.

As we can see, there is no correct answer or set path for those of us wanting to change career directions. What was clear while speaking with both Dr. Vender and Dr. Allen was the importance of enthusiasm in solving issues, a willingness to commit to new projects, and an interest in exploring new areas.

Below is a brief overview of some degree programs that may help promote a change in your career path.
 

Masters in health care

This degree is aimed at those looking to advance their career in the field of health care in various locations, such as hospitals, clinics, and nonprofit organizations.¹ Length of prior health care experience will vary based upon program. Programs are administered on a full-time and part-time basis, as well as online and study abroad. Numerous specialties are offered such as medicine, nutrition, psychiatry, nursing, veterinary medicine, physiotherapy, biomedical engineering, medical laboratory studies, radiology, alternative medicine, and health care management, administration, or leadership.
 

Health care MBA

Master of business administration (MBA) programs in health care administration management are offered by several universities. Given their aim of imparting essential information on a broad range of topics relevant to the health care industry, they are usually quite rigorous. It is recommended that you pursue an MBA only after a few years of working in your chosen field of practice. Many institutions require GMAT scores with the application.^2-4

Executive MBA

EMBA programs are similar to health care MBAs in that they also include rigorous course work.⁵ EMBA programs are developed to meet the educational needs of managers and executives or physicians hoping to advance or change their career. Typically, students can earn an MBA in 2 years or less while working full-time. GMAT scores are required by most institutions offering EMBA.
 

Certification leadership programs

A benefit of leadership programs is that they help to develop a clear vision by creating a mission statement, goals, and action plans. Some notable programs include:

• American Gastroenterological Association leadership programs: Future Leaders Program, Women’s Leadership Conference, and Forward Program (new for 2019). These programs offer robust sessions which are well thought out and intended to advance the careers of traditionally underrepresented groups within the field of gastroenterology.⁶
• American Medical Association’s Women’s Leadership Certificate: This program was developed to promote knowledge and strong leadership, both within oneself and among others. Attendees are awarded with the “AMA Women’s Leadership Certificate” following the 2-day event.⁷
• Executive leadership training and development programs: As with many universities offer programs like these; for example, Harvard Medical School, Boston, offers a popular – and usually sold out – event for women titled “Career Advancement and Leadership Skills for Women in Health Care.”⁸
• American College of Healthcare Executives: Various conferences and educational meetings in addition to the annual ACHE Congress on Healthcare Leadership.⁹
• American Association of Physician Leadership: Physician executive accreditation along with career services, continued education, and publications.¹⁰

After reviewing the experiences of two well-known gastroenterologists and several of the available programs, the question to ask yourself is, “What’s next?” Most will likely have this question already in mind, so here are a few potential career directions/positions to consider:

Academic medicine: department chief, program director, director of endoscopy, chief medical officer

Private practice: managing director, director of endoscopy, finance director

Private sector: pharmaceutical industry, scientific advisor, medical director, medical insurance industry, malpractice insurance industry, medical informatics, public policy, private equity, entrepreneurial
 

Conclusion

In summary, there is no single answer nor a single program that fits everyone’s needs. Health care delivery and management/administration are complicated and will only continue to evolve. Consideration must be given to the fact that any change in one’s career direction needs time and commitment.

Here are some take-home points:

• You needs to be introspective about personal strengths and weaknesses and areas to focus on.
• Asking questions raised in the second paragraph will help you narrow options and choose the correct program.
• Enrolling in, and completing, your chosen program is crucial.
• Experience and exposure to issues are invaluable in building your skill set. As our featured leaders advised: “Put yourself out there.”
• Build your resume by listing any activity outside of clinical work that has contributed to enhancing your skills.

Good luck!

References

1. HealthcareAdministrationEDU.org. Master’s in Health Administration. https://www.healthcareadministrationedu.org.

2. Healthcare Management Degree Guide. https://www.healthcare-management-degree.net.

3. The Best Schools: The 15 Best Online MBA in Healthcare Management Degree Programs. https://thebestschools.org/rankings/best-online-mba-healthcare-management/.

4. US News. Best Executive MBA Programs. 2019. https://www.usnews.com/best-graduate-schools/top-business-schools/executive-rankings.

5. The Best Schools: The Best Executive MBA Programs Online & On-Campus. https://thebestschools.org/rankings/best-executive-mba-programs/.

6. AGA. https://www.gastro.org/.

7. AMA. https://www.ama-assn.org/about/leadership-development-institute.

8. Harvard Medical School. Career Advancement and Leadership Skills for Women in Healthcare. https://womensleadership.hmscme.com/.

9. American College of Healthcare Executives. https://www.ache.org/.

10. American Association for Physician Leadership. https://www.physicianleaders.org.
 

Dr. Alaparthi is in private practice in Hamden, Conn.; assistant clinical professor, Yale University, New Haven, Conn.; and assistant clinical professor, Quinnipiac University, Hamden. She is also an ex-officio member of the AGA Women’s Committee.
 

Introduction

For many young faculty, the transition from trainee to educator can be daunting. We may accrue valuable experiences as a senior resident or fellow on the floors, but nothing fully prepares you for the challenge of integrating education into your daily life as a new attending. This challenge is all the greater in a procedural field such as gastroenterology, in which educators need to turn their tangible skills into verbal instructions for a trainee.

The aim of this article is to ease that transition, whether it be on the wards, in the clinic, or in the endoscopy suite. Below are a few key tips on becoming an effective educator for the new gastroenterology attending.
 

In the clinic and on the wards

Don’t try to do too much: It is impossible to effectively teach every component of a single case. If you attempt to teach on multiple topics at once, the major points of the case may be missed. Choose a salient point from the specific case in front of you and explain how it changed your management. For example, “How did the ulcer stigmata change your management in the case of Mrs. B?” The clinical learning pearl in this case might be the bleeding risk of clean-based ulcers rather than the timing of endoscopy or PPI dosing. By focusing on one takeaway point per case, you can maximize the yield for the learner.

Make them commit: While reviewing a case with a trainee, you want to learn not just what they are thinking but also why they are thinking the way they are. By encouraging trainees to explain why they believe the diagnosis to be a particular disease or why a particular test should be the next step in a work-up, they are forced to explain their decision making. This allows you to truly understand their critical reasoning and ultimately correct any faulty logic along the way. In addition, trainees need practice in making clinical decisions. It is all too easy for them to let the attending drive clinical plans while on a busy service. Having them commit to a diagnosis or a plan will keep them engaged and is a key part of effective teaching frameworks such as the One-Minute Preceptor or SNAPPS.¹

Correct mistakes: Trainee mistakes are a tremendous learning opportunity. A preceptor ought not gloss over these but rather address them directly. Clearly stating that something is wrong and then explaining why it is wrong and what the correct decision should be allows you to demonstrate clinical reasoning for your trainee. On a busy clinical service, it is easy to just say something is wrong, but the trainee will gain little from that experience.
 

In the endoscopy suite

Understand the learner’s objective: Depending on the trainee’s experience, the learning objective for a procedure may be different. A beginning endoscopist may hope to “reach the cecum,” while a more seasoned endoscopist may hope to effectively snare a flat polyp. The available procedural cognitive load for each trainee is different, and a beginning trainee may not be able to effectively integrate advanced techniques no matter how well you communicate with them.² Establishment of the learner’s specific learning objectives for a procedure allows them to identify where they are and provides an opportunity for you to provide specific feedback and assistance to that individual.

Use specific language: Utilizing a common language between yourself and the trainee is very important. Phrases such as “Go right” or “Put your snare at the bottom” may not be specific enough for your learner. More exact language, such as “Little knob upward” or “Move your working channel to the 6 o’clock position,” will help the trainee comprehend your instruction and hopefully achieve the endoscopic objective at hand.³

Create an effective learning environment: Removing distractions from the endoscopy suite such as “multiple separate conversations” or “loud music” may be beneficial for trainees by minimizing extraneous load. Active engagement by the attending during a procedure has also been shown to be helpful in creating an effective learning environment.⁴ Examples of this include giving positive motivation or clear advice at a difficult junction of the case or just being engaged and watching the entire case rather than answering emails.
 

For all locations

Give feedback: Feedback should be given to the trainees on a regular basis in a comfortable, private setting away from the distractions of clinical responsibility. Feedback sandwiches – in which constructive comments are put between positive feedback – are no longer advised because trainees have been shown to not retain the topics they need to improve on but retain only the positive feedback from the end. Instead, utilize a format of soliciting self-reflection from the trainee, providing direct feedback on strengths and targets for improvement, and then concluding with an action plan for improvement.⁵

Get feedback: Do not be afraid of asking your trainees what you can do better. Don’t wait for the formal evaluations to be reviewed with your chairperson. Ask your trainees what you are doing well and what you can improve on. This feedback is a wealth of knowledge just waiting to be tapped.

Use your resources: There are many local, regional, and national resources available to educators. Senior faculty and fellowship directors at your institution can likely assist you. The office of graduate medical education in your institution likely has educational resources that are available for all faculty. Many institutions have some form of an institute for medical education that offers mentorship, online resources, and medical education journal clubs. The journal Gastroenterology includes a “Mentoring, Education, and Training” section in each issue that has many tips for educators. Lastly, there are national resources such as the AGA Academy of Educators that offer plenary sessions on medical education at Digestive Disease Week^® and a collaborative network of faculty interested in medical education within gastroenterology.
 

References

1. Pascoe J et al. J Hosp Med. 2015 Feb;10(2):125-30.

2. Sewell JL et al. Acad Med. 2017 Nov;92(11):1622-31.

3. Dilly CK, Sewell JL. Gastroenterology 2017 Sept;153(3):632-6.

4. Pourmand K et al. J Surg Edu. 2018;75(5):1195-9.

5. Ramani S, Krackov SK. Med Teach. 2012;34(10):787-91.
 

Dr. Whitson is associate fellowship director, gastroenterology, assistant professor of medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New York. Twitter: @MJWhitsonMD

Introduction

For many young faculty, the transition from trainee to educator can be daunting. We may accrue valuable experiences as a senior resident or fellow on the floors, but nothing fully prepares you for the challenge of integrating education into your daily life as a new attending. This challenge is all the greater in a procedural field such as gastroenterology, in which educators need to turn their tangible skills into verbal instructions for a trainee.

The aim of this article is to ease that transition, whether it be on the wards, in the clinic, or in the endoscopy suite. Below are a few key tips on becoming an effective educator for the new gastroenterology attending.
 

In the clinic and on the wards

Don’t try to do too much: It is impossible to effectively teach every component of a single case. If you attempt to teach on multiple topics at once, the major points of the case may be missed. Choose a salient point from the specific case in front of you and explain how it changed your management. For example, “How did the ulcer stigmata change your management in the case of Mrs. B?” The clinical learning pearl in this case might be the bleeding risk of clean-based ulcers rather than the timing of endoscopy or PPI dosing. By focusing on one takeaway point per case, you can maximize the yield for the learner.

Make them commit: While reviewing a case with a trainee, you want to learn not just what they are thinking but also why they are thinking the way they are. By encouraging trainees to explain why they believe the diagnosis to be a particular disease or why a particular test should be the next step in a work-up, they are forced to explain their decision making. This allows you to truly understand their critical reasoning and ultimately correct any faulty logic along the way. In addition, trainees need practice in making clinical decisions. It is all too easy for them to let the attending drive clinical plans while on a busy service. Having them commit to a diagnosis or a plan will keep them engaged and is a key part of effective teaching frameworks such as the One-Minute Preceptor or SNAPPS.¹

Correct mistakes: Trainee mistakes are a tremendous learning opportunity. A preceptor ought not gloss over these but rather address them directly. Clearly stating that something is wrong and then explaining why it is wrong and what the correct decision should be allows you to demonstrate clinical reasoning for your trainee. On a busy clinical service, it is easy to just say something is wrong, but the trainee will gain little from that experience.
 

In the endoscopy suite

Understand the learner’s objective: Depending on the trainee’s experience, the learning objective for a procedure may be different. A beginning endoscopist may hope to “reach the cecum,” while a more seasoned endoscopist may hope to effectively snare a flat polyp. The available procedural cognitive load for each trainee is different, and a beginning trainee may not be able to effectively integrate advanced techniques no matter how well you communicate with them.² Establishment of the learner’s specific learning objectives for a procedure allows them to identify where they are and provides an opportunity for you to provide specific feedback and assistance to that individual.

Use specific language: Utilizing a common language between yourself and the trainee is very important. Phrases such as “Go right” or “Put your snare at the bottom” may not be specific enough for your learner. More exact language, such as “Little knob upward” or “Move your working channel to the 6 o’clock position,” will help the trainee comprehend your instruction and hopefully achieve the endoscopic objective at hand.³

Create an effective learning environment: Removing distractions from the endoscopy suite such as “multiple separate conversations” or “loud music” may be beneficial for trainees by minimizing extraneous load. Active engagement by the attending during a procedure has also been shown to be helpful in creating an effective learning environment.⁴ Examples of this include giving positive motivation or clear advice at a difficult junction of the case or just being engaged and watching the entire case rather than answering emails.
 

For all locations

Give feedback: Feedback should be given to the trainees on a regular basis in a comfortable, private setting away from the distractions of clinical responsibility. Feedback sandwiches – in which constructive comments are put between positive feedback – are no longer advised because trainees have been shown to not retain the topics they need to improve on but retain only the positive feedback from the end. Instead, utilize a format of soliciting self-reflection from the trainee, providing direct feedback on strengths and targets for improvement, and then concluding with an action plan for improvement.⁵

Get feedback: Do not be afraid of asking your trainees what you can do better. Don’t wait for the formal evaluations to be reviewed with your chairperson. Ask your trainees what you are doing well and what you can improve on. This feedback is a wealth of knowledge just waiting to be tapped.

Use your resources: There are many local, regional, and national resources available to educators. Senior faculty and fellowship directors at your institution can likely assist you. The office of graduate medical education in your institution likely has educational resources that are available for all faculty. Many institutions have some form of an institute for medical education that offers mentorship, online resources, and medical education journal clubs. The journal Gastroenterology includes a “Mentoring, Education, and Training” section in each issue that has many tips for educators. Lastly, there are national resources such as the AGA Academy of Educators that offer plenary sessions on medical education at Digestive Disease Week^® and a collaborative network of faculty interested in medical education within gastroenterology.
 

References

1. Pascoe J et al. J Hosp Med. 2015 Feb;10(2):125-30.

2. Sewell JL et al. Acad Med. 2017 Nov;92(11):1622-31.

3. Dilly CK, Sewell JL. Gastroenterology 2017 Sept;153(3):632-6.

4. Pourmand K et al. J Surg Edu. 2018;75(5):1195-9.

5. Ramani S, Krackov SK. Med Teach. 2012;34(10):787-91.
 

Dr. Whitson is associate fellowship director, gastroenterology, assistant professor of medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New York. Twitter: @MJWhitsonMD

Introduction

For many young faculty, the transition from trainee to educator can be daunting. We may accrue valuable experiences as a senior resident or fellow on the floors, but nothing fully prepares you for the challenge of integrating education into your daily life as a new attending. This challenge is all the greater in a procedural field such as gastroenterology, in which educators need to turn their tangible skills into verbal instructions for a trainee.

The aim of this article is to ease that transition, whether it be on the wards, in the clinic, or in the endoscopy suite. Below are a few key tips on becoming an effective educator for the new gastroenterology attending.
 

In the clinic and on the wards

Don’t try to do too much: It is impossible to effectively teach every component of a single case. If you attempt to teach on multiple topics at once, the major points of the case may be missed. Choose a salient point from the specific case in front of you and explain how it changed your management. For example, “How did the ulcer stigmata change your management in the case of Mrs. B?” The clinical learning pearl in this case might be the bleeding risk of clean-based ulcers rather than the timing of endoscopy or PPI dosing. By focusing on one takeaway point per case, you can maximize the yield for the learner.

Make them commit: While reviewing a case with a trainee, you want to learn not just what they are thinking but also why they are thinking the way they are. By encouraging trainees to explain why they believe the diagnosis to be a particular disease or why a particular test should be the next step in a work-up, they are forced to explain their decision making. This allows you to truly understand their critical reasoning and ultimately correct any faulty logic along the way. In addition, trainees need practice in making clinical decisions. It is all too easy for them to let the attending drive clinical plans while on a busy service. Having them commit to a diagnosis or a plan will keep them engaged and is a key part of effective teaching frameworks such as the One-Minute Preceptor or SNAPPS.¹

Correct mistakes: Trainee mistakes are a tremendous learning opportunity. A preceptor ought not gloss over these but rather address them directly. Clearly stating that something is wrong and then explaining why it is wrong and what the correct decision should be allows you to demonstrate clinical reasoning for your trainee. On a busy clinical service, it is easy to just say something is wrong, but the trainee will gain little from that experience.
 

In the endoscopy suite

Understand the learner’s objective: Depending on the trainee’s experience, the learning objective for a procedure may be different. A beginning endoscopist may hope to “reach the cecum,” while a more seasoned endoscopist may hope to effectively snare a flat polyp. The available procedural cognitive load for each trainee is different, and a beginning trainee may not be able to effectively integrate advanced techniques no matter how well you communicate with them.² Establishment of the learner’s specific learning objectives for a procedure allows them to identify where they are and provides an opportunity for you to provide specific feedback and assistance to that individual.

Use specific language: Utilizing a common language between yourself and the trainee is very important. Phrases such as “Go right” or “Put your snare at the bottom” may not be specific enough for your learner. More exact language, such as “Little knob upward” or “Move your working channel to the 6 o’clock position,” will help the trainee comprehend your instruction and hopefully achieve the endoscopic objective at hand.³

Create an effective learning environment: Removing distractions from the endoscopy suite such as “multiple separate conversations” or “loud music” may be beneficial for trainees by minimizing extraneous load. Active engagement by the attending during a procedure has also been shown to be helpful in creating an effective learning environment.⁴ Examples of this include giving positive motivation or clear advice at a difficult junction of the case or just being engaged and watching the entire case rather than answering emails.
 

For all locations

Give feedback: Feedback should be given to the trainees on a regular basis in a comfortable, private setting away from the distractions of clinical responsibility. Feedback sandwiches – in which constructive comments are put between positive feedback – are no longer advised because trainees have been shown to not retain the topics they need to improve on but retain only the positive feedback from the end. Instead, utilize a format of soliciting self-reflection from the trainee, providing direct feedback on strengths and targets for improvement, and then concluding with an action plan for improvement.⁵

Get feedback: Do not be afraid of asking your trainees what you can do better. Don’t wait for the formal evaluations to be reviewed with your chairperson. Ask your trainees what you are doing well and what you can improve on. This feedback is a wealth of knowledge just waiting to be tapped.

Use your resources: There are many local, regional, and national resources available to educators. Senior faculty and fellowship directors at your institution can likely assist you. The office of graduate medical education in your institution likely has educational resources that are available for all faculty. Many institutions have some form of an institute for medical education that offers mentorship, online resources, and medical education journal clubs. The journal Gastroenterology includes a “Mentoring, Education, and Training” section in each issue that has many tips for educators. Lastly, there are national resources such as the AGA Academy of Educators that offer plenary sessions on medical education at Digestive Disease Week^® and a collaborative network of faculty interested in medical education within gastroenterology.
 

References

1. Pascoe J et al. J Hosp Med. 2015 Feb;10(2):125-30.

2. Sewell JL et al. Acad Med. 2017 Nov;92(11):1622-31.

3. Dilly CK, Sewell JL. Gastroenterology 2017 Sept;153(3):632-6.

4. Pourmand K et al. J Surg Edu. 2018;75(5):1195-9.

5. Ramani S, Krackov SK. Med Teach. 2012;34(10):787-91.
 

Dr. Whitson is associate fellowship director, gastroenterology, assistant professor of medicine, The Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New York. Twitter: @MJWhitsonMD