Round Fast, Round Well with Dr. Michelle Kittleson
Oct 16, 2023
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Dr. Michelle Kittleson, an expert in heart failure and transplant, shares insights on running efficient rounds in the pediatric ICU. She discusses her journey in becoming interested in heart failure, her experiences in research, and her passion for cardiology. The podcast covers topics such as fellowship programs, mentorship, open access medical education, efficiency and preparation in rounds, and providing feedback in medical training. Dr. Kittleson emphasizes the importance of concise communication, minimizing time spent during rounds, and delivering timely and specific feedback. She also mentions her book 'Mastering the Art of Patient Care'.
Dr. Kittleson emphasizes outstanding patient care, efficiency, and education as primary goals during rounds, believing that focusing on these aspects allows for effective learning.
Dr. Kittleson promotes healthy disagreements and encourages trainees to have opinions and engage in respectful debates, using the Captain-Waiter-Toddler framework to facilitate constructive discussions and enhance clinical judgment.
Deep dives
Setting goals for efficient rounds
During rounds, Dr. Kittleson emphasizes three goals: outstanding patient care, efficiency, and education. She believes that focusing on exceptional patient care and efficiency allows for effective learning. Dr. Kittleson encourages concise one-liners with plans organized by systems to save time and keep the focus on patient care. She also emphasizes the importance of using every moment wisely and avoiding interruptions unless there is a fundamental misunderstanding or patient safety issue.
Valuing productive disagreements on rounds
Dr. Kittleson appreciates healthy disagreements and believes they contribute to learning and team building. She encourages trainees to have opinions and engage in respectful debates. When trainees have differing viewpoints, Dr. Kittleson asks questions and guides them to consider different perspectives. She believes that dissenting voices should be welcomed, as they show a commitment to the patient's best interests. Dr. Kittleson's Captain-Waiter-Toddler framework allows for constructive discussions and helps trainees develop their clinical judgment and decision-making skills.
Providing structured and timely feedback
Dr. Kittleson strives to provide both positive and constructive feedback in a timely manner. She addresses areas for improvement on rounds when necessary, focusing on patient care goals rather than personal evaluation. Specific feedback is given to address issues such as attention to detail, assessments, and decision-making. Dr. Kittleson acknowledges good performance and publicly highlights trainees' achievements. She recognizes feedback as an opportunity for growth and aims to create a safe space for trainees to learn and improve.
Mastering the Art of Patient Care
Dr. Kittleson has authored a book titled 'Mastering the Art of Patient Care,' which provides guidance on making the most of medical education and careers in medicine. The book covers topics such as engaging mentors, optimizing the consult process, and having difficult conversations with patients. It is a comprehensive resource that can be read from start to finish or as a reference guide for specific topics. The book is available on the Springer website and can serve as a mentorship tool for trainees in need of practical advice.
Dr. Michelle Kittleson is the Director of Postgraduate Education in Heart Failure and Transplantation, Director of Heart Failure Research, and Professor of Medicine at the Smidt Heart Institute at Cedars-Sinai. She received her MD at Yale University School of Medicine followed by a residency in Internal Medicine at Brigham and Women's Hospital, and a fellowship in Cardiology at John Hopkins, where she also received a PhD in clinical investigation from the Johns Hopkins Bloomberg School of Public Health.
Dr. Kittleson is also a guideline author: she was the chair of the writing group for the 2020 American Heart Association Scientific Statement on Cardiac Amyloidosis; she also co-authored the American College of Cardiology’s 2020 Hypertrophic Cardiomyopathy Guidelines and the American Heart Association’s 2022 Heart Failure Guidelines.
Learning Objectives:
By the end of this podcast, listeners should be able to:
Describe goals for rounds on a busy inpatient service.
Critique the common methods for priming trainees for optimal rounds.
Develop a technique for working with trainees at different levels of patient ownership, including the toddler, the waiter, and the captain.
Discuss the best times to add teaching points on rounds
Discuss the different ways to structure feedback on a busy inpatient team.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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