Wednesday, August 28, 2019

Observership - what is it like in an academic hospital?


The Division of Nephrology and Hypertension at the University of Vermont offers opportunities for observership to IMGs (no payment required). I am a faculty member in this wonderful division. For the last two years, we have been hosting 1-2 observers at any given time round with the inpatient Nephrology team at the hospital. I believe we have been able to do so as the declining interest in Nephrology left us with no first year Nephrology fellows for two years in a row.

The observers have been visiting us from India, Pakistan, Nepal and Greece. Typically, the observers (through some discussion forum) would reach out to me or a faculty member in this division. We would then have them contact our fellowship coordinator who then reviews the observer's CV, obtains permission from the division chief and arranges for the observer for a two or four week observership period. This is usually done anywhere from 4 to 8 months in advance. Certainly, the the longer you can stay the more likely you will get a chance to interact and be assessed at multiple levels thus allowing more details to be included in the letter of recommendation that you request.

After the observer obtains his or her ID for hospital use, they are usually expected to be available starting Monday from 9am to 5pm. I would meet with the observer usually in the fellows office and assign them 1 or 2 patients to follow (chart review only). Everyone would have 1-3 patients to follow. Because of rules regarding patient confidentiality and liability, observers would go into the patient room only with a medical student or resident, talk with the patient after a brief introduction, do a focused exam and prepare a brief progress report for presentation at rounds. After I complete my rounds on new consults or followups by 10.30am, I would touchbase with the observers, other medical students and residents in the inpatient team.

At rounds, we would listen and learn from every patient seen. At the bedside, we would discuss any questions at rounds or in the fellows office using a white board if more detailed discussion is warranted. A example would be to discuss the pathophysiology of hyponatremia or hyperkalemia and their management. It needed a little fine tuning on how to improve their case presentation but the observers I interacted with were quick to learn. One observer realized early that a platelet count of '3 lakh' was incomprehensible to many listeners.

I usually give reading assignments to the observers (either research or review papers) and assign them topics to help me with a literature search. For example, one observer whom I worked with recently reviewed the indications for use of tolvaptan in patients with polycystic kidney disease, a novel treatment strategy approved by the FDA. He did an amazing job creating a short PowerPoint slide presentation from available guidelines. Another observer was following an ICU patient with suspected toxic alcohol ingestion and finding of acetonemia. She reviewed the biochemical pathways of acetone production and very elegantly identified causes of acetonemia, thus excluding isopropyl alcohol toxicity and diabetic ketoacidosis (the patients acetonemia was due to alcoholic ketoacidosis) in our patient. These efforts greatly improved the learning environment in our small learning team.

They went a step ahead and using available library resources including Uptodate and printing resources, they presented a PowerPoint talk each on Friday of the week (attending rotations in our division are one week long). I would review their ppt slides with them to ensure that the content is concisely presented and pertinent to the Nephrology division. For example, a thorough family history is needed for a case presentation of a patient with polycystic kidney disease. The observers each presented their 10-15 minute talk to the entire faculty Division on Friday afternoon with rest of the time being used for discussion. In the absence of fellows and having a variable number of medical students and residents every week, the observers filled an important void in the learning environment by their case presentations and evidence based practice. These talks have been greatly appreciated by the faculty members. I also feel thrilled at having been able to contribute, in some minute way, to the careers of these wonderful observers.

Some days when the service was slow, the observers would go to the outpatient clinic in the afternoon and had assigned attendings in that clinic. They would have opportunities to observe at a general nephrology clinic, kidney transplant clinic or kidney stone clinic. I have not been able to have observers in clinic, but I hear that the attending first goes into the patient room with the observer, introduces the observer who then takes a brief history and reviews followup information since the last visit (as he or she has electronic medical record access). The observer would then report to the attending and they would go back to the patient, examine and talk with the patient in 10-15 minutes. Patients have been very appreciative of our learning environment in this busy academic hospital.

In the next blog post, I will discuss how observers can make the best use of his or her time in a clinical observership.


Before you go: Here's your golden opportunity to have your voice heard. Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit of image at top of webpage: http://www.barriedoctors.ca/medical-learners/observerships/

3 comments:

  1. Thank you for your willingness to help IMG's learn about the US medical system. I have heard of some observers having to pay for the privilege. Maybe when you have time, you could explain about the differences between no fee obeserverships and those requiring a fee. Thanks!

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  2. Thanks englishcoach2007 for your kind comments. In my upcoming blog, I have written a little about the pay-to-observe observerships. From the observer standpoint, I dont believe the two are any different as the HIPAA rules still apply. Maybe the teaching attendings are a little more invested in interacting with the observers if they are paid, but I feel that the experiences and what they are expected to do (my next blog) is the same.

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