Hot cases: making general medicine cool again
Shazia Hussain, Rebecca Gorrigan, Mona Waterhouse and William Drake | Features
General internal medicine (GIM) training has been associated with much negativity in recent years. Published evidence indicates that many core medical trainees (CMTs) have been unable to attend educational activities due to service demands, which has knock-on effects on the career choices they make.1
More recently, a brief article was published on how hospitals must ‘sex-up’ general medicine,2 not only to improve the care received by patients with complex needs, associated with multiple morbidities, but also to improve trainee recruitment and retention.
It is hoped that some of these issues will be addressed by the new internal medical training (IMT) curriculum. However, in addition, physicians still need to take active steps locally, to ensure we continue to inspire our younger generation of doctors to choose a career in diabetes and endocrinology. Given the close association with GIM, physicians in diabetes and endocrinology are well placed to have a positive influence on GIM ‘culture’ in secondary and tertiary hospitals.
RAISING THE TEMPERATURE
Recognising these factors, we attempted to improve the delivery of postgraduate general medical training at St Bartholomew’s Hospital, London, by introducing a fortnightly ‘hot cases’ educational programme in October 2018. Our organising clinician team consisted of three experienced physicians in endocrinology/general medicine and an endocrinology, diabetes and GIM/chief registrar.
Based upon the typical ‘morning report’ model, the aim was to promote educational discussion through carefully dissecting the presentation and management of a general medical patient admitted to the hospital in the preceding few weeks, in the course of a 45-minute session. Owing to the increasing regulations surrounding junior doctors’ working hours, and the logistical difficulties in delivering early morning teaching in a tertiary unit, we decided to run these sessions in the early afternoon, with a morale-boosting lunch provided from the hospital education budget.
INITIAL COOL RECEPTION
At first, take-up was cautious. Informal canvassing of opinions revealed competing departmental commitments, a desire to finish the day on time and incomplete publicity as reasons for limited attendance. Over the course of 2 months, collaborative working with the medical education team to publicise the teaching improved attendance, but competing departmental events were still a limiting factor.
Written, anonymised feedback from those who attended was overwhelmingly positive. It was in favour of continuing the sessions, and provided the ‘entrée’ to discussions with other departments about rescheduling activities and releasing trainees to facilitate attendance. Numbers at the sessions continue to rise steadily.
OFFERING A WARM WELCOME
Protocols, guidelines, targets and shift pattern working all combine to threaten the traditional teaching ward round in which the pathophysiology of a clinical case is dissected. The clinical discipline of diabetes and endocrinology, inextricably linked to GIM, lends itself well to the ‘hot cases’ approach. In turn, the opportunity for interaction with junior doctors at pivotal points in their training, in a supportive, facilitative teaching environment, has the potential to attract talented young doctors into the specialty. We strongly encourage other units to consider setting up such programmes locally, and to use ‘hot cases’ to make GIM cool again.
Shazia Hussain, Rebecca Gorrigan, Mona Waterhouse and William Drake, Department of Endocrinology, St Bartholomew’s Hospital, London
- Tasker F et al. 2014 Clinical Medicine 14 149−156.
- Iacobucci G 2017 BMJ 357 j2207.