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Generalists as Clinical Physiologists: Bringing Science Back to the Bedside

Abstract

Background

Few generalists engage in basic science research or feel comfortable teaching physiology at the bedside. This may reflect a lack of understanding or confidence teaching physiologic principles.

Aim

To inspire general internists to relearn and teach physiology in clinical practice.

Setting

An active biomedical research laboratory.

Participants

We educated 67 faculty participants (4 primary care, 59 hospitalists, and 4 other specialties) from 24 medical centers, representing 17 states.

Program Description

The 5-day course was structured around re-learning basic physiology principles and developing teaching skills. Participants engaged in hands-on experiments through 4 modules using aquatic species, each paired with a physiology content primer. Participants also developed teaching scripts based on their experiments.

Program Evaluation

Post-course surveys revealed that 97% felt confident teaching physiology at the bedside, 100% felt the course enhanced their understanding of the mechanisms of disease, and there was a significant improvement in self-reported teaching ability.

Discussion

An immersive, hands-on faculty development course that integrated physiology with clinical decision-making increased participants’ comfort level and self-rated ability to teach and incorporate physiology in their clinical work. We believe faculty development is one potential solution to the growing chasm between clinicians and scientists in general medicine.

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References

  1. 1.

    Natarajan P, Ranji SR, Auerbach AD, Hauer KE. Effect of hospitalist attending physicians on trainee educational experiences: A systematic review. J Hosp Med. 2009;4(8):490-498. doi:https://doi.org/10.1002/jhm.537

    Article  PubMed  Google Scholar 

  2. 2.

    Woods NN, Neville AJ, Levinson AJ, Howey EHA, Oczkowski WJ, Norman GR. The value of basic science in clinical diagnosis. Acad Med. 2006;81(10 SUPPL). doi:https://doi.org/10.1097/00001888-200610001-00031

  3. 3.

    Woods NN, Brooks LR, Norman GR. The value of basic science in clinical diagnosis: Creating coherence among signs and symptoms. Med Educ. 2005;39(1):107-112. doi:https://doi.org/10.1111/j.1365-2929.2004.02036.x

    Article  PubMed  Google Scholar 

  4. 4.

    DeFranco DB, Sowa G. The importance of basic science and research training for the next generation of physicians and physician scientists. Mol Endocrinol. 2014;28(12):1919-1921. doi:https://doi.org/10.1210/me.2014-1343

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Seaburg LA, Wang AT, West CP, et al. Associations between resident physicians’ publications and clinical performance during residency training. BMC Med Educ. Published online 2016. doi:https://doi.org/10.1186/s12909-016-0543-2

  6. 6.

    Mylopoulos M, Woods N. Preparing medical students for future learning using basic science instruction. Med Educ. 2014;48(7):667-673. doi:https://doi.org/10.1111/medu.12426

    Article  PubMed  Google Scholar 

  7. 7.

    Chopra V, Burden M, Jones CD, et al. State of research in adult hospital medicine: Results of a national survey. J Hosp Med. Published online 2019. doi:https://doi.org/10.12788/jhm.3136

  8. 8.

    Shannon EM, Chopra V, Greysen SR, et al. Dearth of Hospitalist Investigators in Academic Medicine: A Call to Action. J Hosp Med. 2021;(Issue 2021-Feb ONLINE 1st):E1-E3. doi:https://doi.org/10.12788/jhm.3536

  9. 9.

    Do AND, Munchhof AM, Terry C, Emmett T, Kara A. Research and publication trends in hospital medicine. J Hosp Med. Published online 2014. doi:https://doi.org/10.1002/jhm.2148

  10. 10.

    Herzig SJ, Aird WC, Shah BJ, McKernan M, Zeidel ML. From hagfish to humans: Teaching comparative physiology to internal medicine residents. Acad Med. 2012;87(3):372-377. doi:https://doi.org/10.1097/ACM.0b013e3182444c1b

    Article  PubMed  Google Scholar 

  11. 11.

    Breu AC. Why is a cow? Curiosity, tweetorials, and the return to why. N Engl J Med. 2019;381(12):1097-1098. doi:https://doi.org/10.1056/NEJMp1906790

    Article  PubMed  Google Scholar 

  12. 12.

    Gonzalo JD, Haidet P, Papp KK, et al. Educating for the 21st-Century Health Care System. Acad Med. 2017;92(1):35-39. doi:https://doi.org/10.1097/ACM.0000000000000951

    Article  PubMed  Google Scholar 

  13. 13.

    Brauer DG, Ferguson KJ. Medical Teacher The integrated curriculum in medical education: AMEE Guide No. 96 The integrated curriculum in medical education: AMEE Guide No. 96. Published online 2014. doi:https://doi.org/10.3109/0142159X.2014.970998

  14. 14.

    Krisberg K. Reshaping Medical Education with Innovative, Early Clinical Experiences. AAMC News.

  15. 15.

    Straus SE, Straus C, Tzanetos K. Career choice in academic medicine: Systematic review. J Gen Intern Med. 2006;21(12):1222-1229. doi:https://doi.org/10.1111/j.1525-1497.2006.00599.x

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Evans DH. Marine Physiology down East: The Story of the Mt. Desert Island Biological Laboratory. 1st ed. Springer; 2015. doi:https://doi.org/10.1007/978-1-4939-2960-3

  17. 17.

    Allen-Dicker J, Hall AM, Donahue C, et al. Top qualifications hospitalist leaders seek in candidates: Results from a national survey. J Hosp Med. 2019;14(12):754-757. doi:https://doi.org/10.12788/jhm.3241

    Article  PubMed  Google Scholar 

  18. 18.

    Spencer AL, Brosenitsch T, Levine AS, Kanter SL. Back to the basic sciences: An innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine. Acad Med. 2008;83(7):662-669. doi:https://doi.org/10.1097/ACM.0b013e318178356b

    Article  PubMed  Google Scholar 

  19. 19.

    Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13). doi:https://doi.org/10.1001/archinte.165.13.1493

  20. 20.

    CRICO Strategies. 2014 Annual Benchmarking Report: Malpractice Risks in the Diagnostic Process.; 2015.

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Acknowledgements

The authors are extremely grateful for to the work of Deborah DeWaay, MD, and Stephanie Call, MD, in helping launching the first course in 2015. The authors would also like to express their deep gratitude for the numerous faculty who tirelessly volunteer their time to make this course possible every year, including Tony Breu, MD; Rich Schwartzstein, MD; Mark Tuttle, MD; Jeff William, MD; Melanie Hoenig, MD; Eric Osborn, MD PhD; Rick Solomon, MD; Rushad Patell, MD; Warren Hill, PhD; Bryce MacIver, PhD; Patricio Silva, MD; and Kate Spokes, BA, and the MDIBL staff including Jane Disney, PhD, and Chris Smith.

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Corresponding author

Correspondence to Daniel N. Ricotta MD FHM.

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Ethical Approval

Ethical approval has been granted by the MDI Biological Laboratory IACUC board: protocol number c18-02.

Conflict of Interest

Drs. Ricotta, Hale, Freed, Zeidel, Scribner, and Herzig all receive nominal honorariums from the Mount Desert Island Biological Laboratory (MDIBL) for teaching in the Physiology on the Fly faculty development course.

The Mount Desert Island Biological Laboratory is an independent, non-profit biomedical research laboratory and all course proceeds are applied to course operating expenses and participants’ room and board. None of the authors have any financial affiliation with MDIBL. None of the authors’ affiliated institutions receive any financial benefit from the course.

Dr. Herzig reports grants from the Agency for Healthcare Research and Quality, outside of the submitted work.

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Ricotta, D.N., Hale, A.J., Freed, J.A. et al. Generalists as Clinical Physiologists: Bringing Science Back to the Bedside. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-06978-0

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KEY WORDS

  • quality improvement
  • faculty development
  • mechanistic thinking
  • comparative physiology