"Lub dub" and so much more - Heart Sounds Workshop

This afternoon I went to a heart sounds workshop put on by The Toledo Hospital. We used an awesome program called CardioSim that broadcasts heart sounds over a wireless network to these headsets (see pictures.) We started with the basics - which side of the stethoscope to use for which sounds, where to listen, how each heart sound is made, etc. Moving on to murmurs we got to see CardioSim in full action, listening to each murmur with and without lung sounds, at varying intensity levels, and with and without prompted visual cues of the sounds on the screen. We ended with a closed eyes "final exam" and a raffle for a Littman stethoscope.


It was the perfect review for medical students, starting at a slow pace and building to practice with critical skills that we will use everyday. These talks are one of many reasons I love coming to these conferences!!

Andrea Rier, BUSM IV
Future Family Physician

Exposition Hall = Games, Prizes, and...oh yeah...Residency Programs

Center for the History of Family Medicine (Booth#1010)

Like many conferences, the AAFP NC has an exposition hall that's filled with a constant hum of "shmoozing" conversations, the flash of cheap give-away gadgets, and, every once-in-awhile, a jewel. Booth 1010 is one such jewel. The Center for the History of Family Medicine's booth does not seem to get much action, but something from their table catches my eye. I walk closer and discover the shiny objects in the picture below.

Past & Present Tools of the Trade

After some time gazing at these historical instruments and chatting with the CHFM's representative, I discovered that there is a rich history of how Family Medicine got to be where it is today - poised to become a unique source of quality primary health care - and there are people actively working to document and preserve that shared story of our profession.

If you want to better understand the future of Family Medicine by better knowing its past, explore the Center for the History of Family Medicine's website. Answer questions like...

• When the first Family Medicine Residency program was introduced to Massachusetts?
• Why is Dr. John Willis considered to be the "Grandfather of Family Practice"?
• How old is the specialty of "Family Medicine?

...and once we know where we've been, what's been tried before, what's succeeded and what hasn't, then we will be best suited to face the uncertainty of the future practice of medicine in the United States of America.

Oh...and if you can guess what the instruments were used for, you get a prize! On to the next booth!!

Best FMIG practices

BUSM FMIG won a categorical Program of Excellence award in Promoting the Value of Primary Care this year! We received our certificate this morning at the FMIG breakfast, and now Marcel and Jen are about to give a brief presentation on what our best practices were. Other FMIG Program of Excellence Award winners will share their best practices too.

I'm going to try to blog live, macworld style.

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Edit: if you are actually following this live, refresh the page often.
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9:37am Oregon Health and Science University is presenting their Baby Beeper program. It sounds pretty cool. Basically, first and second year students get an opportunity to see prenatal and maternity care through the lens of family medicine. Students go to at least one pre-natal visit to meet the mother, and family medicine residents call/beep students when the mother goes into labor. Residents also try to schedule post-natal visits with the students. Needs: a dedicated student coordinator, must establish buy-in from residents and L&D nurses.

9:43am Clarification, beepers are out of style and could be more impersonal. Residents and students exchanged cell phone numbers. Another program OHSU started this year was the "No One Dies Alone" program: students sit with terminally ill patients in the hospital to be there for them.

9:45am Pennsylvania State University won the Program of Excellence Award in Exposure to Family Medicine & Family Physicians. They organized a series of residency dinners wherein FM residents from different programs in the area treated students to dinner in the city to discuss any one of a list of topics that students were interested in.

9:48am Residents in Hershey PA willingly treated students for this dinner series... do you think the Boston residents are up for that?

9:52am University of Nebraska is describing highlights from their procedure night workshops. 3-4 FM residents teach 30-40 students how to do a particular procedure: casting, suturing, lumbar puncture, airways and intubation, ABG's and IV's, elbow injections and lung sounds. Sounds very similar to BUSM FMIG's sports medicine workshop series. Donna Kurowski (MS2) is heading that up this year, so keep an eye out for her emails.

9:56am Sebastian is introducing BUSM FMIG! Marcel and Jen are up...

9:58am We tackled the challenge of making primary care sexy by strengthening the FM community and by highlighting the diversity of family medicine practice. The latter was especially emphasized during last year's National Primary Care Week. I hope we can have another active NPCW this year, want to help plan events?

10:00am NPCW is a great event to co-sponsor with many potential partners on campus. Working together also brings in many students including students who may not necessarily be interested in FM.

10:01am I see Sebastian taking photos from the front, so you'll see pictures here soon.

10:02am New things for our FMIG last year: newsletter "All in the Family", blog, social events. Marcel just gave me a shoutout in the back as one of the contributing bloggers. Little does he know that I am live blogging their talk.

10:03am Ok never mind, he does know. Nice, there's a wordle of blog posts up on the powerpoint. 60 blog posts! 800+ visitors to the blog!

10:07am Meharry Medical College won the Program of Excellence Award in Community Service, Special Consideration Award for First-time Applicant. Some improvements that they implemented this year: paid dues for members to encourage commitment, really cool FMIG shirts ($5 each! Must get on that), text reminders about meetings and events.

10:10am Meharry's Project R.E.C.E.S.S. was featured in the Tennessee Academy of Family Physician's Journal (didn't catch the acronym). The project focused on smoking prevention at a local elementary school because the Tar Wars program couldn't get started in time. The featured booths: Gasping for Air activity, Jar of Tar illustration, Hazards & Effects of Smoking which was a black lung model and display board. The prizes were all active toys, such as kites, promoting active lifestyles-- what a great idea!

10:16am Who's up for starting a Tar Wars program in Boston?

10:18am And it's all over. Onto the Exposition Hall!

Main Stage Lecture: Stephanie Vance, Advocacy Guru

How can we be most effective as citizens going to DC to advocate for health care reform?

We have to bring our personal stories to leaders of the country. We have the day-to-day experiences that we can bring to the table. We already advocate every day for our patients - we should take that to the next level: the state and then the federal government.

Her main points:

Many people in the audience seem to think that our government is broken. Only 4% of bills introduced are passed. Of those that pass ~ 33% are about renaming post offices and federal buildings. The founding fathers of this nation had set up a system with many checks and balances that does not work efficiently. The system was designed to work this way.

Money talks in Washington DC! But constituency also matters. Legislators want to know how you are involved with their constituents. The 14-year-old who picks up the phone still knows how to figure out your relation to constituents but doesn't know how much money you have donated. If we want to be active in the health care debate, you need to know how you are related to each individual legislator. Otherwise, honestly, they won't pay much attention to you.

Reading the bill is not the important part. Understanding the impact of the bill will make a big difference.

The August district work period is an essential time for contacting your legislators. They will be back in their local offices to do work during this period and it will be a great time to contact them.

Key message: Be Very Clear About What You Want!

First time at NC!

It's my first time at the AAFP National Conference and my first time in Kansas City; actually it's my first time in Missouri. Nice place, good barbeque.

Do you remember when we had that discussion: Why is primary care not sexy? I think it was during the Crisis in Primary Care talk last fall. After Dr. Epperly's keynote speech yesterday, I think we can all agree that if primary care was not sexy before, it sure is now. What a great beginning to what is turning out to be a great conference! I definitely think everyone should have the chance to hear Dr. Epperly speak on the current healthcare reform...

Well, guess what?

Dr. Epperly is coming to BUSM in October! More details are coming, but suffice it to say that the FMIG Region 4 Coordinator, our very own Sebastian Tong, cornered Dr. Epperly at NC last year and somehow convinced him into putting BUSM onto his calendar during his trip to the AAFP Scientific Assenbly in Boston!

Yesterday, the first day of the conference, I attended a number of great workshops, my favorite being "Maternal Care and Childbirth." Dr. Scott Stringfield from the Via Christi Family Medicine Residency in Wichita, KS, examined most of the misperceptions surrounding family medicine physicians who practice obstetrics.

I became much more interested in family medicine after learning that family docs CAN deliver babies, and that family docs CAN perform c-sections. Two weeks after my last exam of first-year, I shadowed on the Labor & Delivery floor at BMC for a day. It was so cool, you should definitely do it too. If you didn't know already, at BMC the attending duties on L&D are equally shared by an OB/Gyn physician, a family medicine physician, and a midwife!

However, there are many physicians who will argue that family physicians cannot safely provide obstetrical care for a myriad of reasons such as inadequate training. Dr. Stringfield encouraged all of us to examine the data and to look at existing family medicine residency programs that include extensive OB training.

Family Physician OB Stats from the presentation:

• In 1987 41% of family physicians did OB in practice

As of December 2008 (latest figures available) …

• 22.9% family physicians doing OB (range 8.0 – 45.4 %)
• Highest region – West North Central @ 45.4% (IA, KS, MN, mo, NE, ND, SD)
• 7.3% family physicians do c-sections (range 0.8 – 11.1 %)
• 4% of FM privileges denied (usually related to OB)
• Highest area of restriction – New England region 4.9%
• Studies show that family physicians deliver 23% of America’s babies!
  

After going through many advantages of including OB in your practice, Dr. Stringfield also addressed audience concerns such as rising malpractice costs and difficult schedules. Come talk to me at school or email me if you want to hear more details!

Wilderness Medicine and Outdoor Health

In the afternoon session of the conference I attended a clinical skills workshop put on by our good friends from the Central Maine Medical Center Family Medicine Residency Program (http://www.cmmcfmrp.org/.)

After a brief discussion reviewing the primary and secondary trauma examination surveys (the first for the unconscious, disoriented, unstable patient or one with multiple injuries and the second for a more detailed exam of the pertinent injuries on a stable patient), we broke up into four groups to work on some hands-on skills.

In the first group, we discussed open versus closed trauma and their general management, as well as when to treat an injury and keep hiking versus when to pack out. In the second group, we practiced using various items you may have at a campsite to immobilize and brace a leg, for example using a camping pad and clothes to splint a leg from above the knee to below the ankle.

In the third group, we practiced "unfolding people", safely moving them from positions you find them down after an injury in, back to a neutral position that would make it easier to carry them away from the site. Too bad we didn't have a camera with us at this session; you could have seen your own Jen Hsia professionally unfold me.

Fittingly, in the last group we practiced various ways to carry injured people. We were challenged to come up with ways to carry people alone (piggyback, fireman's carry, allowing them to lean on you) and with a partner (shoulders and ankles, allowing them to brace between you.) One of the best answers was to form a chair out of your and your partner's arms forming a square base. We also experimented to figure out the best way to use a tarp and two long sticks (if you have them) to carry someone out. We decided the best way was to place the sticks on the 1/3 lines of the tarp, folding the tarp over them, using the person's body weight to hold the free ends down.

Overall, it was a great workshop, mixing in some teaching with hands-on practice of some very helpful techniques. It was also nice to see the CMMC people again. They come down about once per year to teach workshops like this at BUSM for the FMIG and some students (myself included) elect to spend their 6 week core Family Medicine rotation up at CMMC in Lewiston, ME.

What Medical Students Can Do for Health Care Reform

Dr. Ted Epperly gave three concrete suggestions about what medical students can do to participate in health care reform right now.

1) Join Connect for Reform. It is an e-advocacy campaign that keeps members up to date about current health care reform efforts and provides easy mechanisms to act.

2) Join Fam Med Pac, the federal political action committee. Donations are welcome there - even a small donation is great!

3) Contact your congress representative or/and senator during August recess about health care reform.

Taking care of business...

While the National Conference for Family Medicine Residents and Students features a multitude of workshops and lectures, there are important "business" meetings that occur in the background. These meetings of the Resident and Student Congresses produce recommendations and actions that range from...

"Recommending that the AAFP express condolences to the families and communities of physicians and their advocates murdered while providing patient care."

to

"Recommending the AAFP strongly promote bicycle helmet usage..."

to

"Recommending that the AAFP strongly encourage the individual constituent chapters to develop preceptorships in underserved areas for all medical students."

This afternoon, I sat in on a 2-hour orientation session where members were nominated for different representative positions, current officers gave updates from the many different boards and committees, and AAFP reps gave an overview of the resolution development process. In all it was remarkable to see the underpinnings of the operation of a large professional organization. How does one reach consensus statements? Where do new ideas come from? This session laid the groundwork for these procedures and I hope to see how they play out tomorrow and Saturday.

After the orientation, student and resident members broke out into smaller topic-based discussion groups on issues surrounding Minority Health, Underserved Populations, Rural Health, Medical Education/Curriculum, Legislature/Public Policy, and more. I sat in on the Legislature/Public Policy discussion - understandably one of the more popular groups this year - and heard about current health reform efforts from those who are intimately involved in the process. It was fascinating to hear the mechanisms and politics involved in the process of shaping different health care bills. At the same time, it was incredibly empowering to know that senior-level officers from the AAFP (present at the discussion) were very interested in us producing resolutions that expressed our opinion on things like the current ideas of a public insurance option.

That's all for now! More from the halls of the Kansas City Convention Center later!

Keynote Speaker: Ted Epperly, MD, FAAFP

The student and resident conference directors introduce Dr. Ted Epperly

Dr. Ted Epperly, the AAFP President and Program Director of Family Medicine Residency in Idaho, spoke eloquently about health care reform at this specific time. He called our current health care system the “perfect storm:” 20 million uninsured, businesses that can’t afford to provide employees health care any more. He believes that the current economic crisis and President Obama will come together to create change in our health care system! For example, the first law that President Obama signed into law on becoming President was S-CHIP providing health care to uninsured children.

Ted Epperly, MD, FAAFP, AAFP President addressing students and residents

He explained things that are being presented in Washington DC currently. President Obama has been engaging different groups stating that:

1. The status quo is not acceptable
2. Each group must give at least a bit in their position.
3. We must have reform this year!

He said that President Obama believes strongly in family medicine and primary care. He recounted a recent town hall meeting on health care reform where he was the only person called on by name by President Obama, not as an individual but as a representative of family physicians and primary care doctors. Dr. Epperly reiterated to the President that reform cannot happen unless we have a primary care backbone to that reform. He argued that “Fixing primary care is fixing the health care system.”

The current system is failing the American public. Medical schools are producing 90% specialists and 10% primary care doctors. We need 50-50 to serve the American people. Medical schools don’t get it: they are producing doctors to function in specialty hospitals and academic centers. The public needs primary care doctors who will serve in the community and serve the people.

The World Health Organization stated this year that each good health care system must be founded on a good primary care system! This was pushed by the American contingency led by the HHS Secretary.

The AAFP is playing a key role in these health care reforms. If the AAFP is not at the table then they are on the menu! The health care reform is changing not by the day but by the hour! We have a great advocate for Family Medicine in President Obama!

This is an exciting time to be a part of family medicine and primary care given all the health care reform - throughout the conference, we will be finding out about more opportunities to get involved with this health care reform in this exciting time in health care reform history!

Student asks question of Ted Epperly, MD, FAAFP

*Read our earlier post on Dr. Epperly's contribution to the White House Health Care Summit back in March 2009.

Welcome to Kansas City - AAFP National Conference for Medical Students and Residents

Good morning from Kansas City! Today is the first day of the 3 day National Conference for Medical Students and Residents. Over the next three days, we will be posting regular updates on the Blog about different sessions and workshops at the conference. Keep checking in regularly for updates and to hear about what’s going on!