APDIM Conference Q&A with Education Editor Dr. Ole-Petter Riksfjord Hamnvik

Academic Internal Medicine Week 2017 (held from March 19–20 in Baltimore) brought together educators from all over the world. Faculty and staff in departments of internal medicine at medical schools and teaching hospitals came to share insights and learn from one another, and to discuss thorny issues in the ever-changing field of internal medicine.

Our NEJM Knowledge+ team sent several representatives to the meeting, including our Senior Consulting Education Editor, Dr. Ole-Petter Riksfjord Hamnvik (known as “O.P.” in our office). We asked him to report back his impressions of the conference in an informal Q&A.

Josette Akresh-Gonzales: What brought you to Academic Internal Medicine Week (formerly known as APDIM)?

OPH: As a clinician-educator, it is important to stay updated on the current hot topics in medical education. In recent months, several changes have occurred that impact educators. Just two examples: the ACGME recently changed its work-hours restriction to allow interns to yet again do 24-hour call, and President Trump’s executive order on immigration has led to some challenges with obtaining training visas for certain international medical graduates. APDIM is the perfect meeting to learn about how to deal with these changes and to learn from my colleagues. In addition, participating in a meeting with like-minded individuals is not only a good opportunity for networking, but it really recharges the batteries. Realizing that you have a community of educators to rely on and learn from is incredibly validating!

JAG: What were you most looking forward to?

OPH: We are in the middle of our program’s self-study, a process mandated every 10 years by the ACGME to allow programs to take a deep look at their strengths and weaknesses and to consider how to deal with opportunities and threats from societal changes. I was looking forward to attending several sessions that were offered during the meeting on how to get the most benefit from the self-study process. I was also looking forward to the plenary sessions – inspirational talks on topics such as value-based health care, medical training with a global health perspective, and implicit bias and how it affects gender disparities.

JAG: Who was represented there?

OPH: For the first time, the APDIM meeting happened at the same time as the annual meetings of the other four societies that comprise the Alliance for Academic Internal Medicine — AAIM. Therefore, in addition to the internal medicine residency program directors and program coordinators from APDIM, the meeting had administrators (AIM — Administrators of Internal Medicine), clerkship directors (CDIM — Clerkship Directors in Internal Medicine), fellowship program directors, division chiefs and other academic subspecialists (ASP — Association of Specialty Professors), and department chairs (APM — Association of Professors of Medicine). In addition, APDIM hosts a workshop for incoming chief medical residents.

JAG: Which sessions did you attend?

OPH: I started off with a precourse on leadership led by Dr. Abby Spencer from Cleveland Clinic and her team. It featured some really well-planned OSCE-style sessions on negotiations, leading a team, and having crucial conversations.

I attended the signature plenary with Dr. Paul Farmer, who discussed why academic medicine should be developed even in countries that struggle with war, natural disasters, or other challenges. He made a compelling argument that even in crisis situations, educating the next generation of providers of medical care is the only way to put the country on a path to delivering high-quality medical care and participate in research on the medical issues that afflict them.

I then went to a workshop that discussed some of the highest impact medical education articles from 2016. While I pride myself in being a medical educator, I do not always have the opportunity to stay as up to date on medical education research as I would like, so this distilled version was really useful.

I made sure to go to the APDIM assembly meeting. This is where a lot of the challenges that face residency programs were discussed. Will newly matched interns be able to get visas on time? Should we change our schedules (again!) so that interns can do overnight call? It was a lively discussion that certainly showed the passion that the program directors have for the well-being of their trainees!

The next session I went to was quite eye-opening. Dr. Molly Carnes from the University of Wisconsin discussed the research of her group and others on unconscious bias and how this is contributing to the low proportion of women among the highest ranks of medical leadership. Even the “good guys” contribute through our implicit biases. Finally, perhaps the most useful session I went to was on the self-study — I realized that our program is right on track to have a successful self-study, but I picked up a few ideas that will be helpful.

JAG: Tell us about the most interesting thing you learned at APDIM.

OPH: One of the most interesting ideas I came across was in an informal conversation with Dr. Chayan Chakraborti of Tulane. I discussed with him ways of creating scholarship from the work that I do every day, and how I worry that no one really cares if we report how our program approached evaluation of trainees, or instituting Core Competency Committees, or other tasks that we found challenging. He made the good point that these reports are like case reports in clinical medicine — they are invaluable when something is brand new and not well characterized and could provide inspiration for other programs. I really liked that way of thinking about these reports!

JAG: What effects do you think this conference will have on your practice or your approach to medical education?

OPH: I have carried around a little notebook for the entire meeting, and I have a list of things I want to implement that is several pages long! But I think one idea that I really liked was using the one that was presented by Dr. Maimoona Inayat from MedStar Union Memorial Hospital. She described the finding of an area of weakness in a resident as a “delta” — it is not a deficiency, which can seem judgmental and negative — but rather an area with growth potential. The words that we use can change the conversation with trainees in a profound way; using a word that doesn’t have the negative connotation of “deficiency” provides the trainee with agency to take advantage of the growth opportunity that has been identified instead of making them feel bad. So my trainees can expect to hear a lot about “deltas.”

JAG: I know you spent some time in the exhibit hall — and the NEJM Knowledge+ booth.

OPH: The exhibit hall was quite different from those that you see at clinical meetings — no pharmaceutical companies, but a lot of companies with great ideas on how to solve problems that program directors struggle with — evaluation, remediation, scheduling, etc. In addition, the AAIM had a well laid-out booth where I learnt a lot about the five organizations that constitute AAIM. I even had my professional photo taken for free!

It was eye-opening to be at the NEJM Knowledge+ booth. It was inspiring to receive the positive feedback from users and to get ideas for how to make it even better. In addition, I learnt about how training programs have implemented NEJM Knowledge+ into their residencies: as a general resource to teach medicine, as a way to prepare for the internal medicine boards, as a way to help struggling residents, and other creative ways.

Ole-Petter Riksfjord Hamnvik, MB, BCh, BAO, MMSc is an endocrinologist at Brigham and Women’s Hospital; Associate Program Director, Endocrinology Fellowship and Assistant Program Director, IM residency, at BWH; and Senior Consulting Education Editor, NEJM Knowledge+.