Teaching Faculty on the Wards:
Teaching Hospitalists & Distinguished Subspecialists
There are no non-teaching services at Tulane: every patient admitted to one of our three hospitals receives care from a Tulane resident who is staffed by one teaching attending. There are no private physicians barking orders without explanation to the Tulane residents. And there certainly isn’t the “follow me around and watch me write orders” shadowing on the part of our attendings. This is important, because you cannot learn medicine without being in the position of making the critical decisions for your patients. And this decision-making cannot come by proxy: you only learn the indications and contraindications for an intervention when you are responsible for the outcomes of the decision. Tulane is about autonomy: learning to make decisions and to be comfortable with that role that will define you as an internist. Tulane is about preparing yourself as a first-rate internist, prepared to handle anything and everything that comes through the door.
This is not to say that Tulane residents do not have supervision, to the contrary, we have hand-picked some of the best clinician educators in the country to serve as our teaching hospitalists. Their role, and they have been extensively trained in this role, is to provide guidance and coaching…. Not to overstep the resident’s station of primarily managing the patient.
All of the teaching services at Tulane are staffed by Teaching Hospitalists. These are individuals who attend on the wards from six to eight months per year, so they become very good in knowing the intricacies of the system, and very adept at the art of teaching residents in the context of clinical care. Furthermore, they have no afternoon obligations (e.g., a colonoscopy clinic) that prompt them to rush through morning rounds so that they can get to their clinic. The morning attending rounds are from 10 to 12 noon each day, and they are devoted to education during this time; there is no rush. In addition, they are around in the afternoon to supervise procedures, often times rounding a second time with the senior residents to do advanced level teaching and patient planning. The final benefit is that the hospitalist each staff a discharge follow-up clinic that allows the ward teams to discharge patients without the anxiety of worrying about whether the patient will be ok until their next clinic visit.
For those interested in a career in hospitalist medicine, the extensive hospitalist system provides a great opportunity to work with mentors performing hospitalist-based research: quality improvement, patient-care protocols, and systems improvement projects. All of our hospitalist faculty are required to undergo a month-long formal course in medical education. In addition to having world-class clinicians as your mentors, you can count on the fact that they are also world-class educators. We are excited to have these new faculty as part of the Tulane mission for years to come.
The ancillary benefit of having all of the teaching services staffed by teaching hospitalists is that it frees up the subspecialists to focus on their procedures and the subspecialty consultation services. This provides the Tulane resident with an intensive focus in the subspecialty during her elective months on those services. Check out the subspecialty that most interests you below...
General Medicine and Geriatrics
Hematology / Oncology
Pulmonary Critical Care
Personal Coaches: The Clinical Competency Committee
For as good as our residents are, every resident deserves to have personal guidance and strategic planning for how he/she can become even better. Every resident receives evaluations each month… from supervising faculty, from peers, from nurses, from patients and from students. The evaluations are not designed to say “who is better than someone else” (i.e., the evaluations that you went through in medical school). Gone are the days of “who’s honors and who’s high pass.” Now is the time for identifying the weakest area in your portfolio of talents, and designing strategies to improve those areas. Welcome to the rest of your life… and at Tulane, that day starts now!
Each firm as a chief resident and an assistant coach (i.e., an associate program director). This comprises the Tulane Clinical Competency Committee. The committee meets with Dr. Wiese every month, and each resident is reviewed at that time. The assistant coach then meets with each individual resident to give him/her feedback, and more importantly… to design plans for continued improvement along the milestones to greatness.
Research Coaches… “The Concierge Mentors”
Perhaps you’ve checked into a hotel in a distant city… you’re hungry, and you want to find a great restaurant in this new city. What do you do? Well of course… you walk down to the hotel lobby, and you talk to the concierge. Now, he’s not going to cook your meal for you, but he has a list of great restaurants where someone will. If one restaurant has no reservations available, he finds you another one. Such is the mentorship plan at Tulane.
In addition to each firm’s chief resident and assistant coach, each firm has its own Concierge Mentor. The role of the concierge mentor is not to provide you mentorship (i.e., she won’t be cooking your food), but she will find you the person who will. You’ll meet with your concierge mentor, tell her your needs (professional or otherwise), and her job is to “hook you up” with the person who can be your mentor. She’ll give you the names and contact information for the faculty member who suits your research/career/life interests, and will facilitate the first meeting. Then you meet with your mentor, and start the research/career/life improvement!
But what if your career interests change, or worst yet…. What if the chemistry isn’t there? This last consideration is very important. In the worst of training programs, there is no strategy for mentorship. In the B minus programs, there is assigned mentorship. But the reality is that mentorship, like all personal relationships, is much more than that the “Match-dot-com” approach of pairing up like interests. The mentorship relationship is about chemistry, and if the chemistry isn’t there, the relationship will not be fruitful.
The Tulane Concierge Mentor approach solves this problem. Once your concierge mentor has assigned you to a faculty, you meet with that faculty. If the chemistry isn’t there (or if your interests change), you simply return to your concierge mentor and say, “Hey, I need a new restaurant (that is, mentor).. that one wasn’t good.” No problem…. She then assigns you to a new mentor. And the process repeats until you find what you need.
And now for some unsolicited advice (as your coach)…. You need more than one mentor. Your career mentor might be different than your research mentor. And independent of your career/research, you may want to have a mentor to help you with unique issues to your life…. Examples might include being a physician with kids, being a woman in medicine, being a minority in medicine, having an alternative lifestyle in medicine, etc. These are not negligible concerns, and the Tulane Team takes this seriously in coaching you through life. By having a concierge mentor, all it takes is a simple question, “Hey, I would like to have a mentor to help me with being a woman in medicine. Who would you suggest?”
No program offers the one-to-one mentorship like Tulane…. Check out the research opportunities on our Research Page for more information. It is one of the many reasons that Tulane has the most national resident presentations in the country, the reason the residents do so well in the fellowship match, and the reason our graduates are so happy…. And why they go on to accomplishing great things in life.