Using flashcards to support your learning

The idea that if you listen to a lecture and make notes you will, by some mysterious process, have learnt all that the lecturer has covered, is a myth. Unfortunately, the lecture is just the start. The best way to learn is by doing. This can be achieved by completing set practical tasks by reading and creating your own notes, listening again to parts or the whole of a lecture via a screencast or using diagrams and illustrations that you annotate. Similarly creating your own learning materials can be useful as actually putting questions and answers together helps you to learn. One of the many ways to support your learning, especially in difficult topics like anatomy and physiology, learning about bones, medical terminology or indeed any subject where there are a lot of new words and terms to learn, is making use of an old technique brought up to date with new technologies called "flashcards".     

Positive politics: playing corporate games with personal integrity

The desire for power is personal. Competence and political intelligence are the prerequisites for handling power in a healthy manner. Politics is not a nasty word or a set of behaviors that inevitably turns you into a shady character of whom your mother would be ashamed. You need never divorce your own morality from the situation. The choice to improve your political functioning is yours. You always retain the right to play, and you retain the right to decide when to play. But you are a better manager, a better professional, and a more educated person if you can identify what others are doing and how their behavior will impact you. It is not just for success, it is for survival--success and survival on your own terms.     

Writing Manuscripts for Peer Review: Your Guide to Not Annoying Reviewers and Increasing Your Chances of Success

“Publish or perish.” Does this send chills down your spine? For many academicians, it certainly does. Publishing your work is a necessary part of achieving success in an academic and research career. The ability to articulate your ideas and contribute to the body of knowledge in your discipline is an essential skill and, happily, one that can be cultivated and refined. We have drawn on our own experiences in learning to write, being reviewed, successfully publishing and being reviewers ourselves. We also have included some excellent resources in the literature to help you maximize your chance of success.     

Medical students' note-taking in a medical biochemistry course: an initial exploration

Beginning medical students spend numerous hours every week attending basic science lectures and taking notes. Medical faculty often wonder whether they should give students pre-printed instructors' notes before lectures. Proponents of this strategy argue that provided notes enhance learning by facilitating the accurate transmission of information, while opponents counter that provided notes inhibit students' cognitive processing or even discourage students from attending lectures. Little if any research has directly addressed medical students' note-taking or the value of providing instructors' notes. The educational literature does suggest that taking lecture notes enhances university students' learning. University students perform best on post-lecture testing if they review a combination of provided notes and their own personal notes, particularly if the provided notes follow a 'skeletal' format that encourages active note-taking.     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Mix of national, local benchmarks are critical for perspective

You need a range of national and local data to make your benchmarking successful: national to help you keep your finger on the pulse and local to help you differentiate your service. Never rely on national averages. Instead, find a better performer and study its processes to find out the reasons behind the data. No matter what your local situation is, you always can learn from someone else, particularly if they're different from you.     

Using an employee handbook to head off problems

Most medical practices agree that an employee handbook is a great idea. Many, however, don't know how to write a good handbook. This article provides a helpful overview of the kinds of materials that should and should not be included in your practice's employee handbook. It explores the many benefits of employee handbooks and identifies four policy topics that you should avoid. It suggests the benefits and potential uses of a glossary in your employee handbook and provides an example of the terms that might be included in a medical practice glossary. This article also suggests the appropriate language and tone for employee handbooks and offers advice about distributing them so your staff will read and understand your personnel policies. Finally, the article offers a blueprint for creating your own employee handbook.     

The Untaught Lesson

My fellow physician and friend died from a rare type of cancer. She was a model for me in many respects. She showed me how to cope with a chronic disease together with a demanding professional life, yet she left me without any comfort or guidelines on how to contend with a terminal disease.This story is a reflection on my frustration and disappointment with my friend’s final choices that prevented us from processing our feelings and sharing our deepest thoughts. The story includes reflections and insights about our ability to understand and accept the preferences of patients and others close to us.I remember the very first time I saw you. I was a young intern in a robe heavily laden with work tools and books; you were a senior intern, petite, energetic, standing at the counter of the ambulatory hematologic department. Your voice was captivating: simultaneously funny, cynical, and confident. It would be the beginning of a long relationship with you as my mentor, my colleague, at times my physician, and my cherished friend.Your family and close friends called you “Tiny.” Having met you as an adult, I could never get used to that. You were larger than life.We both suffered from a chronic disease that we would often discuss. You always knew how to recognize the fact that we had a chronic disease as well as a determination to live with it as best as we were able.We gave birth to our first-born daughters at the same time. A few years later, you accompanied me to the operation room where I gave birth to my last son. Our friendship extended to our families and children, and was graced by several years of shared happiness. We were both living life in the fast lane.When I was 40-something and you were 40-something and a bit more, illness struck you. The tests revealed a strange and rare growth. We read the diagnosis in disbelief: adenocarcinoma of the biliary tract. Neither of us had ever met such a patient. We both voraciously read anything we could get our hands on about the disease and within a few hours summarized: “Pretty lousy, huh?” to which you added: “Only doctors get such exotic diagnoses.”You sought doctors who could treat the disease, requesting second and third opinions. Despite the horrible prognosis, you grasped onto any treatment that offered hope, anywhere in the world. You used your personal and professional connections to obtain experimental treatments and protocols were invented just for you. There was no previous experience in successfully treating your type of cancer. You were willing to suffer any side effect; you forewent every form of quality of life. You held onto life and onto the anger about life slipping out of your control.I secretly lost hope from the first moment. I identified with your denial in one respect only: as a mother of two adolescents, you had to do anything possible to get better. You weren’t allowed to die. It was inconceivable.Yet it was impossible to talk openly about these emotions. I longed to tell you: “Irene, you know how our patients sometimes hold onto life and it is our job to help them accept that death is approaching, and to tell them that maybe they should focus on pain relief and not recovery, and perhaps they should write their advance directives.…? Well, now that patient is you.” But I could not be so blunt. The topic was strictly taboo.I tried to listen to you. Just as you taught me to live with a chronic disease, I thought perhaps you would show me what to do when the battle fails and the disease overtakes unimaginable parts of the body. How does a brave, determined, realistic, and energetic woman like you (and me) deal with a fatal disease?If I had said the word “fatal” you would have kicked me out of your room and out of your life. There was no room for such conversation. You refused to discuss it, to recognize it. You refused to say goodbye. It was heartbreaking to watch you suffer. I supported transferring to palliative care, but you maintained your battle with the disease with all your might and effort.For what would be your last birthday I bought you a comic book about cancer (Cancer Made Me a Shallower Person¹—written and illustrated by Miriam Engelberg, a woman who used humor to work with her breast cancer, from which she eventually died). You always had a cynical sense of humor and you were one of the funniest people I knew, but “This time,” you said, “Ruth, you’ve crossed the limit. It’s like telling a Holocaust joke to a survivor.”I was at a loss of finding a way in, beyond the fortress of denial you imposed on yourself and your surroundings.We never said goodbye. You never told me what you wanted me to do after your death. You never asked me to take care of your husband and the children. You never said any concluding words, no words of farewell. In the past, we often spoke of the fact that as doctors when we accompanied patients to their death, we were in fact also rehearsing for our own death. You stopped training me during those final days when your impending death lingered in the air.On a pain-ridden Saturday, with just your husband at your side, you asked for a terminal sedation until your final rest. When I last saw you, you were already sedated, taking away my final chance for a closure you so adamantly wanted to avoid. You left me: a colleague, a friend, with a huge question mark and without any comfort or guidelines as to how to cope with a serious, fatal, hopeless illness.You could not face the uncontrollable truth, either with yourself or with me, leaving me to contend alone with my own unanswered questions and fears. Perhaps all of my experiences, insights, and resolutions will be of no avail when faced with the threat of losing my own life.Even as an experienced and empathic teacher, well aware of the dynamics between physician and patient, I realize I can never fully comprehend the factors that converge to ultimately determine a patient’s decisions. It is a complex fabric of culture, personality, conditions, community, and family, and there is no formula. I understand that my only remedy is to live life fully with open arms in the hope I will be wise enough to learn how to accept death when it appears.What I did learn from you, Irene, is about the unknown. I learned this: that I cannot assume that just because we were so similar in education, background, vocation, and coping with a chronic disease, that we would cope with death in the same way.You taught me by not teaching me. You taught me by leaving me alone to walk this untrodden path.Your guidance was in reflecting through your example how I would not like to cope with death, yet I fear that I am not immune to such a battle. And you taught me that I simply cannot know how I will cope should I face a similar situation—perhaps I too will fight until the end. Through this, you taught me about humility. There are unknown parts of ourselves that arise when we encounter unknown situations. This is part of what I now try to teach my students—that no matter what knowledge, values, perspectives we hold—to allow for the unknown to surprise us…mold us, shape us, impact us. This is what it truly means to be open to life and death: to agree to not know.Another untaught lesson you gave me was to learn to accept you unconditionally. Despite my deep disappointment and frustration at not being able to communicate openly with you, I accept this as your final lesson for me. Although I wanted to learn something else, perhaps this was exactly what I needed to learn.     

Being part of a multi-generational medical practice team

What happens when you find yourself working in your medical practice every day with co-workers who are the ages of your parents or children? Do you find yourself reverting to age-related roles? Do you become exasperated with or bewildered by the values and behaviors of older or younger colleagues? This article explores the challenges and opportunities the medical practice staff member faces when he or she is part of a multi-generational medical practice team. It describes the tensions that often occur when a medical practice staff runs the gamut from those who remember using a library card catalog and those who can't remember the days before Google. It describes the core values, career goals, key formative events, and attitudes that may have shaped the thinking and behavior of the four generations that may work in the medical practice today: Traditionalists, Baby Boomers, Generation X, and Generation Y. It suggests preferred communication and learning methods for staff members of different generations. Finally, this article offers 10 best practices for working in a multi-generational staff and for creating a supportive multi-generational medical practice culture.     

You must have financial office policies in place to maximize your profits: part I

In summary, it is clear that A/R and collections relate to the business side of medicine and are critical to your financial success. After patient care, your focus should be on getting paid for your services and collecting what is due, having a fine-tuned billing process with all its components working in a coordinated fashion, maximizing revenue, managing patient payments and overdue accounts, and ensuring that your employees are operating in a trustworthy manner. The key to managing your A/R is to be consistent while at the same time flexible with your patients. Staff training and continuing education must be a job requirement. Setting performance and expectation standards is necessary for each and every employee. In your training sessions, which must include all providers, staff members must understand the tasks for which they are accountable and how their individual roles contribute to the success of the entire practice. Remember that the overall goal in managing your A/R is to collect what is due you on a timely basis. The longer funds are due from the patient or insurance company, the longer the practice waits for the money. In some cases, you may never receive payment, so it is critical that you have a team in place to act on collections and everyone in your practice is on the same page. Your staff must learn to work smarter, not harder, when it comes to collecting what you have earned.     

Maintaining evidence-based practice

As part of the Institute of Medical Illustrators' (IMI) scheme for continuing professional development, worksheets will be published at regular intervals in this Journal. These are designed to provide the members of IMI with a structured CPD activity that offers one way to earn credits. It is recognized that this worksheet requires some time spent undertaking the exercises. The answers to the questions, along with any notes and reflections you make or other publications you find, should be kept in your CPD portfolio.     

Continuing education credit through the internet

In summary, CEC by Internet offers many advantages, including the convenience of learning at your own pace, reduced stress during the learning process, and ease in learning topics you are interested in and need to know. Continuing education by Internet uses the highest quality audiovisual technology and provides the opportunity to print presentation materials. This approach to continuing education appears to be an emerging trend that certainly will become prevalent in professional advancement.     

Tools for advance directives. American Health Information Management Association

This issue of the Journal of AHIMA contains a Position Statement on advance directives. Here we have included several "tools" or helpful documents to support your organization's ongoing education regarding advance directives. First, we offer a "Sample Policy and Procedure" addressing the administrative process of advance directives. This sample policy was adapted from a policy shared by Jean Clark, RRA, operations director with Roper Hospital in Charleston, SC, and a director on the AHIMA Board of Directors. Do not automatically accept this policy and procedure for your organization. Instead, the health information management professional could use this sample to write your organization's own, specific policy and procedures that are consistent with your state's law and legal counsel's advice. The second article, "Advance Directives and the New Joint Commission Requirements," compares 1992 Joint Commission standards for Patient Rights and The Patient Self-Determination Act requirements. Selected sections from the Joint Commission chapter on Patient Rights are highlighted and comments added that contrast it with the act. "Common Questions and Answers Related to Advance Directives" is the third tool we offer. These questions and answers may be used for a patient education brochure or staff inservice education program outline. Again, information specific to your own state needs to be added. The fourth tool we offer is miniature "Sample Slides" or overhead transparency copy that can be enlarged and used for a presentation on the basics of advance directives for a community group for staff education. We thank Dee McLane, RRA, director, Medical Information Services at Self Memorial Hospital in Greenwood, SC, who developed these slides for presentations conducted at her hospital. We also thank Jeri Whitworth, RRA, who produced the graphics on these slides. Whitworth is a first year director on the AHIMA Board of Directors this year. Again you can use as is or consider these a model as you develop your own presentation geared for your specific audience. Last, but not least, we include samples of a "Living Will Declaration" and a "Durable Power of Attorney for Health Care" forms reprinted with permission from the American Association of Retired Persons (AARP). We include them here so you can examine the language of each type of advance directive. Copies for your organization should be requested from AARP at 1909 K Street NW, Washington, DC 20049, (202) 662-4895. Forms specific to each state are available from The Society for the Right to Die/Concern for Dying at 250 W. 57th Street, New York, NY 10107, (212) 246-6973. The requirement under The Patient Self-Determination Act became effective December 1, 1991, but the educational requirements of the act are meant to be ongoing. These "tools" are to help you continue to be a regular contributor to the educational process in your organization.     

The pre-clinical curriculum: an information processing problem

In this study revision procedures for examinations were investigated by questionnaire in a group of students undertaking a new pre-clinical course. The results revealed that students' own notes were by far the most preferred source of revision material and that lectures were the main source of these notes. Evidence of the actual revision strategies used together with their time scheduling was also obtained. Since lectures were shown to be the most significant form of input for later revision, a further study investigated the amount written and recalled from a single lecture, immediately afterwards and following a 5 month gap. The amount recalled was surprisingly high on both occasions but was not related to the amount of notes taken in the lecture. No significant sex differences in recall were observed but there was evidence that female students took significantly more notes. A much greater variation in the amount recalled was also observed over the longer time period.     

Developing a competitive benefits program

Offering your employees the right fringe benefits can help staff morale soar, foster loyalty, and increase the chances that a top-notch job applicant will say yes to your job offer. This article suggests practical ways to offer a competitive benefits program without breaking the bank. It includes guidance about specific benefits and suggests a dozen more extra benefits employees value and a sample cafeteria-style fringe benefits plan. Finally, the article includes guidelines about creating and using your own benefits statement with your staff; along with a model statement form you can use or adapt to your needs.     

Are you communicating what you want to say?

More than just words and gestures, communication is the basis of all relationships. Therefore, it is important to learn what effective communication is and how best to use it to get your message across. You want the recipient to hear you and know what you mean by what you are saying and to understand your gestures.     

Sharps safety

All employees need to be very careful handling sharps to minimize risks to themselves and coworkers. The attention, awareness and attitude that lend themselves to safe practice can only be developed through thorough training and following correct procedures. If you have an accident/injury, report it immediately and follow your hospital's Exposure Control Plan. Many resources are available to further your learning in this area. If you are uncomfortable with your knowledge of infection control, Universal Precautions, sharps handling, etc., check with your supervisor, hospital library, and infection control staff for reference materials to increase your level of understanding.     

Relieving one’s relatives from the burdens of care

It has been proposed that an old and ill person may have a ‘duty to die’, i.e. to refuse life-saving treatment or to end her own life, when she is dependent on the care of intimates and the burdens of care are becoming too heavy for them. In this paper I argue for three contentions: (1) You cannot have a strict duty to die, correlating to a claim-right of your relatives, because if they reach the point at which the burdens of care are larger than you can reasonably expect them to take, the natural conclusion is that their duty ends. (2) They may be prepared, however, to go on caring for you beyond that point. In that case your responsibility for their wellbeing may require you to refuse this care, even if this results in a situation for you in which death will be preferable to continued life. (3) If this is the correct understanding of your responsibilities, the objection that in the context of family life the burdens of care attached to one family member’s valued existence can never be ‘too heavy’, fails. It postulates unlimited concern on one side and a total lack of concern on the other.     

Move your group ahead by hiring an assistant

Have you considered hiring an assistant as a solution to handling the increasing responsibilities of your job? While creating the assistant administrator position may contribute to an effective management team, many factors must be considered as you select the most qualified candidate. How will the relationship between administrator and assistant affect the team? Is it best to hire from within or outside the organization? What professional and personal qualities will cause physicians to accept the new assistant? How should the assistant be compensated? The author examines these issues and more as he gives advice to administrators considering this addition to their staff.