Straight TalkA weekly update from management on the issues that matter most. Jul 27, 2017 In less than a month, NCH became fully engaged in teaching and learning as twelve medical residents and two pharmacy residents joined the team after literally a decade of planning and preparation. Our goal was to become a teaching institution, thereby improving quality and training physicians, some of whom might stay and care for all of us. And with the help of our Mayo affiliation, the change came faster than I or anyone ever expected. Teaching/learning occurs at the bedside, in nurses’ stations, and every Monday, Wednesday, and Friday as our medical residents meet for almost two hours to present interesting patient cases and discuss other relevant medical topics. Discussions are led by our new Chief Resident, Dr. Rachel Pyngolil, who just finished Brown University’s three year medical residency, and also by sixty-three Attending Staff Physicians who are following their passion for medical education. A recent session I attended began with a review by Dr. Zakia Rauf on the significance of heart sounds. Nicely researched and beautifully explained, it will be remembered by everyone as they lay a stethoscope over the heart. Having residents teach each other helps instill a passion for life-long learning that is necessary in our era of rapidly advancing medical knowledge. Next came Dr. Lesly Silva’s presentation of a patient with a very unusual illness, an insulinoma. This rare condition occurs in less than one in 250,000 people and is difficult to diagnose. Talk about a one-in-a-million chance of seeing this condition so early in training—as only her second patient. Who would have ever predicted? Dr. Doug Harrington, Critical Care Program Director and core teaching faculty, has often shared that we have so many unusual diseases for a community our size. Dr. Silva then shared the patient’s history with built-in pauses so that her colleagues could share questions they might ask if they were taking a history. The same Socratic Method was employed with the presentation of physical findings, lab results, and treatment options. During the discussion, NCH Department of Medical Education Medical Director, Dr. Jim Bernene, himself an endocrinologist and a Master of the American College of Physicians (an accomplishment limited to a very few top academic internists), shared pertinent questions and observations contributing richly to the learning. Jason Smith, UCF third-year medical student, shared an overview of the related literature, another important aspect of training. Continuing, radiologist Dr. Yash Jadhav reviewed how to read a CT of the chest and abdomen as we all searched carefully for the insulinoma in the image of the pancreas. Our interactive smartboard, which projects images and computer graphics, can also be written on—remarkable how technology has changed the traditional blackboard. Also participating was our Program Director, Dr. Charles Graeber, and some of our senior physician educators who are now Mayo School of Medicine faculty including Drs. Hermes Koop, David Linz, Carlos Quintero, and our newest academic hospitalist, Brian Pulford. A second example of learning is Grand Rounds, convened at 7:30 a.m. every Thursday in the Telford Auditorium on the Baker Campus and broadcast to the North Campus. This engaging forum attracts interested physicians, nurses, nurse practitioners, physician assistants, and supporting colleagues. At a recent Grand Rounds, a patient with amyloidosis, another interesting diagnostic challenge, was thoughtfully discussed by oncologist Dr. Michele Ramirez. A famous clinical aphorism is, “When you hear hoof beats think horses, not zebras,” meaning commonly occurring illnesses are more likely to be the diagnosis. However, as Dr. Ramirez sagely suggested, our patient was a “zebra in plain sight” as she shared a very erudite overview of amyloidosis—a great review and reminder for everyone from our new residents to senior clinicians. These were two wonderful examples of teaching and learning that fortuitously occurred early in our medical residents’ training. Teaching, learning, challenging, stimulating, and refreshing our clinicians and caregivers in an academic setting make for a savvy and smarter medical community, resulting in everyone living a longer, happier, and healthier life.