Want Real Mentorship in Medicine? Bots Aren’t It.

Thursday mornings at our practice are unique. Historically, no patients.

Years ago, Thursday mornings were when the Department of Medicine had its Grand Rounds series, starting at 9 a.m.

However, after being in this time slot for more years than I can count, people in many of the department’s practices, especially the voluntary faculty, reported that they couldn’t afford to miss that first hour of their morning, or get inpatient ward rounds started that late. So, Grand Rounds was switched to 8 a.m. on Wednesdays.

Historically, when Grand Rounds was on Thursday mornings, we didn’t find it an efficient use of faculty, resident, or staff time to open up our practice for the rest of the morning, from that 10 a.m. to 12 p.m. time slot, so we had always blocked it off and considered it as a dedicated administrative session.

This was when we had time to do practice-wide meetings, issue-specific task forces and committees, work on pet projects, follow-up on results, call patients back, and close our notes.

When they moved Grand Rounds to Wednesday mornings, we just continued this practice, so Thursday mornings are fully blocked off now for all of us as an administrative session.

It’s a convenient time for folks to meet, and in addition, we created a special session from 9 to 10 a.m. that we call “PIC Rounds.”

This is a dedicated time for the interns and residents who are doing their outpatient block rotation to meet one-on-one with their continuity supervising attending. From before I started working at the practice about 30 years ago, this faculty role was called the “Physician In Charge (PIC),” a kind of archaic and somewhat paternalistic phrase for the faculty member who is supervising residents during a particular session.

Are you PICing on Friday afternoon, can we swap?

Who are your PICees tomorrow morning?

Each of our clinician educators is assigned a group of residents in this continuity role throughout their years with us, your continuity PICees, and you are their continuity PIC.

We are responsible for helping guide them through the entirety of their outpatient experience, making sure they have the skills they need, ensuring safe and timely follow-up of results, and helping provide one more level of supervision and mentorship based on the needs of the residents and interns.

Historically, those hours for PIC Rounds are protected time, and the housestaff have been told that we’re going to be there, in our offices, with an expectation that they come by after their 8 a.m. educational conference, and that we use that time to catch up and address anything they want to.

This is time for going through their electronic medical record in-baskets, discussing management of results and patients they’ve seen in the previous week, and analyzing clinical conundrums. It’s also a nice opportunity to hear how they are doing, challenges they are facing, and to make sure they’re getting everything they need to succeed in the outpatient world, indeed in all aspects of their personal and professional lives.

Getting this long-term exposure sometimes helps us figure out ways to help them advance their careers or overcome issues they may have encountered, guiding them to the resources they need.

It feels like over the past couple years, residents have come to us with fewer questions as they’ve had more access to powerful tools like Up-To-Date and Open Evidence and other AI-based clinical tools, which are probably answering a lot of questions that they used to come to us for.

But our faculty still has things we can offer, years of experience under our belts, the wisdom of the ages if you will.

We’ve been around, we’ve seen a lot, we’ve had patients with mysterious illnesses and things we couldn’t always figure out what they were, but between all of us we can almost always help figure out a path to getting a patient the best care, and helping the interns and residents become the best doctors they can be.

I’m not saying we have magical powers, we don’t know all the answers, and we ourselves are using these online resources more and more.

But the common sense you get after practicing outpatient medicine for years and years, seeing innumerable patients, getting that gut feeling that something bad is brewing, is still something that a large language model can’t fathom, not yet.

So, for now, we’re going to continue meeting with them, challenging them, asking them how they think they should work up this anemia or chronic kidney disease or acute kidney injury or shortness of breath, or the best medication to add on for a particular problem, or when it’s best to de-prescribe or hold off on prescribing a medicine, and when something else might be going on.

And sometimes we just know the hidden path to get a patient a blood transfusion or iron infusion, a cardiac catheterization, an upper endoscopy, a subspecialists consultation, or a particular piece of durable medical equipment, sooner rather than later.

We’ll be in our offices, every Thursday morning, at 9 a.m. sharp.