Tuesday, January 17, 2012

Update from Jocelyn Carter

Reflections of an LPMR Alum

As I sit in my barely used administrative office adjacent from the main hospital here at MGH, I can hardly believe that nearly six months has passed since I graduated from the Leadership Preventive Medicine Residency and completed the MPH program at The Dartmouth Institute. Since that time I’ve already burned through several white coats, completed multiple ward months, survived an oh so very arduous hospital credentialing process and (as I’ve been assured that this is protocol) a second but somewhat less arduous hospital credentialing process. I feel like a young student once again at the beginning of the semester as I learn the twists and turns of the hospital campus and reconcile that somehow very few of the 3000 people that work here don’t know each other well and it will be some time before I speak to someone without them inquiring just after the introduction “Are you….. new?”

My clinical experience here has been fascinating and my first day of work was no less so. That day a young woman presented to my care after being found down at Logan just after completing a transatlantic flight from her native Eastern European homeland. No history, no English. No problem. I opened the door of her room to hear the piercing sounds of screams and frantic cries of the patient as nursing staff attempted to aid her. After a brief and non-productive attempt to sooth all parties, I completed a limited history (with a helpful translator standing by), exam and assessment and involved security for the safety of the patient and staff. Several days, neuro-psychiatrists, hundreds of milligrams of lorazepam, and an ICU visit later, she was all better and ready to return home. That was only the beginning of week one and marked the evolution of two novel ideas for me: one was that while perhaps the patients here were not sicker, they were at the very least more complex; and two was that I wasn’t in Kansas anymore.
Happily, my LPMR training seems to loom large as begin to link my clinical and non-clinical endeavors and do the work of learning the values of my new peers, how they like to be rewarded and where the power hubs lie within the Microsystems I belong to and work with. Endless e-mails of hospital and medical school forums, conferences and summits whir around me and with the help of a handy mentor and unit chief, I’ve chosen my attendance well and reaped benefit. I watch as the conversations around payment reform, performance measures, high risk populations and physician leadership take shape and fuel a culture of promise and fiercely defiant optimism.

As the new year comes into full view, I can not fully imagine what lies ahead but I find myself holding fast to the edicts of my training as well as the wise words of former and present mentors and coaches. Though over 100 miles away from my former home, all still seems to ring true. This is a wonderfully comforting thought in these unique and changing times.
And still, no snow.

Jocelyn Carter, MD, MPH
DHMC-Leadership Preventive Medicine Residency, 2010 January 15, 2012

New life for the LPMR blog

Hello fellow LPMR alums,

With the start of the new year, I've resolved to update the LPMR blog that Lisa Pastel created on a more frequent basis so that the growing body of alums who are out there can use this to keep in touch and update fellow LPMR alums.

Please let me know what you would like to see on this blog whether it is to (1) update other alums or the program about your current work projects, promotions etc. (2) see new and exciting events as they relate to quality improvement, research, health policy (3) news from the LPMR program, DHMC and the Upper Valley (4) pictures (5) all of the above.

Thanks for the input,

Sunday, March 22, 2009

sister program in sweden

The International Forum was a great time to meet the representatives from our "sister" LPMR program in Sweden. The link to their program is listed here in swedish. We look forward to collaborating with this great group of people as they start their exciting new journey!

IHI berlin

Lisa Pastel recently presented her work in Berlin, Germany at the International Forum on Quality and Safety in Health Care. Her poster was entitled " Improving the care for patients with diabetes at a rural primary care clinic by empowering Licensed Nursing Assistants with a flowsheet tool." Her research and travel was supported by the DHMC Quality Research Grant Program.
Lisa Pastel with Paul Batalden, Program Director for the LPMR.

Thursday, March 12, 2009

PRB Meeting

The Practicum Review Board met Monday, March 9 at DHMC. Two LPM-1 residents presented their formative presentations.

First up was Sharon Alroy-Preis - Fever to first dose: decreasing time to antibiotic administration. Sharon's project working in multiple microsystems to help decrease time from positive blood culture to first dose of antibiotics. She had a lot of supporters from the pharmacy who are also looking at this issue internally. Sharon had a tremendous amount of interesting data and was enthusiastically given the go-ahead to proceed. Looking forward to her summative presentation later in the Spring!

Next was Erin Meyer - Improving the safety of blood transfusions at DHMC. Erin's project is focused specifically on platelets and trying to elucidate why so many of these transfusions do not adhere to established transfusion medicine guidelines. Her microsystems include transfusion medicine and an inpatient unit at DHMC. There was a great discussion on the quality of evidence available surrounding the actual guideline and hopes that Erin will either confirm accepted practice or expand understanding of appropriate platelet transfusion goals. Erin will be finishing up her pathology residency before she starts LPM-2 so she has some time to lay ground work before her summative.

Of note - an LPMR graduate, Auden McClure was one of Erin's reviewers. It is great to see graduates of our program staying involved as coaches and mentors.

Later this week the RAC is meeting - updates to come!

Monday, March 2, 2009

New President for Dartmouth

Dr. Jim Yong Kim was named as the new President-elect of Dartmouth College (includes DMS) today. He is a physician who was one of the founders of Partners in Health and headed up the HIV/AIDS division of WHO. His wife is a pediatrician and gave birth to their second son three days ago.

What do you think? Do you think this will raise the profile of DMS and TDI? Where does quality fit in when we talk about global health?

Friday, February 27, 2009

DHLPMR Retreat

Today is the second day of the LPMR retreat. We are discussing the future of the residency, ways to connect alumni of the program, and current challenges. The discussion has been very fruitful and exciting.

One of the issues we have spent a lot of time discussing is how to keep the LPMR alumni connected. We are exploring the idea of using new social media such as Facebook, Google groups or other means to assist with the goal of creating a network of improvement minded colleagues in the begining of their career. I have started a facebook group as part of this experiment and would appreciate any thoughts or feedback on this effort.

Right now the discussion is centered on how to support residents in their home departments where they may be viewed as taking a TDI "vacation." I know it has taken 5 years for Family Medicine to realize that we add value. I hope that we keep spreading the message of the importance of improvement and stay connected both with LPMR and our home department.