musings of a salt whisperer
A couple of Fridays ago I did my second lecture for the medical students at Providence Hospital. I lectured on potassium.
The handout is good but gets a little light on content towards the end. I will revise this before the next lecture.
Potassium booklet form for printing
Potassium handout for iPhone
Last Friday I started teaching third year medical students. This is the first time I have taught medical students (in isolation, there are always medical students at my lectures for the residents) since 2003, when I ran a teaching section for renal physiology for first year medical students at Pritzker School of Medicine, University of Chicago with John Asplin.
I am now teaching the medical students two lectures every rotation, the first on sodium and the second on potassium and calcium. I hope to expand this to ABGs and another electrolyte lecture so I can isolate potassium and spend an entire hour on it.
I modified my Don’t Panic handout for the students. During the lecture I realized that the SIADH section was weak and too complex for the students. I will probably change it to focus on the fact that ADH reduces water excretion and that this can be adaptive (early CHF, volume depletion, hyperosmolar) or maladaptive (SIADH). I will change the section on the dilution of urine to a background box as I think it is important but only interesting to nephrologists and similar wierdos.
I will add a focus on a few clinical scenarios with increased ADH.
I still need to expand the hypernatremia section.
Yesterday I lectured the St John ER residency program. The ER residency has an impressive commitment to education. They set aside a half day every wednesday for their resident to get dedicated didactic time. They have great attendance with a good number of attendings showing up.
I have been asked to give three lectures and yesterday was the first. I gave a double lecture (running time about 90 minutes) on sodium and potassium. The fact that I could run over the standard 50 minute alotment normally given for medicial education is due to the fact that they have blocked an entire afternoon rather than try to shoehorn a lecture into lunch or before rounds.
The sodium lecture was the first time I used the Sodium handout I created for the St John IM residents. I gave the lectuer Seder-Style with the residents reading different sections, answering questions and me adding commentary. The ER residents are smart and empowered to ask questions. I felt that there was great two-way interactivity.
Sodium iPhone format
Sodium booklet format
The potassium lectuer is an abrdged potassium lecture which is stripped to the bare bones of differential and treatment. It is a traditional powerpoint lecture. Immediately when I started this lectuer I saw about half a dozen exhausted interns fall asleep. My next project is to create a potassium haggadah.
I gave my first lecture to the residents at Providence Hospital on Friday before Labor Day. I did a new lecture on calcium. I tried to base this lecture around this incredibly interesting patient I had a few years ago at St. John.
He was a young man who came in with a fracture due in part from his rip-roaring uncontrolled secondary hyperparathyroidism, which had actually progressed to tertiary hyperparathyroidism. We treated his hypercalcemia, got him a parathyroidectomy and then watched in horror as his hypercalcemia switched to hypocalcemia as part of a wicked case of Hungry Bone Syndrome. To cap it off he developed acute symptomatic hypocalcemia after meeting Alonzo Mourning.
On that one admission, in one patient my team got to see and study:
I call it the greatest case report ever told and regarding calcium it probably is the best.
Again I provided the resident with a booklet and did the lecture Seder Style. This was the best use of that style yet.
I gave the internal medicine residents of St John Hospital an ARF lecture Monday morning. This was a basic ARF lecture. No Powerpoint. I gave this lecture Seder Style. Every resident in the room read a paragraph or two. The Haggadah was a booklet-sized handout of 28 pages (8.5 by 11 sheet turned sideways with two pages per side so the 28 pages were only 7 sheets). Besides text and illustrations the booklet includes questions for discussion, case studies, and problems.
I’m pretty proud of it.