“I like to teach my learners that simply getting to a right answer isn’t good enough; it’s about how did you think through the process and what got you there? So my aim is to teach learners not just facts, but how to think critically.””
— Renee K. Dversdal, MD
Academic Hospitalist, Division of Hospital Medicine, Oregon Health & Science University
Throughout any given day, you’ll find Dr. Renee Dversdal enthusiastically teaching learners of all stages, collaborating with thought leaders across the country, and balancing on-service time at the hospital.
With her broad-ranging impact in medical education and hospital medicine, Dr. Dversdal brings her impressive expertise to the development of our Hospital Medicine Patient Experience Program content. We connected with her about what makes her work days so dynamic, how POCUS (point-of-care ultrasound) became her passion, and which Clinician Experience Project coaching tips she is most excited about sharing with our members.
Q: Share with us what your day-to-day looks like in your current role as Associate Professor of the Hospital Medicine Division at Oregon Health & Science University (OHSU) in Portland.
With the combination of clinical, educational, and administrative work, my days are quite different depending on the week. For instance, yesterday I was teaching our PA students from 8 to 10am, then ran up the hill to the main campus for a meeting, then back down to South Waterfront campus for a few phone calls with national collaborators, finally teaching first year M.D. students in a longitudinal elective from 3 to 5pm. Most Tuesdays I’m in the pre-op clinic, and then my hospitalist time now comes in two-week blocks.
In addition to our group’s work with students, we also work with residents and faculty here at OHSU, and run several continuing medical education courses. Another thing I really enjoy is working with a group called On-Track OHSU where they bring high school students on campus to provide exposure to medical professions. I get to tell them about how we use ultrasound in both the school piece and also clinically, and they get to scan themselves, see their internal jugular vein “blow up” when they valsalva, scan their hand through water in a water bath, and all kinds of fun stuff. So my educational work is so fun and fulfilling as I connect with learners of all types. It’s an incredible experience when you get to see lightbulbs go off in the minds of high schoolers all the way up to docs nearing retirement. They are all excited to learn something new.
In all of this, my primary way to manage my days in terms of self-care is spending time at the gym where I participate in high intensity interval training and weight lifting group classes. This for me is a huge, positive piece of my life. You might think it’s just another thing to put on my schedule, but if I don’t go, I feel worse both mentally and physically. So keeping this gym ritual is a big part of how I remain sane through the day.
Q: Tell us about the work you do with Internal Medicine POCUS and your diverse experience teaching across the medical education spectrum.
POCUS stands for point-of-care ultrasound: it’s the clinician at the bedside with the patient where they are acquiring the images, interpreting them, and clinically integrating right then and there. Those of us who “preach” POCUS believe it takes us back to the bedside, and let’s us answer focused questions immediately to advance care.
So let’s say you have a 2am hospitalist admit, using POCUS with this patient means you don’t have to wait for the chest X-ray or a formal echo—you can get useful information right then to make diagnostic and treatment decisions. You might still get the formal echo to assess the valves and such, but you can rule out pericardial effusion, assess ventricular function, and volume status, all right then. There is a growing body of literature demonstrating improved diagnostic performance when compared with the physical examination, and for many conditions comparability with higher risk/radiation studies such as CT. I feel it truly helps empower clinicians at the bedside. As mentioned above, I have the honor of teaching across the educational spectrum and contributing to both the foundational and clinical knowledge base of our students.
Q: We’d love to learn more about the paths that lead you to your current passion. What originally inspired you to pursue this area of interest?
I initially fell in love with simulation and simulation education. In my residency program the senior residents would run simulations with acute scenarios interns would see on the wards, and I loved helping out.
As I was nearing completion of residency I had a lightbulb moment when one of my co-residents had an unexpected find. It was 7:00 pm and a woman was admitted for shortness of breath and chest pain. They said, “Oh, it’s cancer or radiation-induced, admit for supportive measures.” So after using POCUS this co-resident discovered a large pericardial effusion and it changed the entire course for both immediate treatment and prognostication. And I thought, “That is so cool. Why can’t I do that? Why aren’t all internists taught to do that?”
Then I moved back to my home town and university in Portland. I did a lot of educational work in both stimulation and ultrasound trying to build them both up, and then I experienced what my friend calls the “POCUS first kiss” moment: You’ll never forget the first time it completely changes everything. A patient transferred overnight from a small rural hospital had a finding that was 180 degrees from the billed reason for admission, and thus his workup and treatment was drastically altered by 3am. That’s when I decided, “OK. This isn’t just like a fun educational thing. This is a way to change the practice of medicine.”
Q: There are so many valuable best practices and techniques that you provide in the Clinician Experience Project Hospital Medicine curriculum, from explaining medications to how to confirm to patients they’ve been heard to preparing patients for new responsibilities at home.
What are some of your favorite or most practical coaching tip examples from your coaching tip videos?
For me, the coaching tips that make the biggest impact in my everyday practice with patients are the ones centered on communication. We fall down often when it comes to educating people about what’s going on in their bodies and what they need to do to actively participate in their care during hospitalization and beyond.
I see so many patients who either came from another hospital or who are in the pre-op clinic and I ask them, “So I see here [pointing to the electronic medical record] you were admitted at that hospital for a few weeks and were really sick. Tell me more about what they found?” And they’ll respond, “Oh you know, they noticed some stuff in my heart. I take a bunch more pills now, but I’m hoping my primary doc will let me quit them all.”
It’s the things like confirming to the patient that they’ve been heard that seem to make a difference. When we build trust I believe they then engage more with the process. I hope clinicians watching will get a lot out of tips like making “I wish” statements instead of apologizing. Also the tip outlining listening versus hearing. But it is difficult to pick just one favorite. The reason why we created these tips is that they’re all hugely important.
That being said, the tip that has improved my work life the most has been “Make It A Date,” which is what I call it when I’m scheduling time with the patient and their main support to best communicate diagnostic updates and the plan of care. This helps prevent spending a ton of time counseling that person alone on morning rounds when their significant other is going to want to hear it a second time later on. And I do think it’s better for retention when they both get at the same time as well and can both ask questions. So that has led me to be more efficient with my counseling. I believe if I do it 20 minutes once, that’s better than doing 15 minutes twice! Unless of course it’s a scenario where planned redundancy is necessary for retention of new information.
Q: If you were going to choose what you would hope makes the most impact in your career as an academic hospitalist, what would that be?
I like to teach my learners that simply getting to a right answer isn’t good enough; it’s about how did you think through the process and what got you there? So my aim is to teach learners not just facts, but how to think critically.
I believe in education and the more you work, the more learners go out and take good care of patients. I’m equally passionate about spreading POCUS to “the masses!”
Learn more about our curriculum experts by visiting our Faculty page. If you’d like to have a conversation about how Hospital Medicine content would fit into your clinician coaching initiatives, get in touch with us by Getting Started.
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