Friday, July 26, 2019

March Madness, Palliative Care Style

by Sarah Rossmassler (@srossmassler)and Diane Dietzen (@ddietzen)

As a part of our palliative care team’s educational efforts for the medical residents at Baystate Medical Center, a 712-bed tertiary care academic medical center in Springfield, MA, we prepare and present an academic half-day about twice a year. This year, since our turn came in March, we organized the teaching around a March Madness theme. We had a ton of fun preparing it and felt it was an engaging format for both the palliative care faculty and the residents. In the spirit of Christian Sinclair’s call to use the format in palliative care (as NephMadness has done so beautifully) we wanted to share what we learned and offer our materials and pearls of wisdom to the PalliMed community.

What we did
We began by having palliative care faculty members select two articles from the recent palliative care literature within four topic areas: communication, goals of care, symptom management, and existential distress. For the first round (about 70 minutes), each faculty member had 7-10 minutes to present their two chosen articles to the residents. Faculty volunteers were responsible for researching and identifying their own papers; we asked each faculty member to choose one review article and one recently published paper that would educate residents in palliative care competencies. We assigned two faculty to each topic area in order to provide a well-rounded and representative selection of papers.

After each of the first presentations, the residents voted for one article they found most relevant to their practice. Then we broke into groups of 4-6 residents with roaming faculty preceptors; the small groups allowed residents to delve deeper into the papers and to discuss which paper they felt was most influential and valuable to integrating palliative care into their practices. Faculty had prepared one-page summaries with insights about why they thought the paper was important. We tried to tailor the summaries to the resident perspective, as most are focused on primary palliative care. Next, we came together as a group to continue voting. After residents voted for each of the next pairings of papers we ended up with a final winner.



What worked well
The competitive nature of the format made it fun for both faculty and residents. The faculty member whose paper was voted the winner was promised a prize by our medical director: a jug of local maple syrup… highly coveted! This added to the excitement on the faculty side, and the residents quickly realized that faculty were competing for their selected papers to win. This prompted some good-natured “trash talking” and faculty efforts at persuading the residents to vote for their papers. We believe that the clear bracket framework allowed the residents to quickly review and engage with a broad selection from the palliative care literature.

What could have been better
We used lots of different technologies, and we should have had a test run prior to showtime in the actual room where we had the event. For instance, the YouTube link was expired; which meant our introductory video had to move later in the session, which might have led to confusion about what the theme of the event was. Also, because there were so many transitions (eight different presenters, fifteen voting opportunities) we struggled to hold resident attention and keep faculty on track. We received constructive feedback that some residents felt the organization could have been tighter and that an introduction to the theme would have been helpful for context (some were not familiar with basketball or March Madness). Some residents wished for more clear take-away points. The pace was fast; to those who were not paying close attention, it might have felt frenetic.

Final Thoughts
The March Madness themed academic half-day was a huge success. Since the work was distributed preparation was manageable for our eight interdisciplinary faculty . The advantages of the format are that it includes nerdy paper reviews, showcases the interdisciplinary nature of the palliative care team, and being interactive, it kept the attention of our resident physicians. We loved that the residents selected our Chaplain’s paper on Addressing a Patient’s Hope for a Miracle as their final winner; it showed us that this is clearly a difficult topic for residents and faculty alike.

The Winning Paper
Shinall, M. C., Stahl, D., & Bibler, T. M. (2018). Addressing a Patient’s Hope for a Miracle. Journal of Pain and Symptom Management, 55(2), 535-539. doi:10.1016/j.jpainsymman.2017.10.002

If you want to try our format…
We’d be happy to share what we did. We made:
  • A two-minute video to showcase the theme (with AC/DC Thunderstruck as the score)
  • An interactive excel spreadsheet with the brackets
  • We used Turning Point for the voting. Consider having a tech person on site to manage the interactive technology (we had our tech-savvy librarian there).
  • If you would like our materials (youtube video, excel brackets) e-mail sarah.rossmassler - at - baystatehealth.org.


Sarah Rossmassler works on the palliative care consult team at Baystate Medical Center in Springfield, MA. She recently completed her DNP at the MGH Institute of Health Professions during which she developed and implemented a QI project with Trauma Surgeons, teaching them the Best Case/Worst Case Communication framework. This work has spurred further interest in other types of graphic aids as communication tools for patients, families, and interdisciplinary teams. In her free time Sarah is caretaker of two mini donkeys (Luna and Mabel) who teach her daily about the importance of staying grounded.

Diane Dietzen is the Medical Director of the Palliative Care Program at Baystate Medical Center and is board certified in Internal Medicine and Hospice and Palliative Medicine. Prior to joining Baystate in 2011, Dr. Dietzen planned and developed a Palliative Care Program at the Abington Memorial Hospital in suburban Philadelphia. Dr. Dietzen served as an Associate Director of the Residency Program educating Internal Medicine Residents. Dr. Diane Dietzen earned her Medical Degree and completed her Internship and Residency at the Temple University School of Medicine.




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