Clinical Informatics -
When I began work as an Assistant Professor and Faculty Physician at UT Health San Antonio, I had an interest in QI cultivated from my residency. Working at UH, I took note of potential areas for process improvement and noticed a theme in that much of what I was drawn to had a specific health IT component, either at the level of the current process in need of improvement or at the level of a proposed solution. I became increasingly involved in health IT projects, an involvement which deepened and became more regular after our EHR vendor rolled out a new module for medication reconciliation in June 2014. I highlighted significant safety concerns with the new process, and helped make improvements and provide education. Then in the fall of 2014, I implemented a pilot for a new product for provider on-call listings for UH as part of the CS&E course. In September 2015, I began in a formal role for these efforts as Clinical Director for Coding Documentation Improvement and IT Interfaces.
Starting in January 2017, I offer a resident elective in health IT, which I presented as a poster at one national conference and will present as a workshop and poster at another national conference in 2018. Starting in 2017, I am also planning for a clinical informatics fellowship at UT Health San Antonio and UHS, which has been proposed by Dr. Bradley Brimhall (awaiting approval for start in 2019) and for which I am planned to be core faculty.
From November 2017 to March 2018, I obtained formal training in clinical informatics through the "10x10" program of AMIA, which culminated at the AMIA 2018 Informatics Summit in San Francisco in March 2018.
I plan to seek board certification in the clinical informatics subspecialty in 2018 or 2019.
In 2018 I submitted my first publication in the realm of clinical informatics, an invited editorial on a systematic review on inpatient portals for the Journal of Hospital Medicine, and look forward to future scholarship. |
Evidence-Based Medicine -
On the Medicine Consultation/Co-management Service, we teach the residents from a curriculum that is founded in evidence-based medicine. The service always has two third-year internal medicine residents and has a pace that allows for a different style of teaching than can be achieved on primary inpatient services. For these reasons, we focus on primary literature that informs our perioperative care. Through teaching this curriculum, I cemented an interest in evidence-based medicine. As co-director of the service, I have authored one syllabus revision as a senior editor and am currently co-authoring a subsequent revision.
I regularly serve as faculty sponsor for second-year internal medicine residents in their resident journal club, supervising ten session during the 2016-2017 academic year. I am also involved in planning and teaching a new resident critical appraisal curriculum as of December 2017. |
Medicine Consultation and Co-Management -
As co-director of the Medicine Consultation/Co-management Service, I oversee the service at UH along with another faculty member who oversees operations at Audie L. Murphy Memorial VA Hospital.
Through this role, I have developed interest and expertise in consultative care and perioperative management. Our curriculum is published on MedEdPORTAL`s iCollaborative website. I have also published a journal article on perioperative risk models and have a pending publication on consultative education and a pending book chapter.
I have given Grand Rounds on preoperative evaluation and perioperative management to the Department of Obstetrics and Gynecology, and annually teach on the same topic at internal medicine Intern Learning Group. |
Quality Improvement -
I first became interested in QI when I led a QI project from 2011-2012 as a second-year internal medicine resident. We investigated the high no-show rate of patients at post-hospital discharge follow-up appointments, and made sustained improvements to the process and to the no-show rate. Through this experience, I learned the value and enjoyment of discovering unknown complexity in a process, of hearing additional perspectives, and of partnering with others to collaborate on improvements. Since this time, I have had an interest to not just "do the work" but to "improve the work." I participated in another resident QI project in 2012-2013, and starting in 2014-2015 I am faculty facilitator for a cohort of internal medicine residents learning QI. I also regularly take on QI projects personally, many of which intersect with health IT, work that was formalized into a medical directorship role with UHS in September 2015.
For additional training, I participated in the CS&E curriculum in fall 2014 and completed a project piloting a new system for listing on-call providers at UH. I attended the Quality and Safety Educators Academy through SHM in May 2015 to get specific training on how to educate residents in QI. In April 2016, I attended a three-day Lean course hosted by UHS for further training. |
| Date |
Description |
Institution |
# Students |
| 12/2017 - Present |
Resident Critical Appraisal Curriculum |
UT Health San Antonio |
20 students |
| In the Critical Appraisal Curriculum, internal medicine residents improve their abilities in forming a clinical question, information retrieval, and critical appraisal of journal articles. I was involved with original planning of the curriculum, and helped facilitate the first session. I am content lead on the sessions on prognostic studies and on systematic reviews/meta-analyses. Sessions last an hour, with approximately six hours of preparation for the sessions on which I am content lead. Listing of "number of students" taught for this and other Group Instruction are the number of learners per session. |
| 10/2017 - Present |
Individual Instruction |
UT Health San Antonio |
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| 1/2017 - Present |
Individual Instruction |
UT Health San Antonio |
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| 5/2016 - Present |
Intern Learning Group |
UT Health San Antonio |
20 students |
| Intern Learning Group is a dedicated didactics session for first-year internal medicine residents. Dr. Emily Wang, co-director of the Medicine Consultation/Co-management Service, and I teach a session on preoperative assessment and perioperative care. We provide a background on the relevance of the topic, and teach how to use available risk assessment tools, appropriate perioperative management, and on limitations with the literature. In 2016 and 2017 we taught one 1-hour session. Beginning in 2018, we are expanding the content into two 1-hour sessions. |
| 8/2015 - Present |
Individual Instruction |
UT Health San Antonio |
|
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| 8/2015 - Present |
Individual Instruction |
UT Health San Antonio |
|
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| 7/2015 - Present |
Advanced Practice Provider (APP) Educational Series |
UT Health San Antonio |
8 students |
| I co-founded and co-direct the APP Educational Series, along with Dr. Heather Briggs. We schedule presenters to teach the APPs of the Division of General and Hospital Medicine for UHS and Audie L. Murphy Memorial VA Hospital. Sessions occur one to two times per month for one hour, and are geared toward the development of clinical reasoning skills. I have presented at eight sessions. |
| 9/2014 - Present |
Individual Instruction |
UT Health San Antonio |
|
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| 9/2014 - Present |
Internal Medicine Residency Quality Improvement Curriculum |
UT Health San Antonio |
16 students |
| I facilitate a group of 14-16 internal medicine residents working on a QI project. The group meets for one and a half hours every five weeks, with additional work on tasks between meetings. I teach concepts of QI, and then we reinforce those concepts through hands-on work in a recurring curriculum of longitudinal projects. I have facilitated groups performing the following projects: improved attribution of the intern caring for a patient in the EHR (2014-15), improved communication with inpatients and their caregivers (2015-16), improved prescribing of cardioprudent medications upon discharge of heart failure patients (2016-17), and increased use of a regional health information exchange to access outside hospital records (2017-18). I also supervise residents through the IRB process and oversee academic product that result from these projects, such as poster presentations. |
| 6/2014 - Present |
Post Graduate Rotation Supervision |
UT Health San Antonio |
|
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| 6/2014 - Present |
General Medicine Ward/Subinternship UH/VA |
The University of Texas Health Science Center |
|
| Internal Medicine Inpatient Wards at University Hospital. As ward attending for this sub-internship, I help students learn advanced techniques of the physical examination, advanced diagnostic decision making to include management plans of common and complex medical problems, increased medical knowledge and proficiency in relating medical literature to patient management, and proficiency in performing and interpreting clinical procedures. Teaching venues include bedside teaching, observation of student interview/physical examination, and lectures to the ward team. As an attending, I work with fourth year sub-interns about four weeks per year. I typically spend two to two and half hours with students on morning rounds, and a half hour in dedicated afternoon teaching. I also meet with students at the beginning of the rotation to assess current goals, and at the middle and end of rotation for formal feedback. |
| 6/2014 - Present |
Medicine Clerkship |
The University of Texas Health Science Center |
|
| Internal Medicine Inpatient Wards at University Hospital. In this clerkship, I teach and train students and residents in the knowledge, skills, and attitudes needed to care for adult patients with medical disorders in the hospital. In my role as attending, I am responsible for teaching the students data gathering through history and physical examination, diagnostic decision making to include differential diagnosis and appropriate diagnostic test selection, and prioritization of patient problems. My responsibilities also include teaching and supervising bedside procedures including paracentesis, thoracentesis, and lumbar puncture. Teaching venues include bedside teaching, observation of student interview/physical examination, and lectures to the ward team. I work with 2-3 third-year medical students per rotation, two to three times per year. I typically spend two to two and half hours with students on morning rounds, and a half hour in dedicated afternoon teaching. I also meet with students at the beginning of the rotation to assess current goals, and at the middle and end of rotation for formal feedback. For several students, I have subsequently written a letter of recommendation for residency.
I also supervise about one pharmacy student per year concurrent with supervising medical students on the wards. |
| 3/2014 - Present |
Medicine-Neurosurgery Conference Series |
UT Health San Antonio |
20 students |
| The Department of Neurosurgery and the Division of General and Hospital Medicine meet three times a year for an hour to discuss clinical conditions for which we both provide care. I first attended the series in March 2014 and transitioned to organize them (along with Dr. Viktor Bartanusz and Dr. John Floyd) beginning with the October 2014 session. We have organized ten sessions together and are preparing for our next meeting. Previous topics have included cerebrospinal fluid shunt infections and cauda equina syndrome. |
| 2/2014 - Present |
Internal Medicine Intership Readiness Elective |
The University of Texas Health Science Center |
15 students |
| Twice a year I facilitate a session on diabetic ketoacidosis as part of "intern boot camp" (course for fourth-year medical students planning to go into internal medicine residency). I have also taught on bacterial meningitis twice and on urinary tract infections once, and facilitated two sessions on the interpretation of EKGs. In 2017 I participated in a two-hour session in which students responded to mock pages from two general medicine nurses, and I provided feedback on their performance. |
| 11/2013 - Present |
Post Graduate Rotation Supervision |
UT Health San Antonio |
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| 9/2013 - Present |
Post Graduate Rotation Supervision |
UT Health San Antonio |
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| 8/2013 - Present |
Individual Instruction |
UT Health San Antonio |
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| 8/2013 - Present |
Individual Instruction |
UT Health San Antonio |
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Abstract |
| Tiwari R, Rodriguez RS, Yang SD, Chandawarkar AR, Hoffman J, Shoffeitt M. Designing a Residency Elective in Clinical Informatics. In: Abstracts from the 2018 Society of General Internal Medicine Annual Meeting; 2018 Apr. (Journal of General Internal Medicine; vol. 33, no. S2).
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| Freeman M, Wathen P, Sehgal R, Shoffeitt M. Scheduling Quality: Leveraging 4+1 Block Scheduling to Teach Quality and Safety. In: Abstracts from the 2017 Society of General Internal Medicine Annual Meeting; 2017 Apr. (Journal of General Internal Medicine; vol. 32, no. S2).
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| Wang ES, Moreland C, Shoffeitt M, Simon B, Leykum LK. "Who Consults Us and Why?": A Multi-Institutional Evaluation of the Medicine Consult/Co-Management Service; 2016 Nov. (Journal of Hospital Medicine; vol. 11, no. S1).
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| Shoffeitt M, Moreland C, Wang ES, Simon B, Leykum LK. How is Your Medicine Consult/Co-Management Service Organized?: A Multi-Institutional Survey; 2016 Nov. (Journal of Hospital Medicine; vol. 11, no. S1).
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| Serrano R, Shoffeitt M. Not Your Usual Case of GI Bleed; 2016 Nov. (Journal of Hospital Medicine; vol. 11, no. S1).
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| LeMaster AT, Rodriguez J, Shoffeitt M. Stop the Medication, STATin! (And Start an Immunomodulator). In: Abstracts from the 2016 Society of General Internal Medicine Annual Meeting; 2016 May. (Journal of General Internal Medicine; vol. 31, no. S2).
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Electronic/Web Publication |
| Moreland CJ, Wang ES, Shoffeitt M, Leykum LK. The Education of Residents as Perioperative and General Medicine Consultants 2015 Jun. Available from: https://www.mededportal.org/icollaborative/resource/4018 . |
Journal Article |
| Wang ES, Moreland CJ, Shoffeitt M, Leykum LK. Who Consults Us and Why? An Evaluation of Medicine Consult/Co-Management Services at Academic Medical Centers Journal of Hospital Medicine 2018 Dec;13(12):840-843.
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| Shoffeitt M, Lanham H. Inpatient Portals: The Questions That Remain Journal of Hospital Medicine 2018 Jun;13(6):435-436.
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| Craig CM, Basman C, Wang ES, Shoffeitt M, MacKenzie CR. Perioperative Risk Models: A Narrative Review Journal of Clinical Anesthesia and Management 2016 Jun;1(4):1-11.
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