Nathan W Houchens

• Doctor of Medicine
• Associate Professor of Medicine at University of Michigan

Background Hand hygiene is recommended for all clinicians at entry to and exit from patients’ rooms. Adhering to such recommendations remains suboptimal possibly due, in part, to cognitive biases among clinicians who believe they are more compliant with hand hygiene than they actually are. We observed actual adherence to hand hygiene at room entry...

Medical Professionalism: Theory, Education, and Practice is a comprehensive, four-part look at medical profession in a single resource for learners, educators, independently practicing physicians, and health care administrators. It begins with an examination of the definitions, theoretical underpinnings, and scope of the concept of medical professi...

Mistreatment from patients is prevalent and has far-reaching negative consequences. To develop a practice-based curriculum on patient-initiated mistreatment and examine participant perceptions before and after the curriculum. Single medical school in the United States. 306 senior medical students from classes 2022 and 2023. A single patient-initiat...

Problem: Mistreatment of health care workers and learners by patients and their families is prevalent at all levels of training. This mistreatment has negative consequences and disproportionately affects women and historically marginalized and excluded groups. Approach: The authors designed and piloted a preliminary practice-based curriculum con...

Background Nonverbal communication plays a pivotal role in the provision of effective patient care and has been associated with important patient health outcomes. Clinician posture, a nonverbal form of communication, may influence the patient experience and satisfaction. The relationship between clinician posture (i.e., standing or at the patient’s...

Objective To examine impacts of a structured mentorship committee program on academic promotion and participant perceptions because impacts of formal mentorship programs for clinical faculty are unknown. Participants and Methods This prospective cohort study at a Midwestern Veterans Affairs tertiary care system from December 17, 2019 to December 3...

This cross-sectional study assesses patient preferences for various visual backgrounds during telemedicine video visits.

Background Mentorship is a dynamic reciprocal relationship, wherein a novice (mentee) grows with the encouragement of an advanced careerist (mentor). It is widely implemented in medical training programs. However, there are few reports on mentorship's educational effects in the Japanese context. This study investigated the association between mento...

Empathy with patients improves clinical outcomes. Although previous studies have shown no significant differences in empathy levels between physicians and nurses, investigations have not considered differences in cultural backgrounds and related factors of healthcare providers at the individual level. This study compares empathy between physicians...

Background Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects o...

Purpose of study A physician’s ability to empathize is crucial for patient health outcomes, and this differs according to speciality, personal characteristics, and environmental factors. This study aimed to examine the empathy levels among physicians based on their specialities and to identify the influencing factors. Study design A nationwide, on...

Empathy is essential for physicians to provide patient-centered care. Nevertheless, the degree to which empathy varies among medical residents based on their desired future specialty remains undetermined. This nationwide cross-sectional study compared empathy levels (Jefferson Scale of Empathy, JSE) of 824 year one and two postgraduate residents in...

Importance Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. Objective To determine the relative achievement of f...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

Background Quality improvement and patient safety (QIPS) curricula are critical in graduate medical education, yet barriers limit the educational experience and project outcomes. Objective To explore the impact of QIPS curricular enhancements and integration of continuous improvement specialists (CIS) by examining the A3 document, the primary proj...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

This book combines the social and clinical aspects of teaching to present a comprehensive guide for educators of inpatient medicine in all career stages who are looking to improve their teaching approach and their ability to connect with patients and learners. The authors visited with some of the most outstanding attending physicians teaching in to...

Background “Sacred moments” are brief periods of time in which people experience a deep interconnectedness that may possess spiritual qualities and emotions. This concept has been shown to have a positive impact on individuals’ overall well-being and stress in mental health settings. The concept of sacred moments has not been studied in acute care...

Objective The patient–physician relationship impacts patients’ experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using...

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas...

Background: The Resuscitation Education Initiative (REdI) is a national mock code program for the Veteran Health Administration. We used the REdI rollout to study team dynamics for participants in mock codes. Methods: Mock code evaluation data was obtained from 8 Veterans Affairs Medical Centers across the nation in 2019-2020. Sites utilized a stan...

Refractory dyspnoea can be a challenging symptom to manage. Palliative care specialists are not always available for consultation, and while many clinicians may undergo training in palliative care, this education is not universal. Opioids are the most studied and prescribed pharmacological intervention for refractory dyspnoea; however, many clinici...

Refractory dyspnoea can be a challenging symptom to manage. Palliative care specialists are not always available for consultation, and while many clinicians may undergo training in palliative care, this education is not universal. Opioids are the most studied and prescribed pharmacological intervention for refractory dyspnoea; however, many clinici...

Background While SARS-CoV-2 vaccine breakthrough infections are expected, reporting on breakthrough infections requiring hospitalization remains limited. This observational case series report reviewed ten individuals hospitalized with vaccine breakthrough infections to identify patient risk factors and serologic responses upon admission. Methods E...

A 71-year-old man presented to the emergency department with a 6-month history of melena, easy bleeding and bruising, and lightheadedness.

Purpose Leadership development may be a key strategy to enhance job satisfaction, reduce burnout and improve patient safety in health-care systems. This study aims to assess feasibility of a leadership development series in an effort to invigorate a collaborative culture, create peer networks and elevate autonomy in daily work. Design/methodology/...

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies recently published in major medical journals. Some articles will focus on a particular theme,...

A 47-year-old man in Michigan presented to the ED with a 1-day history of presyncope, swelling of the eyelids, and diffuse pruritic rash. He reported a 3-week history of postprandial watery bowel movements and a 5-day history of diffuse, crampy abdominal pain.

Background Arts exposure is associated with positive psychological constructs. To date, no randomized, controlled studies have integrated art into clinical medical education or measured its effects on positive psychological constructs or educational outcomes. In this study, we assessed the possibility and potential benefits of integrating visual ar...

Background: Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. Objective: To explore the lived experiences of female teaching attending physicians emphasizing s...

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, while ot...

Background: Previous studies have shown that patients have specific expectations regarding physician dress. Japan has a cultural background that is in many ways distinct from western countries. Thus, physician attire may have a different impact in Japan. Methods: We conducted a multicenter, cross-sectional study to examine patients' preferences...

Objectives We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician–patient relationship. Setting The 900-bed University Hospital Zurich, Switzerland. Participants A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory cli...

The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient’s case in an approach typical of a morning report. Similar to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical t...

Background: Effectively interacting with patients defines the consummate clinician. Objective: As part of a broader study, we examined how 12 carefully selected attending physicians interacted with patients during inpatient teaching rounds. Design: A multisite study using an exploratory, qualitative approach. Participants: Exemplary teaching...

BACKGROUND Clinician educators face numerous obstacles to their joint mission of facilitating high‐quality learning while also delivering patient‐centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. OBJECTIVE To desc...

Purpose: Clinical reasoning is a crucial component of training in health professions. These cognitive skills are necessary to provide quality care and avoid diagnostic error. Much previous literature has focused on teaching clinical reasoning in non-clinical environments and does not include learner reflections. The authors sought to explore, thro...

The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical...

As the use of serotonergic agents to treat depression has increased, so too has the incidence of serotonin syndrome. We identify the common agents implicated in serotonin syndrome and the clinical tools to diagnose, manage, and prevent serotonergic toxicity.

The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical...

The term "vasculitis" represents heterogeneous and often overlapping groups of clinicopathologic syndromes that cause vascular damage and organ dysfunction. Diagnoses are categorized into primary and secondary types, by size of affected vessel, and by patient characteristics. Vasculitis should be included in the differential diagnosis of patients p...

Many companies in the manufacturing sector, such as Toyota, have enjoyed immense financial and commercial success by utilizing lean principles to identify value for the customer, eliminate waste in the production process, and deliver high-quality products. Lean encourages participation by the “frontline” workers to generate ideas, enact changes in...