2013 Grant Winners


Developing a Health Advocacy and Public Policy Pathway for Pediatric Residents

Project Leader: 
Lee Savio Beers MD, Medical Director of Municipal and Regional Affairs atChildren’s National Medical Center

Project Description:
For this project, the team will develop a Child Health Advocacy and PublicPolicy Pathway for pediatric residents at Children’s National Medical Center. Thispathway will include a tool kit of experiences that will allow residents to achievemastery of the core competencies in advocacy for physician trainees, as definedby Drs Wright et al in their article “Toward the development of an advocacytraining curriculum for pediatric residents: A National Delphi Study”

(Ambulatory Pediatrics;May/June 2005). Both knowledge and skill competencies are included, in theareas of patient, community and legislative advocacy. The overall goals of thispathway are to:

1. Create anindividualized curriculum for interested residents that addresses core advocacycompetencies. Residents who complete 6 educational units over three years oftraining (including required components and electives) will receive acertificate of completion and additionally meet the requirement for anindividualized curriculum.

2. Create an opportunityfor Community Health track residents, who through their program achieve masteryof the majority of patient and community level but fewer legislative leveladvocacy competencies, to have the opportunity to attain mastery of thoseadditional components.

3. Strengthen advocacyeducation for all program residents.


A Proposal for Case-based Professionalism Education for Internal Medicine Residents and Fellows: A Partnership between SUNY Upstate Medical University and the American College of Physicians

Project Leaders: 
Kathy Faber-Langendoen MD, Chair, Center for Bioethics & Humanities,SUNY Upstate Medical University; Stephen Knohl MD, Internale Medicine ResidencyProgram Director, SUNY Upstate Medical University

Project Description:

SUNY Upstate MedicalUniversity ("SUNY Upstate") will partner with the American College ofPhysicians ("ACP" or "The College"), the nationalprofessional society for internal medicine, to develop a professionalism curriculumthat provides internal medicine trainees practical skills for living out theirprofessional commitments to 1) promote a just distribution of finite resourcesand 2) promote the regulation of the profession by peer-monitoring. Thiscurriculum includes four simulation cases focused on these commitments usingObjective Structured Clinical Examination

(OSCE)-based encounters.These professionalism OSCEs will be integrated into a well-established communicationscurriculum for Internal Medicine residents and subspecialty fellows. Ethicsstaff from ACP will further develop these cases for dissemination through itspopular Medscape CME ethics case study series and as components of a new ACPprogram in ethics and professionalism education focused on resident s.

These two areas addresskey professionalism issues appropriate to the developmental level of residentsand fellows. The first area is the responsibility to promote the just use offinite resources. As Cohen observes, "The need to confront our fears aboutrationing, engage in open and honest dialogue about potential options, andreach consensus on a solution is undeniable and urgent." Over manyeditions of ACP's Ethics Manual, the College has recognized the need forappropriate stewardship of health care resources.

The second area, theprofession's responsibility to self-regulate, rarely gets specific emphasis ineducational programs and is often overlooked by physicians. One study of physiciansfound that "96%o of respondents agreed that physicians should report impairedor incompetent colleagues to relevant authorities, [but] 45% of respondents whoencountered such colleagues had not reported them." This gap betweenprofessional norms and physicians' adherence to them is confirmed in anotherrecent study which found that "more than one-third of physicians were notcompletely certain of their obligation to report a colleague who is impaired orincompetent to practice, one-third reported that they are unprepared to dealwith such colleagues, and many appear to follow through on this lack of convictionand knowledge with a lack of action."


Breathing New Life into an Old Tradition: Teaching Professionalism at the Bedside

Project Leader: 
Peter Lichstein MD, Professor of Internal Medicine and Vice Chair forEducation, Wake Forest School of Medicine

Project Description:
This project willprepare attending physicians, house staff, and students for the practice ofbedside patient presentations (BSPP) of patients newly admitted to the generalmedicine and geriatric services at Wake Forest

Baptist Medical Center(WFBMC). The curriculum will highlight communication skills that (a) embodyrespect for patients’ personhood, (b) provide a foundation for patient-centeredcare, and (c) and enhance patient satisfaction with the professionalism oftheir medical team. In addition, we will emphasize the importance ofparticipating faculty as exemplars of professional behavior and will providethem with tools to effectively role model, articulate and teach communicationskills and professional interactions. Importantly, faculty will be trained toassess and give feedback to trainees, based on communication andprofessionalism competency milestones established for Internal Medicineresidents by the ACGME.


An Integrated Approach to Enhancing Resident and Medical Student Professionalism at Saint Louis University School of Medicine

Project Leader:
Stuart Slavin MD, MEd,Associate Dean for Curriculum, Professor of Pediatrics, Saint Louis UniversitySchool of Medicine

Project Description:
The program will target both residents and students and will have severalarms:

1. A mindfulness,resilience, and emotional self-regulation curriculum will be introduced to PGY1sin Pediatrics and Internal Medicine. This curriculum will be combined with monthlymeetings with first-year residents that will allow them to reflect on both challengingand rewarding experiences in residency.

2. A curriculum on biasand stereotypes will be implemented for residents in Pediatrics and InternalMedicine.

3. A case-based online curriculumwith monthly educational modules focusing on common issues in professionalismand bioethics will be implemented in the Pediatrics and Internal Medicineresidency programs. Residents will participate in small-group discussions each monththat serve as both an opportunity to discuss how these important issues arewoven into daily clinical practice, but also to provide residents with a safe,communal opportunity to reflect on their experiences in training.

4. A concerted effortwill be made to identify and minimize unnecessary stressors and non-value addedwork in the clinical setting in the Pediatrics and Internal Medicine residency programs.This process will be facilitated by a faculty member in organizational psychology.This program is based on empirically-supported practices in organizational stressorreduction interventions, with careful consideration of the unique challenges ofmedical training programs. The organizational psychologist will meet with eachcohort of residents to identify organizational factors that influencewell-being (e.g., procedures, priorities, and communication practices, as wellas aspects of the program culture underlying these practices) and to create areadiness for change.


An Advocacy and Reflective Practices Curriculum: Changing the Culture in a Pediatric Department and Residency to Advance Professional Ideals and Practice

Project Leader: 
Meghan Treitz MD, Associate Professor of Pediatrics, University of ColoradoSchool of Medicine

Project Description:
To expand reflection asa means of personal growth and professional development we anticipate the needfor a culture shift within our large Department of Pediatrics. We plan to bringthe processes and tools that we use in advocacy to this department of more than600 faculty members, almost 90 Pediatric residents, 100 fellows in 17 pediatricfellowship programs, and approximately 160 medical students each year. Thisgrant will enable us to build and implement a series of faculty developmentactivities to extend reflective practices across our community.

One of the limitationsof many advocacy curricula and efforts to influence professionalism lies in thehidden curriculum—medical students or residents hear one message in the formalcurriculum of their educational programs but experience contradictory andpotentially unprofessional messages in the informal, “hidden” curriculum oftheir clinical experiences. This grant will provide the resources needed to addressthe hidden curriculum in our department by engaging faculty members, fellows, residents,students and staff in shared activities of reflective practice. Our goal is to createa culture that supports physician reflection and that will, over time, increasehumanism and professionalism within our Department of Pediatrics.

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